Blog
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New MACPAC Data on the Highly Effective Medicaid Drug Rebate Program
As I have previously explained, under the highly effective Medicaid Drug Rebate Program, drug manufacturers must provide substantial rebates to the federal government and states as a condition of having their drugs covered by Medicaid. The rebates apply to both fee-for-service and to managed care. A groundbreaking 2021 Congressional Budget Office study found that compared…
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Unwinding Wednesday #9: CMS Should Add the Unwinding Supplemental Data to the Medicaid Performance Indicators
In last week’s Unwinding Wednesday blog, my colleague Allie Gardner noted that CMS is requiring states to provide supplemental data for monitoring the unwinding of the Medicaid continuous coverage protection. These data are in addition to the performance indicator data that states have been required to submit monthly since 2013. But … the supplemental data…
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Medicaid Beneficiaries Ask the Supreme Court: Do We Have a Friend in You?
On November 8, the Supreme Court will hear oral argument in what my colleague Leo Cuello has called “the most consequential case you’ve never heard of:” Health and Hospital Corporation of Marion County v. Talevski. The case began as a lawsuit against a county-owned nursing facility in Indiana by a now-deceased resident who alleged that…
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The End of Medicaid Rights May Be Upon Us: You Need to Know About the Talevski Case
The Supreme Court, the same court that trashed decades of settled precedent to overturn Roe and, in NFIB, for-the-first-time-ever ruled that a federal spending program (the Medicaid expansion) was “coercive” upon states, that court, is about to decide whether to completely wipe out the rights of Medicaid enrollees. Buckle up, friends. On November 8, the…
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HHS Announces New Planning Grants for Medicaid-Funded Behavioral Health Clinic Demonstration
Last week, the U.S. Department of Health and Human Services announced it will be awarding up to $15 million in new planning grants to states as part of its national expansion of the Medicaid-funded Certified Community Behavioral Health Clinic (CCBHC) demonstration program under the Bipartisan Safer Communities Act. The announcement comes on the heels of…
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Unwinding Wednesday #8: Key Data to Monitor Unwinding of the Medicaid Continuous Coverage Protection (Part 2)
As we prepare for the eventual end of the Medicaid continuous coverage protection, a key focus here at CCF has been on monitoring the unwinding process. In last week’s Unwinding Wednesday, my colleague Tricia Brooks highlighted data such as the Medicaid and CHIP performance indicator (PI) data that can be useful in monitoring the unwinding.…
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Mandatory Reporting on Medicaid Quality Measures: What Did Congress Intend?
In August, CMS posted its proposed rule to codify Congressional action taken in 2018 to mandate state reporting of the Child Core Set and the Adult Behavioral Health Core Set of quality measures in Medicaid and CHIP, starting in 2024. Until 2024, state reporting on the core sets is voluntary. I did a quick scan…
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Unwinding Wednesday #7: Key Data to Monitor Unwinding of the Medicaid Continuous Coverage Protection (Part 1)
The ninth webinar in our unwinding series with the Center on Budget and Policy Priorities focused on three sources of data to monitor the impact as states begin to process disenrollments once the Medicaid continuous coverage provision is lifted. We discussed 1) the data that states have been required to report as part of the…
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California’s Medicaid Managed Care Procurement: A Transparency Event
On August 25, California’s Medicaid agency announced its selections of managed care organizations (MCOs) to serve some 6.4 million beneficiaries in 21 counties beginning in 2024. The selections, which resulted from the procurement that the agency launched with a Request for Proposal (RFP) in February—a potential game-changer—did not meet with universal applause. Losing bidders have…
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Proposed Rule Provides Opportunity to Advance Behavioral Health Quality
As my colleague, Maggie Clark, wrote about on Say Ahhh! earlier this week – we can’t improve what we don’t measure. This is why CMS’s recently proposed rule on reporting of quality measures in Medicaid and CHIP is critical to advancing behavioral health care quality. The proposed rule, open for comment through October 21, requires…
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HHS Secretary Becerra Extends the Public Health Emergency into 2023
HHS Secretary Becerra has declared that the COVID-19 public health emergency is extended for another 90 days through January 11, 2023. This means that February 1, 2023, is the earliest that the Medicaid continuous coverage protection would be lifted and states could begin to disenroll people after completing a full renewal and review of ongoing…
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Unwinding Wednesday #6: Communications Toolkits Offer a Variety of Messages and Materials to Help Mitigate Coverage Losses
This week on Unwinding Wednesday, we are digging into the communications materials and toolkits found on our 50-state Unwinding Tracker – arguably one of the most critical elements of the tracker for ensuring individuals with Medicaid coverage are adequately prepared for the unwinding. The development of comprehensive communications materials by state Medicaid agencies is vital…
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Proposed Rule Offers Opportunity to Help Advance Maternal Health Equity
We can’t improve what we don’t measure. That’s why it is important for all who want to improve maternal and child health to take a look at a proposed rule now up for comment that provides an important opportunity to increase transparency and accountability for the quality of care delivered through Medicaid and CHIP. The…
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Medicaid Managed Care: OIG, MLRs, and the Future of Oversight
Last month, the Office of Inspector General (OIG) issued a report that speaks volumes about the oversight of Medicaid managed care organizations (MCOs). As the OIG delicately puts it, CMS has “opportunities” to “strengthen States’ oversight.” An alternative framing would be that CMS and many states have not met minimum standards of stewardship for Medicaid…
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Doula Services in Medicaid: Pathways and Payment Rates (Part 3 in a series)
As awareness around the worsening maternal mortality crisis increases, states continue to look towards covering doula care in Medicaid as a potential strategy to improve birth outcomes, particularly for birthing people of color. More than half the states are working towards Medicaid coverage for doula care. But how can states implement these programs effectively and…
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Unwinding Wednesday #5: Application Processing Times Provide Insight into State Capacity to Manage the Medicaid Workload
In last month’s Unwinding Webinar Part 9, we covered the performance indicator and supplemental unwinding data that will be helpful in monitoring the impact of unwinding the Medicaid continuous coverage protection at the end of the public health emergency (PHE). I often talk about call center statistics being the canary in the coal mine. But…
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Lack of Federal Action Puts Puerto Rico and Other Territories in Peril of Dire Medicaid Fiscal Cliff, Yet Again
With Puerto Rico reeling from the widespread damage caused by Hurricane Fiona, it is critical that Puerto Rico receives all the emergency relief and longer-term assistance it needs to recover from yet another devastating natural disaster. But it is also important to remember that the Medicaid programs in Puerto Rico and the other territories —…
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What’s New for 2023 Marketplace Enrollment?
By Emma Walsh-Alker, Georgetown University Center on Health Insurance Reforms The annual open enrollment period for marketplace coverage is right around the corner. There are many new policies impacting the marketplace in 2023, including an extension of enhanced financial assistance through the Inflation Reduction Act; a federal fix to the “family glitch” that will create…
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Unwinding Wednesday #4: PHE Unwinding Related FAQs
Frequently Asked Questions or FAQs are a popular way to provide information based on the types of questions people most frequently ask. But like all types of communications, how well FAQs convey information depends on the audience and how easy the content is to understand. In our 50-State Unwinding Tracker, we have found 28 states…
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Oregon Leads the Nation By Covering Children in Medicaid from Birth to Kindergarten – Which State Will Be Next??
The Biden Administration announced today that it will approve Oregon’s request to provide continuous Medicaid coverage to children from birth through age five and for two years for all Oregonians enrolled in Medicaid age six and up. This use of Section 1115 authority is precisely what Medicaid demonstrations are for — as we and colleagues…
