Blog
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Strengthened Tool to Address Health-Related Social Needs: The New Medicaid Managed Care Regulation’s “In Lieu of Services” Explained
Medicaid managed care plans have long covered “In Lieu of Services” (ILOS), which are services that are provided in substitution of traditional Medicaid state plan services. For example, a managed care plan might provide a community-based depression screening in lieu of an office visit screening. In 2016, CMS first defined the contours of ILOS in…
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New Rule Seeks to Improve Transparency of State Medicaid Provider Payment Rates
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 rules are long and complex; we’ve summarized…
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Delaware and Tennessee Become First States to Cover Diapers for Young Children in Medicaid through Section 1115 Demonstrations
Last week, CMS announced the approval of section 1115 demonstration project requests from Delaware and Tennessee to provide diapers to young children covered by Medicaid. These approvals mark the first time a state has been authorized to cover diapers for infants in Medicaid regardless of medical necessity due to incontinence issues. Under federal statute, section…
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Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q1 2024
It’s now been four corporate reporting quarters since the start of the PHE unwinding on April 1, 2023. During that time, net national Medicaid enrollment—the combination of disenrollments from redeterminations, re-enrollment by some of those terminated, and new enrollments—has fallen by 13.1 million, including 5.0 million children. Of the disenrollments, 70 percent have been for…
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New Brief Unpacks Medicaid and CHIP Mental Health and Substance Use Disorder Provisions in 2024 Government Funding Package
May is Mental Health Awareness Month. And with Medicaid (alongside the Children’s Health Insurance Program) serving as the largest payer of behavioral health services and covering more than half of all children in the US, you can’t talk about mental health without also talking about Medicaid and CHIP. In March 2024, President Biden signed into…
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A Closer Look at Transparency in the Medicaid Managed Care Rule
The Medicaid Managed Care Rule published on May 10 has lots of moving parts. As my colleague Leo Cuello explains, the rule includes provisions to increase the transparency of state directed payments (SDPs). The rule also contains a number of other transparency requirements that are the focus of this blog, most of which are identical to those…
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Federal Task Force Releases National Strategy to Improve Maternal Mental Health Care, Includes Medicaid Policies
This week the Task Force on Maternal Mental Health released a national strategy to improve maternal health care and an accompanying report to Congress. The federal interagency task force was created under the Consolidated Appropriations Act, 2023 for purposes of identifying, evaluating, and making recommendations to coordinate and improve federal activities related to addressing maternal…
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Medicaid Supports Student Success in School Districts Across the Country
By: Aubrianna Osorio, Emma Ford, Anne Dwyer, and Margaux Johnson-Green Research consistently shows that Medicaid coverage in childhood has long-term benefits, including supporting student success. New data on the share of children with Medicaid/CHIP coverage are now available for more than 7,000 school districts nationwide and show how important these coverage programs are to students across…
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Research Update: New Data Show 2020 Census Undercounted Young Children in Every State and Most Counties
New data published by the U.S. Census Bureau indicate that young children ages 0-4 were undercounted in the 2020 Census in every state and in more than four out of five counties examined. The Census Bureau previously found that young children were undercounted by 5.4% nationwide — a larger undercount than for any other age…
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A Closer Look at the Access Provisions in Final Medicaid Managed Care Rule
As my colleague Leo Cuello has explained, the Centers for Medicare & Medicaid Services (CMS) has revised its regulations governing Medicaid managed care. One purpose of this new Managed Care Rule is to improve access to health care for children, families, and other populations enrolled in Medicaid managed care organizations (MCOs). This blog takes a…
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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…
