Medicaid
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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…
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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…
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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.…
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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…
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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…
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Child Uninsured Rate Increases Slightly: Full Impact of Medicaid Unwinding Not Yet Evident
Check out your state’s numbers on our state data hub. Every year we look closely at the U.S. Census Bureau’s American Community Survey health insurance coverage data to see what is happening to coverage rates overall and especially for children. The data, which are released in early September, reflect survey responses collected in the prior…
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Webinar: MAC/BAC Webinar Miniseries
The final Managed Care and Access Rules, released in the spring, included new regulations for Medicaid Advisory Committees, which many states currently refer to as Medical Care Advisory Committees. These are groups intended to support communication and collaboration between state agencies, people enrolled in Medicaid, service providers, and other stakeholders. The new regulations broaden the scope of…
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No Child Should Be Uninsured: New Bill Would Cut Medicaid Red Tape and Reduce Harmful Gaps in Coverage
At Georgetown CCF we have been thinking about a day when no child in the United States is uninsured since our inception 19 years ago. Substantial progress has been made over the past two decades with some ups and downs along the way. However, as the recent Medicaid unwinding made abundantly clear, this day will…
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New Report Explores Insights from Medicaid Unwinding on How to Protect Children’s Coverage
The Urban Institute and Georgetown CCF have released a new report highlighting ways to improve the Medicaid/CHIP redetermination process for children emanating from key lessons learned during the unwinding of the Medicaid continuous coverage protection. These insights are based on interviews of representatives in 8 state Medicaid agencies, offering a unique perspective directly from the…
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Massachusetts Governor Signs a Maternal Health Bill Expanding Access to Midwifery, Birth Centers and Doulas
On August 23rd, Governor Maura Healy of Massachusetts signed an act promoting access to midwifery care and out-of-hospital birth options into law. This comprehensive maternal health bill focused on expanding midwifery coverage to include certified professional midwives (CPMs), birth centers, doulas, and screening and treatment options for postpartum depression. MassHealth is Massachusetts Medicaid and CHIP…
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New Federal Funding Opportunity for State Medicaid and CHIP Programs to Support Continuity of Care for Justice-Involved Individuals
Last week, many in the Medicaid and CHIP community were focused on CMS’s announcement of guidance to states on Medicaid EPSDT requirements (and for good reason). However, we also wanted to make sure folks saw the new notice of funding opportunity for planning grants to state Medicaid and CHIP agencies to develop operational capabilities to…
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CMS Issues Guidance to States on Early and Periodic Screening, Diagnostic and Treatment Requirements
Today, the Centers for Medicare & Medicaid Services (CMS) released much-anticipated guidance on Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements. For those who don’t live in Medicaid jargon land, EPSDT is the pediatric benefit in Medicaid and establishes a higher standard for children than adults covered by Medicaid. Most, but not all,…
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Medicaid/CHIP Mental Health Parity: Latest Federal Actions Explained
Last week, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury released their much-anticipated final rules to strengthen the enforcement of the federal Mental Health Parity and Addiction Equity Act (MHPAEA). As highlighted by the DOL, the final rules, among other provisions, make clear that group health plans and health insurance…
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Unpacking the Unwinding: Medicaid to Marketplace Coverage Transitions
By Emma Walsh-Alker Background As Medicaid unwinding draws to a close, millions of people have had to find new health coverage options, many of them through the Affordable Care Act (ACA) Marketplaces. What do we know about how they have fared, and whether state efforts to smooth coverage transitions have been successful? Following the April 2023…
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State Momentum, New Tools, Implementation Questions on Multi-Year Continuous Eligibility
CCF and its founders have long raised the opportunity to provide multi-year continuous eligibility for young children in Medicaid and CHIP, and have tracked its progress since Oregon and Washington first proposed the policy for children from birth to kindergarten in 2022. (See our latest map and resources to track state progress for children.) Our…
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As More States Allow Medicaid Reimbursements for New Pregnancy-Related Services, Promoting Access Remains a Challenge
KFF and the Health Management Associates (HMA) released their 23rd Annual Medicaid Budget Survey for State Fiscal Years 2023 and 2024 in collaboration with the National Association of Medicaid Directors (NAMD). This year’s survey includes findings about challenges and strategies in expanding non-traditional pregnancy-related services, such as doula care. In the U.S., Medicaid finances more…
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Federal Judge in Tennessee Sides with Individuals Terminated from Medicaid, Finds Numerous Violations in Tennessee Medicaid Eligibility Process
“Poor, disabled, and otherwise disadvantaged Tennesseans should not require luck, perseverance, or zealous lawyering to receive healthcare benefits they are entitled to under the law.” How’s that for an opening sentence to a judicial opinion? That’s how an August 26, 2024, decision in a class action case called A.M.C. v. Stephen Smith started – and…
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Webinar: Using Section 1115 Demonstrations to Support Health-Related Social Needs for Prenatal to 3 Population
Over the past few years, states have been increasingly seeking to use Medicaid section 1115 demonstrations to cover health-related social needs (HRSN) services and supports. While many states are including pregnant and postpartum individuals and their children as eligible populations to receive these benefits, not all individuals within the pregnancy and postpartum eligibility group will…
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GOP Push to Make Trump Tax Cuts Permanent Makes Medicaid Top Target for Draconian Cuts
I have been writing about the many conservative and Congressional Republican plans and proposals to make draconian cuts to Medicaid. The centerpiece of several prominent plans — Project 2025, the Republican Study Committee fiscal year 2025 (RSC) budget and the fiscal year 2025 House GOP budget resolution — is to cap and deeply cut federal…
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CMS Gives Options to States with “Unusual Circumstances” to Extend Unwinding Renewals, Redistributing Renewals, and Deal with Pending Renewals
CMS has released new guidance for states that are not yet done with the unwinding. Due to the unprecedented nature of the unwinding – exacerbated by workforce challenges and resulting in an uneven and unsustainable renewal volume in many states – CMS concludes that the unwinding constitutes an administrative emergency that justifies exceptions to the…
