Medicaid
-
Are Children Receiving the Full Protection of Medicaid’s Pediatric Benefit Package?
Medicaid covers over 30 million children, or about 40 percent of all children. Medicaid covers disproportionately large shares of low-income children, children of color, and children with special health care needs. Medicaid law and policy necessarily impact children, oftentimes children who would be uninsured or underinsured without it. Children with Medicaid coverage are entitled to…
-
Medicaid/CHIP Coverage by Congressional District, 2023
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas…
-
New Report Documents State Action on Maternal Mental Health, Medicaid Cuts Could Undermine Progress
Last month, the Policy Center for Maternal Mental Health (“Policy Center”) released its second annual report highlighting state efforts to improve maternal mental health outcomes. Over the past few years, maternal mental health has gained momentum at both the federal and state levels. The report evaluates 2024 state legislation introduced on maternal mental health care,…
-
Webinar: How Medicaid Works & What’s at Stake in 2025
The Georgetown University Center for Children and Families held a special session of our new Child Medicaid Policy Institute on Tuesday, December 10. The Child Medicaid Policy Institute seeks to educate child health advocates, providers, stakeholders, and policymakers on the fundamentals of the Medicaid program and its importance for children, families, and other low-income individuals.…
-
Federal Funding Cuts to Medicaid May Trigger Automatic Loss of Health Coverage for Millions of Residents of Certain States
Despite virtually no discussion of Medicaid during the election, Medicaid is facing proposals for significant reductions in federal funding. My colleague Edwin Park has already detailed some of the discussion around these cuts – which are being considered in service of facilitating an extension of tax breaks, the majority of which would go to the…
-
How Covering Adults Through Medicaid Expansion Helps Children
Opponents of Medicaid expansion often argue that enacting expansion will harm “traditional” Medicaid beneficiaries including children. This brief cites studies finding the opposite is true. Studies have documented multiple positive effects for children of expanding coverage for parents and other adults including higher child coverage rates, lower rates of infant mortality and higher birthweights, and…
-
Congressional Republican Leaders Start to Show Their Hand: Draconian Medicaid Cuts on the Agenda for Next Year
I have been warning for months that Medicaid would be on the chopping block if there is a second term of the Trump Administration and if Congressional Republicans win House and Senate majorities in 2025. That is because the Project 2025 blueprint, the fiscal year 2025 Republican Study Committee budget plan, and the fiscal year…
-
CMS Approves Five More States to Adopt Medicaid Multi-Year Continuous Coverage for Young Children As Threats to Coverage Loom
Yesterday, CMS approved a set of another five state 1115 waiver demonstration applications to adopt multi-year continuous eligibility for children in Medicaid. Four states (Hawaii, Minnesota, New York and Pennsylvania) were approved to adopt continuous eligibility for children in Medicaid from birth to age 6; Colorado was approved to implement for children up to age…
-
Transparency in Medicaid Managed Care: CMS Posts Annual MLR Reports
On November 1, CMS posted on its website Medical Loss Ratios (MLRs) for individual Medicaid managed care organizations (MCOs) in 2018, 2019, and 2020. These data come from the MLR Summary Reports that states are required to submit to CMS. This CMS action follows the posting on July 15 of the first tranche of Managed…
-
Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q3 2024
Another quarter, another round of earnings reports from the “Big Five.” The story of Q3 continues the basic narrative of Q1 and Q2. For all but one of the companies that dominate the Medicaid managed care market, net Medicaid enrollment continued to decline, driven primarily by the PHE unwinding. There is one new wrinkle, however.…
-
New Brief: States Should Act to Ensure All Former Foster Youth Receive Medicaid Continuity of Coverage
A group often overlooked in Medicaid coverage conversations is foster youth. While they are a small segment of the population, youth aging out of foster care have higher physical and mental health care needs than their peers, but often lack health insurance due to high costs. The authors of the Affordable Care Act (ACA) took into…
-
Ensuring Continuity of Medicaid Coverage for Former Foster Youth
Youth transitioning out of foster care are at both a challenging and pivotal time of their lives. Having health coverage through Medicaid provides security and stability as they make the steep climb to adulthood, often on their own. The authors of the Affordable Care Act (ACA) took into account the needs of former foster youth and the fact…
-
CMS Highlights EPSDT Policies and Strategies for Improving Care for Children with Behavioral Health Needs
As discussed in our blog series on the CMS’s new EPSDT guidance, the 57 page state health official letter lays out a number of policies and strategies to help states meet their EPSDT requirements under Medicaid – including care for children with behavioral health needs. As you may recall, in 2022, CMS released an informational…
-
Georgia’s Much Vaunted Medicaid Waiver “Pathways to Coverage” Has Turned Into “Pathways to Profit” for Consultants
As of June 2024, a paltry 4,231 Georgians were enrolled in Georgia’s section 1115 Medicaid waiver, according to reports from the state recently posted by federal CMS. Data from the newly released reports confirm that Governor Kemp’s “Pathways to Coverage” alternative to the Affordable Care Act’s Medicaid expansion – approved during the last year of…
-
New EPSDT Guidance Reinforces Key Medicaid Prior Authorization Protections for Children – And We’d Like to See Even More
Everyone under the age of twenty-one in Medicaid should have access to health care services they need thanks to Medicaid’s Early and Periodic Diagnostic Screening and Treatment (EPSDT) requirement. In short, EPSDT requires children to get regular screenings and treatment when necessary. And this isn’t a vague hope – it’s the law. However, in at…
-
CMS EPSDT Guidance Blog Series
CMS released a state health official (SHO) letter outlining the requirements states and managed care plans must meet under Medicaid’s pediatric benefit, known as Early and Periodic Screening, Diagnostic and Treatment or EPSDT. The EPSDT SHO also describes some strategies and identifies best practices currently in use by states to meet the various requirements. This…
-
CMS EPSDT Guidance: MCO Monitoring and Oversight Critical, States Ultimately Responsible
We at Georgetown CCF have been poring over CMS’s new EPSDT state health official (SHO) letter. Naturally, we do have some favorite points and analysis we will continue to highlight through this series on Say Ahhh!!! Today’s topic: The importance of state agency oversight of Medicaid managed care organizations, which the SHO refers to as…
-
CMS Plans Major Upgrade to Faulty Account Transfer Process Between the Federal Marketplace and State Medicaid Agencies
Last week CMS announced plans to replace the technology and processes used to coordinate eligibility and enrollment through electronic accounts between the federal marketplace (healthcare.gov) and states that use the federal platform. The account transfer (AT) process, although riddled with glitches, has been in place since the Affordable Care Act’s coverage expansions began in 2014.…
-
Urban Institute Report on Parent Health Coverage Finds Mothers of Young Children Showed Greatest Gains
Last month, the Urban Institute released a report detailing uninsurance rates between 2019 and 2022 for families with young children (under age 3). The report revealed significant drops—for the children, for fathers, and most significantly, for mothers. There were multiple factors contributing to these rises in coverage rates—pandemic-era continuous enrollment policies such as the Families…
-
New Guidance from CMS Lifts Up Medicaid’s EPSDT Pediatric Benefit
Last month, CMS released a state health official (SHO) letter outlining the requirements states and managed care plans must meet under Medicaid’s pediatric benefit, known as Early and Periodic Screening, Diagnostic and Treatment or EPSDT. The EPSDT SHO also describes some strategies and identifies best practices currently in use by states to meet the various…
