Medicaid in a Post-COVID World: Waivers Can Provide Flexibility for States

September 6, 2022

The COVID-19 pandemic has taught states a lot about health policy, especially around Medicaid.

The pandemic highlighted ineq­uities in health care across the states, according to speakers at a recent CSG East Health Policy session.

“It highlighted communities without access where COVID has the highest impact on com­munities with the least access to health care,” said Rhode Island Sen. Joshua Miller. In his state, it also highlighted a lack of trust and a lack of competency in dealing with the pandemic.

In Maryland, said Del. Joseline Peña-Melnyk, chair of the House Health and Government Op­erations Committee, it also illustrated the need for more oversight, especially as executive orders proliferated during the early days.

She, too, noted the impact on communities of color and how they were affected. “We started thinking about equity, but we also started thinking about racism. For the Black and Brown communities, there is structural racism,” she said. “You have to really think about the history.”

Delegate Joseline Peña-Melnyk speaks to the CSG East Health Committee

In addressing some of these issues, states found ways to improve the health care delivery system. Peña-Melnyk worked to pass legislation to recognize racism as a public health issue and create a commission on health equity, which is required to provide yearly recommendations to state leaders on how to improve the lives of those who are marginalized.

Both Maryland and Rhode Island addressed the use of telehealth in communities across the states.

“Telehealth was one, but not the only effort and opportunity, to expand health care to where it was not present,” Miller said.

In Maryland, legislation was passed to ensure undocumented pregnant women have access to prenatal care.

But COVID also illustrated the impact on state budgets and economies when undocumented people don’t have access to health care. Many of them are on the front lines as restaurant workers, grocery workers, and nursing home caregivers.

“If those people have less access to health care, it’s going to not only affect them, it’s going to affect the community because of the pan­demic,” Miller said.

The health care system continues to change and the pandemic has provided some valuable lessons. But to adapt with Medicaid, states need to be more aware of potential for change through the Medicaid waiver process, Miller and Peña-Melnyk said.

“States are very shy. [CMS] would love for states to be creative and submit these waivers and just try and they would be willing to do it,” Peña-Melnyk said.

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