Say Ahhh!
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Proposed Eligibility Rule Simplifies Medicaid and CHIP Enrollment Process for Children
In a continuing effort to strengthen Medicaid and access to affordable, quality health coverage, the Biden Administration has proposed a series of eligibility rule changes. The Notice of Proposed Rulemaking (NPRM) seeks to streamline application and enrollment, improve retention rates, remove barriers specific to CHIP, and enhance program integrity. Eliminates enrollment barriers and benefit caps…
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DHS Finalizes DACA Regulations To Protect Young DREAMers
[For most update information on DACA health coverage, see this blog post.] The Department of Homeland Security (DHS) recently finalized regulations on the Deferred Action for Childhood Arrivals (DACA) policy, bringing much needed reassurance to DACA grantees, sometimes called “DREAMers.” After the proposed rule was issued last fall, we submitted comments suggesting DHS adopt a…
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Federal Report Estimates 383,000 Losing Medicaid at End of PHE in Non-Expansion States Will Have No Affordable Options Open to Them
As part of the public health emergency declared by the federal government during the COVID-19 pandemic, people who were enrolled in Medicaid in states across the country were protected from losing it through a continuous coverage provision. The idea was to keep as many people covered as possible with comprehensive, affordable health care during the…
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CMS Preps for Upcoming School Year with New Guidance on Leveraging Medicaid to Support School-Based Services
As summer is nearing its end, the Centers for Medicare & Medicaid Services (CMS) is getting a jump on the new school year with a series of announcements aimed at improving children’s physical and mental health. As our colleague Kelly Whitener previewed last week, CMS released a number of Informational Bulletins (CIBs), including two related…
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Medicaid Managed Care Meets the False Claims Act (Again)
Last week the Department of Justice announced that a California managed care organization (MCO) and three providers had agreed to pay a total of $70.7 million to settle allegations that they submitted false claims to the state’s Medicaid program. Most of the payments ($68.25 million) will go to the federal government, the remaining $2.45 million…
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CHIP Helped My Family Through a Tough Time
We often hear “it takes a village to raise a child” and that adage certainly holds true for my childhood. I am the third oldest in a large family. My parents worked different shifts so one of them could usually be home with us while my grandparents filled in the gaps. Additionally, my two older…
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An Estimated 3.8 Million Eligible Children Could Lose Medicaid Due to Administrative Churn During the Unwinding
The Office of the HHS Assistant Secretary for Planning and Evaluation (ASPE) released new projections of the number of people likely to lose Medicaid after the COVID-related continuous coverage protection is lifted at the end of the public health emergency (PHE). Similar to other analyses, ASPE estimates that about 15 million people, including 5.3 million…
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Coalition Recommends HHS Take Steps to Improve Medicaid Waiver Process
Section 1115 Medicaid waivers drive a large and growing share of Medicaid spending. Currently, 46 states and D.C. operate some or all of their Medicaid programs under section 1115 demonstration authority. Many of these waivers promote coverage; others undermine it, and in the process, the Medicaid program. Unfortunately, the federal regulations governing section 1115 waivers…
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Long-Awaited Rule on Mandatory Reporting of Child Core Set Quality Measures Proposed
Yesterday, CMS released its Notice of Proposed Rulemaking (NPRM) on the Child Core Set of Health Care Quality Measures in Medicaid and CHIP (known as the child core set). The proposed rule will implement the mandatory reporting of the child core set in 2024 as required by the Bipartisan Budget Act of 2018. The NPRM,…
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CMS Reminds States EPSDT Requirement Includes Behavioral Health, Offers Specific Strategies
Medicaid’s pediatric benefit, Early and Periodic Screening Diagnostic and Treatment (EPSDT), is getting more attention from federal officials. As part of its child health-focused release yesterday, CMS released a new Informational Bulletin reiterating EPSDT’s requirement to cover screenings and medically necessary treatment for children’s behavioral health, mental health and substance use disorders. The timing is…
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Children’s Health and Well-Being Get Much Needed Attention from CMS this Week
CMS made three big announcements yesterday, drawing attention to ways Medicaid and CHIP can support children’s health and well-being. The first two announcements are sub-regulatory guidance documents, essentially bringing together all of the existing state options and best practices on behavioral health and school-based health. Sub-regulatory guidance doesn’t include new policy, but rather aims to…
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New Rule Lays Groundwork for Hospital Transparency and Accountability for Maternity Care
Last month, CMS finalized a rule that lays the groundwork for a major step forward for hospital accountability for maternity care. Tucked inside an annual final rulemaking on Medicare hospital payment, CMS added a new requirement for hospitals to publicly report maternity care quality metrics. Depending on the hospital’s performance, hospitals may be awarded a…
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CMS Spotlights State Strategies for Protecting Continuity of Health Coverage when PHE Lifts
As planning for the eventual unwinding of the COVID-19 related Medicaid continuous coverage protection continues, CMS has made significant efforts to provide additional tools and flexibilities to smooth the process for states and promote continuity of coverage. One such effort is allowing states to request time-limited waivers, authorized under Section 1902(e)(14)(A), to assist Medicaid agencies…
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New Report Offers Another Compelling Reason for States to Expand Medicaid
There are plenty of reasons for states to expand Medicaid. It can increase access to health care, improve health outcomes and financial security, encourage employment and education gains, and the list goes on. A report released by the Urban Institute in June offers yet another reason: it is associated with decreased medical debt. The report…
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Medicaid Managed Care: The Big Five in PHE Q10 (Q2 2022)
June 30 marked the end of calendar quarter 10 of the COVID-19 Public Health Emergency (PHE), or PHE Q10. For the five national companies with the largest Medicaid managed care businesses, the past two- and one-half years have been a period of particularly robust growth. Since PHE Q1, which ended on March 31, 2020, enrollment…
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Medicaid and the 988 Mental Health Crisis Services Lifeline: State Approaches
Last month, the new three-digit mental health crisis and suicide prevention number – 988 – went live for call, text, and chat. Established by the National Suicide Hotline Designation Act of 2020, this easy to remember number is meant to support people experiencing suicidal ideation, mental health and substance use crises, or any kind of…
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Waiver Update: CMS May Have Found a Path Forward in Tennessee
The Biden CMS inherited a real waiver mess in Tennessee, but CMS may have found a path forward. CMS has asked the state to amend the most problematic parts of its section 1115 demonstration known as TennCare III, so that the TennCare program can continue. Just as importantly, to its credit (and unlike some other…
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CMS Awards Over $49 Million to 36 Organizations in 20 States to Connect Kids, Parents, and Pregnant People to Coverage
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), recently awarded $49 million to 36 organizations in 20 states to provide enrollment and renewal assistance to children, their families, and pregnant people. These grants will allow a wide range of organizations, including state and local governments,…
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Bipartisan Safer Communities Act Provision Directs CMS to Review State EPSDT Implementation, including in Managed Care
Last month my colleague Anne Dwyer summarized the now-enacted Bipartisan Safer Communities Act and its provisions with potential to boost access to mental health services for children and families. One we will be watching closely: a review of state Medicaid EPSDT requirements, services, and practices. Long time Say Ahhh! Readers know that Medicaid’s Early Periodic…
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Transparency in Medicaid Managed Care: Are the Times A-Changin’?
If the phrase “transparency in Medicaid managed care” sounds like an oxymoron, that’s because in many states it is. Finding information on the performance of individual Medicaid managed care organizations (MCOs) for children and families and other Medicaid beneficiaries on state Medicaid agency websites can be challenging. This is more than unfortunate because in the…
