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States Fret Over Covid-19 Medicaid Relief as HHS Plays Catch-Up

May 13, 2020, 6:26 PM

Health-care providers that serve the poorest populations are eager to get a piece of the Covid-19 relief fund, but state leaders and advocacy groups are worried it won’t be enough.

Medicaid providers so far have seen very little of the $175 billion that Congress set aside for hospitals and providers in the Coronavirus Aid, Relief and Economic Security (CARES) Act. The administration signaled funding is on the way in a request for data that has sent states scrambling.

The Centers for Medicare & Medicaid Services asked states for a list of their Medicaid providers, how much money each made in the last two calendar years, and their bank routing numbers.

Providers are concerned, however, that whatever money they may get will be too little too late, said Matt Salo, executive director of the National Association of Medicaid Directors (NAMD).

Medicaid providers including pediatricians, primary care doctors, and dentists have been largely left out of the funding grants until now. Many are on the brink of closing as social distancing and fears of coronavirus keep patients at home.

“We’re not sure it will go to those who need it, we’re not sure if it will actually be enough to stem the bleeding, and there really isn’t enough transparency for us to be able to make those determinations or figure out how to supplement them,” Salo said.

Collecting Data

The CMS, an agency within the Department of Health and Human Services, originally gave states two business days to turn over the data it requested in a May 1 call, but it extended that deadline after several states asked for more time. A handful of states are still working on the request, but “no one isn’t doing it,” Salo said.

The HHS didn’t answer questions about which states have yet to submit data.

“We would’ve of course liked more time to do that work, but the flip side of it is our providers are in such significant need that we didn’t want to do anything that would delay the opportunity for them to get those funds,” said Dave Richard, deputy secretary for North Carolina Medicaid.

Long-term care, primary care, pediatric, and behavioral health providers have been the hardest hit in states like Virginia and need the funding to keep their practices open. But Medicaid advocates say the administration hasn’t been transparent about who will ultimately receive money and when it will come.

“We provided the data, but indications have not been provided yet when that funding would be released or to whom,” Karen Kimsey, director of the Virginia Department of Medical Assistance Services, said. “We’re very eager to hear about that and provide any support that we can.”

An HHS spokesperson told Bloomberg Law that it’s committed to distributing CARES Act relief funds in a way that is fast, fair, simple, and transparent.

To date, 407 Medicaid providers in Virginia have been forced to close as a result of the coronavirus while the state’s Medicaid program continues to grow, gaining 60,000 new members since the governor issued a state of emergency in March, Kimsey said.

The Virginia secretary of health and human resources asked HHS Secretary Alex Azar in a letter May 11 to dedicate $50 billion from the relief fund to Medicaid providers.

Overwhelming Strain

While some money has gone to disproportionate share hospitals and nursing homes that see a large number of Medicaid patients, Salo said other Medicaid providers that make up the health-care infrastructure—pediatricians, OB-GYNs, opioid-care treatment facilities, non-emergency medical transportation providers, and health clinics—have been neglected.

A coalition of industry groups told Azar and members of Congress in a letter May 8 that it is encouraged by the agency outreach to collect data but stressed the need to expeditiously deliver federal financial relief to those providers.

“For providers that serve a high number of Medicaid enrollees and operate on very small financial margins while delivering high quality care to a very needy population, that strain has been overwhelming,” according to the letter signed by NAMD, America’s Health Insurance Plans, and six other organizations.

The HHS allocated $50 billion to Medicare facilities and providers at the beginning of April. The first $30 billion was distributed immediately, proportionate to providers’ share of Medicare fee-for-service reimbursements in 2019, according to the agency’s website.

Providers that billed Medicare fee-for-service in 2019 but have a large portion of Medicaid revenues are receiving a relatively larger portion of the second, $20 billion general distribution, the HHS spokesperson said in an email.

“There are some providers who will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid,” the spokesperson said.

Catching Up

Money went to Medicare first because that’s the way the CARES Act was written, Salo said. Money had to flow directly to providers and Medicare is a federal program in which HHS has a direct relationship with them, he added.

“I think they’re starting to catch up, but there’s been a serious lag in recognizing that Medicaid providers need help,” Salo said.

For now, states are hopeful providers will see funding soon.

“There is a certain set of uncertainty, but I think it’s couched with cautious optimism,” Kimsey said. “Because they are asking for the data, I think it’s a very positive sign and step that our federal partners are seriously looking at providing funding support to the Medicaid providers.

—With assistance from Christopher Brown

To contact the reporter on this story: Lydia Wheeler in Washington at

To contact the editors responsible for this story: Fawn Johnson at; Alexis Kramer at