Say Ahhh!
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Nebraska Uses State Medicaid Managed Care Excess Profit Fund to Leverage New Federal Home Visiting, Medicaid Dollars
While its neighbor Iowa cut access to prenatal care, Nebraska invested in new supports for maternal and early childhood health. Nebraska is one of the 37 managed care states with a state Medicaid Medical Loss Ratio (MLR). MLRs help limit public dollars’ support of exorbitant profits for the private, for-profit managed care organizations (MCOs), the…
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Medicaid Managed Care Excess Profits and Maternal and Early Childhood Health in Nebraska
Like most states, Nebraska contracts with managed care organizations (MCOs) to deliver covered services to people enrolled in Medicaid. Unlike most states, Nebraska operates a Medicaid Managed Care Excess Profit Fund. Established in 2020, the Excess Profit Fund holds profits that MCOs are required to return to the state, remittances from MCOs in the event…
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Final Medicaid Managed Care Rule Explained
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 Managed Care Rule addresses five primary areas:…
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New Federal Rules Aim to Improve Access to Care for People Enrolled in Medicaid and CHIP
Medicaid and CHIP provide health insurance coverage to more than 84 million people, including low-income children, families, seniors, pregnant people, and people with disabilities. While Medicaid has a proven track record of providing affordable, high quality health care, stakeholders have long sought better transparency and accountability with respect to access to services. CMS recently finalized…
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New Report Focuses on Child Health Coverage Declines and What States Can do to Help Reconnect Kids with Medicaid/CHIP
As our nation approaches another sad milestone with nearly 5 million fewer children enrolled in Medicaid, we released a report looking at how states have responded to the challenge of the Medicaid “unwinding” process. With approximately half of the nation’s children enrolled in Medicaid, the stakes are very high for children and the providers who…
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Postpartum Coverage and Benefits Key, But Merely the Start of Needed Medicaid Work to Address Maternal Health Crisis
Federal and state leaders have prioritized maternal health in Medicaid in recent years with welcome (if overdue) attention. As Say Ahhh! readers know, the new state option to extend postpartum coverage to 12 months for all pregnant women in Medicaid has been adopted or is in progress in all but two states (AR and WI)…
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Exploring CMS’ Medicaid School-Based Services Technical Assistance Center
As a part of the Bipartisan Safer Communities Act, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Education (ED) were directed to develop a technical assistance center (TAC) to assist and expand the capacity of state Medicaid and education agencies, local education agencies, and school districts to deliver school-based services…
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New Research Links Postpartum Medicaid Coverage to Increased Mental Health Care
A new study in this month’s issue of Health Affairs offers additional insights into the impact of postpartum Medicaid coverage on access to care. In short: continuous postpartum Medicaid coverage increased stability, access, and affordability to outpatient mental health and prescription medication treatments for perinatal mood and anxiety disorders compared with those who transitioned to…
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It Looks Like Florida is Cutting Children Off CHIP in Violation of Federal Rules
While children are losing Medicaid coverage nationwide due to the unwinding process, new data reveals that Florida has disenrolled 22,576 children from its Healthy Kids CHIP program since January 1, 2024, when new federal protections requiring states to provide 12 months of continuous coverage in Medicaid and CHIP went into effect, which included barring states…
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State Momentum on Medicaid Doula Coverage, Rate Increases
Doula care continues to be a hot topic as our nation struggles to address the current maternal and infant health crises. Research has shown that doulas help reduce the risk of adverse birth outcomes, reduce infant mortality rates and help improve perinatal mental health. Access to doula care services can be out of reach for…
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Wondering what’s in the recent Medicaid and CHIP eligibility and enrollment rule?
On April 2, 2024, the Centers for Medicare & Medicaid Services (CMS) published the second part of a two-part final rule that simplifies the eligibility and enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). The rule eliminates certain access barriers for children enrolled in CHIP; makes transitions…
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Federal Inspector General Highlights Medicaid Managed Care Mental Health Parity Failings
Last week, the Office of Inspector General (OIG) released a report finding that the Centers for Medicare & Medicaid Services (CMS) did not ensure that selected states complied with Medicaid managed care mental health parity requirements. Of the eight states reviewed — Arizona, Illinois, Kansas, Mississippi, New Jersey, New York, South Carolina and Texas —…
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Newly Updated Child Health Quality Data Now Available on State Data Hub
By Aubrianna Osorio and Emma Ford, CCF Graduate Research Intern Wondering how many children with Medicaid/CHIP coverage are getting their recommended well-care visits or developmental screenings? What about follow-ups for new medications, or dental sealants? Curious about how many women had a low-risk Cesarean section delivery or a prenatal or postpartum visit? Then check out…
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Marketplace Enrollment Among Those Losing Medicaid Coverage During Unwinding Increased by Nearly One-Third in the Second Month of Open Enrollment
As readers of Say Ahhh! know, I have been tracking monthly data (here, here, here, here, here, here, here and here) from the Centers for Medicare and Medicaid Services (CMS) on the number of people who were either previously enrolled in Medicaid or had experienced a denial or termination during unwinding who then selected a…
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CMS Released Additional Resources to Help Medicaid and CHIP Enrollees Retain Coverage
March 31 marks the one-year anniversary of the end of the COVID-related Medicaid continuous enrollment requirement. While it was expected that renewing nearly 90 million Medicaid enrollees would be a heavy lift for states, it’s taking some states longer to complete renewals due to system changes and efforts to improve ex parte renewal rates or…
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New ASPE Report: 17 Million Children Live in States That Could Benefit from 12 Months Continuous Coverage in Medicaid and CHIP
One commonsense policy change can make a huge difference in the lives of children. A new federal report released yesterday finds that the 12-month continuous eligibility period for children in Medicaid and CHIP that took effect on January 1, 2024 will protect more than 17 million children who live in states that previously did not…
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Biden Administration Adds Protections to Keep Children Covered in CHIP
Today the Biden Administration announced the final federal regulation “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” which, among other things, eliminates outdated red tape barriers to coverage for children insured through the Children’s Health Insurance Program (CHIP) that have been in place since its…
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Call Center Data Shows Trends Across States, But May Not Provide Full Picture
Before the unwinding began, Tricia Brooks highlighted why call center data would be an important piece of the puzzle in understanding how states’ returns to routine operations were going. Reporting call center data, along with other data reporting requirements enacted by the Consolidated Appropriations Act, 2023 (CAA) help CMS track how the unwinding is going…
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Update: Georgia Now Suing CMS For Denying an Extension Request That Hasn’t Really Even Been Filed
As we have recently covered, and as we explained before it launched, Georgia’s “Pathways to Coverage” demonstration is riddled with defects. Pathways is the state’s alternative to a standard Medicaid expansion—an expansion with work requirements that has resulted in Georgia enrolling (as best we can tell) less than one percent of those eligible (yes, that’s…
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Child Enrollment in the Marketplaces Rose by Nearly 40 Percent During 2024 Open Enrollment but Increase Offsets Only Modest Share of Child Medicaid Unwinding Enrollment Losses
On March 22, 2024, the Centers for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare and Medicaid Services (CMS) released more detailed information on the nearly 21.5 million people — a historic high by far — who enrolled in the Affordable Care Act’s marketplaces during the 2024 Open Enrollment Period. According to…
