FROM THE CENTER & OUR PARNTERS

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Center's Federal Policy Priorities 2021-22

Every two years, the Center analyzes ways to advance our federal policy priorities based on the opportunities and environment at the federal level. After the destructive policies of the past four years, we’re looking forward to working with the Biden-Harris administration and Congress on protecting individuals with complex health and social needs, while simultaneously working to build a consumer and community-driven health system that dismantles historical racial and economic inequity. The development of our 2021-22 federal policy priority agenda is a reflection of the need to do both in this moment.

Our focus in the next two years will center on:

1. Incorporating robust consumer engagement initiatives into delivery system and payment reform initiatives
2. Encouraging the health system to better address the social determinants of health
3. Supporting person-centered enrollment options for dually eligible individuals
4. Advancing a long-term care system that is person-centered, equitable and sustainable
5. Promoting a primary care system that is high-quality, culturally competent and robust
6. Suspending medical debt collection practices during COVID-19

More detail about these priorities can be found on our website.

Community Catalyst's Equitable Vaccine Distribution Toolkit

Now that the COVID-19 vaccination program in the United States is well underway, the very same disparities exist for communities of color to access vaccines as they did with COVID-19 testing and health care access. In response to this failure to ensure vaccine equity in all states, Community Catalyst engaged our partners across the country to learn how to improve equitable COVID-19 vaccine distribution and have created a toolkit, Equitable Covid-19 Vaccine Distribution Policies and Practices, with practical information and links to additional resources.

Andi Mullin, director of state and local technical assistance at the Center, offered this assessment in a recent Pew Trusts article: “So far we’re finding the same inequities in vaccine distribution that we find in the health care system as a whole….In nearly every state in the country, White people and wealthier people are getting vaccinated in higher proportions than lower income people and people of color, despite the fact that COVID-19 has had a more devastating impact on these communities.”

Center partner Jim Carnes of Alabama Arise, who has been advocating in his state to prioritize vaccines for homebound residents, bluntly told The New York Times, "Our approach to rural health care has been shameful."

To create this resource, we engaged with communities of color and other populations most disproportionately stricken by the pandemic and who are now struggling to gain access to the vaccine. By completing a survey, participating in a listening session and sending us materials, they helped us to understand how localities, states and the federal government could do better at insuring equitable access to vaccination. We are grateful to all who provided us with ideas, as well as our friends at the Healthcare Value Hub, who also provided us with reams of material. These materials are available as a single document that we hope will provide you with a robust menu of policy options for making vaccine distribution more equitable. 

We have kept this as a simple Word document to allow us to quickly add suggestions or make corrections. Should you have a suggestion or correction, please reach out to Mehreen Khan at mkhan@communitycatalyst.org. 

New Center Materials for Engaging Older Adults and Family Caregivers for Better Health

The Center partnered with Rush University Medical Center’s Geriatric Workforce Enhancement Program (GWEP), CATCH-ON (Collaborative Action Team training for Community Health – Older adult Network), to develop a suite of consumer-facing, age-friendly “4M” materials. The 4Ms are a framework first developed by the Institute for Health Improvement and The John A. Hartford Foundation as part of their Age-Friendly Health Systems initiative - an evidence-based approach to high quality care for older adults. They are: What Matters, Medication, Mind (or Mentation) and Mobility.

We developed the materials through a co-design process with older adults and family caregivers. These educational materials describe the 4Ms in language easily understood by older adults and family caregivers and enable them to ask helpful questions at their doctors’ appointments in order to get the care they need and want. Listed below are links to our project partners, our five GWEP partners and a selection of related external resource links. This blog post describes the process of co-desiging the materials, including convening of focus groups conducted in both English and Spanish, that led to the development of a brochure and poster in each language. In addition to Rush, our partnering GWEPs were: Baylor College of Medicine, Southeast Texas GWEP; BayState Health; Hartford Institute for Geriatric Nursing; and the University of North Carolina.

Please visit this page to access the brochure and poster on the 4Ms, in both English and Spanish versions for use in your community.

Medical Debt Legislative Victory in New Mexico

Even for those with health insurance, medical debt is still a major factor that holds people back financially and leads to poor health outcomes, with many forgoing needed treatment in fear of taking on debt. For Community Catalyst’s  Community Benefit and Economic Stability Project, policies addressing medical debt are a priority. We are very excited to announce that our partners in New Mexico – where almost a quarter of people have medical bills in collections – have successfully advocated for new consumer protection legislation.  Center partner New Mexico Center on Law and Poverty, along with Casa De Salud and Strong Families NM are a part of NM Together for Healthcare, a statewide, multiracial coalition of families and community organizations working together to strengthen healt hcare access in New Mexico. Together, they played an instrumental role in working towards passage of SB 71, The Patients' Debt Collection Protection Act.

In an article about SB 71, , signed into law on April 5, Nicolas Cordova, an attorney with the New Mexico Center on Law and Poverty said that the law "will make healthcare more accessible for all New Mexicans.” He added, “[n]o one should have to choose between putting food on the table or going to the doctor. The Patients’ Debt Protection Act is literally life-changing.”

Health Affairs Spotlights Center’s Work on LTSS

According to the Kaiser Family Foundation, as of Jan. 5, 2021, more than a third of COVID-19 deaths in the United States occurred among the residents and staff of long-term care (LTC) facilities. The impact of the pandemic in LTC facilities exposed to a newly alarming degree the vulnerabilities of the long-term services and supports (LTSS) system, the inadequate funding of which has been a topic of robust discussion and research for many years.

A recent Health Affairs article highlighted a July 2020 report by the Center and its partner, LeadingAge LTSS Center @UMass Boston, which looked at initiatives in six states to bolster financing of LTSS. . The report, Learning from New State Initiatives in Financing Long-Term Services and Supports, is based on qualitative interviews with stakeholders in California, Hawaii, Maine, Michigan, Minnesota and Washington. Some of the key findings include the importance of story collection, effective coalitions and activating key stakeholders.

The same Health Affairs article also reports on the Center’s recent grant from the Tufts Health Plan Foundation to bring the voice of older adults and caregivers into the discussion around LTSS reform in Massachusetts.

NOTEWORTHY NEWS & FEATURES

Mathematica: Mixed Findings on MLTSS Effectiveness

Despite the growing use of managed care models for long-term services and supports (MLTSS), evidence on its merits has been scarce and largely limited to studies of single-state programs. Recently, Mathematica conducted a cross-state evaluation of MLTSS programs under a contract with the Centers for Medicaid & Medicare Services (CMS) which found mixed results on the effects of MLTSS on nursing facility use, home and community-based services (HCBS) use, and hospitalizations. However, MLTSS enrollees rated their experience of care and quality of life more favorably than fee-for-service beneficiaries. Mathematica recommends CMS and states work toward improving data to help future evaluators compare measures and outcomes across states.

The Case for Inclusion 2021: COVID-19 Impacts on Services for People with IDD

The ANCOR Foundation and United Cerebral Palsy released a special edition of The Case for Inclusion, examining the impact of the COVID-19 pandemic on community-based disability services. Since 2006, the Case for Inclusion has been a leading source for data and policy recommendations regarding the effectiveness of state Medicaid programs in serving people with intellectual and developmental disabilities (IDD) and their families. The 2021 report offers a blueprint for concrete policy actions that should be taken by state Medicaid programs, the Biden administration and the 117th Congress to ensure providers can stay afloat through and beyond the pandemic. Policy recommendations include those that address providers’ immediate needs triggered by the pandemic, policies that supercharge the direct support workforce, and policies that foster innovations that enable better outcomes.

Provider Toolkit: Meeting the Needs of Diverse Family Caregivers

The Diverse Elders Coalition, which works to improve aging for racially and ethnically diverse people; American Indians and Alaska Natives; and lesbian, gay, bisexual and/or transgender people, released a toolkit that offers information on what providers need to know about meeting the needs of diverse family caregivers. The toolkit includes "What Providers Should Know Factsheets" and resources such as information on national caregiving resources, ten things to know about language-access advocacy for older adults and COVID-19 resources for diverse family caregivers. The creation of the toolkit was supported by funding from The John A. Hartford Foundation.

NASHP Resource: Holding Hospitals Accountable for Their Community Benefit Expenditures

A resource from the National Academy for State Health Policy (NASHP) examines the variety of legislative and regulatory levers states have at their disposal to ensure hospitals invest in their communities to improve population health. Nonprofit hospitals receive large tax exemptions in exchange for providing meaningful community benefit investments. However, there have been concerns about transparency, especially as more health care institutions merge to form vast systems. Current community benefit spending reported in aggregate makes it difficult to assess the impact of community benefit and whether hospitals are meeting identified needs. A 2017 study found that 65 percent of urban non-profit hospitals cited health disparities or health equity explicitly in their CHNAs, but only 9 percent of the hospitals' implementation strategies included activities explicitly designed to improve health equity.

While the top two categories for community benefit expenditures includes charity care and unreimbursed Medicaid, current reporting structures allow the potential for hospitals to report higher community benefit spending that is based on hospital charges or insurance-allowed amounts. Since federal requirements are unable to offer accurate and transparent standards, many states have led the way with examples such as setting minimum spending limits; setting community benefit requirements in hospital licensing programs; using audits to determine community benefit impact; requiring hospitals to link spending to community health improvement activities; and requiring hospitals to invest in their communities through community service.

The Critical Role of AAAs in Addressing the Health-Related Social Needs of Older Adults

The National Association of Area Agencies on Aging (n4a) conducted their AAA National Survey, which tracks trends in programs, services, and funding affecting Area Agencies on Aging (AAAs) and the older adults they serve. A blog post published in the Better Care Playbook highlights the findings from the survey, including the wide range of needs that AAAs address in their communities, as well as the expertise their staff bring to meet those needs. The blog post emphasizes how AAAs provide critical services to keeping older adults and people with disabilities living in their homes and communities and can be valuable partners to health care organizations in addressing the holistic needs of those populations. 

STATE HIGHLIGHTS

California

A recent court decision upheld the community benefit obligations emerging from a 2010 purchase of a nonprofit hospital in the Los Angeles area.

Deanco Healthcare, a for-profit company based in Panorama City, CA purchased Mission Community Hospital in 2010. However, the attorney general's approval of the purchase was conditioned upon the requirement that Deanco would provide a minimum amount of charity care services for six years after the purchase. If it failed to meet the annual threshold of charity care, Deanco was required to make up the shortfall by making a payment to a nonprofit public benefit corporation providing direct medical care to patients in the community. The amount of charity care drastically declined since the ACA was enacted in 2010. In 2017, Deanco asked the attorney general to reduce their charity care obligation by 52 percent, but was denied. Deanco challenged the decision, but the court ruled that Deanco would have to show "a change in circumstances that could not have reasonably been foreseen at the time of the [AG]'s action." The court deemed that the decrease in uninsured/underinsured individuals due to the ACA was not reasonably unforeseeable.

Illinois

State of Reform reported that AARP has collaborated with Illinois racial justice groups to launch a “disrupt disparities” effort across the state. The multi-year effort will address the disproportionate number of Black, Latino and Asian American older adults who have died of COVID-19 in the state and will work with state legislators to address this and other issues, such as access to broadband internet and economic security.

Massachusetts

Last month, Massachusetts Executive Office of Health and Human Services (EOHHS) announced it would submit a request to CMS to amend the MassHealth (Medicaid) Section 1115 Demonstration to CMS.

The Demonstration Amendment Request flexibilities include: to expand eligibility for the Medicare Savings Programs to comply with state law, to extend eligibility for postpartum coverage to 12 months, to authorize postpartum coverage for members not otherwise eligible due to immigration status, to enhance services for specialized populations and to provide flexibility related to place of services. A summary of the request is available here.

South Carolina

South Carolina’s Department of Health and Human Services shared several key stakeholder updates on the Health Connections Prime program, the state’s duals demonstration. Among the updates, include:

• Non-Emergency Medical Transportation (NEMT) Provider changed their name from LogistiCare to ModivCare
• Reminders about various resources, such Member and Advocate Toolkit as well a Provider Toolkit.
• Enrollment updates for January 2021 – March 2021

KEY DATES

Wednesday, April 21 (1-2 p.m. Eastern) - Webinar: Vaccine Equity Bright Spot Briefing: Breaking Down Access Barriers, presented by the Vaccine Equity Cooperative. Please register for the webinar.  

Thursday, April 22 (1:30-3 p.m. Eastern) - Webinar: Promoting Disability-Competent Care during COVID-19, presented by The Lewin Group. Please register for the webinar.  

Thursday, April 22 (3-4:30 p.m. Eastern) - Webinar: Forming Strategic Partnerships Between Housing, Medicaid HCBS Payers, and Community-Based Services, presented by The Administration for Community Living (ACL) and the Centers for Medicare & Medicaid Services. Please register for the webinar.

Tuesday, April 27 (1-2 p.m. Eastern) - Webinar: Community Health Workers: A Key Support for People Living with Dementia and their Caregivers, presented by the National Alzheimer’s and Dementia Resource Center and sponsored by the Administration for Community Living. Please register for the webinar.  

Tuesday, April 27 (2-4 p.m. Eastern) - Webinar: The Quality of Care in Nursing Homes, presented by the National Academies of Sciences, Engineering, and Medicines' Committee on the Quality of Care in Nursing Homes. Please register for the webinar.  

Wednesday, April 28 (2-3 p.m. Eastern) - Webinar: Restuccia Health Justice Fellowship Informational Webinar, presented by Community Catalyst. Please register for the webinar.  

Wednesday, May 5 (12-1:30 p.m. Eastern) - Webinar: Diabetes Care Assessment, Planning, and Management during COVID-19, presented by Resources for Integrated Care, in collaboration with the Center for Consumer Engagement in Health Innovation . Please register for the webinar.  

Thursday, May 6 (10-4 p.m. Eastern) - Symposium: 4th Annual Older Adult Mental Health Awareness Day Symposium, presented by the National Council on Aging. Please register for the webinar.  

Wednesday, May 12 (1-2:30 p.m. Eastern) - Webinar: Supporting the Preventive Health Care Needs of Dually Eligible Women with Disability, presented by Resources for Integrated Care. Please register for the webinar.