Introducing our Medicaid/CHIP Managed Care Series

As readers of Say Ahhh! know all too well, CMS recently finalized sweeping Medicaid and CHIP managed care regulations. The rules cover a wide range of topics important to children and low-income families, like improving consumer information, enhancing the beneficiary experience, assuring network adequacy and access to services, advancing quality and ensuring accountability and transparency. The sheer magnitude of the regulation is daunting for even the most seasoned child health advocate. Thankfully, here at CCF we’ve teamed up with NHeLP to break the rule down into more manageable pieces, highlighting the areas where state advocates can make the rule even better for children and low-income families along the way.

Today, we’re launching our series of explainer briefs by Looking at the New Medicaid/CHIP Regulations Through a Children’s Lens. Almost nine of every 10 children enrolled in Medicaid and CHIP receive health care through a managed care arrangement, so this rule will have huge implications for their care delivery. This brief highlights those provisions of general applicability but of utmost importance to children – like network adequacy, quality and populations with special health care needs – and those provisions uniquely applicable to children – like EPSDT and CHIP. It’s important to note that the federal rules set the minimum standards that states must meet in Medicaid and CHIP, but states can and should go further. In this brief and future briefs in this series, we’ve identified areas where child and legal advocates should work with their states and managed care plans to make the rules even stronger for consumers.

Each brief will be followed by a webinar, which we will make available on our website, so check back over the summer to find the latest information.

Kelly Whitener
Kelly Whitener is an Associate Professor of the Practice at the Center for Children and Families