X

Managed Care

  • Centene’s takeover of WellCare: What would it mean for kids and families covered by Medicaid?

    Andy Schneider

    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…

  • Proposed Changes to Medicaid Managed Care Rule Will Reduce Access to Providers

    Andy Schneider

    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…

  • “Pain & Profit:” How Not to Do Medicaid Managed Care

    Andy Schneider

    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…

  • Ongoing Advocacy Needed to Ensure Children Covered by Managed Care Plans Receive Medicaid’s Guaranteed Pediatric Benefit

    Tricia Brooks

    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…

  • Protecting and Promoting Medicaid’s Guaranteed Benefits for Children: Iowa EPSDT and Managed Care

    Tricia Brooks

    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…

  • Protecting and Promoting Medicaid’s Guaranteed Benefits for Children: Illinois EPSDT and Managed Care

    Tricia Brooks

    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…

  • Medicaid Proves to be a Winning Topic in this Year’s Pulitzer Prize Contest

    Maggie Clark

    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…

  • How Can We Tell Whether Medicaid MCOs are Doing a Good Job for Kids?

    Andy Schneider

    Introduction Nearly 40 percent of the nation’s children—37 million—are covered by Medicaid.[note]Source for 40 percent: “Public Health Insurance Coverage by Type 2016: American Community Survey 1-Year Estimates,” U.S. Census Bureau’s 2016 American Community Survey, available at https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_1YR_S2704&prodType=table; source for 37 million, “Unduplicated Number of Children Ever Enrolled, FY 2016,” Center for Medicaid and CHIP Services,…

  • HHS Bulletin on Medicaid and CHIP Managed Care Regulations Raises Red Flags

    Kelly Whitener

    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…

  • Three Ways to Ensure EPSDT Works in Managed Care

    Kelly Whitener

    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…

  • Medicaid Managed Care Rules Will Improve Transparency, Accountability

    Kelly Whitener

    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…

  • Medicaid/CHIP Managed Care Regulations: Ensuring Accountability and Transparency

    Kelly Whitener

    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…

  • Rhode Island: Working to Improve Access to Oral Health Care for Children through RIte Smiles and TeethFirst!

    Guest

    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…

  • Quality Provisions of the Medicaid/CHIP Managed Care Rules

    Tricia Brooks

    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…

  • Medicaid/CHIP Managed Care Regulations: Assuring Quality

    Tricia Brooks

    While the rules governing Medicaid/CHIP managed care remained unchanged for more than a decade, significant advances have been made in assessing quality, access, and timeliness of care in health coverage programs. During this time, there has been a growing recognition of the need to ensure that the care delivered through capitated managed care arrangements is…

  • How One Florida Newspaper Went Beyond Reporting to Spur Original Research

    Maggie Clark

    (This blog was originally published by the USC Annenberg Center for Health Journalism.) By Maggie Clark, Sarasota Herald Tribune Some of the best ideas are the ones that initially sound the craziest. I was about four months in on my reporting on Florida’s Medicaid managed care program, and I was hitting a wall. I’d been…

  • Medicaid/CHIP Managed Care Regulations: Network Adequacy and Access to Services

    Kelly Whitener

    Georgetown University Center for Children and Families (CCF) and the National Health Law Program (NHeLP) have teamed up to bring advocates for children and low-income families critical information about the recently finalized Medicaid and CHIP managed care regulations. This paper is the fourth in the series, and it describes how the new rules assure network…

  • Medicaid/CHIP Managed Care Regulations: Enhancing the Beneficiary Experience

    Tricia Brooks

    As managed care and particularly mandatory managed care programs have become the predominant model for delivering care in Medicaid, there has been a growing recognition of the need to provide potential enrollees with accurate and timely information about their managed care options, to enable and encourage an active choice of plans, and to ensure that…

  • Medicaid/CHIP Managed Care Series

    Tricia Brooks

    The Centers for Medicare and Medicaid Services (CMS) finalized sweeping Medicaid and CHIP managed care regulations earlier this year. The rules cover a wide range of topics important to children and low-income families such as improving consumer information, enhancing the beneficiary experience, assuring network adequacy and access to services, advancing quality, and ensuring accountability and transparency. The sheer…

  • How the New Medicaid/CHIP Managed Care Regulations Improve Consumer Information

    Tricia Brooks

    As my colleague, Kelly Whitener, announced last week, thanks to a grant from the Robert Wood Johnson Foundation, CCF has teamed with NHeLP to launch a series of explainer briefs to unpack the new Medicaid/CHIP managed care regulations. The first brief, Looking at the New Medicaid/CHIP Regulations Through a Children’s Lens, was published last week.…