Raising Our Voice to Support Those in Need 

Alliance Health has joined with other Medicaid health plans across the country to encourage the U.S. Congress to increase its support of low-income Americans and the health systems that serve them. We seek to ensure that these same individuals and families, often from low-income communities of color, receive access to the health care they need and deserve during the COVID-19 pandemic and beyond. See the letter sent to Congress below.


Dear Leaders:

The undersigned managed care organizations serve over 17.5 million Medicaid beneficiaries throughout the nation.  We applaud the efforts of Congress to date to support low-income Americans and the health systems that serve them during the COVID-19 pandemic. We write now to encourage you to take additional needed actions to ensure these same individuals, often from low-income communities of color, continue to receive access to the health care they need and deserve.

As a result of the extraordinary consequences of the national emergency, the impacts of the pandemic are expected to increase Medicaid enrollment throughout the country, further straining every state’s budget over the next two years, if not longer.

During the financial crisis of 2008-2011, the 2009 American Recovery and Reinvestment Act (ARRA) provided for $98 billion in much-needed direct fiscal relief over the two-and-a half-year period. We believe that the following steps, taken in concert, will help Managed Care Organizations, Medicaid beneficiaries, and safety net plans across the country maintain stability during this recession.

Stable Medicaid Funding

Increase the federal share of Medicaid spending and commit to at least a two-year period of federal Medicaid funding for states. 

Because of the pandemic, states will experience large declines in revenue just as the need for services, including Medicaid, will significantly increase, resulting in large budget gaps. Not surprisingly, states are already estimating significant revenue declines and unemployment estimates that could easily exceed those experienced during the last recession.

Based on analysis of the provisions included in ARRA to fund a temporary increase in the federal share of Medicaid costs, as well as Medicaid enrollment trends, we calculated an inflation-adjusted, per-enrollee amount of funding currently needed. We then applied this to recent estimates from Health Management Associates (HMA) that predict a national increase in Medicaid enrollment from the current 71 million beneficiaries to 82 to 94 million beneficiaries as a result of growth in unemployment[i].  We found that between $167.6 and $192.1 billion in funding is needed to sustain the Medicaid program at the current level in the midst of the pandemic and the resulting recession.

The national health crisis also will increase demands on Medicaid utilization. By picking up a larger share of the costs of Medicaid, the federal government can make sure that state budget decisions do not constrain the health response needed by the states to address the pandemic. It will also ensure that increased Medicaid costs do not force states to cut spending in other areas (e.g., education or public safety) in ways that could contribute to a further economic downturn or even cause a delay of economic recovery.

Medicaid Fiscal Accountability Proposed Rule

Suspend the proposed Medicaid Fiscal Accountability Proposed Rule (MFAR) during the COVID-19 pandemic, and wait for further analysis from the Centers for Medicare & Medicaid Services to understand the devastating impact MFAR will have on millions of Americans.

In November 2019, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid Fiscal Accountability Proposed Rule (MFAR), which would reduce the amount of funding provided to states as part of their Medicaid matching funds when the funding is generated through various supplemental means (e.g., provider taxes, intergovernmental transfers).  Many states use supplemental funding mechanisms to provide the non-federal share of some of its Medicaid funding.

MFAR must not be finalized during the pandemic. Due to the devastating financial impact on states that the Rule would have, we contend the proposed rule be suspended until more analysis is done by CMS. It is vital that the policy and financial impact the proposed rule would have on states and in particular, the Medicaid delivery system and beneficiaries be fully understood.  Moving forward without this information is dangerous to the efficiency and operation of any Medicaid program, and it jeopardizes beneficiary services. Prior to the pandemic, it was estimated that the enactment of MFAR would cause millions of patients to lose access to care in public health care systems alone, and it was projected that many public health care systems would not be financially stable and thus would have to close.

For nearly all states, the reductions that would result from MFAR would unquestionably mean cuts in Medicaid program enrollment and services. The impact in some states could be catastrophic on state Medicaid funding and ultimately reduce access to critically needed health services for Medicaid beneficiaries.

Telehealth Services

Advance telehealth and telephonic policies and payment reform in both the Medicaid and Medicare programs that expanded access to critically needed care to hundreds of thousands of patients. 

Under your leadership, the pandemic response packages have made important strides toward ensuring patients can access covered services via telehealth technology. In part, because of these regulatory and statutory changes, telehealth usage has increased significantly. Although provider visits dropped dramatically at the beginning of the stay-at-home orders, the quick conversion to telehealth visits allowed providers, particularly health centers, to rebound quickly – keeping providers and their office staff safe and leaving no gap in care. The increased use of telehealth has proven to be key in limiting the spread of the virus by keeping people at home, when appropriate, and providing access to those with mobility issues.

It is important that patients do not lose access to telehealth services after the pandemic ends and to ensure our nation is truly prepared for any future public health emergencies. We encourage Congress to advance telehealth policies and payment reform in both the Medicaid and Medicare programs. Properly designed programs will promote access to care while still offering quality assurances and protections from Fraud, Waste and Abuse.    It is also evident that telehealth has removed barriers to treatment for our members, especially in behavioral health.

Suspend Implementation of the Public Charge Rule

Fully suspend the Public Charge Rule (Rule) until the COVD-19 emergency has subsided. 

On February 23, 2020, the U.S. Supreme Court removed the remaining Public Charge injunctions, allowing the policy to go into full effect on February 24, 2020.  The Public Charge rule makes legal immigrants who receive non-cash public benefits, such as Medicaid, food assistance, and housing assistance, potentially ineligible for green cards and visas. Although on July 29th, a federal district judge issued a nationwide injunction preventing the Administration from implementing, enforcing, or applying the Public Charge Rule during the pandemic, we are still requesting congressional action.

Not surprisingly, the Rule has created an environment of fear throughout immigrant communities who were already wary of accessing health care coverage, long before the Rule went into place. In December 2018, the Urban Institute conducted a survey on non-elderly adults in immigrant families and found that one in seven did not participate in non-cash government benefit programs because of their fear it would impact their green card application.

As an effective public health response, it is vital that the federal government fully suspend the Rule for the duration of the emergency, at a minimum.

Presumptive Eligibility

Extend Presumptive Eligibility (PE) to all applicants that appear to be Medicaid eligible (based on initial income screening by a qualified entity); expand the types of entities qualified to perform PE screening; allow qualified entities to utilize online/telephonic applications and online/telephonic signatures for PE applications; and disallow any maximum limitation amounts that would prohibit a person from applying for PE more than once in a twelve-month period. 

Presumptive Eligibility (PE) is a Medicaid policy option allowing states to authorize specific types of entities (e.g., federally qualified health centers, hospitals, and schools) to screen eligibility based on income and temporarily enroll them in Medicaid coverage while their full enrollment application is being considered. The goal of PE is to provide short-term coverage of health care services for those who appear to be eligible for Medicaid but are not currently enrolled. This allows those individuals to receive much needed medical care while they complete the full Medicaid application and counties to conduct the enrollment process. The expected influx of Medicaid applications could prove challenging for counties to process in a timely manner. Thus, we are asking that the federal government allow PE for a period of 90 days while counties and the Medicaid applicants complete the enrollment process, and allow for extensions if counties are experiencing delays in processing Medicaid applications.

As managed care plans, we are prepared to provide expertise, data and ideas as you consider various issues to be addressed in the next relief package.  We stand ready to work with you to craft solutions that will ensure the solvency of the Medicaid program during and after this national emergency. These are trying and uncertain times for all Americans, and more so for our most vulnerable. Taking the above steps will result in better health care outcomes for the vulnerable members of our communities and for the nation as a whole.

[i] https://www.healthmanagement.com/wp-content/uploads/HMA-Estimates-of-COVID-Impact-on-Coverage-public-version-for-April-3-830-CT.pdf

 

Sincerely,

Alameda Alliance for Health

Aloha Care

Alliance Health

AmeriHealth Caritas

Amida Care

Blue Shield of California Promise Health Plan

CalOptima

CalViva Health

CareOregon

CenCal Health

Central California Alliance for Health

Children’s Community Health Plan

Communitycare Plan

Community Health Group

Community Health Plan of Washington

Contra Costa Health Plan

County Care/Cook County Health Plan Services

Gold Coast Health Plan

Healthfirst

Health Net of California & California Health and Wellness

Health Plan of San Mateo

Health Plan of San Joaquin

Inland Empire Health Plan

Kern Health Systems

L.A. Care Health Plan

MetroPlus Health

Partnership Healthplan of California

San Francisco Health Plan

Santa Clara Family Health Plan

UPMC For You

Virginia Premier

Alliance Health Initiates Digital Communications to Improve Member Health

Over the next several months, Alliance Health will be piloting the use of digital communication channels, primarily secure texting, to better engage members about their healthcare needs. This is a population health strategy that focuses on improving health literacy and provides education and outreach to our members. Members may receive text messages related to tobacco cessation resources, medication adherence, and/or the importance of following up with their primary care physician about recommended healthcare screenings and preventative care.

This week members on antipsychotic medications for the treatment of schizophrenia will begin to receive information about the importance of medication as part of their treatment. Members will receive several similar reminders in the coming weeks. All reminders to members will include a statement to call their doctor with any questions. These reminders may increase the number of calls from our members to their treating providers.

Beginning next week, Alliance will be launching a similar direct-to-member campaign that provides our members who are prescribed antipsychotic medications with reminders about the importance of routine follow-up with their doctors for blood sugar monitoring and other routine lab work.

Ann Oshel Presents Donation to NC Justice Center

Last month, Alliance Health Senior Vice President, Community Health and Well-Being Ann Oshel received the Making a Difference Award from the Association for Community-Affiliated Plans, which came with a cash donation to a cause of Oshel’s choosing. This week, she presented the donation to the North Carolina Justice Center, a leading progressive research and advocacy organization.

The Justice Center’s mission is to eliminate poverty in North Carolina by ensuring that every household in the state has access to the resources, services, and fair treatment it needs to achieve economic security.

“The North Carolina Justice Center represents every facet of the lives of the people we serve and the mission of Alliance to eliminate health disparities and help people in economic distress,” Oshel said.

Bill Rowe, General Counsel and Deputy Director of Advocacy for the Justice Center, said that the donation is much needed and appreciated by the center,  “Donations give us a great deal of flexibility to invest in the advocacy and other work that we might not be able to find grants for,” Rowe said.

“Alliance has been a great partner over the years in trying to open up opportunities around affordable housing for folks and making sure they get the health services they need.” Rowe said. “I’ve seen Ann be a tremendous advocate, pushing the envelope and getting things done.”

The Justice Center pursues its goal through a five-strategy approach of litigation to protect and expand the rights of workers, consumers, immigrants, and families with low incomes, public policy advocacy to protect and expand economic security, research to develop policy recommendations that promote shared prosperity, community outreach to create movements for change, and communications to inform the public dialogue and influence state policy.

“Our work would not be possible if it weren’t for the work of the Justice Center,” Oshel said.

For more information about the NC Justice Center visit ncjustice.org.

Alliance CHWB staff innovate to meet new community needs

As the social distancing requirements of the COVID 19 pandemic upended the way we work at Alliance, the public health emergency also created new, pressing needs in our communities. Our Community Health and Well-Being staff sprang into action to help address these new needs and find new ways of leveraging our community partnerships.

One of our biggest areas of focus during this health crisis has been to make sure our members experiencing homelessness are in a safe place. To house these members, we have opened three “healthy hotels,” two in Wake County and one in Cumberland County, which have housed to-date 32 adults and 9 children who had previously been sleeping in campsites and cars.

Alliance staff have been assisted in providing supports for our members by the Wake Med PATH team, the Food Bank of Central and Easter North Carolina, the Interfaith Food Shuttle and SouthLight Peer Support Team.

The goal of this initiative is to have everyone exit into permanent term housing and not back into homelessness. Toward this end and as part of our continued efforts to prevent and end homelessness among the most vulnerable people in our communities, we have received additional permanent Housing Choice vouchers from the Raleigh, Durham and Fayetteville public housing authorities, and we have made a capital investment in the rehabilitation of 8 single room occupancy dwellings to start a bridge housing program in Durham.

We have also approved 91 Independent Living Initiative (ILI) applications to rapidly re-house members or help them avoid eviction. Alliance had expanded ILI at the beginning of the COVID public health emergency so that hospitals and health care providers could apply for assistance to speed up the process of transitioning people from facilities into supported housing.

In addition to our housing efforts, our Community Health and Well-being staff have been busy supporting our communities through the difficult times caused by school and business closures and the need for isolation.

  • We hosted virtual resource fairs featuring information about Durham and Wake Networks of Care, our Independent Living Initiative, and resources and services available through county agencies. These fairs are archived for viewing here:
  • We partnered with local food insecurity and homeless service organization to help ensure people in need in our communities could access food and critical supplies. This included using funds that had been planned for now canceled programs and events to contribute food, cleaning supplies, hand sanitizer, healthy snacks, books, diapers and formula, and art supplies​ and games to community partners who distribute them to those who need them.
  • Alliance staff also distributed and shared with community partners educational flyers related to COVID19 and stress/anxiety.
  • We printed 15,000 copies of the coloring book “Joey the Kangaroo and Her Coping with Covid Plan” for distribution by community partners to help kids understand COVID-19.
  • We implemented a FEMA Crisis Counseling Program grant, which has allowed the state to extend the Hope4NC program to provide COVID-related emotional support and service connections to people who need them. Our participation includes helping to staff the Hope4NC helpline (1-855-587-3463) with four Alliance System of Care (SOC) coordinators.
  • We are using funds that were meant for sponsorships at events to purchase cloth masks for children and distributing them to a variety of organizations in each county.

Alliance Boosts Support to Providers

The providers who make up our network are the front line healthcare professionals who ensure our members receive critical treatment and support, and their financial viability is of utmost concern during this challenging time, which has entailed some cost increases and negative revenue.

In the May issue of Alliance InTouch we told you about our Provider Financial Sustainability Program, which pumped over $7.2 million to about 100 of our larger outpatient providers and providers of community-based care, rate increases to operators of intermediate care facilities (ICFs) for people with intellectual/developmental disabilities, and rate hikes ranging from 15-30% for all child residential providers during the COVID-19 emergency. We committed $300,000 in financial support to providers who offer solely research-based behavioral health treatment, as well as reimbursements for Assertive Community Treatment Team (ACTT) providers who purchase mobile phones to work with our members remotely. We invested $1.1 million to expand access to inpatient and residential treatment beds, and increased access to transitional residential treatment beds for individuals dealing with substance use disorders.

More recently, recognizing that some provider organizations within our network have sustained impacts but have not qualified for this first wave of assistance, Alliance allocated $750,000 to provide support to network providers who experienced increased service delivery costs or a decline in revenue when many of the new social distancing guidelines and safety measures where ordered by the governor. Provider organizations that did not receive a financial stability payment from Alliance were able to apply for up to $15,000 in financial support to cover a percentage of lost revenue and/or increased service delivery cost. We’ve also committed financial support for our residential providers by extending the date of the rate enhancements to them through September 30 to support direct care staff and increased facility-related costs due to COVID.

And we want to better understand how the COVID pandemic has affected providers’ work, and what is and isn’t working in regards to telehealth/telephonic services, so we’ve asked providers to complete this short survey to help us make improvements and continue to support our network. The survey is open through July 10.

Ann Oshel, SVP, Community Health and Well-Being

Ann Oshel wins ACAP Making a Difference Award

UPDATE: This award included a cash donation, which Ms. Oshel chose to give to the NC Justice Center. Click here to learn more.

The Association for Community-Affiliated Plans (ACAP) has awarded its 11th annual Making a Difference Award to Alliance Health Senior Vice President—Community Health and Well-Being Ann Oshel.

ACAP is a national trade association which represents not-for-profit safety net health plans that serve more than twenty million enrollees through Medicaid, Medicare, and other public health coverage programs. Their mission is to strengthen these health plans in their work to improve the health and well-being of lower-income people and/or people with significant health needs.

ACAP presents its annual Making a Difference Award to an employee at an ACAP-member plan who goes far beyond the boundaries of their job description in efforts to improve their community, support underserved populations, and fulfill community needs. Awardees are judged by a committee of human resources directors from ACAP-member health plans on how well they support ACAP’s principles of advocacy for beneficiaries, care, access to quality health care, and a commitment to the public good.

“Throughout her 30-year professional career in community-based mental health and leadership, Ann Oshel has maintained a deep personal belief that it is the community’s collective responsibility to respond to the needs of its most vulnerable citizens. She has spent that career advocating for them and developing the partnerships that have been uniquely successful in leveraging her principles into practice,” said Alliance CEO Rob Robinson in his nomination letter. Read the entire nomination letter here.

The award was presented to Ms. Oshel at Alliance’s virtual all-staff meeting June 12, 2020, by ACAP CEO Meg Murray and ACAP Vice President for Quality and Operations Enrique Martinez-Vidal.

Alliance Brand A

A Public Statement from the Leadership of Alliance Health

We offer these heartfelt sentiments about the events that have evolved across the country over the past few days stemming from the horrific act of violence against an unarmed Black man, George Floyd. The violence that has occurred in the wake of peaceful protests across the country is frightening and hopefully will come to an end soon, and meaningful conversations about race and inequities can begin.

We respectfully acknowledge that as white men our experiences do not allow us to fully identify with what some of our neighbors are dealing with or feeling. What we do know is that everyone deserves to be treated fairly and with kindness and respect, and to be able to live without fear.

As you can imagine, there is a myriad of emotions being experienced by the staff of Alliance Health and the people we serve as members of our health plan. Each is experiencing their own unique set of feelings and we want to assure them that Alliance stands behind each of them. For our staff, we want to do everything we can to ensure that we offer a workplace environment that truly understands and appreciates diversity and cultural competency. Our Alliance staff are of the upmost importance to us and are the greatest strength of this organization. We do know that if our staff are hurting, we are in no position to help others.

Our leadership team is committed to ensuring that we at Alliance do better, and our company is actively researching and identifying additional resources and strategies to increase our understanding and empathy, to expand our perspectives, and to more fully support each other. Moreover, Alliance’s Board has voted unanimously to review and revise the organization’s Code of Ethics to include stricter expectations of itself and our employees and management with regard to matters of racism and racist acts.

We are proud to be part of an organization whose Board and staff are dedicated to helping all who find themselves in need. At Alliance, we stand resolute in our values of diversity and inclusivity and denounce all forms of racism. It is important now, as it has always been, that we fulfill our mission and values and continue to help improve the lives of those who are in the greatest need, and that we strive to do it in the most inclusive and accepting way.

With hope for the future,

Rob Robinson
Chief Executive Officer

Gino Pazzaglini
Chair, Board of Directors

Alliance Health Launches Web-Based Behavioral Health Screening Tool

(Morrisville, NC) – Alliance Health has launched an online screening tool to help people determine if they or someone they care about should connect with a behavioral health professional. The easy-to-take screening is completely anonymous and confidential, and provides quick results, recommendations for next steps, and valuable resources that can offer help.

Completing a screening at AllianceHealthPlan.org/screening can help an individual understand if their recent thoughts or behaviors may be associated with a common, treatable mental health or substance use issue. Users can choose a screening for depression, anxiety, post-traumatic stress disorder, substance use, or a variety of other concerns, or can take a “wide range screening” if they’re not sure what is at the root of their feelings.

“A web-based screening tool cannot replace assessments from a professional, and the results are not a diagnosis,” points out Alliance Chief Medical Officer Mehul Mankad, M.D. “However, a screening can provide valuable insight to help folks better understand what they or a loved one may be feeling, and where they can reach out for help if needed.”

The screening tool was developed by MindWise Innovations of Dedham, MA to increase prevention through early identification of mental health and substance use issues. With the goal of fostering psychological safety and cultural change, the program helps organizations like Alliance Health prioritize awareness efforts, while maximizing existing investments in community wellness. Over 16 million screens have been taken to date using the MindWise platform.

“The isolation and anxiety of COVID-19 highlights the growing need for more mental health and substance use resources,” said MindWise Senior Vice President Bryan Kohl. “We are firmly committed to providing organizations with a platform to support the behavioral health of their communities – something that’s now more important than ever.”

If you or someone you know is feeling suicidal, call the National Suicide Prevention Lifeline at (800) 273-TALK (8255) or text ACT to 741741. Alliance Health also maintains a toll-free 24/7 Access and Information Line at (800) 510-9132.

Public Hearing on Budget Approval Process

A public hearing on Alliance Health’s proposed FY20/21 budget will be held on Thursday, June 4 at 4:00pm via a virtual meeting. The meeting can be joined by clicking here. Persons wishing to speak at the hearing must sign up to do so prior to the start of the meeting.

Community Mental Health Center at Cape Fear Valley Crisis

24/7 Operations Begin at Cumberland Recovery Response Center

Cumberland Recovery Response Center (CRRC) is now operating 24/7 at its facility at 1724 Roxie Avenue in Fayetteville.

Formerly known at the Roxie Center, it provides a range of services for people experiencing mental illness and substance use disorder. CRRC is one of the facilities operated in the four-county Alliance Health service area that is designed to provide a clinically appropriate, community-based option to help stabilize those in behavioral health crisis without a hospital emergency department or inpatient setting. Alliance is the managed care organization for publicly-funded behavioral health services for citizens of Cumberland, Durham, Wake and Johnston counties who are insured by Medicaid or are uninsured.

CRRC employs a warm open concept called “The Retreat” that offers behavioral health urgent care and a 23-hour observation unit where individuals are assessed by a psychiatric nurse practitioner or physician’s assistant to determine their needs. Based on that assessment, psychiatric evaluations are conducted, medications are started or continued for mental health concerns, detox protocols are initiated for substance use concerns, peer support is provided, and basic needs are addressed.

The Retreat has the ability to stabilize individuals 18 years and older for up to 23 hours until the next appropriate level of care is secured, which may include community services, facility based crisis services off-site, or inpatient hospitalization. CRRC is expected to begin offering in-house facility based crisis services in late summer of this year. People can walk into the facility or call the Alliance Access and Information Center at (800) 510-9132 to learn more.

CRRC is operated by RI International, a national leader in developing and providing recovery-oriented behavioral health and substance use disorder crisis services. It has been operating crisis assessment and stabilization services since 1990 and currently operates 12 state-of-the-art crisis programs across four states. This includes the Recovery Response Center in Henderson as well as the Durham Recovery Response Center.