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 […]

Joan Alker

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 […]

Leonardo Cuello

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 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. […]

Tricia Brooks
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