Medicaid

Medicaid APMs Moving in New Directions

For the most part, states’ use of alternative payment models in their Medicaid programs so far have focused on the work done by primary and acute-care providers. Now, a number of states are starting to extend their use of APMs in other areas, including: behavioral health providers safety-net providers long-term care providers For a look at what states are doing to drive value in Medicaid payments in these new areas, see the Commonwealth Fund article “The Next Generation of Paying for Value in Medicaid,” which can be found here.

iqtsupport2018-10-18T06:00:25-04:00October 18, 2018|Alternative payment models, Medicaid|

Proposed “Public Charge” Regulation Could Hit Medicaid, Hospitals

If a regulation proposed by the Department of Homeland Security to redefine what constitutes a “public charge” is adopted, millions of people currently enrolled in the Medicaid and Children’s Health Insurance Program might choose to disenroll from those programs rather than risk losing their opportunity to obtain legal permanent resident status in the U.S. The proposed regulation seeks to filter out of possible residency status individuals who might become public charges, or dependent on government programs, over time. A new analysis published by the Kaiser Family Foundation concluded that Under the proposed rule, individuals with lower incomes, a health condition, [...]

iqtsupport2018-10-17T06:00:51-04:00October 17, 2018|Medicaid|

DSRIP Evolves

Medicaid Delivery System Reform Incentive Payment waivers, unleashed by the Affordable Care Act and other Obama administration initiatives, sought to foster a greater focus on value in the delivery of health care. Medicaid DSRIP waivers typically provided new Medicaid funds to health care organizations that met performance goals for improving the quality of care, improving health care outcomes, and improving health care infrastructure in ways that improved care quality and outcomes. To a significant extent, early DSRIP programs helped protect Medicaid payments to hospitals that were jeopardized by hospital-specific and state-wide upper-payment limit problems. State DSRIP initiatives are now moving [...]

iqtsupport2018-10-04T06:00:03-04:00October 4, 2018|Medicaid|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. to review a number of Medicaid- and CHIP-related issues. MACPAC members heard presentations on and discussed the following issues: Multistate Collaboration: Panel on State Perspectives Themes from Interviews on the Development of Hospital Payment Policies DSH Payments: Policy Changes and Policy Options Operational Considerations for Work and Community Engagement Requirements Medicaid Coverage of New and High Cost Drugs Managed Care Oversight Oversight of UPL Payments: Additional Analyses and Policy Options Mandated Report: Therapeutic Foster Care Find outlines of these subjects and additional materials by clicking the links [...]

iqtsupport2018-09-25T06:00:56-04:00September 25, 2018|MACPAC, Medicaid, Medicaid managed care, Medicaid regulations|

CMS Reinforces Need for Budget Neutrality in Medicaid Waivers

States that seek federal waivers for permission to employ new approaches to serving their Medicaid population will have to pass more rigorous tests to ensure that those new approaches are budget-neutral, the Centers for Medicare & Medicaid Services has announced. In a detailed letter to state Medicaid directors, CMS outlines some of the current methodologies employed by states to demonstrate the budget neutrality of their waiver requests and details instances in which it will judge those methodologies differently in the future. A news release accompanying the letter explains that ….this letter marks the first time that CMS has formally outlined [...]

iqtsupport2018-08-31T06:00:11-04:00August 31, 2018|Medicaid|

Medicaid Expansion Helping Diabetics

The Affordable Care Act’s Medicaid expansion has led to a 40 percent increase in the number of prescriptions for diabetes medicine filled in the 30 states that expanded their Medicaid programs. Meanwhile, there was no change in the number of diabetes-related prescriptions filled in states that did not expand their Medicaid programs. This is considered important because it suggests that many low-income people who either could not afford their diabetes medicine or whose illness was undiagnosed are now being treated for the disease – a significant development because every diabetic who is treated for the condition represents a cost savings [...]

iqtsupport2018-08-08T06:00:12-04:00August 8, 2018|Affordable Care Act, Medicaid|

Battle Over Medicaid Work Requirements Not Over

The Secretary of Health and Human Services is not accepting a recent federal court ruling as the final word on Medicaid work requirements. Although the court ruled against a federally approved plan to permit the state of Kentucky to implement a work requirement for some able-bodied Medicaid recipients, HHS Secretary Alex Azar insists that his department will continue to support work requirements for Medicaid beneficiaries. Azar told a Heritage Foundation audience that We suffered one blow in district court in litigation, but we are undeterred. We’re proceeding forward…We’re fully committed to work requirements and community participation in the Medicaid program…we [...]

iqtsupport2018-08-01T06:00:24-04:00August 1, 2018|Medicaid|

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs. According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible. Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it. Despite this, the authors note, access to [...]

iqtsupport2018-07-23T06:00:18-04:00July 23, 2018|Affordable Care Act, Medicaid|

CMS: Not Done With Medicaid Work Requirements

Despite the ruling of a federal court that Kentucky’s new Medicaid work requirement violates federal law, the Centers for Medicare & Medicaid Services has not ruled out approving future requests from state governments to impose work requirements on Medicaid recipients. Or so asserted CMS administrator Seema Verma at a recent health care event in Washington, D.C. The Washington Examiner reports that at that event, Verma said that We are looking at what the court said. We want to be respectful of the court’s decision while trying to push ahead with our policy and our goals. CMS currently has applications from [...]

iqtsupport2018-07-18T09:24:15-04:00July 18, 2018|Medicaid|

Medicaid Managed Care Plans Suffer High Physician Turnover

The physician networks developed by Medicaid managed care plans suffer from a degree of turnover that threatens continuity of care for their members. While the number of Medicaid managed care plans using so-called narrow networks of providers declined by more than a third between 2010 and 2015, physician turnover is higher in those narrow network plans: three percentage points higher after one year and 20 percentage points higher after five years than the networks of plans that do not employ narrow networks. Collectively, Medicaid managed care plans experienced physician turnover of 12 percent a year from 2010 to 2015. Learn [...]

iqtsupport2018-07-10T06:00:28-04:00July 10, 2018|Medicaid, Medicaid managed care|