Medicaid
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Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey
Executive Summary Enrollment in Medicaid has grown significantly during the coronavirus pandemic. Provisions in the Families First Coronavirus Response Act (FFCRA) require states to provide continuous coverage for Medicaid enrollees until the end of the month in which the public health emergency (PHE) ends in order to receive enhanced federal funding. Continuous enrollment has helped to preserve…
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Medicaid Managed Care: SDOH, MCO, and MLR
There is no shortage of acronyms or initialisms in government agencies and programs and Medicaid is no exception. The Medicaid and CHIP Payment and Access Commission or MACPAC (one of our favorite acronyms) devotes an entire glossary to them. The most prominent initialism in Medicaid policy discussions these days is SDOH: social determinants of health,…
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More States Make Progress on Extending Postpartum Medicaid Coverage
The 2022 state legislative season is nearing its end in the coming weeks, and this year we’ve continued to see significant efforts in a broad range of states working to extend the Medicaid postpartum coverage from the current cutoff of just 60 days to a full 12 months after the end of the pregnancy. Regular…
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CMS Releases New Guidance on Unwinding the Medicaid Continuous Coverage Requirement
Yesterday, CMS released additional guidance and tools for states and Medicaid stakeholders on resuming routine operations when the Medicaid continuous coverage provision is lifted at the end of the public health emergency (PHE). While the State Health Official (SHO) reinforces prior guidance, it also provides new content and emphasizes the importance of protecting enrollees from…
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Medicaid Managed Care: What Can the Annual MLR Report Tell Us?
Over 32.8 million children are covered by Medicaid, and the large majority are enrolled by their state Medicaid agencies in managed care organizations (MCOs). In exchange for monthly capitation payments, the MCOs contract with the state Medicaid agency to furnish covered services through networks of providers. These arrangements, in 40 states and the District of…
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Increase in Maternal Mortality During COVID Underscores Need for Policy Changes
The rate of women who died during pregnancy or shortly after birth increased significantly during the first year of the COVID-19 pandemic, according to new data from the National Center for Health Statistics, and Black women continued to experience maternal death at rates more than twice the national average. In 2020, there were 861 women…
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Congressional Committees Focus on Mental Health, Announce Bipartisan Efforts
Mental health was in the spotlight this month on Capitol Hill with four Congressional committees holding hearings on the subject during the first three weeks of February and some committees formally announcing plans to pursue bipartisan legislation. As we’ve discussed on Say Ahhh!, the pandemic has taken an unprecedented toll on the mental health of…
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Outreach for Pregnant People Included in Latest CMS Grant Funding Opportunity
CMS recently announced $49.4 million in outreach grants available to connect eligible children and parents to Medicaid and CHIP coverage, and for the first time, specifically included outreach to pregnant people as one of the target groups. This is an important step, both for reaching eligible but uninsured pregnant people, and for facilitating access to…
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What Can States Do to Reduce Risk of Children Unfairly Losing Health Insurance
In part 1 of this blog series, my colleague and report co-author Joan Alker, explained the dire consequences if states don’t put in the time and effort to get renewals right when the Medicaid continuous coverage provision is lifted. This blog will focus on how we developed risk assessments for children in all 50 states…
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California’s Medicaid Managed Care Procurement: A Leap Forward
Last week, California’s Medicaid agency issued a Request for Proposals (RFP) to provide managed health care services to program beneficiaries. This is not just another Medicaid RFP. California is far and away the nation’s largest Medicaid managed care market. As of September 2021 the state Medicaid agency contracted with 24 managed care organizations (MCOs) to…
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Governors Should Make the Protection of Children and Families from Health Coverage Loss a Top Priority
A unique and unprecedented set of public policy circumstances create a grave risk for the stability of health coverage in the year ahead for millions of children and families. First, some background. In response to the COVID-19 pandemic, Congress and the Trump Administration enacted a law in 2020, known as the Families First Coronavirus Relief…
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Millions of Children May Lose Medicaid: What Can Be Done to Help Prevent Them From Becoming Uninsured?
Introduction As of June 2021, over 40 million children were enrolled in Medicaid or CHIP for their health insurance — the vast majority in Medicaid.[note]Georgetown University Center for Children and Families analysis of February 2020-June 2021 Centers for Medicare and Medicaid Services State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data, available at https://data.medicaid.gov/dataset/6165f45b-ca93-5bb5-9d06-db29c692a360.…
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Medicaid Managed Care Financial Results for 2021: A Big Year for the Big Five
The Q4 2021 earnings reports are in, and the five largest companies in the Medicaid managed care market—CVS Health, Anthem, Centene, Molina, and UnitedHealth Group—did very well, thank you very much. CVS Health made $17.3 billion last year; Anthem, $7.5 billion; Centene, $1.8 billion; Molina, $1.0 billion; and UnitedHealth Group $24.0 billion. Not all of…
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Texas Medicaid Section 1115 Waiver Drama Trilogy: Part II
Texas Expects to Get, But Not Give, Notice The Biden Administration came to town with clear intentions to review some of the waiver agreements that the Trump Administration had authorized – most notably on work requirements. We and others had urged the Trump Administration to reconsider the January 15th demonstration approval in Texas in light…
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American Rescue Plan Helps States Respond to Youth Mental Health Crisis
The COVID-19 pandemic has disrupted lives in many ways and has taken an unprecedented toll on children’s mental health, exacerbating long-standing gaps in mental health care for children in the United States. According to CDC reports, children’s emergency room visits for mental health issues increased significantly during the pandemic, with visits for adolescent girls for…
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States Should Continue Medicaid and CHIP Improvements Achieved Through State Disaster SPAs Beyond PHE
Since the start of the COVID-19 pandemic, states have been utilizing Medicaid and CHIP disaster state plan amendments (SPAs) for temporary, additional flexibilities to respond to the challenges resulting from the pandemic. As the administration considers when to end the federally declared Public Health Emergency (PHE), states and stakeholders should think about how to continue…
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How the COVID-19 Pandemic Affected U.S. National Health Spending
The Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) has recently issued updated National Health Expenditure (NHE) estimates for 2020. The key takeaway is that the 2020 data offers little insight into future national health care spending trends, due to the “unprecedented government response to the global pandemic” and the…
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Biden Administration and States Should Better Ensure Medicaid and CHIP Beneficiaries Have Access to At-Home COVID-19 Rapid Tests
As the Kaiser Family Foundation (KFF) recently explained, state Medicaid and CHIP programs are required to cover at-home COVID-19 rapid tests, without cost-sharing, until at least one year after the end of the COVID-19 public health emergency. However, there seems to be substantial variation across state Medicaid and CHIP programs in how they actually cover…
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Georgia Drops the Ball on Health Care, Again
Faced with an easy opportunity to dramatically improve the lives of Georgians, Georgia Governor Brian Kemp has snatched defeat from the jaws of victory. On January 21, 2022, instead of moving forward with a backup plan to help over 400,000 Georgians get health insurance, Governor Kemp decided to file a lawsuit. It’s not the first…
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CMS Commits $49 Million to Connect Kids, Parents, and Pregnant People to Coverage
A wide range of organizations, including state/local governments, tribal entities, safety net providers, non-profits, schools, and others, may apply for up to $1.5 million over three years to connect eligible people to Medicaid or CHIP under a new CMS funding opportunity. A total of $49.4 million in funding will build on efforts initiated by the…
