Say Ahhh!
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Medicaid Wars: The Unwinding at the One Year Mark (Episode V)
In its first twelve months, the Biden administration has been unwinding the anti-Medicaid actions taken by its predecessor. The unwinding has been slow and methodical, and it is not yet finished. In part, this is because the new management at CMS has necessarily been focused on responding to the COVID-19 pandemic and in part because…
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The Proper Use of Medicaid Improper Payment Rates
For the first time, CMS has posted state-specific rates of improper payments in Medicaid. This welcome exercise in transparency is a sea change in the Payment Error Rate Measurement (PERM) program, which CMS has been using since 2007 to help states improve the accuracy of their Medicaid payments. Until now, CMS has been reporting only…
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Fixing the Family Glitch and Other Priorities: The Next Wave of Federal Administrative Action to Enhance the Affordable Care Act
Last year was a busy time for health policy. After a change in administration in the midst of the ongoing COVID-19 pandemic, we saw numerous federal policy changes to strengthen the Affordable Care Act (ACA) and Medicaid program. Policymakers weren’t going it alone; stakeholders weighed in on health policy priorities, outlining administrative actions to increase access…
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California’s Medicaid Managed Care Waiver: New Potential for Access and Transparency
One of the most significant Medicaid managed care developments in 2021 happened on December 29, when CMS approved federal funding and waivers for California’s reform initiative, Advancing Innovation in Medi-Cal (CalAIM). The approval involved two sets of waivers, one operating under section 1115 of the Social Security Act, the other under section 1915(b)(4). For good…
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Secretary Becerra Extends the PHE: What Does This Mean for Medicaid and the Continuous Enrollment Provision?
[Editor’s Note: Read the latest on the public health emergency Medicaid continuous coverage protection here.] Earlier today, HHS Secretary Becerra renewed the COVID-related public health emergency (PHE). The latest extension will expire on April 16, 2022. By law, public health emergencies are declared in 90-day increments. The current PHE ends January 16, 2022, so a 90-day…
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Biden Administration Says No to Premiums in Medicaid
Just before the end of the year, the Biden Administration took an important stand protecting people enrolled in Medicaid. Three states (AR, GA, and MT) received news from CMS the week before Christmas on section 1115 Medicaid waiver requests of various kinds – but with one common element – that their plans to charge premiums…
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Research Update: New Urban Institute Report Highlights Pandemic-Related Barriers to Health Care Among Low-Income Parents
Parents’ lack of health insurance coverage and access to health services can reduce children’s access to care and harm their families’ broader financial health. This is why the Urban Institute’s new report on coverage, access, overall health, and ability to meet family financial needs among parents at different income levels after the first year of…
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CMS Releases Guidance on New Medicaid Mobile Crisis Services Option
The Centers for Medicare & Medicaid Services kept busy over the holidays with the release of new guidance to states on the American Rescue Plan Act’s new Medicaid state option to provide qualifying community-based mobile crisis intervention services. As discussed here on Say Ahhh!, ARPA included a provision allowing state Medicaid programs to provide community-based…
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Texas Medicaid Section 1115 Waiver Drama: A Trilogy
The world of Section 1115 Medicaid waivers can be mysterious and weedy, arcane and annoying, boring and, at times, dramatic. And in recent years, the use of Section 1115 authority by the Trump Administration stretched all previously known boundaries and wound up in court on multiple occasions – most famously in the Arkansas work requirements…
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Oregon’s Waiver Proposal: Continuous Eligibility for Young Children as a School Readiness Tool, But Why Not EPSDT?
As my colleagues blogged last week, Oregon released its 1115 waiver proposal for state public comment, which included precedent-setting concerns and innovations. We were pleased to see multi-year continuous eligibility included—up to five years for children under age 6, and two years for ages 6 and older. While a few states are in various stages…
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Medicaid Managed Care in 2021: The Year that Was
The Medicaid managed care ecosystem is huge and complex. (If you need a primer, the health policy podcast Tradeoffs has a short and entertaining one). As of March of this year, forty states and the District of Columbia were contracting with over 280 different managed care organizations (MCOs). The federal government and states combined spend…
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Research Update: More than 1 in 3 Children Lacked Access to Adequate Coverage in 2019
Regular readers know that, since record lows in 2016, child uninsurance has been climbing in recent years. Regular readers also know that uninsured rates don’t give a full picture of children’s coverage. Similar to our recent paper on kids who experience coverage gaps, a new article in Pediatrics shows that just having some health insurance…
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More from CMS on Postpartum Coverage: FAQs and New State Data
It seems that every week brings a new development in the movement to extend postpartum coverage for 12 months, and this week was no different. On Wednesday, CMS added a “frequently asked questions” section to the extended postpartum coverage option guidance issued on December 7 (see page 14). The agency also released state-specific data on…
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Georgia’s 1332 Waiver Proposal Puts Children and Families at Risk of Losing Coverage
In 2020, Georgia submitted a waiver under Section 1332 of the Affordable Care Act (ACA) to allow the state to exit HealthCare.gov; the Trump Administration approved the request in November of last year. Under this proposal, the 500,000 Georgians who use the federal marketplace every year to enroll in private health plans and Medicaid would…
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Is the Biden Administration Planning to Help Struggling Families by Fixing the Family Glitch?
Close followers of administrative activity may have noticed that the Treasury Department is aiming to issue a notice of proposed rulemaking (NPRM) on the eligibility rules for advanced premium tax credits (APTCs) in the Marketplace. Though no deadline is specified – and the regulatory agenda is often overly ambitious – this could mean that the…
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Oregon’s 1115 Medicaid Waiver Request is a Mixed Bag
State seeks to become the first to provide continuous coverage to all children enrolled in Medicaid until age six while continuing to restrict children’s access to health care by continuing to deny them the EPSDT benefit package provided to children in all other states. After months of engaging stakeholders, Oregon has posted its draft…
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Lessons Learned from Early State Experiences Using Medicaid to Expand Access to Doula Care
The United States is currently experiencing a maternal health crisis, but it’s pregnant people of color who experience its worst effects: Black women, American Indian, and Alaska Native women are up to three times more likely to die from pregnancy-related causes than White women and are also more likely to experience severe complications from pregnancy…
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Removing Barriers to Vaccines for Kids Should be Top Priority
As the COVID-19 vaccine has been approved for adults, then teens and school-aged children, researchers are monitoring the vaccination trends for different groups. About a year after vaccines were approved for adults, almost 72% of the US adult population is fully vaccinated according to the most recent CDC data. Vaccines for teens ages 12 and…
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States Await Federal Action, Use Creative Ways to Fill Gaps in Health Coverage
Momentum is building in state capitals to expand access to health coverage for people left out by the current system, including people excluded from federal coverage options due to immigration status and Marketplace affordability rules known as the family glitch. But before getting into plans for 2022, let’s recap progress made in 2021. As my…
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Surgeon General Issues Advisory on Youth Mental Health Crisis, Highlights Importance of Medicaid and CHIP Coverage and Calls for More Action
This week, the U.S. Surgeon General Dr. Vivek Murthy issued an Advisory highlighting the urgent need to address the nation’s youth mental health crisis. As discussed here on Say Ahhh!, the pandemic has taken an unprecedented toll on the mental health and wellbeing of children, exacerbating long standing gaps in mental health care for children…
