Medicaid/CHIP Managed Care Regulations: Improving Consumer Information

Over the past decade or so as managed care has become the predominant delivery system in Medicaid and CHIP, there has been a growing recognition of the need for current, accurate, and thorough consumer information to aid potential managed care enrollees in making an informed plan selection and in understanding how to maximize their benefits and rights. To this end, the modernization of federal Medicaid/CHIP Managed Care regulations released in May 2016 seeks to improve consumer information. The rules specify content, timeliness standards, and delivery methods for notices, enrollee handbooks, provider directories, and drug formularies to assure that consumers have current and complete information. Information for enrollees and potential enrollees must be provided in a manner and format that may be easily understood and is readily accessible. Importantly, the rule specifies language access requirements and access to alternative formats and auxiliary aids. And last but not least, the rules move consumer information into the digital age by embracing electronic communications. This brief reviews the consumer information provisions of the new federal managed care rules, and is the second in a series of explainer briefs, funded by a grant from the Robert Wood Johnson Foundation.

For the full series, visit our Medicaid/CHIP Managed Care page.

The video recording of our webinar on this paper is available below.

Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families

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