Medicaid

CMS Speeds Up Medicaid Review Process

The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs. Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests. According to a recent post on the CMS blog (in CMS’s own words), Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs [note: state plan amendments]. Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016. Between calendar year 2016 [...]

iqtsupport2019-05-14T06:00:36-04:00May 14, 2019|Centers for Medicare & Medicaid Services, Medicaid|

New Poverty Level Standards to Jeopardize Medicaid Eligibility?

The Trump administration is considering changing how the federal government measures inflation for the purpose of calculating the federal poverty level. Such a change, if implemented, could potentially reduce inflation-related increases in the federal poverty level, which in turn could limit the ability of some individuals and families to qualify, or continue to qualify, for a variety of public safety-net services – including, potentially, Medicaid. Among the possible alternatives to the current methodology for calculating inflation is the Chained Consumer Price Index for All Urban Consumers. The Obama administration also explored substituting this index for the current inflation factor. The [...]

iqtsupport2019-05-13T06:00:02-04:00May 13, 2019|Medicaid|

MACPAC Seeks Input on IMDs

A 2018 law calls for the Medicaid and CHIP Payment and Access Commission to report to Congress on institutions for mental diseases, or IMDs, receiving Medicaid payments. The law specifies that MACPAC solicit input from a variety of sources, including the Centers for Medicare & Medicaid Services, state Medicaid and mental health agencies and authorities, Medicaid insurers, Medicaid advocates, and others. To help fulfill this requirement, MACPAC is now soliciting views from stakeholders. Among the many subjects on which MACPAC seeks input are (in MACPAC’s words), state requirements, including certification, licensure and accreditation applied to IMDs seeking Medicaid payment and [...]

iqtsupport2019-05-10T06:00:59-04:00May 10, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|

CMS Adopts Rule to Protect Medicaid Payments

A new Medicaid provider payment reassignment regulation eliminates the ability of states to divert any portion of Medicaid payments to third parties. Such diversion was authorized, in a limited manner, in 2014, when CMS created an exception to the existing prohibition on the diversion of provider payments to third parties. That exception involved diversion of payments to selected third parties, mostly in-home personal care workers, but in this new, final regulation, the agency eliminates this exception, maintaining that it is inconsistent with the Social Security Act. Learn more about the new regulation in a CMS news release or see the [...]

iqtsupport2019-05-07T06:00:52-04:00May 7, 2019|Medicaid, Medicaid regulations|

Senate Finance Committee Reports on Supplemental Medicaid Payments

The majority members of the Senate Finance Committee have published a report on supplemental Medicaid payments. According to the new document, This report seeks to increase educational understanding of Medicaid supplemental payments, as well as outline the reporting mechanisms for these payments to ensure adequate stewardship of taxpayer dollars. The report consists of descriptions of the different types of supplemental Medicaid payments that states make to some providers, including: Medicaid disproportionate share payments (Medicaid DSH) non-DSH payments upper-payment limit payments (UPL payments) demonstration supplemental payments medical education payments It also describes the magnitude of these payments, noting that supplemental Medicaid [...]

iqtsupport2019-05-03T06:00:54-04:00May 3, 2019|Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid upper-payment limit|

Uninsured ED and Inpatient Visits Down Since ACA

Uninsured hospital admissions and emergency department visits are down since passage of the Affordable Care Act. And Medicaid-covered admissions and ER visits are up, according to a new analysis. The report, published on the JAMA Network Open, found that ER visits by uninsured patients fell from 16 percent to eight percent between 2006 and 2016, with most of this decline after 2014, while uninsured discharges fell from six percent to four percent. The rate of uninsured ER visits declined, moreover, at a time when overall ER visits continued to rise. While the Affordable Care Act is likely the cause of [...]

iqtsupport2019-05-01T06:00:26-04:00May 1, 2019|Affordable Care Act, hospitals, Medicaid|

Bureaucratic Requirements May Be Driving Medicaid Enrollment Decline

State eligibility redetermination processes may be pushing down Medicaid enrollment nation-wide. Last year, national Medicaid enrollment fell 1.5 million, more than half of them children, and according to a new report from Families USA, much of that decline may be attributable to the challenging eligibility redetermination requirements imposed on Medicaid-eligible individuals by some states. Those requirements include a 98-page packet that Tennessee sends to individuals seeking to retain their Medicaid eligibility; Arkansas’ limit of 10 days to respond to requests for information to redetermine eligibility; and Missouri’s decision to discontinue using data from other public safety-net programs to redetermine eligibility. [...]

iqtsupport2019-04-30T06:00:02-04:00April 30, 2019|Medicaid|

Low-Income Patients More Likely to End Up in Low-Quality SNFs

Dually eligible individuals are more likely than others to find themselves in low-rated skilled nursing facilities, recent research has found. According to a study published in the Journal of Applied Gerontology, more than 50 percent of dually eligible individuals – those covered by both Medicare and Medicaid – who are admitted to skilled nursing facilities are served by facilities that have low (one or two stars) ratings under Medicare’s five-star quality rating system for nursing homes. Overall, the dually eligible are 9.7 percentage points more likely than patients not on Medicaid to be served by lower-rated facilities. The education of [...]

iqtsupport2019-04-19T06:00:35-04:00April 19, 2019|Medicaid, Medicare post-acute care, post-acute care|

MACPAC Recommends Changes in Medicaid Shortfall Definition

Hospitals’ calculation of their Medicaid shortfall would change under a recommendation that MACPAC voted to make to Congress. That change, in turn, could affect hospitals’ future Medicaid disproportionate share payments. Last week the Medicaid and CHIP Payment and Access Commission voted overwhelmingly to change how hospitals calculate their Medicaid shortfall: the difference between what they spend caring for their Medicaid patients and what Medicaid pays them for that care. Under MACPAC’s proposal, hospitals would need to deduct from their shortfall total all third-party payments they receive for the care they provide to their Medicaid patients. If this proposal were to [...]

iqtsupport2019-04-17T06:00:13-04:00April 17, 2019|hospitals, MACPAC, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

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 wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon. First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and [...]

iqtsupport2019-04-16T06:00:59-04:00April 16, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations|