Medicaid in a Post-COVID World: Waivers Can Provide Flexibility for States

The COVID-19 pandemic has taught states a lot about health policy, especially around Medicaid.

The pandemic highlighted ineq­uities in health care across the states, according to speakers at a recent CSG East Health Policy session.

“It highlighted communities without access where COVID has the highest impact on com­munities with the least access to health care,” said Rhode Island Sen. Joshua Miller. In his state, it also highlighted a lack of trust and a lack of competency in dealing with the pandemic.

In Maryland, said Del. Joseline Peña-Melnyk, chair of the House Health and Government Op­erations Committee, it also illustrated the need for more oversight, especially as executive orders proliferated during the early days.

She, too, noted the impact on communities of color and how they were affected. “We started thinking about equity, but we also started thinking about racism. For the Black and Brown communities, there is structural racism,” she said. “You have to really think about the history.”

Delegate Joseline Peña-Melnyk speaks to the CSG East Health Committee

In addressing some of these issues, states found ways to improve the health care delivery system. Peña-Melnyk worked to pass legislation to recognize racism as a public health issue and create a commission on health equity, which is required to provide yearly recommendations to state leaders on how to improve the lives of those who are marginalized.

Both Maryland and Rhode Island addressed the use of telehealth in communities across the states.

“Telehealth was one, but not the only effort and opportunity, to expand health care to where it was not present,” Miller said.

In Maryland, legislation was passed to ensure undocumented pregnant women have access to prenatal care.

But COVID also illustrated the impact on state budgets and economies when undocumented people don’t have access to health care. Many of them are on the front lines as restaurant workers, grocery workers, and nursing home caregivers.

“If those people have less access to health care, it’s going to not only affect them, it’s going to affect the community because of the pan­demic,” Miller said.

The health care system continues to change and the pandemic has provided some valuable lessons. But to adapt with Medicaid, states need to be more aware of potential for change through the Medicaid waiver process, Miller and Peña-Melnyk said.

“States are very shy. [CMS] would love for states to be creative and submit these waivers and just try and they would be willing to do it,” Peña-Melnyk said.

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America’s Bus Fleet Awarded $409.3 Million

On March 14, 2022, the U.S. Department of Transportation’s Federal Transit Administration (FTA) awarded $409.3 million to modernize and electrify America’s buses, make bus systems and routes more reliable, and improve their safety. FTA received 303 proposals totaling approximately $2.56 billion. Grants were given to 70 projects in 39 states.

“These grants will help people in communities large and small get to work, get to school, and access the services they need,” said U.S. Transportation Secretary Pete Buttigieg. “Everyone deserves access to safe, reliable, clean public transportation – and thanks to the President’s historic Bipartisan Infrastructure Law, we are bringing modern buses to communities across America.”


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CSG East job opening: Meetings and Operations Coordinator

The Meetings and Operations Coordinator supports the planning, coordination, and execution of the organization’s meetings, programs, and special events of various sizes, as well as booking travel for individual trips of members and colleagues. These events range from a dozen or so participants to 400+ for our annual meeting.

You’ll work with a small team of professionals and consultants on a hybrid schedule out of our New York City office.


Apply here


What you’ll do: 

Specific responsibilities of the Meetings and Operations Coordinator include the following: 

Works with meetings program manager to plan, coordinate, and conduct logistics for conferences, programs, and events, including speaker management, registration and reporting, transportation, technology, equipment, printing, food and beverage, and other related issues.
Processes accounts payable and receivable, reconciles credit card accounts; keeps accurate records, prepares reports, provides cost analysis, and requests bids. 
Compiles and prepares onsite briefing packets, name badges, signage, and tent cards, and ensures that onsite equipment and supply needs are met; packs, ships, and arranges for return of meetings materials. 
Assists the professional development program manager with application outreach, tracking, compilation of rankings, as well as other administrative tasks. 
Works with director on developing and implementing member engagement initiatives and fundraising. 
Assists in scheduling, preparation for, and organizing state visits and related materials. 
Establishes and maintains all office/vendor/contract filing systems.

What you’ll bring: 

Administrative work experience with some background in meeting and/or event planning; preference given to those with a post-secondary degree. 
Ability to interact effectively with diverse people in different contexts and foster equity and inclusion through self-awareness, cultural sensitivity, and valuing others. 
Dedication to public service with an unfailing commitment to act with civility, be nonpartisan in performing CSG duties, and be a responsible steward of member and donor funds. 
Ability to work effectively in a highly collaborative team environment as well as independently. 
Excellent customer service and interpersonal skills. 
Ability to organize, prioritize, and complete multiple projects in a detail-oriented manner to meet schedule and timelines. 
Solid computer skills, specifically in Microsoft Excel and Word. 
Ability to communicate, both verbally and in writing, with business contacts and legislators in a courteous and professional manner. 


How you apply: 

If you’re interested in helping us facilitate the exchange of ideas among state leaders, you should upload the following elements with your application using this link:

Cover letter explaining your interest in the position and CSG East. Applications without a cover letter will not be considered. (See this article from Indeed on how to write a simple cover letter.)

CSG believes that pay equity and pay transparency advance workplace fairness. Compensation will be equitable and based on experience and education. The salary range for this position, based in New York City, is $55,000 to $65,000. This salary range is subject to change based on work location and market conditions. 

Qualified applicants will receive consideration for employment without regard to characteristics including but not limited to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

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New 988 Suicide and Crisis Lifeline marks first week since launch

The National Suicide Prevention Lifeline has a new, easy-to-remember number for 24/7 crisis care.

The transition to 988 — a three-year joint effort by the U.S. Department of Health and Human Services (HHS), Federal Communications Commission (FCC), and the U.S. Department of Veterans Affairs (VA) to put crisis care more in reach for people in need — officially ended with the launch of 9-8-8 last Saturday, July 16.

The 988 Suicide and Crisis Lifeline is a network of more than 200 state and local call centers supported by HHS through the Substance Abuse and Mental Health Services Administration (SAMHSA).

The initiative is part of the Biden administration’s effort to address the nation’s ongoing mental health crisis and was identified by U.S. Health and Human Services Xavier Becerra as a top priority at HHS.

Since January 2021, federal investments to support the 988 transition have increased 8-fold (from $24M to $432M).

The 10-digit Lifeline number 1-800-273-TALK (8255) will continue to be operational after July 16 and will route calls to 988 indefinitely. Veterans, service members, and their families can also still reach the Veterans Crisis Line with the current phone number 1-800-273-8255 and Press 1, or by chat


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Supreme Court hands down flurry of major decisions

By:  Lisa Soronen, State and Local Legal Center, Washington, D.C.

The State and Local Legal Center (SLLC) files Supreme Court amicus curiae briefs on behalf of the Big Seven national organizations representing state and local governments. CSG East occasionally republishes briefs, like the one below, on cases and decisions that affect the Eastern Region.

Recent decisions handed down by the Supreme Court will have major implications for states, including a school funding case originating in Maine and a gun licensing case originating in New York. Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade, is covered below as well.



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SCOTUS Brief: United States v. Vaello Madero

By:  Lisa Soronen, State and Local Legal Center, Washington, D.C.

The State and Local Legal Center (SLLC) files Supreme Court amicus curiae briefs on behalf of the Big Seven national organizations representing state and local governments. CSG East occasionally republished briefs, like the one below, on cases and decisions that affect the Eastern Region.


In United States v. Vaello Madero the U.S. Supreme Court held 8-1 that Congress hasn’t violated the equal-protection component of the Fifth Amendment’s Due Process Clause by failing to make Supplemental Security Income (SSI) benefits available to Puerto Rico residents.

Through SSI, the federal government makes monthly cash payments to qualifying low-income individuals who are over 65 years old, blind, or disabled. To receive SSI, an individual must be a “resident of the United States,” which the statute defines as the 50 states, the District of Columbia, and the Northern Mariana Islands.

According to the Court, “the Federal Government provides supplemental income assistance to covered residents of Puerto Rico through a different benefits program — one that is funded in part by the Federal Government and in part by Puerto Rico.” Residents of Puerto Rico don’t pay most federal income, gift, estate, and excise taxes.

When Jose Luis Vaello Madero moved from New York to Puerto Rico he was no longer eligible to receive SSI. He claimed excluding Puerto Rican residents from SSI is unconstitutional.

In a very brief opinion written by Justice Kavanaugh, the Court disagreed, citing the “text of the Constitution, longstanding historical practice, and this Court’s precedents.”

Regarding the constitution’s text, the Territory Clause states that Congress may “make all needful Rules and Regulations respecting the Territory . . . belonging to the United States.” According to Justice Kavanaugh, “[t]he text of the Clause affords Congress broad authority to legislate with respect to the U.S. Territories.”

Regarding precedent, in Califano v. Torres (1978) the Court held that Congress’s refusal to extend SSI to Puerto Rico didn’t violate the constitutional right to interstate travel. In that case, the Court applied the “deferential” rational-basis test and explained that Congress had exempted Puerto Rician residents from federal taxes. Likewise, in Harris v. Rosario (1980) “the Court again ruled that Congress’s differential treatment of Puerto Rico in a federal benefits program did not violate the Constitution — this time, the equal-protection component of the Fifth Amendment’s Due Process Clause.”

According to the Court, the above two cases determine the result in this case and that the rational-basis test applies. “Puerto Rico’s tax status — in particular, the fact that residents of Puerto Rico are typically exempt from most federal income, gift, estate, and excise taxes — supplies a rational basis for likewise distinguishing residents of Puerto Rico from residents of the States for purposes of the Supplemental Security Income benefits program.”

Justice Sotomayor dissented alone, opining “there is no rational basis for Congress to treat needy citizens living anywhere in the United States so differently from others. To hold otherwise, as the Court does, is irrational and antithetical to the very nature of the SSI program and the equal protection of citizens guaranteed by the Constitution.”

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