HHS secretary talks Medicaid coverage, mental health services

There are a lot of big health care stories happening in Montana right now from 120,000 Montanans losing Medicaid coverage to the expansion of 24/7 services for mental health crises. U.S. Health and Human Services Secretary Xavier Becerra recently spoke with Montana Public Radio's Aaron Bolton to talk about those issues.

Aaron Bolton: U.S. Department of Health and Human Services Secretary Becerra, thanks for joining us. Our time is limited, so we're going to get right into what is one of the biggest health care issues, which is Medicaid redetermination. The federal Centers for Medicare and Medicaid Services, which is under HHS, has warned several states like Montana, for disenrolling a large number of people for technical reasons, such as incomplete paperwork. I want to get your thoughts on how this process has gone from the federal level. Does it seem like states were prepared for this process?

Xavier Becerra: Aaron, from the federal level, it's all hands on deck because no one, especially a child, should lose the health care that they are entitled to, or are working hard to keep. And so we want to work with our state partners to make sure, under Medicaid, that no procedural glitch causes someone in America to lose the peace of mind that comes from being able to go visit a doctor or stay at a hospital and not worry about going bankrupt. So, our efforts are to work with states who administer the Medicaid program to make sure it's done right.

Aaron Bolton: And HHS did launch a new enrollment hub to help people navigate that process. Why launched that hub in January, months into the redetermination process?

Xavier Becerra: This hub was a response to what we were seeing in a number of states that seemed to be losing families from Medicaid coverage while there was information from other sources, for example, housing on the housing side or perhaps on the welfare side or the food stamps side, that said those families probably did qualify. So what we did is create this hub to help some of those states be able to access the information that would give them a more complete answer about who qualifies for Medicaid in their state.

Aaron Bolton: Yeah, thousands of people have lost coverage in Montana and in many more across the country. And, providers we've talked to say, you know, this is eroding trust in the health care system. I guess, what do you say to people who've lost coverage and convince them that they should have faith in these government safety net programs?

Xavier Becerra: Well, the safety net programs have been there. And they haven't changed. It's how they are being administered. And, as I said, 50 states are administering them in 50 different ways. We hope that every governor is taking an interest in how they administer a program for their families because no families should be disillusioned about Medicaid simply because procedural glitches are causing them to lose access. That's not a fault of the program. It's the fault of the administration of that program. And that's why we're working closely with governors in every state to make sure that, as they administer the Medicaid program, they do it properly. So no American loses their health care, and certainly no American should become disillusioned about the value of Medicaid.

Aaron Bolton: And I want to shift over to another issue that's plaguing Montana and many other states, which is the growing number of seniors who are becoming homeless. And HHS put out a report on senior homelessness back in October and identified several gaps in services. What are some of the solutions HHS thinks could help seniors maintain or regain housing?

Xavier Becerra: Yeah, as I think most Americans are aware, today, the federal government has established a number of very important critical programs for seniors that have helped so many older Americans stay out of poverty, whether it's the Social Security Program, whether it is the Medicare program, health care wise for seniors. We also have older age statutes that protect seniors in many ways. All of these are meant to help states who are the ones who have responsibility for issues of health care, homelessness for their populations, including their senior populations. We're working closely with states to try to provide the support that we can and beef up services on top of the social security, the Medicare, the Supplemental Security Income that's provided at the federal level.

Aaron Bolton: What are some examples of working with states to beef up those programs, as you say?

Xavier Becerra: So, take Medicaid, for example. We're working with states that wish to have some flexibility in the use of their Medicaid health dollars so that they could actually combine it with work that they're doing to keep people housed. And we can justify using a Medicaid health dollar to help someone in the process of staying healthy, if it means keeping them housed and sheltered, because they may have chronic conditions, for example. And if they're out in the streets, not getting their medication, they'll get sicker and then use the emergency room. If we can show, if the state can show us, that by helping that person stay housed, that they also help that person not only stay healthy, but improve their health, then using a Medicare dollar for that purpose is going to be a good savings for all taxpayers, because we're keeping Americans healthy. And so we're working with states, giving them flexibilities. And some states have taken us up on those opportunities to use Medicaid dollars to help keep their populations not just healthier, but also better housed.

Aaron Bolton: Yeah, and the last thing I wanted to touch on is mental health, specifically crisis services. And that's an issue that's really hamstringing rural states, Montana in particular, where we don't have a lot of these services available. And the federal government did make a big push to overhaul the suicide hotline, which is 988 now. Are there plans to help states provide mobile crisis and stabilization services for folks in crisis? Are there things in work that could help there?

Xavier Becerra: We try to supplement whatever states are doing. And as you mentioned, in too many states, there aren't enough services for mental health in those states. And what we're doing, whether it's through the 988 program, which is the new three-digit crisis lifeline that people can contact, whether by phone, text or chat, or whether it's the certified community behavioral health clinics that have been stood up, starting with the federal government providing services where they provide 24/seven crisis care. And so it's the critical need that's out there. We're supporting those, but we need the states to do their part because, again, we can only support. We don't drive, we don't dictate health and our mental health, we need the states to step up. As I said, President Biden has proven that he's more than willing to partner with states to address the mental health crisis. Because when nine out of 10 Americans are telling you that America is facing a mental health crisis, everyone needs to act. And we're willing to work and partner with those states.

Aaron Bolton: And you mentioned certified community behavioral health clinics. HHS has a pilot program, and Montana is among those states that is shooting for CCBHCs. Do you think those are a big answer, you mentioned 24/seven crisis care, is that a big solution, especially for rural states?

Xavier Becerra: When you need someone, you should be able to reach out to someone. And, it could be beyond the hours of 9 a.m. to 5 p.m.. And that's why these community behavioral health clinics are so important. And we are working to support states that want to set these up. And so when the federal government says, 'here's some money, if you establish these critical care centers, we're willing to support your efforts. So it's not just done with your state dollars.' That's how the federal government gets into the health care game. And we'll continue to do more because the American public is saying 'we need more,' especially, by the way, Aaron, for our young people. So many of our youth today are really going through crisis, when the second leading cause of death for 10 year olds is suicide. You know, we got to do something.

Aaron Bolton: Yeah. In before we in this conversation, Secretary Becerra, I just wanted to ask if there's anything in particular to Montana or Montanans that you wanted to touch on, beyond what we talked about?

Xavier Becerra: Yeah. Montana being a more rural state than many, faces the challenge of access. And we're working really hard to try to make sure that we can get people connected to the care that they need. One of the best ways we found, and COVID probably really brought this to the surface most, was telehealth. If you have to drive two or three hours to get to the caregiver, it makes it very tough, especially if you're lower income or don't have a reliable vehicle. Telehealth could solve a lot of those problems and make it easier for folks to connect with the care that they need. And so we're hoping that Congress will continue to give us the flexibilities that we need to be able to work with states to provide telehealth services to so many people throughout this country. But certainly in rural communities because we want to make sure that there's a hospital that is up and running and can service them. And so if we can focus resources and investments in keeping those hospitals open, we don't have to worry so much because telehealth will have provided people access with the early upfront care that they need before they have to use a critical care hospital facility.

Aaron Bolton: Thanks for taking the time to speak with us, secretary.

Xavier Becerra: Thank you very much, Aaron.