Medicaid
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Medicaid Wars: The Unwinding at the One Year Mark (Episode V)
In its first twelve months, the Biden administration has been unwinding the anti-Medicaid actions taken by its predecessor. The unwinding has been slow and methodical, and it is not yet finished. In part, this is because the new management at CMS has necessarily been focused on responding to the COVID-19 pandemic and in part because…
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The Proper Use of Medicaid Improper Payment Rates
For the first time, CMS has posted state-specific rates of improper payments in Medicaid. This welcome exercise in transparency is a sea change in the Payment Error Rate Measurement (PERM) program, which CMS has been using since 2007 to help states improve the accuracy of their Medicaid payments. Until now, CMS has been reporting only…
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California’s Medicaid Managed Care Waiver: New Potential for Access and Transparency
One of the most significant Medicaid managed care developments in 2021 happened on December 29, when CMS approved federal funding and waivers for California’s reform initiative, Advancing Innovation in Medi-Cal (CalAIM). The approval involved two sets of waivers, one operating under section 1115 of the Social Security Act, the other under section 1915(b)(4). For good…
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Secretary Becerra Extends the PHE: What Does This Mean for Medicaid and the Continuous Enrollment Provision?
[Editor’s Note: Read the latest on the public health emergency Medicaid continuous coverage protection here.] Earlier today, HHS Secretary Becerra renewed the COVID-related public health emergency (PHE). The latest extension will expire on April 16, 2022. By law, public health emergencies are declared in 90-day increments. The current PHE ends January 16, 2022, so a 90-day…
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Biden Administration Says No to Premiums in Medicaid
Just before the end of the year, the Biden Administration took an important stand protecting people enrolled in Medicaid. Three states (AR, GA, and MT) received news from CMS the week before Christmas on section 1115 Medicaid waiver requests of various kinds – but with one common element – that their plans to charge premiums…
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Research Update: New Urban Institute Report Highlights Pandemic-Related Barriers to Health Care Among Low-Income Parents
Parents’ lack of health insurance coverage and access to health services can reduce children’s access to care and harm their families’ broader financial health. This is why the Urban Institute’s new report on coverage, access, overall health, and ability to meet family financial needs among parents at different income levels after the first year of…
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CMS Releases Guidance on New Medicaid Mobile Crisis Services Option
The Centers for Medicare & Medicaid Services kept busy over the holidays with the release of new guidance to states on the American Rescue Plan Act’s new Medicaid state option to provide qualifying community-based mobile crisis intervention services. As discussed here on Say Ahhh!, ARPA included a provision allowing state Medicaid programs to provide community-based…
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Texas Medicaid Section 1115 Waiver Drama: A Trilogy
The world of Section 1115 Medicaid waivers can be mysterious and weedy, arcane and annoying, boring and, at times, dramatic. And in recent years, the use of Section 1115 authority by the Trump Administration stretched all previously known boundaries and wound up in court on multiple occasions – most famously in the Arkansas work requirements…
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Georgia’s 1332 Waiver Proposal Puts Children and Families at Risk of Losing Coverage
In 2020, Georgia submitted a waiver under Section 1332 of the Affordable Care Act (ACA) to allow the state to exit HealthCare.gov; the Trump Administration approved the request in November of last year. Under this proposal, the 500,000 Georgians who use the federal marketplace every year to enroll in private health plans and Medicaid would…
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Is the Biden Administration Planning to Help Struggling Families by Fixing the Family Glitch?
Close followers of administrative activity may have noticed that the Treasury Department is aiming to issue a notice of proposed rulemaking (NPRM) on the eligibility rules for advanced premium tax credits (APTCs) in the Marketplace. Though no deadline is specified – and the regulatory agenda is often overly ambitious – this could mean that the…
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Oregon’s 1115 Medicaid Waiver Request is a Mixed Bag
State seeks to become the first to provide continuous coverage to all children enrolled in Medicaid until age six while continuing to restrict children’s access to health care by continuing to deny them the EPSDT benefit package provided to children in all other states. After months of engaging stakeholders, Oregon has posted its draft…
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Removing Barriers to Vaccines for Kids Should be Top Priority
As the COVID-19 vaccine has been approved for adults, then teens and school-aged children, researchers are monitoring the vaccination trends for different groups. About a year after vaccines were approved for adults, almost 72% of the US adult population is fully vaccinated according to the most recent CDC data. Vaccines for teens ages 12 and…
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Surgeon General Issues Advisory on Youth Mental Health Crisis, Highlights Importance of Medicaid and CHIP Coverage and Calls for More Action
This week, the U.S. Surgeon General Dr. Vivek Murthy issued an Advisory highlighting the urgent need to address the nation’s youth mental health crisis. As discussed here on Say Ahhh!, the pandemic has taken an unprecedented toll on the mental health and wellbeing of children, exacerbating long standing gaps in mental health care for children…
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CMS Issues Guidance on New Postpartum Coverage State Option in Medicaid and CHIP
Today CMS released highly anticipated guidance to states implementing the new Medicaid and CHIP state plan option to provide 12 months of extended postpartum coverage to pregnant individuals enrolled in Medicaid beginning April 1, 2022. Created by the American Rescue Plan Act passed earlier this year, this policy option has been widely embraced by states…
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Recent Resources from Healthy Schools Campaign Illuminate That There is Still Much To-Do to Advance Medicaid Reimbursement in Schools
Pop quiz: How many schools have a full-time nurse on staff? If you guessed anything above 40%, you would unfortunately be wrong. Only 39% of schools in the nation employ full-time school nurses. If you think the numbers on school behavioral health professionals would be better, you would unfortunately be wrong again. 8 million students…
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Build Back Better Act: Health Coverage Provisions Explained
On November 19, 2021, the House of Representatives passed the Build Back Better Act, the budget reconciliation bill, with the Senate expected to consider the legislation in coming weeks. The Build Back Better Act includes numerous provisions that would dramatically strengthen and expand both public and private health insurance coverage. Some of the new provisions…
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Build Back Better Legislation: What Does It Mean for Children’s Health Coverage and Care?
There has been very little public discussion of the provisions to advance child health in the Build Back Better (BBB) bill. Big ticket items like whether a Medicare dental, hearing, and vision benefit will be added, disputes over drug pricing reforms, and of course, filling the coverage gap in the non-expansion states, have taken up…
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Maternal Health Home Option in Build Back Better Plan Lays Groundwork for Two-Generation Success
Released in late October, the most recent House text of the Build Back Better plan included an exciting late addition: a new Medicaid pathway to incentivize high-quality, team-based care for pregnant and postpartum people. The new state option provides a temporary enhanced match to develop and grow practices to comprehensively anticipate and coordinate care needs,…
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HHS Secretary Becerra Approves New Jersey Waiver Request to Extend Postpartum Medicaid Coverage
New mothers covered by Medicaid and CHIP in New Jersey will now be able to stay enrolled for one year after the end of pregnancy under a Medicaid Section 1115 waiver approved by the Centers for Medicare and Medicaid. The state will extend postpartum coverage for individuals from the state’s current pregnancy coverage cutoff at…
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Maternal Depression and Medicaid Policy Solutions Highlighted in Special Issue of Health Affairs
About one in five pregnant and postpartum people are diagnosed with mental health conditions each year, and a new research finding adds to the growing body of evidence that sustained Medicaid coverage before, during, and after pregnancy can help. Medicaid expansion was associated with a 16 percent decline in self-reported pre-pregnancy depression and the improvements…
