Search

Kudos to the OIG!  That would be the Office of the Inspector General of the Department of Health and Human Services.  Although OIG is better known for its fraud-fighting persona, it also has a broader mission of making government programs work better.  And with last month’s report, “High Rates of Prior Authorization Denials by Some…

There’s a new box on the Center for Medicaid & CHIP Services (CMCS) organization chart!  It’s the Managed Care Group, one of (now) eight Groups within CMCS that manage the Medicaid program for the federal government.  You’re probably thinking, “So what? A federal bureaucracy gets a new Group. What difference will that make for children…

Editor’s Note: Since this post was published, CCF submitted formal comments on the Managed Care proposed rule.  Earlier this month, CMS proposed changes to regulations that govern the operation of  Medicaid managed care in 41 states.  The main purpose of the proposals is to improve access to care (by, among other things, beefing up network adequacy…

The earnings reports for the “Big Five” for the quarter ending March 31—known here as PHE Q13—are in.  The “Big Five”—CVSHealth (Aetna), Centene, Elevance Health (formerly Anthem), Molina Healthcare, and United Health Group—need no introduction, either to state Medicaid agencies or investors.  Together, they had 44.2 million Medicaid enrollees as of March 31.  If children…

Editor’s Note: Since this post was published, CCF submitted formal comments on the Managed Care proposed rule.  Last week my colleague Kelly Whitener promised readers of the Say Ahhh! Blog a series of blogs on the proposed rules that CMS has published to improve access to care in Medicaid and CHIP.  Promises made, promises kept. …

Here is where we are today.   Managed care—more precisely, comprehensive risk-based managed care—is the dominant delivery system in Medicaid.  States can require beneficiaries to enroll in Medicaid managed care organizations (MCOs) in order to receive the health care services to which they are entitled, and 40 states now do so.  MCOs can limit the network…

The 2022 earnings reports for the “Big Five”—CVS Health (Aetna), Centene, Elevance Health (formerly Anthem), Molina, and United Health Group—are now in. As expected, combined Medicaid enrollment for the “Big Five” increased during 2022 by 3.3 million to 43.2 million, an increase of 8.2 percent (Table 1). (If children are enrolled in “Big Five” MCOs…

September 30 marked the end of the 3rd quarter of this calendar year.  It also marked the end of the 11th quarter of the Public Health Emergency (PHE).  The two are not unrelated.  During the PHE, states receive an additional 6.2 percentage points on their regular federal matching rate if they agree not to terminate…