How the New Medicaid/CHIP Managed Care Regulations Improve Consumer Information

As my colleague, Kelly Whitener, announced last week, thanks to a grant from the Robert Wood Johnson Foundation, CCF has teamed with NHeLP to launch a series of explainer briefs to unpack the new Medicaid/CHIP managed care regulations. The first brief, Looking at the New Medicaid/CHIP Regulations Through a Children’s Lens, was published last week. Today, we are releasing the second brief of the six-part series on “Improving Consumer Information.”

Why are these rules so important? First, nearly 9 out of every 10 children in Medicaid and CHIP receive health care through a managed care arrangement. Importantly, 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 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.

The rule embraces current technology that enables states and managed care plans to provide access to information quickly, accurately, and less expensively. The rule pushes managed care consumer information into the digital age by allowing information to be made available electronically. If states or managed care plans meet specific standards for electronic sharing, the rule eliminates the redundant requirement for consumer information to be mailed in paper form to enrollees, although it must always be available at no cost upon request.

We’ll be reviewing the brief and covering the consumer information provisions in a webinar on Thursday, June 23rd at 1:30pm. Click here to register for the webinar.

Look for upcoming briefs in the series to include enhancing the beneficiary experience, assuring network adequacy and access to services, advancing quality, and ensuring accountability and transparency. If you missed the webinar featuring the first brief, you’ll find a recording here.

Tricia Brooks
Tricia Brooks is a Research Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families