Medicaid
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CMS Administrator Verma Proposes to Repeal the Medicaid Access Rule
For the past two years, CMS Administrator Seema Verma has wanted to “rollback” the Medicaid Access Rule. That’s the CMS regulation that implements the requirement in the Medicaid statute that rates paid to physicians and other providers be “sufficient” so that enough participate in Medicaid to give beneficiaries access to covered services. In the…
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Child Enrollment in Medicaid and CHIP Slips Again
We continue to closely monitor the trends in child enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) following our report on the precipitous enrollment decline in 2018. As of March 2019, overall child enrollment in Medicaid and CHIP was down an additional 41k children in the first quarter of 2019. However, the national…
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Trump Administration Withdraws Harmful Drug Rebate Safe Harbor Rule
On July 10, the Trump Administration announced that it would withdraw a proposed rule to eliminate the safe harbor in the federal anti-kickback law for rebates negotiated by pharmacy benefit managers (PBMs) on behalf of Medicaid managed care plans and Medicare Part D plans. This is a highly welcome move. As we have explained since…
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House Committee Advances Bill to Sustain Medicaid Programs in the Territories and Avoid Deep, Harmful Cuts
On July 11, by voice vote, the Health Subcommittee of the House Energy and Commerce Committee reported out essential legislation (H.R. 3631) to avert large federal Medicaid funding shortfalls the territories will face starting in 2020. Without additional federal funding the bill would provide, the territories would have no choice but to institute damaging cuts…
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Proposed HUD Rule Adds to Climate of Fear for Immigrant Families, Puts America’s Children at Greater Risk of Homelessness
Yesterday was the deadline for comments on yet another anti-immigrant proposed rule, this one targeting over 55,000 citizen children in mixed status families that rely on prorated housing assistance under current program rules. We joined other child health groups in submitting comments, underscoring the serious negative impacts of homelessness and housing insecurity for child well-being…
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Real Protections for Kids and Families in the Newest Texas Medicaid Managed Care Laws
In June 2018, the Dallas Morning News began publishing a series of in-depth investigative reports on Texans harmed through Medicaid managed care, potential conflicts of interest, and weaknesses in oversight and enforcement of Medicaid managed care contracts. The articles resulted in public hearings in the Texas House of Representatives that further explored the issues and allowed the public to comment. In…
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CMS Awards $48 Million in Outreach Funds for Children’s Coverage
Earlier this week, CMS announced that it was awarding $48 million in cooperative agreements to 39 organizations in 25 states to enroll eligible children in health coverage. Since 2009, CMS has awarded $210 million in funds to connect kids to coverage through various federal appropriation bills. Unfortunately, this latest round of grants was delayed as…
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State Medicaid Programs Already Have Considerable Flexibility to Adopt Innovative Payment Models for New High-Cost Prescription Drugs
As I have previously warned, the ongoing prescription drug pricing debate could intentionally or unintentionally lead to significant harm to the Medicaid program and its effective Drug Rebate Program. That, in turn, could result in higher federal and state Medicaid drug costs and reduced beneficiary access to needed medications. One key element of the Medicaid…
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How a Small Provision of ACA Made a Big Difference for One Pennsylvania Family
Years after its passage, I am still finding new ways that the ACA helps my family. For over two and a half years, my family has been involved in the fight to save the Affordable Care Act and prevent cuts to Medicaid. We travel around Pennsylvania and Capitol Hill educating others about the importance of…
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Sound House Bill Would Establish Pathway for a Sustainable, Improved Medicaid Program in Puerto Rico
As we wrote last year, Congress should consider making permanent changes to Puerto Rico’s federal Medicaid financing structure to ensure the long-term viability of its Medicaid program. This includes eliminating Puerto Rico’s federal funding cap over time, raising the federal matching rate and requiring fuller compliance with the same federal Medicaid requirements that now apply…
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New Texas Report Details Opportunities to Keep Moms Healthy During the Fourth Trimester
“If we want kids, moms, and communities to thrive in Texas, then we need to help local moms stay healthy.” — Adriana Kohler, Senior Health Policy Associate, Texans Care for Children A new report, Healthy Moms Raising Healthy Babies: Central Texas and Statewide Challenges and Opportunities to Support Maternal…
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South Carolina’s Medicaid Waiver: Who Would be Impacted?
A few months ago, we released an analysis of South Carolina’s application to impose work reporting requirements on very low-income parents and caregivers with incomes below 67 percent of the poverty level insured through Medicaid. Since then, the state has revised its application, proposing eligibility expansions for several groups including parents, children, and pregnant women;…
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Pending CMS Guidance on Medicaid Block Grants: Executive Overreach Strikes Again
It has been reported that CMS is developing guidance to encourage states to pursue a new “block grant” or “per capita” cap on federal Medicaid funding through Section 1115 waiver requests. And sure enough, this “Dear State Medicaid Director” letter has appeared on the Office of Management and Budget’s website signaling that it is under…
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Weaponizing Program Integrity: A New Assault on Medicaid Expansion
CMS Administrator Seema Verma has never been a fan of the Affordable Care Act’s Medicaid expansion or the positive difference it has made in the lives of low-income Americans. In fact, ever since Congress refused to repeal the expansion and block grant the program in 2017, Administrator Verma has been trying to make it harder…
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New Study Finds Arkansas Medicaid Work Requirement Isn’t Working
As readers of SayAhhh! know, we have been closely following the developments in Arkansas – which was the first state to implement a Medicaid work requirement in the second half of 2018 before a federal judge stepped in and put a hold on the state’s Section 1115 waiver. However, prior to the court’s intervention, more…
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New Data Find Troubling Decline in Child Enrollment in Medicaid and CHIP Continues in Many States
Several months ago, we began to highlight concerns over the declining enrollment of children in Medicaid and CHIP. Just last month we published a brief on the unusual decline, noting that child enrollment had dropped by nearly 1 million children in 38 states in 2018. Although overall national enrollment was up by close to 20k…
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Counting All Children in the 2020 Census Would Benefit Poor Children: State and Local Advocates Can Help
Being counted in the Decennial Census helps young children thrive. When they are counted, their communities get their fair share of over 800 billion dollars a year in federal funding that is allocated by formula using data derived from the federal Census. Those programs include many that remediate the harmful effects of poverty on young…
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State Policymakers Can Give Children the Best Start in Life by Maximizing and Aligning Investments
So much about a child’s health and growth is set in the years before their third birthday, when their brain is developing at a faster pace than at any time in life. As research continues to confirm, the early years of a child’s life set the stage for a lifetime of good health and well-being.…
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How Does Health Coverage for Adults Impact Children’s Healthy Development?
As federal and state policymakers debate the merits of affordable health care coverage for adults, it’s important to review the impact that adult coverage has on children’s healthy development. So naturally we were delighted when the Society for Research in Child Development asked us to work with them on a summary of the latest research.…
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In Utah, Another Attempt to Limit Access to Health Care Coverage
Utah revealed the next chapter in its drawn-out Medicaid expansion debate on May 31. Unsurprisingly, it’s yet another attempt to limit access to affordable health care coverage. Rather than heeding the will of the voters and implementing Prop 3 – which would have given 150,000 low-income Utahans access to Medicaid coverage – the state has…
