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 […]
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 […]
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 […]
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: […]
Last week, GAO issued a performance audit of data on Medicaid MCO appeals and grievances. The database GAO examined was the first year of Managed Care Program Annual Reports (MCPARs) submitted by state Medicaid agencies to CMS. MCPARs are one of three reports on which CMS relies to conduct oversight of state managed care programs […]
On March 9, the President signed into law the Consolidated Appropriations Act, 2024 (P.L. 118-122). Buried in the 428-page text is a 3-line provision delightfully, if somewhat obscurely, titled “Promoting Value in Medicaid Managed Care.” This is a classic in the genre of offsets, flying well under the radar to carry out its mission of […]
