With Sophie Gardner 

Driving The Day

STATES’ MEDICAID INNOVATION STRUGGLE — The Biden administration is struggling to keep up with an influx of requests from states wanting to implement innovative Medicaid expansions, POLITICO’s Kelly Hooper reports.

The process of reviewing requests for the Social Security Act’s Section 1115 waivers — which allow states to roll out experimental projects to better serve Medicaid enrollees — used to average 71 days.

Partly because of staffing challenges at CMS, Medicaid programs wait more than 450 days on average for their applications to be approved, according to the National Association of Medicaid Directors.

The backlog delays care for vulnerable people, state Medicaid directors say. Some of them fear the upcoming presidential election and a potential transition of power in November could further delay or even tank their proposals.

What CMS says: The agency told POLITICO that the problems stem from a lack of funding from Congress, which has resulted in a hiring freeze that disrupts “the core work of the agency.” CMS also said that states are amending waivers to add more complicated expansions, such as for people who are incarcerated, which makes the review process more time-consuming.

Why it matters: The delays — affecting blue and red states alike — according to Medicaid officials, deprive people of potentially lifesaving care and stifle lower costs, a key priority for the Biden administration.

Kentucky, Utah and West Virginia have been waiting two years for permission to use Medicaid to pay for addiction treatment. In 2023, California asked to use Medicaid to connect behavioral health patients with housing and employment. Nevada applied for approval in 2022 to have Medicaid cover dental care for adults with diabetes.

“We very much appreciate that CMS has opened the door for state innovation, but unfortunately, I don’t think anyone expected the significant backlog and staffing challenges that would come along with that,” said Stacie Weeks, administrator of Nevada’s Medicaid program.

Some Medicaid directors also worry that certain waiver proposals, like ones providing housing services to some enrollees, might not be approved under a new administration. The backlog can also stifle Medicaid directors’ drive to innovate.

“The average life of a Medicaid commissioner is 24 months, and if somebody can’t get this across the finish line in their tenure, you're losing all that momentum at the state level,” said Cindy Beane, West Virginia’s Medicaid commissioner.

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AROUND THE AGENCIES

CMS FACES MORE MA LEGAL BATTLES — Medicare Advantage consultants are “waiting for the other shoe to drop” after the Biden administration lost a court battle earlier this week, requiring HHS to pay a plan millions of dollars, POLITICO’s Robert King and Kelly report.

SCAN Health Plan, a not-for-profit regional Medicare Advantage plan, won in federal court on Monday in a ruling that found CMS miscalculated the insurers’ star ratings, which determine how much an insurer gets in bonus payments. The judge ordered CMS to pay SCAN $250 million after its 2023 star rating declined from 4.5 to 3.5.

Another three insurers — Elevance, Zing Health and Hometown Health Plan — have filed similar lawsuits against CMS.

“The more momentum this gets, and the more [plans] realize others are also going to be following suit, it will kind of have a snowball effect, which is always interesting to watch because we’ve been sitting back and talking to our clients and kind of waiting for the other shoe to drop,” said Betsy Seals, CEO of the Rebellis Group, a Medicare Advantage consultancy.

CMS declined to say whether it would appeal the ruling because it doesn’t comment on litigation.

NAVIGATORS GET BOOST — HHS said today it’s investing an additional $500 million in its Navigators program, which helps people sign up for insurance on the marketplace or via state Medicaid. The program was created under the Affordable Care Act.

The announcement comes as the Biden administration touts record-high enrollment numbers since the ACA was implemented — a cornerstone of the president’s reelection campaign — and points to gains in enrollment among minority communities.

“The Biden-Harris Administration is closing the coverage gap so that everyone can get health care, regardless of the color of their skin,” said HHS Secretary Xavier Becerra in a statement.

HHS unveiled data in four reports Friday showing declines in uninsured rates among various demographics from 2010 to 2022, based on census data. The biggest declines were among Latinos, whose uninsured rate dropped nearly 15 percent during that time.

The $500 million in Navigator funding will be made available in grants over the next five years, HHS said, with the first investment at $100 million. The agency has praised the program for reaching underserved populations.

Public Health

CANNABIS USE TIED TO CVD — For women, heavy long-term cannabis use is associated with increased deaths from cardiovascular disease, according to a new study in JAMA Network Open, Sophie reports.

The study, which enrolled nearly 122,000 participants, found that among women, heavy cannabis users were more than twice as likely to die of cardiovascular disease than noncannabis users.

There was no association for men.

Why it matters: Complex regulatory hoops have made cannabis difficult to study, despite the widespread use of the substance. Last month, researchers found that people who use cannabis daily or near-daily outnumbered people who drink alcohol at the same rate for the first time.

IN THE STATES

MEDICAL-AID-IN-DYING GAINS TRACTION — Colorado’s governor this week signed a bill expanding access to a state law allowing adults diagnosed with a terminal illness and six months or less to live the option to choose assisted death.

It comes amid a push by lawmakers in other states to expand their own laws or legalize the option altogether. Medical aid-in-dying is authorized in 10 states and Washington, D.C.

In recent weeks, activists for medical aid-in-dying have pressured New York lawmakers to pass legislation. While the lawmakers have considered the proposal over the years, support has recently grown, giving activists hope it will pass this year. A key endorsement came in April from the Medical Society of the State of New York, which has long opposed the legislation.

However, in California, one lawmaker withdrew her bill to expand the state’s medical aid-in-dying program before it could be considered after opposition to her attempts to remove the six-month prognosis limit.

“At this point, there is a reluctance from many around me to take up this discussion, and the future is unclear,” state Sen. Catherine Blakespear said in April. “The topic, however, remains of great interest to me and to those who have supported this bill thus far.”

The Colorado law, which goes into effect Aug. 7, builds on a 2016 ballot initiative legalizing medical aid-in-dying. It shortens the mandatory minimum waiting period for people who orally request the option from 15 days to seven days and allows advanced practice registered nurses to act as attending and consulting providers. It also allows a prescribing provider to waive the waiting period if a patient isn’t likely to survive more than 48 hours.

Names in the News

David Merritt has been promoted to senior vice president at the Blue Cross Blue Shield Association and will oversee the group’s communications, policy and lobbying work. He previously spent six years at AHIP, an insurer trade group.

Larke Huang is retiring from her role as director of the Office of Behavioral Health Equity at SAMHSA. She previously was a faculty member at the University of California, Berkeley, and Georgetown University and managing director at the American Institutes for Research.

WHAT WE'RE READING

The Washington Post reports on a doubling of whooping cough cases in the U.S.

STAT reports on the looming impact of a congressional proposal to restrict American biotechs from working with certain Chinese firms.