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HHS Selects 10 States to Participate in Medicaid Behavioral Health Clinic Demonstration
Today, the U.S. Department of Health and Human Services (HHS) announced 10 new states have been selected to participate in the Certified Community Behavioral Health Clinic Medicaid Demonstration – Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island and Vermont. The Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration was created in…
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DACA Grantees Can Now Access Marketplace Coverage
The U.S. Department of Health and Human Services (HHS) recently finalized a rule that will allow Deferred Action for Childhood Arrivals (DACA) grantees to access Marketplace coverage starting in November. Under the new rules, DACA grantees will be able to purchase qualified health plans (QHPs) in the Marketplaces and receive financial help in the form…
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How Families’ Medicaid Unwinding Experience Can Help Us Advance Health Equity
By: Kristen Golden Testa, Policy Director at The Children’s Partnership In California, more than half of children get health coverage through Medi-Cal, the state’s Medicaid program. Medi-Cal is a critical support system for California families with low incomes, providing children access to the care they need for a healthy start in life. As nearly 75%…
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Introduction to Medicaid and CHIP Outreach Snapshot Blog Series
We recently released our snapshot of state Medicaid and CHIP outreach activities, just as a number of states are in the final stages of the unwinding and getting people reconnected to coverage becomes more important than ever. While the report provides in-depth analysis into state-provided outreach resources and enrollment assistance, we are also writing a…
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Judge Dismisses Florida’s Attempt to Take Down New Federal Coverage Protection for Children
A federal court in Tampa dismissed the state of Florida’s legal challenge to the Biden Administration’s implementation of a new provision of federal law guaranteeing 12 months of continuous coverage in the Children’s Health Insurance Program – denying the state’s request for a preliminary injunction and, more importantly, dismissed the case from his courtroom. The…
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Strengthened Tool to Address Health-Related Social Needs: The New Medicaid Managed Care Regulation’s “In Lieu of Services” Explained
Medicaid managed care plans have long covered “In Lieu of Services” (ILOS), which are services that are provided in substitution of traditional Medicaid state plan services. For example, a managed care plan might provide a community-based depression screening in lieu of an office visit screening. In 2016, CMS first defined the contours of ILOS in…
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New Rule Seeks to Improve Transparency of State Medicaid Provider Payment Rates
CMS recently finalized two key regulations: “Ensuring Access to Medicaid Services” (Access Rule) and “Medicaid, CHIP Managed Care Access, Finance, and Quality” (Managed Care Rule), aimed at improving access to care in Medicaid across delivery systems (fee-for-service and managed care) and authorities (state plan and waiver services). The rules are long and complex; we’ve summarized…
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Delaware and Tennessee Become First States to Cover Diapers for Young Children in Medicaid through Section 1115 Demonstrations
Last week, CMS announced the approval of section 1115 demonstration project requests from Delaware and Tennessee to provide diapers to young children covered by Medicaid. These approvals mark the first time a state has been authorized to cover diapers for infants in Medicaid regardless of medical necessity due to incontinence issues. Under federal statute, section…
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Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q1 2024
It’s now been four corporate reporting quarters since the start of the PHE unwinding on April 1, 2023. During that time, net national Medicaid enrollment—the combination of disenrollments from redeterminations, re-enrollment by some of those terminated, and new enrollments—has fallen by 13.1 million, including 5.0 million children. Of the disenrollments, 70 percent have been for…
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New Brief Unpacks Medicaid and CHIP Mental Health and Substance Use Disorder Provisions in 2024 Government Funding Package
May is Mental Health Awareness Month. And with Medicaid (alongside the Children’s Health Insurance Program) serving as the largest payer of behavioral health services and covering more than half of all children in the US, you can’t talk about mental health without also talking about Medicaid and CHIP. In March 2024, President Biden signed into…
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A Closer Look at Transparency in the Medicaid Managed Care Rule
The Medicaid Managed Care Rule published on May 10 has lots of moving parts. As my colleague Leo Cuello explains, the rule includes provisions to increase the transparency of state directed payments (SDPs). The rule also contains a number of other transparency requirements that are the focus of this blog, most of which are identical to those…
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Federal Task Force Releases National Strategy to Improve Maternal Mental Health Care, Includes Medicaid Policies
This week the Task Force on Maternal Mental Health released a national strategy to improve maternal health care and an accompanying report to Congress. The federal interagency task force was created under the Consolidated Appropriations Act, 2023 for purposes of identifying, evaluating, and making recommendations to coordinate and improve federal activities related to addressing maternal…
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Medicaid Supports Student Success in School Districts Across the Country
By: Aubrianna Osorio, Emma Ford, Anne Dwyer, and Margaux Johnson-Green Research consistently shows that Medicaid coverage in childhood has long-term benefits, including supporting student success. New data on the share of children with Medicaid/CHIP coverage are now available for more than 7,000 school districts nationwide and show how important these coverage programs are to students across…
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Research Update: New Data Show 2020 Census Undercounted Young Children in Every State and Most Counties
New data published by the U.S. Census Bureau indicate that young children ages 0-4 were undercounted in the 2020 Census in every state and in more than four out of five counties examined. The Census Bureau previously found that young children were undercounted by 5.4% nationwide — a larger undercount than for any other age…
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A Closer Look at the Access Provisions in Final Medicaid Managed Care Rule
As my colleague Leo Cuello has explained, the Centers for Medicare & Medicaid Services (CMS) has revised its regulations governing Medicaid managed care. One purpose of this new Managed Care Rule is to improve access to health care for children, families, and other populations enrolled in Medicaid managed care organizations (MCOs). This blog takes a…
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Which States Were Furthest Along in Medicaid Unwinding in 2023?
We recently released a report looking at state performance during the Medicaid unwinding with a focus on children. We examined data from the beginning of the unwinding, which varies by state, through the end of 2023. Some states (7) acted very cautiously and saw very little to no change in their net child Medicaid enrollment…
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Draft Senate Finance Committee Bill Addressing Drug Shortages Includes Broad Rollback of Medicaid Inflation-Related Rebates for Generic Drugs, Raises Serious Concerns
Congress has been examining ways to address the ongoing problem of generic drug shortages, especially with cancer patients continuing to face severe shortages of widely used generic chemotherapy drugs. Both the House Energy and Commerce Committee and the Senate Finance Committee have held hearings on generic drug shortages, with the Senate Finance Committee also issuing…
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Series: Improving Access and Managed Care in Medicaid and CHIP
Earlier this year, the Center for Medicare & Medicaid Services (CMS) finalized two new regulations aimed at improving access to care for those enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) across delivery systems. CCF experts summarize both rules in “An Explanation of Final Medicaid Managed Care and Access Rules“. Below is a…
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Beneficiary Advisory Councils: Historic Opportunity for State Medicaid Programs
The Center for Medicare & Medicaid Services’ (CMS) recent final regulation on Ensuring Access to Medicaid Services (“Access Rule”) is ushering in a new era of participation for people enrolled in Medicaid and their families and caregivers. (We summarized the new regulation here, and its companion managed care regulation here.) The Beneficiary Advisory Councils (BACs)…
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CMS Releases Guidance on Timely Processing of Applications and Extension of Unwinding Flexibilities
The unprecedented volume of Medicaid redeterminations generated by the expiration of the continuous coverage provisions has been somewhat of a “stress test” for state Medicaid systems. The number of Medicaid applications exceeding federal timeliness standards is one indicator that a state is not doing well on this stress test and a signal that something needs…
