Governor Stein Advocates for Health Care Coverage Amid CMS Rule Changes
In a significant move to safeguard health care provisions for North Carolinians, Governor Josh Stein, along with the North Carolina Department of Health and Human Services (NCDHHS), has formally urged the Centers for Medicare & Medicaid Services (CMS) to reconsider its interim rule regarding medical frailty. This appeal, articulated through a public comment letter, highlights potential risks to the health care of over 64,000 residents dealing with life-threatening conditions such as cancer.
Governor Stein emphasized the importance of existing protections, stating, “We have laws protecting vulnerable people because Congress recognized that people with life-threatening illnesses cannot afford to lose their access to health care.” He criticized the new CMS guidance for disrupting essential care and increasing difficulty for some of the sickest Medicaid beneficiaries to retain coverage, urging CMS to “reverse course and protect people’s health care.”
Implications of the New CMS Rule
The interim rule from CMS challenges provisions established by Congress in H.R. 1, which are designed to protect individuals with serious medical conditions from losing coverage due to new Medicaid work requirements. Despite these protections, the revised rule could jeopardize coverage for vulnerable populations, posing a risk of losing health care during critical treatment periods.
This change adds to the potential coverage loss for more than 255,000 Medicaid enrollees in North Carolina facing new work and recertification requirements. The expiration of ACA tax credits further compounds this issue, leading to a rise in uninsured individuals, which strains hospitals and the health care system, increasing costs for all through higher premiums and hospital fees.
Challenges with Medical Frailty Definition
The concept of medical frailty, an avenue for individuals with complex medical needs to maintain coverage, is being reshaped by CMS. The interim rule imposes additional documentation burdens on beneficiaries to prove their work impairment due to illness, potentially requiring medical documentation from providers.
States, including North Carolina, previously relied on claims data and diagnosis codes to define medical frailty. The new rule complicates this process, adding administrative burdens on county staff and hindering efficient Medicaid application processes.
Melanie Bush, NCDHHS Deputy Secretary for Medicaid, expressed concerns, “However, the new federal guidance on medical frailty will lead to a greater number of eligible individuals losing coverage because of the new narrower medical frailty definition, administrative complexity, and operational barriers.”
State-Level Response and Advocacy
North Carolina, one of nine states with a state-supervised and county-administered Medicaid eligibility system, faces increased pressure on county staff due to these changes. The staff is tasked with implementing new exemption rules alongside work requirements and recertification for nearly 740,000 Medicaid expansion beneficiaries.
Governor Stein has remained steadfast in his efforts to protect health care access, previously communicating the adverse impacts of H.R. 1 to Congress through letters. He continues to collaborate with various stakeholders to mitigate these impacts and ensure Medicaid funding is maintained to safeguard health coverage for millions in the state. As co-chair of the National Governors Association’s Public Health and Emergency Management Task Force, Stein has leveraged his position to advocate for protective guidance from CMS regarding H.R. 1.
Click here to read Governor Stein and NCDHHS’ letter.
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