One in three adults who are enrolled in Medicaid have high blood pressure, which costs the U.S. about $131 billion each year. This includes the cost of health care services, medications and the loss of productivity from illness and premature death.
The use of self-measured blood pressure (SMBP) monitoring can help improve hypertension control and reduce costs, yet Medicaid coverage is insufficient in some states and remains a key access barrier to wider adoption of SMBP. That is something Maryland set out to change and did.
In December 2020, the Centers for Medicare & Medicaid Services finalized new policies for how remote-patient monitoring is paid for under Medicare. At the same time, the Maryland Department of Health put out a plan identifying the reduction of emergency room visits due to hypertension as a priority.
There are about 9 million low-income, nonpregnant adults enrolled in Medicaid living with hypertension, which presented an opportunity to reduce gaps in care and improve public health.
Knowing this, several organizations formed a coalition to pass a bill that would provide Medicaid coverage for blood pressure measurement devices that have been validated for clinical accuracy as well as reimbursement for clinical support services. That coalition was comprised of The Maryland State Medical Society (MedChi), the Maryland Department of Health, Maryland Association of County Health Officers, American Heart Association and John Hopkins University School of Medicine. That bill passed due to their efforts.
The bill, which took effect Jan. 1, requires Medicaid to provide coverage for SMBP (PDF) for all Maryland Medicaid patients diagnosed with uncontrolled high blood pressure. That coverage must include validated home blood-pressure monitors. It also must include payment for physician and health care team time used for patient training, transmission of BP data, interpretation of blood-pressure readings and reporting as well as delivery of co-interventions.
“The proposal had so much support because blood pressure—and the heart—is a priority in Maryland’s State Health Improvement Plan,” said MedChi CEO Gene Ransom.
“If Medicaid covers SMBP services, it allows patients with high blood pressure to get remote monitors, additional treatment and access to practitioners,” Ransom said. “Not treating Medicaid patients leads to more costs in the long run and inequities. Simply put, this proposal improves outcomes and makes economic sense.”
Showing the need was key
“Somebody has to identify that there is a problem in the state that requires state action. Part of that was just data,” said Maryland State Sen. Brian J. Feldman, a sponsor of the bill who sits on the finance committee to which the bill was assigned.
“It was brought to my attention that in Maryland—out of 6 million folks, 1.5 million have high blood pressure and almost half don’t have any blood-pressure control,” Feldman said. “That’s an eye-popping number and you start to get some data on what the consequences are of that.”
For example, “if you aren’t monitoring your blood pressure then your risks of everything go way up and that has economic and fiscal impacts,” he explained.
“When it’s all said and done, it’s probably a net savings to the state of Maryland. I was surprised it wasn’t covered and more states have not required it to be covered,” Feldman said.
In 2024, Medicaid spending will rise by $2.8 million each year in Maryland to reflect annualization and the ongoing provision of services, but that figure does not account for the anticipated drops in spending to care for patients with uncontrolled BP. Physicians are encouraged to discover the Medicaid coverage in their state (PDF).
Removing barriers to access through Medicaid coverage of SMBP is a key component of AMA’s larger effort to improve blood pressure control rates nationwide.
AMA MAP BP™, a leading evidence-based quality improvement program, helps provide a clear path to significant, sustained improvements in BP control. With AMA MAP BP, health care organizations can increase BP-control rates quickly. The program has demonstrated a 10% increase in BP control in six months with sustained results at one year.