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New EPSDT Guidance Reinforces Key Medicaid Prior Authorization Protections for Children – And We’d Like to See Even More
Everyone under the age of twenty-one in Medicaid should have access to health care services they need thanks to Medicaid’s Early and Periodic Diagnostic Screening and Treatment (EPSDT) requirement. In short, EPSDT requires children to get regular screenings and treatment when necessary. And this isn’t a vague hope – it’s the law. However, in at…
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What’s New for the 2025 Plan Year Open Enrollment
As the Affordable Care Act Marketplaces enter their 12th year, enrollment is at an unprecedented high, insurer competition is robust, and four out of five Marketplace enrollees can find a plan for $10 per month or less. This has also been a year of relative stability, without dramatic policy reforms or market disruptions. However, there are several…
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CMS EPSDT Guidance Blog Series
CMS released a state health official (SHO) letter outlining the requirements states and managed care plans must meet under Medicaid’s pediatric benefit, known as Early and Periodic Screening, Diagnostic and Treatment or EPSDT. The EPSDT SHO also describes some strategies and identifies best practices currently in use by states to meet the various requirements. This…
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CMS EPSDT Guidance: MCO Monitoring and Oversight Critical, States Ultimately Responsible
We at Georgetown CCF have been poring over CMS’s new EPSDT state health official (SHO) letter. Naturally, we do have some favorite points and analysis we will continue to highlight through this series on Say Ahhh!!! Today’s topic: The importance of state agency oversight of Medicaid managed care organizations, which the SHO refers to as…
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CMS Plans Major Upgrade to Faulty Account Transfer Process Between the Federal Marketplace and State Medicaid Agencies
Last week CMS announced plans to replace the technology and processes used to coordinate eligibility and enrollment through electronic accounts between the federal marketplace (healthcare.gov) and states that use the federal platform. The account transfer (AT) process, although riddled with glitches, has been in place since the Affordable Care Act’s coverage expansions began in 2014.…
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Urban Institute Report on Parent Health Coverage Finds Mothers of Young Children Showed Greatest Gains
Last month, the Urban Institute released a report detailing uninsurance rates between 2019 and 2022 for families with young children (under age 3). The report revealed significant drops—for the children, for fathers, and most significantly, for mothers. There were multiple factors contributing to these rises in coverage rates—pandemic-era continuous enrollment policies such as the Families…
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More States Expanding Medicaid/CHIP for Pregnant Women, Including Immigrants
The 2024 Survey of Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies conducted by the Kaiser Family Foundation and Georgetown CCF highlights gains in maternal health coverage. Eleven states expanded coverage for pregnant people in the past year as detailed in the table below. Nevada, North Dakota, and Tennessee, increased income eligibility limits for pregnant…
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New Guidance from CMS Lifts Up Medicaid’s EPSDT Pediatric Benefit
Last month, CMS released a state health official (SHO) letter outlining the requirements states and managed care plans must meet under Medicaid’s pediatric benefit, known as Early and Periodic Screening, Diagnostic and Treatment or EPSDT. The EPSDT SHO also describes some strategies and identifies best practices currently in use by states to meet the various…
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Trump-appointed Federal Court Judge Undercuts Important Legal Tool Used to Eliminate Health Care Fraud
Ultra-conservative politicians often use the risk of health care fraud to stoke fears about investing in public health care programs like Medicaid and Medicare. The funny thing is, their own judges appear to be working hard to make fraud more common. On September 30, 2024, a Trump-appointed Florida judge issued a radical decision to weaken…
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Child Uninsured Rate Increases Slightly: Full Impact of Medicaid Unwinding Not Yet Evident
Check out your state’s numbers on our state data hub. Every year we look closely at the U.S. Census Bureau’s American Community Survey health insurance coverage data to see what is happening to coverage rates overall and especially for children. The data, which are released in early September, reflect survey responses collected in the prior…
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Courts Weigh Protections and Access to Health Care for DACA Recipients
The Deferred Action for Childhood Arrivals (DACA) policy continues to come under legal attack despite more than ten years of proven success – helping people who arrived in the US as children graduate from high school, go to college, and start their families and careers here. There are more than 500,000 DACA recipients (and many…
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States Make Strides, Share Lessons in Financing Infant and Early Childhood Mental Health
By: Alex Busuito In the first five years of life, children develop the social, emotional, and cognitive capacities that are the foundation for lifelong health and wellbeing. A significant financial investment in a robust system of care to support the mental health of babies, young children, and their caregivers goes a long way towards increasing…
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Webinar: MAC/BAC Webinar Miniseries
The final Managed Care and Access Rules, released in the spring, included new regulations for Medicaid Advisory Committees, which many states currently refer to as Medical Care Advisory Committees. These are groups intended to support communication and collaboration between state agencies, people enrolled in Medicaid, service providers, and other stakeholders. The new regulations broaden the scope of…
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No Child Should Be Uninsured: New Bill Would Cut Medicaid Red Tape and Reduce Harmful Gaps in Coverage
At Georgetown CCF we have been thinking about a day when no child in the United States is uninsured since our inception 19 years ago. Substantial progress has been made over the past two decades with some ups and downs along the way. However, as the recent Medicaid unwinding made abundantly clear, this day will…
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New Report Explores Insights from Medicaid Unwinding on How to Protect Children’s Coverage
The Urban Institute and Georgetown CCF have released a new report highlighting ways to improve the Medicaid/CHIP redetermination process for children emanating from key lessons learned during the unwinding of the Medicaid continuous coverage protection. These insights are based on interviews of representatives in 8 state Medicaid agencies, offering a unique perspective directly from the…
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Massachusetts Governor Signs a Maternal Health Bill Expanding Access to Midwifery, Birth Centers and Doulas
On August 23rd, Governor Maura Healy of Massachusetts signed an act promoting access to midwifery care and out-of-hospital birth options into law. This comprehensive maternal health bill focused on expanding midwifery coverage to include certified professional midwives (CPMs), birth centers, doulas, and screening and treatment options for postpartum depression. MassHealth is Massachusetts Medicaid and CHIP…
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New Federal Funding Opportunity for State Medicaid and CHIP Programs to Support Continuity of Care for Justice-Involved Individuals
Last week, many in the Medicaid and CHIP community were focused on CMS’s announcement of guidance to states on Medicaid EPSDT requirements (and for good reason). However, we also wanted to make sure folks saw the new notice of funding opportunity for planning grants to state Medicaid and CHIP agencies to develop operational capabilities to…
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CMS Issues Guidance to States on Early and Periodic Screening, Diagnostic and Treatment Requirements
Today, the Centers for Medicare & Medicaid Services (CMS) released much-anticipated guidance on Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements. For those who don’t live in Medicaid jargon land, EPSDT is the pediatric benefit in Medicaid and establishes a higher standard for children than adults covered by Medicaid. Most, but not all,…
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Medicaid/CHIP Mental Health Parity: Latest Federal Actions Explained
Last week, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury released their much-anticipated final rules to strengthen the enforcement of the federal Mental Health Parity and Addiction Equity Act (MHPAEA). As highlighted by the DOL, the final rules, among other provisions, make clear that group health plans and health insurance…
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Georgetown CCF Executive Director Joan Alker Accepts the Grantmakers In Health Andy Hyman Award
Joan Alker, Executive Director and a cofounder of the Georgetown University Center forChildren and Families (CCF) received the Grantmakers In Health’s 2024 Andy Hyman Award. Theaward pays tribute grantees who embody a commitment to principled action, passionateleadership to advance social change, and dedication to making progress in policy and practicedespite challenging political environments. Ms. Alker was nominated…
