Blog
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House Budget Committee Chair Pushes House Republican Caucus to Adopt His List of Draconian Medicaid Cuts
According to press reports, at a January 4th meeting of the House Republican caucus, House Energy and Commerce Committee Chair Brett Guthrie (R-KY) presented policy options to deeply cut federal Medicaid spending, including a proposal to convert Medicaid to a per capita cap, as part of budget reconciliation legislation this year. Now, according to a…
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The Truth about Fraud Against Medicaid
[Read Andy Schneider’s most recent blog about fraud against Medicaid: The Improper Use of Improper Payments.] As my colleague Edwin Park has explained, capping federal Medicaid payments to states will likely be a key objective for the incoming administration. To lay the groundwork for this radical cost shift, the administration and its allies can be…
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House Republicans Actively Considering Deep and Damaging Cuts to Medicaid
As we have previously written, since the November election, Congressional Republican leaders have been increasingly open about their intent to make deeply damaging cuts to Medicaid. Now, at a caucus retreat on January 4th, House Republicans actively discussed policy options to cut federal Medicaid spending — including converting Medicaid to a per capita cap —…
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CMS Announces State Recipients of the Transforming Maternal Health (TMaH) Model
Last year, CMS announced a grant opportunity to boost state Medicaid agency efforts to improve maternal health in the United States. The Transforming Maternal Health (TMaH) Model seeks to help states develop a comprehensive approach to the perinatal period that addresses the whole person’s physical, mental health, and social needs that may be experienced during…
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Medicaid Managed Care in 2024: The Year That Was
2024 was a year of transition for Medicaid managed care. At the federal level, there were significant revisions in regulatory requirements relating to access to care and increases in transparency about MCO performance. At the state level, the end of the unwinding of the public health emergency continuous eligibility requirement meant the end of the…
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Medicaid Managed Care: Transparency for Young Children in 12 States
Regular Say Ahhh! readers know that most children covered by Medicaid in most states received their coverage through private insurance companies, or managed care organizations (MCOs). We believe that publicly-available data on Medicaid managed care performance is key to fully understanding how well Medicaid MCOs are working for children. Consistent, MCO-level data helps identify gaps…
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New Tool to Help States Support Community Health Workers – What Would Federal Medicaid Cuts Mean for Progress?
Community health workers (also known as promotores and community health representatives) fill an important role in the health care system by linking individuals to public health and medical resources that support their health and well-being. Community health workers are unique in that they are trusted members of the community and are able to serve as…
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The Budget Resolution and Reconciliation Process Explained
In early 2021, we wrote about the basic rules for passing legislation in the House versus the Senate and how the budget reconciliation process allows certain legislation to move forward with approval from a simple majority of Senators rather than be subject to the filibuster and the usual three-fifths or 60-vote threshold. Given recent reports…
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Are Children Receiving the Full Protection of Medicaid’s Pediatric Benefit Package?
Medicaid covers over 30 million children, or about 40 percent of all children. Medicaid covers disproportionately large shares of low-income children, children of color, and children with special health care needs. Medicaid law and policy necessarily impact children, oftentimes children who would be uninsured or underinsured without it. Children with Medicaid coverage are entitled to…
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New Report Documents State Action on Maternal Mental Health, Medicaid Cuts Could Undermine Progress
Last month, the Policy Center for Maternal Mental Health (“Policy Center”) released its second annual report highlighting state efforts to improve maternal mental health outcomes. Over the past few years, maternal mental health has gained momentum at both the federal and state levels. The report evaluates 2024 state legislation introduced on maternal mental health care,…
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Federal Funding Cuts to Medicaid May Trigger Automatic Loss of Health Coverage for Millions of Residents of Certain States
Despite virtually no discussion of Medicaid during the election, Medicaid is facing proposals for significant reductions in federal funding. My colleague Edwin Park has already detailed some of the discussion around these cuts – which are being considered in service of facilitating an extension of tax breaks, the majority of which would go to the…
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Congressional Republican Leaders Start to Show Their Hand: Draconian Medicaid Cuts on the Agenda for Next Year
I have been warning for months that Medicaid would be on the chopping block if there is a second term of the Trump Administration and if Congressional Republicans win House and Senate majorities in 2025. That is because the Project 2025 blueprint, the fiscal year 2025 Republican Study Committee budget plan, and the fiscal year…
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CMS Approves Five More States to Adopt Medicaid Multi-Year Continuous Coverage for Young Children As Threats to Coverage Loom
Yesterday, CMS approved a set of another five state 1115 waiver demonstration applications to adopt multi-year continuous eligibility for children in Medicaid. Four states (Hawaii, Minnesota, New York and Pennsylvania) were approved to adopt continuous eligibility for children in Medicaid from birth to age 6; Colorado was approved to implement for children up to age…
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Transparency in Medicaid Managed Care: CMS Posts Annual MLR Reports
On November 1, CMS posted on its website Medical Loss Ratios (MLRs) for individual Medicaid managed care organizations (MCOs) in 2018, 2019, and 2020. These data come from the MLR Summary Reports that states are required to submit to CMS. This CMS action follows the posting on July 15 of the first tranche of Managed…
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Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q3 2024
Another quarter, another round of earnings reports from the “Big Five.” The story of Q3 continues the basic narrative of Q1 and Q2. For all but one of the companies that dominate the Medicaid managed care market, net Medicaid enrollment continued to decline, driven primarily by the PHE unwinding. There is one new wrinkle, however.…
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New Brief: States Should Act to Ensure All Former Foster Youth Receive Medicaid Continuity of Coverage
A group often overlooked in Medicaid coverage conversations is foster youth. While they are a small segment of the population, youth aging out of foster care have higher physical and mental health care needs than their peers, but often lack health insurance due to high costs. The authors of the Affordable Care Act (ACA) took into…
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CMS Highlights EPSDT Policies and Strategies for Improving Care for Children with Behavioral Health Needs
As discussed in our blog series on the CMS’s new EPSDT guidance, the 57 page state health official letter lays out a number of policies and strategies to help states meet their EPSDT requirements under Medicaid – including care for children with behavioral health needs. As you may recall, in 2022, CMS released an informational…
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Georgia’s Much Vaunted Medicaid Waiver “Pathways to Coverage” Has Turned Into “Pathways to Profit” for Consultants
As of June 2024, a paltry 4,231 Georgians were enrolled in Georgia’s section 1115 Medicaid waiver, according to reports from the state recently posted by federal CMS. Data from the newly released reports confirm that Governor Kemp’s “Pathways to Coverage” alternative to the Affordable Care Act’s Medicaid expansion – approved during the last year of…
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House Budget Proposal Seeks to Eliminate Healthy Start, a Proven Program to Reduce Maternal and Infant Mortality
By Kay Johnson For more than 30 years, the federal Healthy Start program has been investing in community-based solutions to reduce maternal and infant mortality in communities with infant mortality rates at least 1.5 times the U.S. national average. At a time when many are rightly calling for more community and family engagement to reduce…
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A Look at Maternal Health Legislation in the 118th Congress
By: Tanesha Mondestin and Kay Johnson Maternal health continues to be a priority for many Members of Congress. We previously scanned maternal health legislation that Members of Congress may consider in the 2022 “Lame Duck” session. We revisited this topic this election year to consider proposals pending in the 118th Congress as their chance of…
