Medicaid

Improper Medicaid, CHIP Payments on the Rise

The rate at which Medicaid and the Children’s Health Insurance Program made improper payments rose considerably in federal fiscal year 2019. According to the Centers for Medicare & Medicaid Services, the Medicaid improper payment rate in FY 2019 was 14.9 percent, amounting to $57.36 billion in improper payments. The improper payment rate that year for CHIP services was 15.83 percent, representing $2.74 billion in improper payments. Both are significant increases over FY 2018, when the Medicaid improper payment rate was 9.7 percent, representing $36.25 billion, and the CHIP rate was 8.57 percent, for $1.39 billion. CMS maintains that the improper [...]

iqtsupport2019-11-20T06:00:32-05:00November 20, 2019|Centers for Medicare & Medicaid Services, Medicaid|

Verma Addresses Medicaid Issues

Earlier this week, Centers for Medicare & Medicaid Services administrator Seema Verma spoke at a conference of the National Association of Medicaid Directors. In addition to discussing a proposed regulation posted earlier in the day that would introduce changes in the regulation of state financing of their Medicaid programs, Verma also addressed: Medicaid demonstration programs Medicaid work requirements a shift toward value-based payments better coordination of care for the dually eligible (individuals serve by both Medicaid and Medicare) enrollment issues improvements in the efficiency of the federal Medicaid bureaucracy Read Verma’s complete remarks here.

iqtsupport2019-11-15T06:00:58-05:00November 15, 2019|Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid upper-payment limit|

MACPAC Posts Meeting Transcript

The Medicaid and CHIP Payment and Access Commission met in Washington, D.C. earlier this month. The issues on MACPAC’s agenda were: state readiness to report mandatory core set measures analysis of buprenorphine prescribing patterns among advanced practitioners in Medicaid Medicaid’s statistical information system (T-MSIS) Medicaid disproportionate share hospital payment (Medicaid DSH) allotments Medicaid policies related to third-party liability Medicaid and maternal health A transcript of the MACPAC meeting is now available. Find it here.

iqtsupport2019-11-14T06:00:13-05:00November 14, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

Feds Open Door for Exemptions from Medicaid IMD Exclusion

New federal guidelines will make it easier for state Medicaid programs to cover mental health services provided in institutions for mental diseases (IMD). For years, Medicaid regulations greatly limited the ability of states to pay for care – generally, care related to substance abuse disorder treatment – provided in IMDs; this was generally known as the IMD exclusion. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act, which was passed in 2018, opened the door for more exceptions to these limits, and last week, [...]

iqtsupport2019-11-13T06:00:36-05:00November 13, 2019|Centers for Medicare & Medicaid Services, Medicaid|

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 Commission devoted its Thursday morning discussion to integration of care for beneficiaries who are dually eligible for Medicaid and Medicare. Panelists Amber Christ, directing attorney at Justice in Aging; Griffin Myers, chief medical officer at Oak Street Health; and Michael Monson, senior vice president for Medicaid and complex care at Centene, presented beneficiary, provider, and health plan perspectives and a question and answer session followed. After lunch, MACPAC staff briefed the Commission on [...]

iqtsupport2019-11-07T06:00:47-05:00November 7, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

Medicaid Expansion Brings Improvements to Expansion States

States that expanded their Medicaid programs under the Affordable Care Act have experienced fewer hospital admissions, shorter lengths of stays in the hospital, and lower hospital costs, according to a new Health Affairs study. Specifically, they experienced: a 3.1 percent decline in inpatient days a 3.5 percent decrease in discharges for conditions considered “ambulatory care-sensitive,” such as diabetes, chronic respiratory problems, and pneumonia a reduction of nearly three percent in hospital costs. Learn more about how Medicaid expansion has improved the health of the population in states that expanded their Medicaid programs in the Health Affairs study “Medicaid Expansion Associated [...]

iqtsupport2019-11-06T06:00:39-05:00November 6, 2019|Affordable Care Act, Medicaid|

MACPAC Looks at Medicaid Substance Abuse Treatment

The treatment of substance abuse problems with medication within the Medicaid population is the subject of a new report by the Medicaid and CHIP Payment and Access Commission. As required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, which was enacted last year, MACPAC has prepared a report on how selected states administer and regulate the use of medications used to treat opioid and alcohol use disorders. Among its findings: The frequency with which providers are prescribing medication to treat opioid and alcohol use disorders has exploded in recent years. States are [...]

iqtsupport2019-11-05T06:00:24-05:00November 5, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|

Verma Hints at More Medicaid Changes, Deregulation

Stay tuned for more Medicaid changes, Centers for Medicare & Medicaid Services administrator Seema Verma told a Las Vegas health care gathering last week. CMS, she told her audience, will …soon outline new opportunities for states to flip the Medicaid paradigm and free themselves from federal micromanagement. While Verma offered few details, one idea clearly emerged: there will be more deregulation. She insisted, for example, that Medicaid work requirements are not dead. While such requirements have run into trouble in the courts in recent months, she explained that CMS is developing new implementation guidelines to address some of the challenges [...]

iqtsupport2019-10-31T06:00:04-04:00October 31, 2019|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Number of Uninsured Children on the Rise

The number of children insured by Medicaid and CHIP has fallen by more than one million over the past two years after reaching an all-time low (by percentage) in 2016. Why? According to the New York Times, Some state and federal officials have portrayed the drop — 3 percent of enrolled children — as a success story, arguing that more Americans are getting coverage from employers in an improving economy. But there is growing evidence that administrative changes aimed at fighting fraud and waste — and rising fears of deportation in immigrant communities — are pushing large numbers of children [...]

iqtsupport2019-10-23T06:00:06-04:00October 23, 2019|Medicaid|

Immigrants Intimidated by New Public Charge Guidelines?

Immigrants served by community health centers appear less inclined than in the past to seek public aid to help them with their medical problems. And community health center staff believes this is the result of confusion and fear as a result of changing federal immigration policies. As stated in the Kaiser Family Foundation issue brief “Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among Health Center Patients,” Health centers reported that, in recent months, immigrant patients have declined to enroll or reenroll themselves and/or their children in Medicaid for fear of public charge. Health center respondents [...]

iqtsupport2019-10-16T06:00:49-04:00October 16, 2019|Medicaid, Medicaid regulations|