On March 31, 2020, Aimed Alliance led an effort to encourage state governors and Medicaid directors to rapidly respond to the public health challenges presented by Coronavirus Disease 2019 (COVID-19).
Joined by 21 organizations, Aimed Alliance asked each state governor to improve health insurance coverage for treatments of underlying conditions that place individuals at high risk of developing severe COVID-19 symptoms. According to the Centers for Disease Control and Prevention (CDC), high-risk conditions include chronic lung disease, asthma, heart disease, a compromised immune system, severe obesity, diabetes, chronic kidney disease, and liver disease, among others. Because patients with these conditions are more likely to experience COVID-19 complications, we recommended that state-regulated health plans cover such treatments without prior authorization or step therapy to allow patients to successfully manage these conditions, improve overall health outcomes, and reduce likelihood of COVID-19 mortality.
We also advised state Medicaid directors, who have not already done so, to submit Section 1135 waivers to the Centers for Medicare and Medicaid Services (CMS) to improve care for vulnerable Medicaid beneficiaries during the COVID-19 outbreak. Specifically, we recommended that states provide coverage, waive cost-sharing, and waive prior authorization for testing, treatment, and supportive services related to COVID-19. Additionally, Aimed Alliance recommended that states waive prior authorization requirements and step therapy protocols for the treatment of high-risk conditions and improve access to treatment from out-of-network providers and facilities due to the country’s strained health care resources. As of April 3, 2020, CMS has approved 1135 waiver requests from 44 states, many of which requested these same flexibilities.
Read a sample letter to Governors.
Read a sample letter to Medicaid Directors.