Managed Care
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COVID-19, State Budget Deficits, and Medicaid Managed Care
The COVID-19 pandemic has unleashed not just death, but also massive unemployment and a steep recession. Among the economic casualties are state budgets, which have been knocked badly out of balance by the resulting drop in revenues and the prospect of increased enrollment in Medicaid and other safety net programs. Among those spared from the…
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Taxing Medicaid Managed Care to Mitigate Medicaid Cuts
In many states, Medicaid is under budgetary siege. The steep recession brought on by the COVID-19 pandemic has led to large revenue shortfalls and budget deficits, most notably an estimated $54 billion in California for the fiscal year ending June 30 and the next. States must balance their budgets, and they have only a few…
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Medicaid Managed Care in the Time of COVID-19 and State Budget Cuts
Three months into the pandemic, Medicaid’s role as the nation’s frontline health insurer has come into sharp relief. The focus is on the struggles of frontline hospitals, nursing homes, and health care workers; the vertiginous climb in the number of unemployed and uninsured; the threat to the solvency of pediatric and other primary care providers;…
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Medicaid Managed Care Transparency: A Leap Forward
The California Health Care Foundation has just issued a path-breaking report that marks an important step forward on the road to full transparency about Medicaid managed care. The report, prepared by Dr. Andrew Bindman and his colleagues at the University of California at San Francisco, examines the performance of managed care plans (MCPs) in Medi-Cal…
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Real Protections for Kids and Families in the Newest Texas Medicaid Managed Care Laws
In June 2018, the Dallas Morning News began publishing a series of in-depth investigative reports on Texans harmed through Medicaid managed care, potential conflicts of interest, and weaknesses in oversight and enforcement of Medicaid managed care contracts. The articles resulted in public hearings in the Texas House of Representatives that further explored the issues and allowed the public to comment. In…
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Medicaid Managed Care Transparency: What Can Quality Data Do?
Earlier this week the data transparency door to Medicaid managed care opened. Not as wide as some of us would hope, but wide enough to start a detailed conversation about the performance of individual MCOs on quality. It happened at a briefing sponsored by the California Health Care Foundation and took the form of a…
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Centene’s takeover of WellCare: What would it mean for kids and families covered by Medicaid?
On March 27, the Centene Corporation announced it would acquire WellCare Health Plans, Inc. in a cash and stock transaction valued at $17.3 billion. The transaction is subject to approval by the shareholders of both companies as well as state regulators. The companies “expect to complete the transaction in the first half of 2020.” For…
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Proposed Changes to Medicaid Managed Care Rule Will Reduce Access to Providers
One year ago, CMS Administrator Seema Verma gave a major policy address to state Medicaid directors in which she promised to “rollback burdensome regulations that the federal government has imposed on states.” She specifically targeted two, both of which were issued by the prior administration: the Access Rule (November 2015), and the Managed Care Rule…
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“Pain & Profit:” How Not to Do Medicaid Managed Care
We know that CMS Administrator Seema Verma doesn’t think Medicaid should cover “able-bodied” adults. But she does believe that coverage of the “society’s most vulnerable citizens” is the right thing for Medicaid to do. In her major policy address to state Medicaid directors last November, she opened with the stories of Richard, a para-pelagic, and…
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Ongoing Advocacy Needed to Ensure Children Covered by Managed Care Plans Receive Medicaid’s Guaranteed Pediatric Benefit
Child health advocates know the importance of five simple but powerful letters in Medicaid: EPSDT or Early and Periodic Screening Diagnostic and Treatment Services. EPSDT – that is, Medicaid’s comprehensive pediatric benefit standard – provides children with preventive and diagnostic services and ALL medically necessary services that can be covered under federal Medicaid law to…
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Protecting and Promoting Medicaid’s Guaranteed Benefits for Children: Iowa EPSDT and Managed Care
Introduction With support from the Georgetown University Center for Children and Families under a Robert Wood Johnson Foundation grant, the Child and Family Policy Center (CFPC, also referred to as the Center) engaged in activities in 2017 to protect and strengthen Medicaid’s critical pediatric benefit in the context of Iowa’s managed care rollout. CFPC welcomed…
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Protecting and Promoting Medicaid’s Guaranteed Benefits for Children: Illinois EPSDT and Managed Care
Introduction In 2017, the Sargent Shriver National Center on Law Poverty and Everthrive Illinois engaged in activities to protect and strengthen Medicaid’s comprehensive and preventive pediatric benefits as more children were enrolled into Managed Care Plans (MCOs). This work was supported by the Georgetown University Center for Children and Families through a grant from the…
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Medicaid Proves to be a Winning Topic in this Year’s Pulitzer Prize Contest
Stories about Medicaid earned top honors in this year’s Pulitzer Prize contest: editorial writer Andie Dominick from the Des Moines Register earned a top prize for her columns on the consequences of Iowa’s transition to Medicaid managed care, and health journalist Andy Marso won a finalist mention for his coverage of the lack of transparency in…
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How Can We Tell Whether Medicaid MCOs are Doing a Good Job for Kids?
Introduction Nearly 40 percent of the nation’s children—37 million—are covered by Medicaid. Of those, over two thirds are enrolled in managed care organizations (MCOs). While not all state Medicaid programs enroll children in MCOs, in 24 of the states that do, more than 80 percent of Medicaid beneficiaries who are children are enrolled in “comprehensive…
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HHS Bulletin on Medicaid and CHIP Managed Care Regulations Raises Red Flags
Last year, HHS finalized changes to the Medicaid and CHIP managed care regulations to modernize and streamline program rules for the first time in over a decade. Nearly 9 in 10 children enrolled in Medicaid/CHIP get their care through some type of managed care arrangement, so we teamed up with NHeLP to review the rules…
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Three Ways to Ensure EPSDT Works in Managed Care
We are continuing our look at EPSDT, this time turning to EPSDT and managed care. Nearly 9 out of 10 children in Medicaid and CHIP receive services through some type of managed care arrangement, so understanding how EPSDT works in a managed care context is critical. If you followed our work on managed care over…
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Medicaid Managed Care Rules Will Improve Transparency, Accountability
Thanks to a grant from the Robert Wood Johnson Foundation, CCF has teamed up with NHeLP to launch a series of explainer briefs that unpack the Medicaid/Children’s Health Insurance Program (CHIP) managed care regulations. The importance of these rules cannot be understated. Nearly nine out of ten children in Medicaid and CHIP receive care through…
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Medicaid/CHIP Managed Care Regulations: Ensuring Accountability and Transparency
In May 2016, the Centers for Medicare & Medicaid Services (CMS) completed its modernization of the regulations governing managed care in Medicaid and the Children’s Health Insurance Program (CHIP). One of CMS’ primary goals in this regulatory overhaul is to promote transparency, enabling policy makers, beneficiaries, providers, and other stakeholders to better understand and monitor…
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Rhode Island: Working to Improve Access to Oral Health Care for Children through RIte Smiles and TeethFirst!
By Katherine Chu and Jim Beasley, Rhode Island KIDS COUNT Oral health is a critical but overlooked component of overall health and well-being among children and adults. Poor oral health has immediate and significant negative impacts on children’s general health, school attendance and academic achievement. Untreated dental disease can lead to eating, sleeping, speaking and learning…
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Quality Provisions of the Medicaid/CHIP Managed Care Rules
Thanks to a grant from the Robert Wood Johnson Foundation, CCF has teamed up with NHeLP to launch a series of explainer briefs that unpack the new Medicaid/Children’s Health Insurance Program (CHIP) managed care regulations. Three briefs in the series have been released already: Looking at the New Medicaid/CHIP Managed Care Regulations Through a Children’s Lens, Medicaid/CHIP…
