Say Ahhh!
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CBO Confirms House Bill Prohibiting Use of “QALYs” Would Undermine State Negotiation of Medicaid Supplemental Rebates
I previously raised significant concerns about a House health bill that would expand an existing Medicare prohibition on the use of Quality-Adjusted Life Years (QALYs) to other federal programs including Medicaid and the Children’s Health Insurance Program (CHIP). I warned that the bill was overbroad in its prohibition of the use of QALYs and could…
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CMS Takes Swift Action to Require States to Address Medicaid Auto-Renewal Errors and Reinstate Children’s Coverage
We have long feared that large numbers of children were losing Medicaid during the unwinding, essentially by mistake, and the ex parte debacle underscores the fact that this is indeed happening. As we’ve previously explained, the ex parte issue came to light in August after a CMS investigation found several states were doing automatic renewals…
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Midwives Offer State Medicaid Agencies Another Tool to Address the Maternal Health Crisis
Doulas have been a popular topic in the maternal health space as one means of improving birthing outcomes, especially for Black women and other communities of color that have been historically marginalized from the traditional health system. It can be confusing to differentiate between the different support persons and clinicians that may assist expecting or…
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House Republican Budget Resolution Includes Draconian Medicaid Cuts
Yesterday, on September 19, 2023, House Budget Committee Chair Jodey Arrington issued a House budget resolution for fiscal year 2024 that would cut federal Medicaid spending by $1.9 trillion — or nearly 28 percent — over the next 10 years. While the budget resolution includes very little detail, it offers some indication about how the…
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Update on Medicaid Unwinding and Marketplace Enrollment
I previously reported that according to data from the Centers for Medicare and Medicaid Services (CMS), of the 715,000 Medicaid beneficiaries who lost Medicaid coverage in April due to unwinding of the Medicaid continuous coverage protection, a total of about 54,000 people or 7.5 percent — who were either previously enrolled in Medicaid in March…
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Bipartisan House Health Bill Includes Sound Medicaid Drug Pricing Provisions
A bipartisan health price transparency bill — The Lower Costs, More Transparency Act (H.R. 5378) — is scheduled to be considered on the House floor “on suspension” this week. The bill includes two sound Medicaid provisions related to “spread pricing” in Medicaid managed care and to Medicaid pharmacy reimbursement, which are similar to those included…
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Analysis: New Mothers Gained Health Coverage During Pandemic-Era Coverage Protections, But 1 in 10 Still Uninsured
The Families First Coronavirus Response Act (FFCRA) required states to maintain uninterrupted coverage for all Medicaid beneficiaries in exchange for additional federal funding. This continuous coverage protection also extended to pregnant women in Medicaid beyond the previous 60-day postpartum cutoff that most states have now moved to extend to 12 months postpartum. A new analysis…
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State Response Due Today on Ex Parte Noncompliance Issue Impacting Kid’s Coverage
On August 30, CMS revealed that a number of states were incorrectly processing ex parte (automated renewals), an issue that mostly often impacts children although there are circumstances where other eligible members may be affected. In a nutshell, if one person in the family could not be renewed automatically via ex parte, no one is…
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CMS Releases Postpartum Care Toolkit to Help States Address Access, Quality, and Equity of Care in Medicaid and CHIP
The rapid state adoption of extended postpartum Medicaid coverage from 60 days to 12 months offers an important opportunity to help ensure new parents and their infants get the health care they need during a critical period of family change following a birth. Last month, CMS released a timely resource for states seeking to help…
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CMS Posts May 2023 Unwinding Data
In this snapshot dated August 2023, CMS reports on certain unwinding metrics based on May 2023 data. Those metrics include: Percent and number monthly change in total Medicaid enrollment; Current month and monthly change in applications processed over 45 days; Current month and monthly change in average call time; and Current month and monthly change…
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Breaking News: CMS Reveals States Are Incorrectly Processing Ex Parte Renewals; Kids Are Most at Risk
Today, CMS released troubling information. Based on the agency’s monitoring of the unwinding of the COVID-related Medicaid continuous enrollment requirement, CMS found that many states are conducting ex parte renewals incorrectly. As a result, many children and other enrollees are or could soon be losing their Medicaid coverage when the state had information that they…
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Statement by Joan Alker on Biden Administration Medicaid Ex Parte Announcement
The following is a statement by Joan Alker, executive director of the Georgetown University Center for Children and Families in response to Biden Administration letter to states requiring Medicaid ex parte renewal fixes and reinstatement of children and others impacted. “Children are especially at risk during the current process of checking eligibility for everyone covered…
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Medicaid Coverage for Pregnant Women and Their Young Children Linked to Health of the Next Generation
As we see increasing numbers of pregnant women and newborns being disenrolled from Medicaid, a new study adds to evidence of long-term benefits of Medicaid investments– this time for the grandchildren and children of pregnant women and their newborns. For many years, CCF has highlighted the growing research on the long-term health and educational impacts…
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“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;…
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How Would Medicaid Expansion Help Rural Communities in 10 Holdout States?
Last week, my colleague Joan Alker announced the publication of our latest report on the importance of Medicaid in rural areas and small towns around the country. She covered how as states “unwind” pandemic-era Medicaid continuous coverage protections, the reach of Medicaid in rural areas means negative effects there can be quite significant if states…
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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…
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Why Are So Many Kids Losing Medicaid Coverage?
At the end of the COVID pandemic, more than half (54%) of the nation’s children were covered by Medicaid or CHIP; the vast majority by Medicaid. So, the lifting of the pandemic-related Medicaid continuous enrollment protection this spring is a really big deal, putting low-income children at risk of losing access to health care and/or…
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Medicaid Provision of Draft House Drug Shortages Bill Raises Concerns
This year, there has been renewed focus in Congress on how to address the ongoing problem of drug shortages, especially with cancer patients now facing severe shortages of widely used generic chemotherapy drugs. On July 28, 2023, House Energy and Commerce Committee Chair Cathy McMorris Rodgers unveiled a draft bill intended to address the “root…
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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…
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Medicaid’s Role in Rural Areas Has Grown: Families Have Much at Stake in the Unwinding
In 2017 we published our first report examining the role of Medicaid in rural areas. We’ve updated the data a few times and our newest look is based on Medicaid coverage in 2020-2021. The data underscores the outsize importance of Medicaid as a source of health insurance coverage in rural areas and small towns –…
