Say Ahhh!
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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 –…
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Community Health Workers & Medicaid: Advancing Health Equity Depends on State Implementation
As National Community Health Worker Awareness Week approaches at the end of August, we want to take stock of the advances in Medicaid’s role in financing community health worker (CHW) services and the road ahead. CHWs have a long history of supporting community public health by engaging individuals in communities that the traditional health system…
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Senate Finance Committee PBM Legislation Includes Sound Medicaid Drug Pricing Provisions
On July 26, 2023, on a 26-1 bipartisan vote, the Senate Finance Committee approved the Modernizing and Ensuring PBM Accountability Act. The bill includes a number of Medicare provisions related to pharmacy benefit managers (PBMs) and pharmacies but also includes two sound Medicaid provisions related to “spread pricing” in Medicaid managed care and to Medicaid…
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New Inspector General Report Finds Manufacturers Would Have to Pay Substantial Rebates if the Medicaid Drug Rebate Program Applied to Separate State CHIP Programs
The Office of Inspector General (OIG) at the Department of Health and Human Services issued a new report estimating that applying the Medicaid Drug Rebate Program (MDRP) to separate state CHIP programs would have resulted in drug manufacturers paying $641.2 million in rebates in calendar year 2020 alone, with the federal government receiving $515.7 million…
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Limited Child Medicaid Unwinding Data Begins to Paint Bleak Picture, Highlights Need for More Transparency
As we continue to unpack the first round of unwinding data released by CMS a few weeks ago, it remains disappointing that there is not more data on children. As readers of SayAhhh! know, the stakes for children are very high with over half of the children in the country insured through Medicaid, and they…
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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…
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Understanding the Medicaid Unwinding Data: Marketplace Enrollment
On July 28, 2023, the Centers for Medicare and Medicaid Services (CMS) finally released renewal outcome data from the first two months — March and April 2023 — of unwinding of the Medicaid continuous coverage protection. The data is largely consistent with data that we have already posted in our tracking of state administrative unwinding…
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Data shows kids greatly impacted by KanCare redeterminations
By Heather Braum, Kansas Action for Children Kansas released the second set of data for how the year-long KanCare unwinding process is going, with data available through June 30, 2023, and has now broken out the data into age ranges and by county for those who had not returned a renewal form in April or May. Since…
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First Batch of CMS Unwinding Data Includes Key Call Center Statistics
Last Friday, CMS released the first round of long-anticipated Medicaid unwinding data. The main focus has been on the renewal outcome data submitted in state monthly reports, which unfortunately was only available for the 18 states who began terminating coverage as of March 31 or in April 2023 due to a lengthy lag – and…
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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…
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Administration Releases Medicaid and CHIP Mental Health and SUD Action Plan, Parity Initiatives
In another round of mental health-related announcements, this week, the Centers for Medicare & Medicaid Services (CMS) released a Medicaid and CHIP Mental Health and Substance Use Disorder Action Plan alongside Administration announcements focused on mental health parity. The seventeen page Mental Health and Substance Use Disorder Action Plan provides an overview of Medicaid and…
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Transparency, Trackers, and Toolkits: Updates on CCF Unwinding Materials
By Ella Mathews and Shreya Kalra As Unwinding Wednesday readers know, our 50 State Unwinding Tracker is updated regularly as we monitor new information, specifically new unwinding data, provided by states. The tracker has evolved since we released it almost a year ago – both in the number of states publicly providing unwinding information and…
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The Medicaid Unwind’s Impact on Children: Are They Moving to CHIP?
As of July 1st all states in the country (except for Oregon) have started the process of renewing and disenrolling children and adults from Medicaid according to CMS’s latest chart. As readers of SayAhhh! are well aware, states are checking eligibility for everyone enrolled in Medicaid after the continuous coverage protections associated with the COVID-19…
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Expanding Options to Identify Renewal Dates Could Help Minimize Procedural Disenrollments
We’re only four months into the Medicaid unwinding and the scale of coverage loss for procedural reasons is already staggering. An estimated 1.6 million individuals have lost coverage, with 71 percent terminated for procedural reasons. Stories are trickling in about why these procedural disenrollments may be occurring, including families not getting notices in the mail.…
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Georgetown CCF Analysis Finds Georgia’s Pathways to Coverage Program Would Cost More to Cover Fewer People
This week, we released a new analysis, written by Allexa Gardner, Joan Alker and Leo Cuello, that finds Georgia’s limited Medicaid expansion program, known as “Pathways,” is fiscally foolish and sets up a structure that discriminates against parents. Enrollment for Pathways begins on July 1st with coverage being at a later date likely September 1.…
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Research Update: This Pride Month, We Celebrate Improvements in Coverage and Access for LGBTQ+ Adults
This week I am proud to highlight two recent studies showing that adults identifying as lesbian, gay, bisexual, and transgender (LGBT) have made significant gains in coverage and access to care over the past several years since the Affordable Care Act (ACA) and its Medicaid expansions have taken effect. LGBT adults have historically faced serious…
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House Republican Study Committee Budget Plan Again Includes Draconian Medicaid Cuts
On June 14, 2023, the Republican Study Committee (RSC), whose members comprise more than three-quarters of the House Republican caucus, announced its fiscal year 2024 budget plan. The budget plan proposes to cut total federal Medicaid, CHIP and Affordable Care Act marketplace subsidy spending by more than half over the next decade, relative to current…
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Research Update: What Does Persistent Poverty Mean for Medicaid?
A recent report from the U.S. Census Bureau has identified 341 counties nationwide that are in persistent poverty, which is defined as having a poverty rate of 20% or higher during the past 30 years from 1989 through the 2015-2019 data period (for context, the national poverty rate in 2015-2019 was 13.4%). While persistent poverty…
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Medicaid Unwinding: Why Retroactive Coverage is not the Answer to Procedural Disenrollments as Some Claim
As readers of SayAhhh! know, we are closely monitoring the impact of Medicaid unwinding. We’ve been worried about inappropriate and large coverage losses for children and families for quite some time now – and as states get started and are reporting large numbers of procedural terminations our fears have not been allayed. There are those…
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Unpacking Unwinding Data: What’s with All the Different Numbers?
As of June 1st, most states have started terminating Medicaid coverage for children, low-income families, and others for non-eligibility, procedural reasons. We are trying to get our hands on as much data as we can to get a sense of the outcomes of Medicaid renewals and what the unwinding process looks like across states. Transparency…
