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By Suzanne Blake
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President Joe Biden has proposed three changes to Medicaid and Medicare that could mean more access to coverage for Americans under the government-provided health care system.
In a new announcement Wednesday from the Centers for Medicare and Medicaid Services (CMS), the Biden administration unveiled plans that could reduce maternal mortality and advance health equity in underserved communities.
One of his proposals includes creating exceptions to the Medicaid clinic services "four walls" requirement. This stipulation typically requires covered clinic services to occur within the clinic, so certain coverage could be expanded if the new Biden plan goes into effect.
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Additionally, Biden called to codify the requirement of 12 months of continuous eligibility for children enrolled in Medicaid and CHIP. This would further solidify children being entitled to a year of continuous Medicaid even if their parents' situations change or they have procedural issues related to applying for health insurance again.
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This is especially important for low-income mothers after they give birth, to secure coverage for their children in the first year of life.
"President Biden and I are fully committed to addressing a maternal health crisis in which women across America—disproportionately Black women, Native women, and women in rural communities—are dying before, during, and after childbirth at higher rates than in any other developed nation," said Vice President Kamala Harris in a statement.
"That is why I called on states to extend Medicaid postpartum coverage from two months to 12 months—with 46 states taking action—and why we launched the White House Blueprint for Addressing the Maternal Health Crisis, an unprecedented whole-of-government strategy to improving maternal care."
The outpatient rule would also work to ensure mothers and their children can gain meaningful coverage, according to the CMS.
"The proposed hospital outpatient rule builds on the Biden-Harris Administration's commitment to reducing the nation's high maternal mortality rate and actions outlined in the White House Blueprint for Addressing the Maternal Health Crisis, increasing access to services in tribal, rural, and other underserved communities, and addressing barriers to Medicare coverage for those recently incarcerated," said CMS Administrator Chiquita Brooks-LaSure in a statement.
"This proposed rule is proof that we are committed to ensure people aren't just covered, but that coverage is meaningful."
The administration also asked to create support for individuals returning to their communities after being incarcerated so that they can more easily enroll in and maintain their Medicare coverage. Currently, those who have been imprisoned for many years often miss their chance to get enrolled in Medicare because they didn't collect Social Security in prison.
Specifically, CMS is proposing to make the definition of "custody" narrower so that people with Medicare who are no longer incarcerated or in physical custody can access Medicare. CMS would also revise the eligibility criteria for the special enrollment period for former inmates to include people who have been released or are on parole or probation.
"With this proposed rule, we are helping make sure that all people can access care more equitably," said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare in a statement. "The Medicare program is meant to work for everyone—including those transitioning from incarceration and those accessing care at IHS and tribal hospitals and the policies in this proposed rule represent a significant step forward in doing just that."
Chris Fong, a Medicare specialist and the CEO of Smile Insurance Group, said most people just released from prison are focused on finding jobs, food and shelter, with Medicare often set aside for later.
"It is important for them to get the support they need to enroll into Medicare along with getting access to jobs, food, and shelter," Fong told Newsweek. "The recidivism rate within the first year is 43 percent and 82 percent within 10 years following release. It is the hope that provisions such as this one on support to enroll into Medicare will reduce this rate and improve the lives of those formerly incarcerated."
Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, said if the proposals become Medicare and Medicaid policy, many Americans would face less barriers in accessing the benefits available via the programs.
"Over the past few decades, we've seen increasingly difficult circumstances for individuals and families living in rural environments to get access to basic health care services," Beene told Newsweek.
"Hospitals, clinics, and other sites have had to close because it was no longer economically viable to serve those areas, yet there are still many in those communities who require care. Creating exceptions to the 'four walls' requirement would help open up coverage of services to those areas that may not have a physical facility but could benefit from other means of delivery of services."
Fong said for years, the "four walls" requirement had good intentions but was limited in how pregnant women in rural or underserved areas were able to access quality care.
"Most women are able to go through a pregnancy with their obstetrician-gynecologist but in some cases of certain medical complications the risk of life increases and their care team needs to include a specialist," Fong said. "However, the specialists may not accept Medicaid or the specialist who does is so far away from them that it makes it very difficult. The provision on providing exceptions to the 'four walls' requirement will be extremely helpful."
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