COVID-19 State Resource Guide Update: Leveraging Federal and State Authorities to Ensure LTSS Access

Health Highlights

Editor’s Note: Since the start of the COVID-19 pandemic, federal and state policymakers have acted to preserve access to services for populations that use Medicaid-covered long-term services and supports (LTSS). These populations include older adults and people with chronic conditions or disabilities who are at high risk for experiencing severe cases if they contract COVID-19 and face disruptions in access to care if they or their caregivers must quarantine or isolate. Among other actions, policymakers have directed emergency funding to bolster providers and maintain Medicaid coverage for individuals, and have granted regulatory relief to minimize administrative, clinical or financial barriers to accessing services.

Manatt Health described these actions in “COVID-19 State Resource Guide: Leveraging Federal and State Authorities to Ensure Access to Long-Term Services and Supports for High-Risk Individuals,” published in February 2021.1 Manatt has updated the resource guide based on a scan of new or modified regulatory flexibilities and other state administrative actions through July 2021, as well as on continued monitoring of states’ overall responses to the pandemic to ensure access to LTSS for high-risk individuals. Key findings are summarized below. Click here to access a free copy of the full update.

Manatt Health found that as states operationalized their existing temporary Medicaid regulatory flexibilities, they gained greater insights on long-standing vulnerabilities in their LTSS systems that were worsened during the pandemic and turned their attention to making long-term system improvements.

Major trends in 2021 include:

  • States strategically leveraged federal funding to improve their COVID-19 responses and invest in longer-term system reforms. All 50 states plus the District of Columbia submitted to the Centers for Medicare & Medicaid Services (CMS) and began to implement home and community-based services (HCBS) “spending plans” to leverage new federal funding authorized in the American Rescue Plan Act of 2021 to address their COVID-19-related HCBS needs and strengthen and improve their HCBS systems.2
  • States, including California and Massachusetts, more closely examined the health disparities in their states that were illuminated by the pandemic, including the disproportionate impacts that COVID-19 and state vaccination efforts have had on residents and communities of color.3
  • States continued to administer and monitor their existing pandemic-related regulatory flexibilities, and a few states made select temporary flexibilities permanent. Most states were focused on continued implementation and monitoring of their existing flexibilities and did not request new pandemic-related regulatory flexibilities or modify existing ones.

Planning for 2022

The temporary regulatory flexibilities enacted during the public health emergency (PHE) present a unique opportunity for states to innovate new policies and care delivery approaches with the goals of minimizing barriers to care and strengthening their LTSS systems. While quantitative Medicaid data on the impact of the temporary regulatory flexibilities on consumer access and service utilization, the reduction of health disparities, and the provider and direct care workforce is sparse at this point, states are learning from their pandemic experiences, and some states have begun to make temporary reforms permanent. In 2022, all states will continue to leverage American Rescue Plan funds to make strategic investments in LTSS benefits, infrastructure and programming to ensure seamless and safe access to critical services for high-risk Medicaid members.

1 This report was published as an update to the original report released by Manatt Health in 2020.

2 Strengthening and Investing in Home and Community Based Services for Medicaid Beneficiaries: American Rescue Plan Act of 2021 Section 9817 Spending Plans and Narratives.

3 Unlocking Race and Ethnicity Data to Promote Health Equity in California: Proposals for State Action (April 2021); Racism and Racial Inequities in Health: A Data-Informed Primer on Health Disparities in Massachusetts (December 2021).



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