Medicaid
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New Rule Seeks to Improve Transparency of State Medicaid Provider Payment Rates
CMS recently finalized two key regulations: “Ensuring Access to Medicaid Services” (Access Rule) and “Medicaid, CHIP Managed Care Access, Finance, and Quality” (Managed Care Rule), aimed at improving access to care in Medicaid across delivery systems (fee-for-service and managed care) and authorities (state plan and waiver services). The rules are long and complex; we’ve summarized…
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Delaware and Tennessee Become First States to Cover Diapers for Young Children in Medicaid through Section 1115 Demonstrations
Last week, CMS announced the approval of section 1115 demonstration project requests from Delaware and Tennessee to provide diapers to young children covered by Medicaid. These approvals mark the first time a state has been authorized to cover diapers for infants in Medicaid regardless of medical necessity due to incontinence issues. Under federal statute, section…
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Medicaid Managed Care: Results of the PHE Unwinding for the Big Five in Q1 2024
It’s now been four corporate reporting quarters since the start of the PHE unwinding on April 1, 2023. During that time, net national Medicaid enrollment—the combination of disenrollments from redeterminations, re-enrollment by some of those terminated, and new enrollments—has fallen by 13.1 million, including 5.0 million children. Of the disenrollments, 70 percent have been for…
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Consolidated Appropriations Act, 2024: Medicaid and CHIP Mental Health and Substance Use Disorder Provisions Explained
Download the Full Report Here On March 9, 2024, President Biden signed into law the Consolidated Appropriations Act, 2024 (P.L. 118-42). The Consolidated Appropriations Act, 2024 (CAA 2024) includes a number of Medicaid and Children’s Health Insurance Program (CHIP) provisions related to mental health and substance use disorder (SUD) care and coverage including provisions extending…
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A Closer Look at Transparency in the Medicaid Managed Care Rule
The Medicaid Managed Care Rule published on May 10 has lots of moving parts. As my colleague Leo Cuello explains, the rule includes provisions to increase the transparency of state directed payments (SDPs). The rule also contains a number of other transparency requirements that are the focus of this blog, most of which are identical to those…
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Medicaid Supports Student Success in School Districts Across the Country
By: Aubrianna Osorio, Emma Ford, Anne Dwyer, and Margaux Johnson-Green Research consistently shows that Medicaid coverage in childhood has long-term benefits, including supporting student success. New data on the share of children with Medicaid/CHIP coverage are now available for more than 7,000 school districts nationwide and show how important these coverage programs are to students across…
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Draft Senate Finance Committee Bill Addressing Drug Shortages Includes Broad Rollback of Medicaid Inflation-Related Rebates for Generic Drugs, Raises Serious Concerns
Congress has been examining ways to address the ongoing problem of generic drug shortages, especially with cancer patients continuing to face severe shortages of widely used generic chemotherapy drugs. Both the House Energy and Commerce Committee and the Senate Finance Committee have held hearings on generic drug shortages, with the Senate Finance Committee also issuing…
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Series: Improving Access and Managed Care in Medicaid and CHIP
Earlier this year, the Center for Medicare & Medicaid Services (CMS) finalized two new regulations aimed at improving access to care for those enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) across delivery systems. CCF experts summarize both rules in “An Explanation of Final Medicaid Managed Care and Access Rules“. Below is a…
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CMS Releases Guidance on Timely Processing of Applications and Extension of Unwinding Flexibilities
The unprecedented volume of Medicaid redeterminations generated by the expiration of the continuous coverage provisions has been somewhat of a “stress test” for state Medicaid systems. The number of Medicaid applications exceeding federal timeliness standards is one indicator that a state is not doing well on this stress test and a signal that something needs…
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Medicaid Managed Care Excess Profits and Maternal and Early Childhood Health in Nebraska
Like most states, Nebraska contracts with managed care organizations (MCOs) to deliver covered services to people enrolled in Medicaid. Unlike most states, Nebraska operates a Medicaid Managed Care Excess Profit Fund. Established in 2020, the Excess Profit Fund holds profits that MCOs are required to return to the state, remittances from MCOs in the event…
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New Report Focuses on Child Health Coverage Declines and What States Can do to Help Reconnect Kids with Medicaid/CHIP
As our nation approaches another sad milestone with nearly 5 million fewer children enrolled in Medicaid, we released a report looking at how states have responded to the challenge of the Medicaid “unwinding” process. With approximately half of the nation’s children enrolled in Medicaid, the stakes are very high for children and the providers who…
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Child Medicaid Disenrollment Data Shows Wide Variation in State Performance as Continuous Coverage Pandemic Protections Lifted
Download the Full Report (PDF) Background During the COVID-19 public health emergency, states received increased federal Medicaid matching rates in exchange for a commitment to maintain continuous coverage for those enrolled in Medicaid. With the public health emergency winding down, as part of the Consolidated Appropriations Act (CAA), 2023, Congress ended the continuous coverage requirement…
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Postpartum Coverage and Benefits Key, But Merely the Start of Needed Medicaid Work to Address Maternal Health Crisis
Federal and state leaders have prioritized maternal health in Medicaid in recent years with welcome (if overdue) attention. As Say Ahhh! readers know, the new state option to extend postpartum coverage to 12 months for all pregnant women in Medicaid has been adopted or is in progress in all but two states (AR and WI)…
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Exploring CMS’ Medicaid School-Based Services Technical Assistance Center
As a part of the Bipartisan Safer Communities Act, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Education (ED) were directed to develop a technical assistance center (TAC) to assist and expand the capacity of state Medicaid and education agencies, local education agencies, and school districts to deliver school-based services…
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New Research Links Postpartum Medicaid Coverage to Increased Mental Health Care
A new study in this month’s issue of Health Affairs offers additional insights into the impact of postpartum Medicaid coverage on access to care. In short: continuous postpartum Medicaid coverage increased stability, access, and affordability to outpatient mental health and prescription medication treatments for perinatal mood and anxiety disorders compared with those who transitioned to…
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Webinar: Unwinding – Where Do We Go From Here?
As unbelievable as it may seem, the “unwinding,” or the return to routine operations following the end of the FFCRA’s continuous coverage requirement, is nearing completion for almost all states. With a net decrease of almost 10.6 million enrolled in Medicaid, including over 4 million children, and a long list of issues that need to…
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State Momentum on Medicaid Doula Coverage, Rate Increases
Doula care continues to be a hot topic as our nation struggles to address the current maternal and infant health crises. Research has shown that doulas help reduce the risk of adverse birth outcomes, reduce infant mortality rates and help improve perinatal mental health. Access to doula care services can be out of reach for…
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Wondering what’s in the recent Medicaid and CHIP eligibility and enrollment rule?
On April 2, 2024, the Centers for Medicare & Medicaid Services (CMS) published the second part of a two-part final rule that simplifies the eligibility and enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). The rule eliminates certain access barriers for children enrolled in CHIP; makes transitions…
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Medicaid Eligibility and Enrollment Rule Explainer
Download the Full Explainer (PDF) On April 2, 2024, the Centers for Medicare & Medicaid Services published the second part of a two-part final rule that simplifies the eligibility and enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP).1 The rule eliminates certain access barriers for children enrolled…
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Marketplace Enrollment Among Those Losing Medicaid Coverage During Unwinding Increased by Nearly One-Third in the Second Month of Open Enrollment
As readers of Say Ahhh! know, I have been tracking monthly data (here, here, here, here, here, here, here and here) from the Centers for Medicare and Medicaid Services (CMS) on the number of people who were either previously enrolled in Medicaid or had experienced a denial or termination during unwinding who then selected a…
