Q&A: Medicaid director Emma Chacon discusses equity, COVID and the merger

Emma Chacon has served as Utah’s interim state medicaid director since March 2021, replacing Nathan Checketts who moved to the Department of Human Services as deputy director. She has acted as the medicaid deputy director and operations director at the Department of Health since 2005.  

In this Q&A, Chacon discusses Medicaid operations during the pandemic, equity discussions at UDOH, and the department merger’s impact on Medicaid. 

 

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Patrick Jones: How has the pandemic changed the way Utah Medicaid provides services to those who need it? How has Utah Medicaid expanded services to meet the rising pandemic demand?

Emma Chacon: “There’s no question the COVID-19 pandemic has had an impact on not only Utah Medicaid, but Medicaid across the nation primarily in three different areas. One is that it caused us to make some modifications to some of our services that we provide, like telehealth. We expanded the utilization of telehealth through a number of different ways that CMS provided — mainly things like emergency waivers for emergency state plan amendments. We were able to change the telehealth policy to allow phone-only and not require audio and visual. 

That actually has gone a long way to helping providers to maintain services, particularly in the behavioral health area where they have been able to engage individuals, both in individual and group therapy sessions just over the phone. We have heard from our behavioral health providers that it’s been so successful because they’ve been able to engage some people in services who in the past would never come to their door, but were willing to pick up the phone and have a phone discussion with a behavioral health provider. So we’re looking at potentially modifying our state plan to allow that service as an audio-only service long term. 

We had to expand our coverage for things like testing for COVID-19 and for the vaccines as a different iteration of vaccine eligibility came out. Adding coverage for monoclonal antibodies is another area. We’re in the process of modifying our contract for non-emergency medical transportation to allow us to provide transportation for the purposes of vaccines only for some of our Medicaid groups who are not eligible for this non-emergency medical transportation. 

Lastly, there was an option that CMS provided that would allow states to open up a category of Medicaid for uninsured individuals for the purposes of testing only. We did that, and we’ve had thousands of individuals take advantage of that. It’s 100% funded by the federal government, but it does allow us to open up that provision and hopefully get a lot of people tested who normally would not be.”

PJ: What have been the main struggles for Utah’s Medicaid program during this pandemic? What has taken up most of your mental energy in the last few months, and what’s it been like adjusting to this new role?

EC: “You know I think just the pandemic and the intensity and the fact that not only Medicaid but the state as a whole had to respond so rapidly to everything, and then we’ve had to get our partners to respond rapidly as well — that’s a lot of pressure. We were dealing with that at the same time that all of us, including our partners, are having to deal with the impact of the pandemic on our employees and how we do business generally. We, like everyone else, went into a teleworking mode where we set all of our employees and as did the rest of the state government. In a matter of weeks, we had everyone outfitted and checked with their technology in a way that we could continue business pretty seamlessly. This was pretty amazing because we didn’t think we could pull it off that fast.”

PJ: How has your department incorporated discussions of equity, inequity and access into your decision-making throughout this pandemic?

EC: “I think not only our program but the whole department has definitely been focused in this area. One of the things that we have been doing is engaging our managed care plans to help with reaching out to unvaccinated Medicaid members to try to get them to make the choice to get vaccinated just by providing them with information about the vaccine itself and where to get it. We have a group of staff who provide customer service and we have a significant number of those folks who are Spanish speaking. We targeted some of our outbound calling and interactions for our Spanish speaking dedicated members with our Spanish speaking staff so that they were more comfortable. 

We are trying to target as much as we can individually by race and lower income areas of the state to try to target those areas and use community health workers to try to get out there to work within their own communities. As a state as a whole, we’ve been trying to target [communities]. Rather than having large vaccination sites, we’re trying to get more neighborhood vaccination sites where people feel more comfortable. It’s just more convenient and easier for them to get there.”

PJ: How has the recent merger between the health department and the human services department affected Medicaid, if at all? What does the merger mean for the future of Utah Medicaid?

EC: “We’re just in the process of having those discussions. So our legislature passed the bill and told our two departments to get together and work out that plan and to submit a written plan in December that our legislature will take action on in the next session in 2022. For Medicaid, I don’t see much difference. We’ve sort of had a foot in both worlds. We are located in the Department of Health and have a lot of interaction with our public health partners, but we are also a major funding source of all the programs in the Department of Human Services. This is nothing new to us. We engage and collaborate with all these parties all the time anyhow so I’m not seeing a big change for us with all of this.”

PJ: So how does Utah Medicaid plan to incorporate mental health and behavioral health benefits? How can Medicaid play a part in helping Utahns with their mental and behavioral health struggles?

EC: “This is a big priority for us and we already have a pretty robust behavioral health benefit package. We cover a broad array of outpatient services. We’ve been very proactive in terms of getting waivers like institutions for mental disease waivers in the areas of substance as well as mental health. We have collaborated again with our partners in human services to figure out how to fund things like crisis, saving standards and crisis lines. The other thing that we have done with our Medicaid expansion population I mentioned is that we’re a very managed care state. We actually created integrated plans for our expansion population. These are plans where we have one entity responsible to coordinate both physical health and behavioral health care because we really think that’s the best approach for individuals.”

This interview was edited for clarity and length.