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The Health 202: Medicaid providers had to wait weeks for coronavirus relief dollars

with Paulina Firozi

The coronavirus pandemic dealt a massive blow to medical providers serving low-income Americans. 

Getting federal coronavirus relief funds out the door to doctors, hospitals and other facilities in the Medicaid program didn’t exactly go smoothly even though the Department of Health and Human Services had $175 billion to distribute this past spring. 

That's because it's normally states — not the federal government — who pay them. 

The delays and bumps left Medicaid providers frustrated. Already operating on thin margins, they are now facing steep revenue losses after they were forced to suspend elective procedures and services during the state shutdowns.

“Everything about this has been very confusing to organizations,” Chuck Ingoglia, president of the National Council for Behavioral Health, told me.

This week, HHS announced $25 billion is available specifically for providers with large shares of low-income patients. Of that total $10 billion will go to about 750 hospitals that treat many patients on Medicaid or who are uninsured, while the other $15 billion will go to doctors, dentists, clinics and other facilities that treat low-income adults and children, my colleague Amy Goldstein reported.

It took 10 weeks for the agency to award the Medicaid-specific funds.

And the announcement only came after heavy pressure from top lawmakers on Capitol Hill.

Last week, the leaders of the House and Senate committees overseeing Medicaid warned in a letter to HHS Secretary Alex Azar that the delays “could result in long term financial hardship for providers who serve some of our most vulnerable populations.”

Other providers — particularly those with many elderly patients — had already gotten several rounds of funding from a $175 billion allocation from Congress, passed within two coronavirus relief bills in March and April.

The legislation didn’t spell out precisely who would get the money or how much they would be eligible for — that was up to HHS’s Health Resources and Services Administration to decide. Because the Medicare program is already within HHS, the agency took the easiest route of basing the early awards on hospitals’ Medicare income.

But when CMS tried to award some of the funds to Medicaid providers, it ran up against a problem: It didn’t have direct inroads to these providers. That’s because Medicaid is run by states, boosted by federal funds. Staff had to ask states and provider associations for help in gathering information about Medicaid providers, in a process aides and lobbyists described as cumbersome and inefficient.

“The broader relationship between HHS and a Medicare provider is very clear because they are paid by CMS,” a Republican congressional aide told me. “That doesn’t exist in Medicaid.”

When asked why the funds weren’t sent sooner, a senior HHS official said “the biggest challenge” was getting a list from each state of doctors, hospitals and others that participate in Medicaid, Amy reported.

It would have been faster for the states to distribute the dollars — but the administration decided that wasn’t allowed.

Counsel for HHS concluded that the text of the relief bills only allowed for a direct transfer of dollars from the agency to the providers — without using the states as a go-between. Some on Capitol Hill disagreed with the interpretation, feeling that it would have been okay for the agency to let states do the work.

“I don’t think many people on the Hill were sympathetic to that argument,” the GOP aide told me. “But ultimately it was up to HHS to get the money out, so their general counsel had to make a decision on what they thought was legal based on a reading of the text.”

HHS has been under heavy pressure to get the relief funds out the door faster as providers bleed money.

The pandemic has been a massive financial blow to health providers across the board.

Their patient revenue dried up as they were forced to cancel elective services amid the lockdowns. Patients told to stay at home opted to hold off on all but the most urgent procedures. On top of all that, hospitals also had to prepare for possible coronavirus outbreaks — even if they never materialized in some places. 

Out of 1.4 million health-care jobs that disappeared in April, nearly 135,000 were at hospitals, more than 243,000 were at doctors offices, and more than 503,000 were at dental offices. The American Hospital Association has estimated hospitals were losing as much as $50 billion per month.

Many of the nation’s hospitals can ill afford these losses,” Ted Mellnik, Laris Karklis and Andrew Ba Tran reported, in this look at how medical providers were devastated during the pandemic. 

“A third were already losing money on patient care before the virus hit, according to data compiled by Definitive Healthcare,” they add. “More than 1,200 hospitals operated in the red in two or more of the last five years.

Community health centers serving the low-income are particularly hard hit.

As of May 8, nearly 2,000 community health centers had closed at least temporarily because of financial pressures from the pandemic, the Kaiser Family Foundation found. Axios spoke to several community health centers who said they had only 70 to 80 days of cash to operate.

These providers, which generally get far more of their revenue from Medicaid than from Medicare, either weren't eligible for the initial round of funds, or were only eligible for a small amount. 

Yet if they received any sum from that initial pot of money, HHS officials say, they're now ineligible to apply for more funds based on their Medicaid income. 

“According to a senior administration official who briefed reporters on the condition of anonymity, the requirement to have not received relief money earlier this spring means that most of the nation’s community health centers will be unable to claim any of the $15 billion,” Amy reported. 

Ahh, oof and ouch

AHH: Doctors aren’t sure why some coronavirus patients have been sick for more than 60 days. 

Some patients are experiencing rotating symptoms that come in waves: “fatigue one week, headache the next, sore throat after that,” Ariana Eunjung Cha and Lenny Bernstein report. 

“Those infected with the coronavirus are urged to self-quarantine for 14 days, partly based on the idea that symptoms usually last about that long,” they report. “While the majority of people with mild illness recover completely in that time, doctors say they’re seeing a small percentage … who remain sick for many weeks, or even months.” 

But it’s unclear if the virus is alive in these patients for the lengthy duration or if the virus has left the body but leaves an immune or inflammatory response that continues to create such symptoms.

OOF: If you go to a Trump rally and get sick, the Trump campaign says you can’t sue. 

The campaign’s sign-up page for tickets to the president’s rally in Tulsa next week notes attendees must sign liability waivers that say they “voluntarily assume all risks related to exposure to COVID-19” and agree not to hold the campaign or rally venue liable if they contract the novel coronavirus. 

“At the bottom of the registration page for tickets to the upcoming Trump campaign rally is a disclaimer notifying attendees that ‘by clicking register below, you are acknowledging that an inherent risk of exposure to COVID-19 exists in any public place where people are present,’ ” Felicia Sonmez reports. 

Oklahoma is not among the more than a dozen states that are now reporting record-high new infections, although Felicia adds that “Tulsa County has reported a gradual uptick of new cases since the beginning of June, according to health department data compiled by The Washington Post.”

The notice on the rally sign-up page reads: “By attending the Rally, you and any guests voluntarily assume all risks related to exposure to COVID-19 and agree not to hold Donald J. Trump for President, Inc.; BOK Center; ASM Global; or any of their affiliates, directors, officers, employees, agents, contractors, or volunteers liable for any illness or injury.”

OUCH: Nursing homes said some of the critical protective gear shipped by federal officials was unusable. 

Facilities described medical gowns that are not appropriate for patient-care settings and gloves too small for staffers, the Wall Street Journal’s Anna Wilde Mathews reports.

“The shipments, coordinated by the Federal Emergency Management Agency, are ultimately supposed to provide two weeks’ worth of gloves, gowns, surgical masks and eye protection for each of approximately 15,000 facilities. A FEMA spokeswoman said that as of Tuesday, 13,654 packages have been sent, with more slated for the coming weeks,” Anna writes.

Noah Marco, chief medical officer of the Los Angeles Jewish Home, described blue plastic gowns that were “embarrassingly unusable” and could increase the risk of infection for the wearer. John Hovey, health-care administrator at Warm Beach Senior Community in Washington state, called the gowns “glorified garbage bags.”

A spokeswoman for FEMA said the supplies sent meet requirements by the FDA or the Association for the Advancement of Medical Instrumentation.

There's still more to learn about the coronavirus

Surgeons in Chicago have performed the first known U.S. lung transplant for a covid-19 patient. 

“Northwestern Medicine in Chicago said the recipient, a woman in her 20s who would not have survived without the transplant, is in intensive care recovering from the operation and from two previous months on lung and heart assistance devices,” Lenny and Martine Powers report

Ankit Bharat, chief of thoracic surgery and surgical director of Northwestern’s lung transplant program, told The Washington Post that organ transplantation may become more common for victims with severe covid-19 cases. 

“Bharat’s patient, who has not been publicly identified, was on immunosuppressant medication for a previous condition when she contracted the coronavirus, he said,” Lenny and Martine write. “Perhaps for that reason, the virus devastated her lungs, leaving physicians few options. She developed secondary bacterial infections that could not be controlled by antibiotics because her lungs were so badly damaged, he said.”

Researchers think some tried-and-true vaccines may offer limited protection against the coronavirus. 

The tuberculosis vaccine is being tested to see if it can slow down the novel coronavirus, Carolyn Y. Johnson and Steven Mufson report. And researchers suggested in a scientific journal that the polio vaccine may help. 

“The old vaccines are oddities among the cutting-edge and targeted technologies being developed to combat the novel coronavirus,” they report. “New vaccines aim to teach the body’s immune system to recognize and destroy the coronavirus, but scientists are only now beginning to test them in people. Vaccines developed against TB and polio have already been used in millions of people and could offer a low-risk way to rev up the body’s first line of defense — the innate immune system — against a broad array of pathogens, including the coronavirus.” 

In the states

Florida Gov. Ron DeSantis (R) announced new guidance for school reopenings — the same day the state reported a high for new coronavirus cases. 

The state reported 1,698 new cases yesterday, following the previous high of 1,419 new cases June 4, Kareem Copeland reports for The Post’s live blog.

“The kindergarten through 12th grade recommendation comes in three steps,” Kareem writes. “Campuses open in June for youth activities and summer camps in Step 1. Step 2 includes expanding campus capacities for summer recovery instruction in July. The final step features fully open campuses in August for a normal start of the school year.” 

Georgia Gov. Brian Kemp (R) continued easing coronavirus restrictions even as the state saw a spike in confirmed cases. 

People 65 and older no longer have to stay home unless they have health issues or live in a nursing home or long-term care facility; gatherings of 50 people are allowed beginning on Tuesday with social distancing in place; restaurants no longer have to limit the number of people who can sit together. 

“Georgia reported 993 cases Thursday, the most since May 1 and a 37 percent increase over the previous seven-day average. In the past three days, 167 deaths have been attributed to covid-19,” Steven Goff reports for the live blog.

Idaho Gov. Brad Little (R) announced the state would move toward a next phase of reopening, despite troublesome numbers of new cases. 

“The Idaho Statesman reported the state’s daily caseload has increased by 50 percent during the second and third phases of reopening, according to the 14-day moving average health officials told the paper they would use on May 1,” Ruby Mellen writes for the live blog. “But officials have since switched to measuring day-to-day numbers, which, even as the 14-day average increases, indicate a “downward trend” in cases — paving the way for the state to meet the criteria for Phase 4 of reopening.

“I want to stress something very important: We almost did not make it to Stage 4 this week,” the governor said. “… Even if contracting covid-19 is low on your personal concerns, I urge you to practice safe measures to protect others.” 

Nashville’s mayor decided to delay the next stage of reopening because of a rise in new cases.

“As of today, the majority of our public health metrics are satisfactory. But our 14-day new case average remains slightly elevated, prompting us to stay in Phase Two of our road map for Reopening Nashville,” Mayor John Cooper (D) said in a statement.

He said the city’s health department will focus efforts on southeast Nashville, where Nashville’s coronavirus task force says about half of new cases in the last month were concentrated. 

“More than three weeks ago, Nashville moved into the second phase of its reopening plan, with salons, restaurants and retail shops welcoming guests back at half or even sometimes three-quarters their normal capacity,” Kim Bellware writes for the live blog. “A move into Phase Three would include grade schools reopening, services such as salons and tattoo parlors returning to full capacity and ‘socially-driven’ businesses like bars and clubs open to half-capacity.”

Coronavirus latest

Here are a few more stories to catch up on ahead of the weekend: 

The public debate: 
  • Democratic political leaders’ move to join recent demonstrations fueled the debate over coronavirus restrictions, Rachel Weiner reports.
Industry impact: 
  • Ridgeback Biotherapeutics struck a deal with Emory University to license an experimental coronavirus pill with the help of $16 million in grants from U.S. taxpayers. The company’s quick move to later sell exclusive worldwide rights to drug giant Merck “highlights the frenzy of financial speculation that has accompanied the spread of the coronavirus around the world,” Christopher Rowland reports.
In other news: 
  • The former Veterans Affairs pathologist who the agency says misdiagnosed 3,000 cases pleaded guilty to one count of mail fraud and another of involuntary manslaughter, Lisa Rein and Matt Zapotosky report.

Sugar rush

Daily mask wear comes with a slew of irritations and annoyances. Here are solutions for mask acne, ear pain and fogged up glasses. (Video: The Washington Post)