New EPSDT Guidance Reinforces Key Medicaid Prior Authorization Protections for Children – And We’d Like to See Even More

Everyone under the age of twenty-one in Medicaid should have access to health care services they need thanks to Medicaid’s Early and Periodic Diagnostic Screening and Treatment (EPSDT) requirement. In short, EPSDT requires children to get regular screenings and treatment when necessary. And this isn’t a vague hope – it’s the law. However, in at […]

What’s New for the 2025 Plan Year Open Enrollment

As the Affordable Care Act Marketplaces enter their 12th year, enrollment is at an unprecedented high, insurer competition is robust, and four out of five Marketplace enrollees can find a plan for $10 per month or less. This has also been a year of relative stability, without dramatic policy reforms or market disruptions. However, there are several […]

CMS Plans Major Upgrade to Faulty Account Transfer Process Between the Federal Marketplace and State Medicaid Agencies

Last week CMS announced plans to replace the technology and processes used to coordinate eligibility and enrollment through electronic accounts between the federal marketplace (healthcare.gov) and states that use the federal platform. The account transfer (AT) process, although riddled with glitches, has been in place since the Affordable Care Act’s coverage expansions began in 2014. […]