Latest From Andy
“Deemed Newborns:” Collateral Damage in the PHE Unwinding
This blog is about the babies on the bus. You know, the ones who go “Wah-Wah-Wah” all around the town. It seems that, in the course of the PHE unwinding, some of them are getting thrown under the bus. As my colleague Elisabeth Wright Burak recently reported, Arkansas disenrolled 3,300 newborns from Medicaid in April; […]
Transitional Medical Assistance (TMA): Extending Medicaid Coverage for Working Parents
Terminations of Medicaid eligibility are much in the news these days. While the large majority of disenrollments to date have been for procedural reasons, there are individuals who have been disenrolled after a state Medicaid agency has actually made a determination that the individual is ineligible. In these situations, the agency is required to determine […]
The Biden Administration CMS Unwinds the Tennessee “Block Grant”
Two and a half years ago, on January 8, 2021, with considerable fanfare, the Trump administration CMS announced the approval of a Medicaid “aggregate cap waiver” for Tennessee. The Governor was more forthcoming, trumpeting the state’s receipt of a “block grant waiver.” You say “aggregate cap,” I say “block grant,” let’s call the whole thing […]
Medicaid Managed Care: Early Results of the PHE Unwinding for the Big Five in Q2 2023
The Medicaid enrollment results for the “Big Five” during the quarter ending June 30 are now in. The Big Five have the largest share of the Medicaid managed care market: Centene, CVSHealth (Aetna), Elevance Health (formerly Anthem), Molina Healthcare, and UnitedHealth Group. They, along with two large nonprofit companies, were the focus of a recent […]
Medicaid Managed Care: Denials of Prior Authorization for Services
Kudos to the OIG! That would be the Office of the Inspector General of the Department of Health and Human Services. Although OIG is better known for its fraud-fighting persona, it also has a broader mission of making government programs work better. And with last month’s report, “High Rates of Prior Authorization Denials by Some […]