The Trump administration is collecting information that could be used to distribute COVID-19 provider relief grant funds to providers that serve Medicaid enrollees.
CMS on Friday asked states to submit provider-level Medicaid payment information by Tuesday. That signals the administration is currently working on Medicaid-centric distribution of provider relief funds, though details are still unclear.
Some states struggled to compile the datasets by Tuesday's deadline. Several states including Oklahoma, Wyoming, Tennessee, North Carolina, Texas, Wisconsin and Kansas requested extensions to submit the Medicaid data. A spokesperson for Oklahoma's Medicaid agency said it expects to submit the information by Thursday.
HHS has $28 billion remaining in Congress' initial $100 billion in provider grants set aside in the CARES Act. The agency said those will go to "skilled nursing facilities, dentists, and providers that solely take Medicaid," as well as reimbursing providers for COVID-19 care for the uninsured. Lawmakers also refilled the fund with an additional $75 billion, and HHS has not yet said how it will distribute those funds.
McDermott+Consulting Vice President Rodney Whitlock, who discussed the CMS data request on the firm's healthcare podcast on Monday, said it's unclear exactly how HHS will use the information, but the department has so far avoided complex grant distribution formulas.
"To date, the HHS and CMS approach has tended to be rather simple. They have basically said, 'What's simple? Let's do it,'" Whitlock said.
The National Association of Medicaid Directors on April 27 called on HHS Secretary Alex Azar to work with state Medicaid directors to ensure CMS has accurate payment data. The group also asked the administration to distribute funds to Medicaid providers by May 11.
NAMD Executive Director Matt Salo said there's a chance HHS could send out more than one tranche of Medicaid-focused grant funding. The Medicaid directors' goal, Salo said, was to ensure that Medicaid providers are part of the conversation on how to distribute future funds.
"HHS has a clear line of sight to Medicare providers, but there's not that clear line of sight into anyone else. And that's what we are trying to change," Salo said.
CMS did not respond to an inquiry about whether the agency is considering additional Medicaid-focused grant tranches.
NAMD highlighted behavioral health providers, home- and community-based providers, Federally Qualified Health Centers, rural health centers, substance use disorder treatment providers, children's hospitals, nursing homes, pediatricians and others as providers underrepresented in cost report data that CMS has used to dictate past distributions.
CMS on Friday asked states for provider-level Medicaid fee-for-service and managed care revenue information for 2018 and 2019. However, states do not have to include information about provider type. Salo said that breaking down distributions by provider type would be difficult, as states use different definitions.
The American Health Care Association/National Center for Assisted Living said they understand the Trump administration is working on a funding tranche for Medicaid-only providers, including home and community-based services and called for HHS to release the funds quickly. The group asked HHS on Tuesday to set aside $10 billion in future grant funds for testing, personal protective equipment, and additional staffing for long-term care facilities.
"These providers have also been on the front lines working hard to prevent and contain this deadly virus, especially in a number of the hot zone areas. An expedited release of such funds to these Medicaid providers is much needed during this difficult time," AHCA/NCAL President and CEO Mark Parkinson wrote.
Safety-net hospitals hope the data can also be used to target future funding distributions for facilities that don't exclusively accept Medicaid payments.
The Medicaid and CHIP Payment and Access Commission wrote to HHS and congressional leaders on April 30 about concerns that the net patient revenue metric used to distribute general hospital funding so far favors providers with a higher share of commercially insured patients. MACPAC stated that disproportionate share hospitals account for 19% of total hospital net patient revenue, but accounted for 31% of hospitals' uncompensated care costs in 2017.
America's Essential Hospitals Senior Policy Analyst Zina Gontscharow said HHS should use Medicaid data to further target funds, and that future grant distribution formulas should also factor in care for the uninsured.
"We hope this data collection exercise will result in better targeting to Medicaid-dependent hospitals that have yet to see real relief from CARES Act funding," Gontscharow said.