Medicaid managed care

Relatively Few Docs Treating Medicaid Patients

Just a small portion of the providers theoretically available to serve individuals enrolled in Medicaid managed care plans are actually caring for such patients, a new study has found. According to a report in Health Affairs, 25 percent of the primary care physicians serving patients in selected managed care plans are providing 86 percent of the primary care to those plans’ members while 16 percent of those plans’ listed primary care providers have gone more than a year without filing a single claim. Similarly, 25 percent of the medical specialists participating in the plans provided 75 percent of the plans’ [...]

iqtsupport2022-05-10T06:00:21-04:00May 10, 2022|Medicaid, Medicaid managed care|

Federal Health Policy Update for Thursday, April 28

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, April 28. Some of the language used below is taken directly from government documents. White House The White House has announced a series of steps designed to increase the availability of oral treatments for COVID-19. Those steps include nearly doubling the number of places oral antivirals are available in the coming weeks; launching a new effort to establish federally-supported test-to-treat sites; supporting medical providers with more guidance and tools to understand and prescribe treatments; and communicating to the public that safe, effective [...]

iqtsupport2022-04-28T17:23:03-04:00April 28, 2022|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. During the April 2022 Medicaid and CHIP Payment and Access Commission meeting, the Commission voted to approve a package of recommendations to: create a new approach for monitoring access to care for Medicaid beneficiaries; improve vaccine access for adult Medicaid beneficiaries; improve the oversight and transparency of directed payments in Medicaid managed care; and encourage the adoption of health information technology (IT) in behavioral health. The recommendations will appear in MACPAC’s June report to [...]

iqtsupport2022-04-13T06:00:07-04:00April 13, 2022|Alternative payment models, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations|

Medicaid as a Tool for Addressing Racial Health Inequities

Medicaid can be an important tool for addressing racial health inequities, the Kaiser Family Foundation suggests in a new issue brief. Among the measures involving Medicaid that might be undertaken to address racial health inequities and addressing social determinants of health, the brief suggests (in words taken directly from the issue brief): One significant action that would help close coverage disparities for people of color is adoption of the ACA Medicaid expansion in the 12 non-expansion states. Other expansions of Medicaid eligibility could also address racial disparities in coverage and access to care. Making it easier for eligible people to [...]

iqtsupport2022-03-25T06:00:31-04:00March 25, 2022|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, Medicaid, Medicaid managed care, Medicaid regulations|

Federal Health Policy Update for Thursday, March 10

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, March 10. Some of the language used below is taken directly from government documents. White House The White House has posted a transcript of the March 2 press briefing given by its COVID-19 response team to outline the administration’s National COVID-19 Preparedness Plan. 340B Eligibility Protection and Telehealth Extensions in the Omnibus Spending Bill Providers that feared they might lose their eligibility to continue participating in the 340B prescription drug discount program because they have fallen below that program’s Medicare disproportionate share [...]

iqtsupport2022-03-10T17:37:25-05:00March 10, 2022|Centers for Medicare & Medicaid Services, Congress, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy, MedPAC, Telehealth|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The March 2022 meeting began with a follow-up discussion on directed payments in managed care. This presentation reviewed a package of five proposed recommendations related to: improving the transparency of existing directed payment approval documents, rate certifications, and evaluations; collecting new provider-level data on directed payment spending; further clarifying directed payment goals and their relationship to network adequacy requirements; providing guidance for more meaningful, multi-year assessments of directed payments; and improving the coordination of [...]

iqtsupport2022-03-08T10:50:01-05:00March 8, 2022|MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid upper-payment limit|

Federal Health Policy Update for Thursday, January 6

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, January 6. Some of the language used below is taken directly from government documents. Provider Relief Fund The Provider Relief Fund reporting portal is now open for reporting period 2 and will remain open through March 31, 2022. Go here for more information about what organizations do and do not need to report and how to do so. The Provider Relief Fund web page offers updated information about what constitutes an allowable expense when reporting on the use of Provider Relief Fund [...]

iqtsupport2022-01-06T17:30:52-05:00January 6, 2022|Centers for Medicare & Medicaid Services, Coronavirus, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicare, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for Monday, June 28

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, June 28. Some of the language used below is taken directly from government documents. Supreme Court Decision in Affordable Care Act Case The Supreme Court has declined to hear an appeal of a case in which insurers unsuccessfully sued to recover reductions in their Affordable Care Act federal cost-sharing reduction payments. White House The White House has posted a transcript of the June 22 press briefing given by its COVID-19 response team and public health officials. Department of Health and Human Services [...]

iqtsupport2021-06-28T17:33:25-04:00June 28, 2021|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid managed care, Medicare, MedPAC|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The February 2020 MACPAC meeting opened with a continuation of MACPAC’s examination of Medicaid’s role in maternal health, when Medicaid officials from Michigan, New Jersey, and North Carolina joined the Commission to discuss how their states are addressing maternal morbidity and mortality.* The Commission plans to include a chapter on maternal health in its June 2020 report to Congress. Commissioners later turned their attention to policy options for improving enrollment in the Medicare Savings Program. [...]

iqtsupport2020-03-06T06:00:04-05:00March 6, 2020|hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare|

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report. According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially. The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices. Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers [...]

iqtsupport2019-01-09T14:43:28-05:00January 9, 2019|Medicaid managed care|