News

Moderna and FDA Agree to JN.1 Strain for COVID Vaccine Application

• On June 7, Moderna announced it submitted an application to the FDA for the 2024-2025 formula of the mRNA COVID-19 vaccine. The FDA has had internal disagreements over vaccine targeting strain selection with top officials advocating for the KP.2 strain, which can be produced for the fall respiratory virus season. Many advisors pushed for the JN.1 strain, which as of this time Novavax will only be producing. Ultimately, the FDA and Moderna chose the JN.1 strain based on the evidence that it will provide broad protection against circulating subvariants. Moderna will submit data to regulators worldwide to support the supply of the vaccine ahead of the 2024-2025 fall virus season (Inside Health Policy, June 7).

Federal Litigation

SCOTUS Rules In Favor of San Carlos Apache Tribe in Case Against the HHS

• On June 6, the Supreme Court ruled 5-4 in favor of the tribes in Becerra v. San Carlos Apache Tribe. The majority opinion states that, in accordance with the Indian Self-Determination and Education Assistance Act, the Indian Health Service must pay the overhead and administrative costs for tribes that operate their own healthcare programs. The case was decided jointly with Becerra v. Northern Arapaho Following the ruling, Becerra released a statement recognizing the HHS’ duty to comply with the decision, as well as calling on Congress to act on President Biden’s proposal to shift the Indian Health Service budget from discretionary to mandatory funding to create adequate and stable funding in the future (Inside Health Policy, June 6; HHS, June 6; Justia; June 6).

SCOTUS to Review Medicare DSH Calculations Case Again

• According to the order list, the Supreme Court will once again consider the question of how CMS can calculate Medicare disproportionate share hospital (DSH) payments through hearing the Advocate Christ Medical, et al. v. Becerra. The latest case focuses on HHS’ practice of counting patients who receive Supplementary Security Income (SSI) benefits in DSH calculations. Stakeholders believe HHS’ DSH formula runs counter to the standard determined in the 2022 case, Becerra v. Empire Health Foundation, where the Court decided HHS can exclude patients “who have exhausted their Medicare Part A benefits from hospital’s DSH payments.” Hospitals believe HHS’ interpretation excludes patients who are eligible for cash SSI payments but do not receive them, and patients who are eligible for other SSI benefits besides cash payments. Furthermore, hospitals believe HHS doesn’t share full data on patients’ SSI status and continue to call on the courts to review these challenges to the DSH system. The Supreme Court has now accepted to hear this case after the U.S. Court of Appeals for the District of Columbia Circuit ruled in HHS’ favor (Inside Health Policy, June 10).

Federal Regulation and Guidance

CMS Publishes FAQ on Medicaid and CHIP Coverage for Peer Support Services

• On June 5, CMS published a Frequently Asked Questions (FAQs) document on coverage of peer support services in Medicaid and CHIP. CMS worked with SAMHSA to develop the FAQs and provide clarification of federal policy related to coverage of peer support services initially established in State Medicaid Director (SMD) letter #07-011. CMS urges states to increase availability, accessibility, and utilization of peer support services to serve children, families, and adults who experience mental health conditions and/or substance use disorders (SUDs). These services are believed to be an integral part of the mental health and SUD treatment continuum of care that includes prevention, treatment, harm reduction, and recovery (Medicaid.gov, June 5).

Federal Studies and Reports

Black and Hispanic Enrollees More Likely to be Disenrolled from Medicaid Due To Procedural Issues

• According to a June 2024 study in JAMA, Black and Hispanic people were twice as likely as White people to lose their Medicaid coverage during the unwinding period due to administrative issues. Dr. Jane Zhu of Oregon Health & Science University and her team examined U.S. Census Bureau data from March 29, 2023, to October 2, 2023, to calculate the number of people disenrolled from Medicaid and determine which groups were most impacted. The majority of disenrollments, 75%, were due to procedural reasons such as not receiving a renewal notice, not filing the correct paperwork, or missing another step in the process. Among that 75%, Black and Hispanic enrollees were more likely to experience a procedural termination compared to White enrollees. Zhu and her team discussed creating expedited processes, increased assistance with the renewal process, and prioritizing redeterminations as ways to help eligible beneficiaries retain their coverage (UPI, June 4).

MACPAC Releases June Report to Congress

• On June 11, MACPAC released its June report to Congress, which included chapters covering transparency for the non-federal share of Medicaid and CHIP funding, coordination of care for dual eligibles, Medicare Savings Programs, and collection of demographic data (MACPAC, June 11).
  • Chapter 1
    • Chapter 1 focuses on ways to improve transparency in the financing of the non-federal share of Medicaid and CHIP. The Commission asserts that the main objective of improving transparency efforts is to gain a clearer understanding of current provider payment amounts under allowable financing mechanisms. This identification is the first step in MACPAC’s framework for evaluating whether payments align with statutory goals of efficiency, economy, quality, and access. The Commission recommends to Congress that states should be required to collect and publicly report data on the sources of the non-federal share of Medicaid and CHIP spending. This includes detailing financing methods, state-level financing amounts, and provider-level financing amounts.
  • Chapter 2
    • Chapter 2 provides recommendations for states and CMS to optimize and oversee State Medicaid Agency Contracts (SMACs) with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). When benefits between the two programs are not coordinated, beneficiaries often experience fragmented care and poor health outcomes. The chapter underscores the importance of care coordination data in aiding state efforts to evaluate integrated care and monitor D-SNPs. Building on previous work, the Commission recommends that states exercise their contracting authority at 42 CFR 422.107 and require the submission of care coordination data. The Commission also recommends that CMS update SMAC guidance to support states.
  • Chapter 3
    • Chapter 3 focuses on Medicare Savings Programs (MSPs), which provide Medicaid coverage for Medicare premiums and cost-sharing. MACPAC is interested in MSPs as they believe it could aid in improving access to care for low-income Medicare beneficiaries. The Commission delves into its past work in analyzing MSPs participation rates, recommendations for improving participation, and the results of their recent analysis of MSPs, which found that federal and state attempts to increase awareness of the program for low-income Medicare beneficiaries may have made substantial progress.
  • Chapter 4
    • Chapter 4 focuses on the importance of collecting demographic data, specifically on how Medicaid plays a key role in both providing healthcare to historically marginalized populations and allowing for disparities to exist within these groups. The Commission highlights how data collection can help states better understand the experiences of individuals who may identify with multiple characteristics and identities, such as race/ethnicity, language, sexual orientation and gender identity, and disability. MACPAC discusses how the availability of this type of data can aid in addressing existing health disparities within the Medicaid population, as well as key considerations for demographic data collection based on purpose, burden, and data quality.