Blog
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Governors Should Make the Protection of Children and Families from Health Coverage Loss a Top Priority
A unique and unprecedented set of public policy circumstances create a grave risk for the stability of health coverage in the year ahead for millions of children and families. First, some background. In response to the COVID-19 pandemic, Congress and the Trump Administration enacted a law in 2020, known as the Families First Coronavirus Relief…
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School-Based Health Care: One Answer to Ohio Children’s Unmet Health Care Needs
By Kelly Vyzral, Senior Health Policy Associate, Children’s Defense Fund Ohio February is School-Based Health Care Awareness Month. This is a great opportunity to talk about improving access to health care for Ohio’s children. All children deserve to grow up healthy with the opportunity to thrive into adulthood. But the reality is that in many…
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Medicaid Managed Care Financial Results for 2021: A Big Year for the Big Five
The Q4 2021 earnings reports are in, and the five largest companies in the Medicaid managed care market—CVS Health, Anthem, Centene, Molina, and UnitedHealth Group—did very well, thank you very much. CVS Health made $17.3 billion last year; Anthem, $7.5 billion; Centene, $1.8 billion; Molina, $1.0 billion; and UnitedHealth Group $24.0 billion. Not all of…
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Texas Medicaid Section 1115 Waiver Drama Trilogy: Part II
Texas Expects to Get, But Not Give, Notice The Biden Administration came to town with clear intentions to review some of the waiver agreements that the Trump Administration had authorized – most notably on work requirements. We and others had urged the Trump Administration to reconsider the January 15th demonstration approval in Texas in light…
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American Rescue Plan Helps States Respond to Youth Mental Health Crisis
The COVID-19 pandemic has disrupted lives in many ways and has taken an unprecedented toll on children’s mental health, exacerbating long-standing gaps in mental health care for children in the United States. According to CDC reports, children’s emergency room visits for mental health issues increased significantly during the pandemic, with visits for adolescent girls for…
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States Should Continue Medicaid and CHIP Improvements Achieved Through State Disaster SPAs Beyond PHE
Since the start of the COVID-19 pandemic, states have been utilizing Medicaid and CHIP disaster state plan amendments (SPAs) for temporary, additional flexibilities to respond to the challenges resulting from the pandemic. As the administration considers when to end the federally declared Public Health Emergency (PHE), states and stakeholders should think about how to continue…
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How the COVID-19 Pandemic Affected U.S. National Health Spending
The Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) has recently issued updated National Health Expenditure (NHE) estimates for 2020. The key takeaway is that the 2020 data offers little insight into future national health care spending trends, due to the “unprecedented government response to the global pandemic” and the…
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Biden Administration and States Should Better Ensure Medicaid and CHIP Beneficiaries Have Access to At-Home COVID-19 Rapid Tests
As the Kaiser Family Foundation (KFF) recently explained, state Medicaid and CHIP programs are required to cover at-home COVID-19 rapid tests, without cost-sharing, until at least one year after the end of the COVID-19 public health emergency. However, there seems to be substantial variation across state Medicaid and CHIP programs in how they actually cover…
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Georgia Drops the Ball on Health Care, Again
Faced with an easy opportunity to dramatically improve the lives of Georgians, Georgia Governor Brian Kemp has snatched defeat from the jaws of victory. On January 21, 2022, instead of moving forward with a backup plan to help over 400,000 Georgians get health insurance, Governor Kemp decided to file a lawsuit. It’s not the first…
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CMS Commits $49 Million to Connect Kids, Parents, and Pregnant People to Coverage
A wide range of organizations, including state/local governments, tribal entities, safety net providers, non-profits, schools, and others, may apply for up to $1.5 million over three years to connect eligible people to Medicaid or CHIP under a new CMS funding opportunity. A total of $49.4 million in funding will build on efforts initiated by the…
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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…
