The chaos of the coronavirus is scrambling all levels of health-care policymaking and analysis right now. It’s been just a few weeks since we started putting significant — and now total — attention on how medical providers, states and the federal government are responding to the crisis. Every day, the channels of information we’re working through are getting more convoluted and confusing.
For instance, there was a time early on when we could get officials from a state’s health department on the phone in a matter of minutes. Now even getting an emailed response to an inquiry can take hours, if not days.
The delay in response reflects not just how overwhelming the situation has now gotten in certain parts of the county, but also how fluid the circumstances are in the health care policy decisions experts are making. What could be true one day might not be true the next.
State officials in both Washington and North Carolina have bemoaned the “inundation” that has befallen them in conversations with TPM, saying that it has been difficult to manage constantly changing situations in their own states while anticipating what is to come.
For instance, a California doctor told us he saw no need for his emergency room to get relief from a federal mandate on which patients his hospital must treat, as other states are now trying to do. But he said that within a few days for that to change. That’s a far shorter time period than it usually takes for states to get such exemptions to federal health-care requirements approved.
And the outside experts who help us analyze what policies states and medical providers are pushing are facing their own challenges in digesting the firehose of information coming out.
Those experts have been giving us insight on what changes states want to make to their Medicaid programs to adapt to the crisis. But they’re having a harder and harder time keeping up with the slew of proposals. Right now, about a handful of states have filed waiver applications, some of them including dozens of proposed changes to health-care systems. Experts are expecting that number to grow significantly in the days to come, and are struggling to keep all the requests organized in a centralized place.
Likewise, the guidance that the Trump administration has issued to assist states in getting those changes approved has come at a rapid pace, and not all of the guidance documents fit neatly together.
Centers for Medicare & Medicaid Services director Seema Verma is holding regular phone calls with Medicaid administrators. One person who participated in a Wednesday evening call with Verma told TPM that she told the states, “tell us what you need, and we’ll get you what you need.”
But there hasn’t really been a template offered for what states can ask for in the case of a national catastrophe like a pandemic, and how they can ask for it. CMS has said it plans to put out a checklist states can use to streamline their efforts to change their programs.
States, it appears, don’t feel they have time to wait for that clarity about how they should be filing their requests. Instead, some are filing waiver applications citing multiple laws that could give the administration the authority to grant them the approvals they’re seeking.
The effect of this COVID-19 crush is also apparent in our dealings with U.S. Department of Health and Human Services, and specifically CMS.
There too, spokespeople have had trouble responding to our questions in time for our deadlines, and have acknowledged that their staff are facing a high volume of inquiries related to COVID-19 and the policies that CMS is rolling out.