Blog
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Which States Were Furthest Along in Medicaid Unwinding in 2023?
We recently released a report looking at state performance during the Medicaid unwinding with a focus on children. We examined data from the beginning of the unwinding, which varies by state, through the end of 2023. Some states (7) acted very cautiously and saw very little to no change in their net child Medicaid enrollment…
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Draft Senate Finance Committee Bill Addressing Drug Shortages Includes Broad Rollback of Medicaid Inflation-Related Rebates for Generic Drugs, Raises Serious Concerns
Congress has been examining ways to address the ongoing problem of generic drug shortages, especially with cancer patients continuing to face severe shortages of widely used generic chemotherapy drugs. Both the House Energy and Commerce Committee and the Senate Finance Committee have held hearings on generic drug shortages, with the Senate Finance Committee also issuing…
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Series: Improving Access and Managed Care in Medicaid and CHIP
Earlier this year, the Center for Medicare & Medicaid Services (CMS) finalized two new regulations aimed at improving access to care for those enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) across delivery systems. CCF experts summarize both rules in “An Explanation of Final Medicaid Managed Care and Access Rules“. Below is a…
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Beneficiary Advisory Councils: Historic Opportunity for State Medicaid Programs
The Center for Medicare & Medicaid Services’ (CMS) recent final regulation on Ensuring Access to Medicaid Services (“Access Rule”) is ushering in a new era of participation for people enrolled in Medicaid and their families and caregivers. (We summarized the new regulation here, and its companion managed care regulation here.) The Beneficiary Advisory Councils (BACs)…
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CMS Releases Guidance on Timely Processing of Applications and Extension of Unwinding Flexibilities
The unprecedented volume of Medicaid redeterminations generated by the expiration of the continuous coverage provisions has been somewhat of a “stress test” for state Medicaid systems. The number of Medicaid applications exceeding federal timeliness standards is one indicator that a state is not doing well on this stress test and a signal that something needs…
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Marketplace Enrollment Among Those Losing Medicaid Coverage During Unwinding Slowed in Last Month of Open Enrollment
As readers of Say Ahhh! know, I have been tracking monthly data (here, here, here, here, here, here, here, here and here) from the Centers for Medicare and Medicaid Services (CMS) on the number of people who were either previously enrolled in Medicaid or had experienced a denial or termination during unwinding who then selected…
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Nebraska Uses State Medicaid Managed Care Excess Profit Fund to Leverage New Federal Home Visiting, Medicaid Dollars
While its neighbor Iowa cut access to prenatal care, Nebraska invested in new supports for maternal and early childhood health. Nebraska is one of the 37 managed care states with a state Medicaid Medical Loss Ratio (MLR). MLRs help limit public dollars’ support of exorbitant profits for the private, for-profit managed care organizations (MCOs), the…
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Medicaid Managed Care Excess Profits and Maternal and Early Childhood Health in Nebraska
Like most states, Nebraska contracts with managed care organizations (MCOs) to deliver covered services to people enrolled in Medicaid. Unlike most states, Nebraska operates a Medicaid Managed Care Excess Profit Fund. Established in 2020, the Excess Profit Fund holds profits that MCOs are required to return to the state, remittances from MCOs in the event…
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Final Medicaid Managed Care Rule Explained
CMS recently finalized two key regulations: “Ensuring Access to Medicaid Services” (Access Rule) and “Medicaid, CHIP Managed Care Access, Finance, and Quality” (Managed Care Rule), aimed at improving access to care in Medicaid across delivery systems (fee-for-service and managed care) and authorities (state plan and waiver services). The Managed Care Rule addresses five primary areas:…
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New Federal Rules Aim to Improve Access to Care for People Enrolled in Medicaid and CHIP
Medicaid and CHIP provide health insurance coverage to more than 84 million people, including low-income children, families, seniors, pregnant people, and people with disabilities. While Medicaid has a proven track record of providing affordable, high quality health care, stakeholders have long sought better transparency and accountability with respect to access to services. CMS recently finalized…
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New Report Focuses on Child Health Coverage Declines and What States Can do to Help Reconnect Kids with Medicaid/CHIP
As our nation approaches another sad milestone with nearly 5 million fewer children enrolled in Medicaid, we released a report looking at how states have responded to the challenge of the Medicaid “unwinding” process. With approximately half of the nation’s children enrolled in Medicaid, the stakes are very high for children and the providers who…
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Postpartum Coverage and Benefits Key, But Merely the Start of Needed Medicaid Work to Address Maternal Health Crisis
Federal and state leaders have prioritized maternal health in Medicaid in recent years with welcome (if overdue) attention. As Say Ahhh! readers know, the new state option to extend postpartum coverage to 12 months for all pregnant women in Medicaid has been adopted or is in progress in all but two states (AR and WI)…
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Exploring CMS’ Medicaid School-Based Services Technical Assistance Center
As a part of the Bipartisan Safer Communities Act, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Education (ED) were directed to develop a technical assistance center (TAC) to assist and expand the capacity of state Medicaid and education agencies, local education agencies, and school districts to deliver school-based services…
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New Research Links Postpartum Medicaid Coverage to Increased Mental Health Care
A new study in this month’s issue of Health Affairs offers additional insights into the impact of postpartum Medicaid coverage on access to care. In short: continuous postpartum Medicaid coverage increased stability, access, and affordability to outpatient mental health and prescription medication treatments for perinatal mood and anxiety disorders compared with those who transitioned to…
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It Looks Like Florida is Cutting Children Off CHIP in Violation of Federal Rules
While children are losing Medicaid coverage nationwide due to the unwinding process, new data reveals that Florida has disenrolled 22,576 children from its Healthy Kids CHIP program since January 1, 2024, when new federal protections requiring states to provide 12 months of continuous coverage in Medicaid and CHIP went into effect, which included barring states…
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State Momentum on Medicaid Doula Coverage, Rate Increases
Doula care continues to be a hot topic as our nation struggles to address the current maternal and infant health crises. Research has shown that doulas help reduce the risk of adverse birth outcomes, reduce infant mortality rates and help improve perinatal mental health. Access to doula care services can be out of reach for…
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Wondering what’s in the recent Medicaid and CHIP eligibility and enrollment rule?
On April 2, 2024, the Centers for Medicare & Medicaid Services (CMS) published the second part of a two-part final rule that simplifies the eligibility and enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). The rule eliminates certain access barriers for children enrolled in CHIP; makes transitions…
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Federal Inspector General Highlights Medicaid Managed Care Mental Health Parity Failings
Last week, the Office of Inspector General (OIG) released a report finding that the Centers for Medicare & Medicaid Services (CMS) did not ensure that selected states complied with Medicaid managed care mental health parity requirements. Of the eight states reviewed — Arizona, Illinois, Kansas, Mississippi, New Jersey, New York, South Carolina and Texas —…
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Newly Updated Child Health Quality Data Now Available on State Data Hub
By Aubrianna Osorio and Emma Ford, CCF Graduate Research Intern Wondering how many children with Medicaid/CHIP coverage are getting their recommended well-care visits or developmental screenings? What about follow-ups for new medications, or dental sealants? Curious about how many women had a low-risk Cesarean section delivery or a prenatal or postpartum visit? Then check out…
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Marketplace Enrollment Among Those Losing Medicaid Coverage During Unwinding Increased by Nearly One-Third in the Second Month of Open Enrollment
As readers of Say Ahhh! know, I have been tracking monthly data (here, here, here, here, here, here, here and here) from the Centers for Medicare and Medicaid Services (CMS) on the number of people who were either previously enrolled in Medicaid or had experienced a denial or termination during unwinding who then selected a…
