Blog
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New Tool to Help States Support Community Health Workers – What Would Federal Medicaid Cuts Mean for Progress?
Community health workers (also known as promotores and community health representatives) fill an important role in the health care system by linking individuals to public health and medical resources that support their health and well-being. Community health workers are unique in that they are trusted members of the community and are able to serve as…
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The Budget Resolution and Reconciliation Process Explained
In early 2021, we wrote about the basic rules for passing legislation in the House versus the Senate and how the budget reconciliation process allows certain legislation to move forward with approval from a simple majority of Senators rather than be subject to the filibuster and the usual three-fifths or 60-vote threshold. Given recent reports…
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Are Children Receiving the Full Protection of Medicaid’s Pediatric Benefit Package?
Medicaid covers over 30 million children, or about 40 percent of all children. Medicaid covers disproportionately large shares of low-income children, children of color, and children with special health care needs. Medicaid law and policy necessarily impact children, oftentimes children who would be uninsured or underinsured without it. Children with Medicaid coverage are entitled to…
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New Report Documents State Action on Maternal Mental Health, Medicaid Cuts Could Undermine Progress
Last month, the Policy Center for Maternal Mental Health (“Policy Center”) released its second annual report highlighting state efforts to improve maternal mental health outcomes. Over the past few years, maternal mental health has gained momentum at both the federal and state levels. The report evaluates 2024 state legislation introduced on maternal mental health care,…
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Federal Funding Cuts to Medicaid May Trigger Automatic Loss of Health Coverage for Millions of Residents of Certain States
Despite virtually no discussion of Medicaid during the election, Medicaid is facing proposals for significant reductions in federal funding. My colleague Edwin Park has already detailed some of the discussion around these cuts – which are being considered in service of facilitating an extension of tax breaks, the majority of which would go to the…
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Congressional Republican Leaders Start to Show Their Hand: Draconian Medicaid Cuts on the Agenda for Next Year
I have been warning for months that Medicaid would be on the chopping block if there is a second term of the Trump Administration and if Congressional Republicans win House and Senate majorities in 2025. That is because the Project 2025 blueprint, the fiscal year 2025 Republican Study Committee budget plan, and the fiscal year…
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CMS Approves Five More States to Adopt Medicaid Multi-Year Continuous Coverage for Young Children As Threats to Coverage Loom
Yesterday, CMS approved a set of another five state 1115 waiver demonstration applications to adopt multi-year continuous eligibility for children in Medicaid. Four states (Hawaii, Minnesota, New York and Pennsylvania) were approved to adopt continuous eligibility for children in Medicaid from birth to age 6; Colorado was approved to implement for children up to age…
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Transparency in Medicaid Managed Care: CMS Posts Annual MLR Reports
On November 1, CMS posted on its website Medical Loss Ratios (MLRs) for individual Medicaid managed care organizations (MCOs) in 2018, 2019, and 2020. These data come from the MLR Summary Reports that states are required to submit to CMS. This CMS action follows the posting on July 15 of the first tranche of Managed…
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Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q3 2024
Another quarter, another round of earnings reports from the “Big Five.” The story of Q3 continues the basic narrative of Q1 and Q2. For all but one of the companies that dominate the Medicaid managed care market, net Medicaid enrollment continued to decline, driven primarily by the PHE unwinding. There is one new wrinkle, however.…
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New Brief: States Should Act to Ensure All Former Foster Youth Receive Medicaid Continuity of Coverage
A group often overlooked in Medicaid coverage conversations is foster youth. While they are a small segment of the population, youth aging out of foster care have higher physical and mental health care needs than their peers, but often lack health insurance due to high costs. The authors of the Affordable Care Act (ACA) took into…
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CMS Highlights EPSDT Policies and Strategies for Improving Care for Children with Behavioral Health Needs
As discussed in our blog series on the CMS’s new EPSDT guidance, the 57 page state health official letter lays out a number of policies and strategies to help states meet their EPSDT requirements under Medicaid – including care for children with behavioral health needs. As you may recall, in 2022, CMS released an informational…
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Georgia’s Much Vaunted Medicaid Waiver “Pathways to Coverage” Has Turned Into “Pathways to Profit” for Consultants
As of June 2024, a paltry 4,231 Georgians were enrolled in Georgia’s section 1115 Medicaid waiver, according to reports from the state recently posted by federal CMS. Data from the newly released reports confirm that Governor Kemp’s “Pathways to Coverage” alternative to the Affordable Care Act’s Medicaid expansion – approved during the last year of…
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House Budget Proposal Seeks to Eliminate Healthy Start, a Proven Program to Reduce Maternal and Infant Mortality
By Kay Johnson For more than 30 years, the federal Healthy Start program has been investing in community-based solutions to reduce maternal and infant mortality in communities with infant mortality rates at least 1.5 times the U.S. national average. At a time when many are rightly calling for more community and family engagement to reduce…
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A Look at Maternal Health Legislation in the 118th Congress
By: Tanesha Mondestin and Kay Johnson Maternal health continues to be a priority for many Members of Congress. We previously scanned maternal health legislation that Members of Congress may consider in the 2022 “Lame Duck” session. We revisited this topic this election year to consider proposals pending in the 118th Congress as their chance of…
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Congressional Appropriations Proposals Cut Maternal Health Investments
By: Elisabeth Wright Burak, Kay Johnson, and Tanesha Mondestin In 2022, the maternal mortality rate for 2022 decreased to 22.3 deaths per 100,000 live births, compared with a rate of 32.9 in 2022. Black and Indigenous mothers have maternal mortality rates much higher than other racial/ethnic groups. And beyond the narrower category of maternal mortality…
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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…
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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…
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CMS EPSDT Guidance Blog Series
CMS released a state health official (SHO) letter outlining the requirements states and managed care plans must meet under Medicaid’s pediatric benefit, known as Early and Periodic Screening, Diagnostic and Treatment or EPSDT. The EPSDT SHO also describes some strategies and identifies best practices currently in use by states to meet the various requirements. This…
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CMS EPSDT Guidance: MCO Monitoring and Oversight Critical, States Ultimately Responsible
We at Georgetown CCF have been poring over CMS’s new EPSDT state health official (SHO) letter. Naturally, we do have some favorite points and analysis we will continue to highlight through this series on Say Ahhh!!! Today’s topic: The importance of state agency oversight of Medicaid managed care organizations, which the SHO refers to as…
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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.…
