Medicaid

A Look at Medicaid Managed Care

With 74 million people enrolled in Medicaid managed care plans – roughly 71 percent of the U.S. Medicaid population – the Health Affairs Blog has taken a broad look at Medicaid managed care, addressing the question of how it works, whether it’s working, and what its future may be. The two-part report notes that some Medicaid managed care companies are highly profitable and that this profitability has increased in recent years. It also notes that the manner in which these companies serve their members varies greatly, that their medical loss ratios vary considerably from state to state, and that the [...]

iqtsupport2018-05-08T06:00:00-04:00May 8, 2018|Medicaid, Medicaid managed care|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP issues, met publicly in Washington, D.C. last week. The following is MACPAC’s own summary of its two days of meetings. The April 2018 meeting began with session on social determinants of health. Panelists Jocelyn Guyer of Manatt Health Solutions, Arlene Ash of the University of Massachusetts Medical School, and Kevin Moore of UnitedHealthcare Community & State discussed state approaches to financing social interventions through Medicaid. In its second morning session, the Commission reviewed a draft [...]

iqtsupport2018-04-23T06:00:05-04:00April 23, 2018|MACPAC, Medicaid, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations|

Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing. Or so reports a new study published in the journal Health Affairs. According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims. While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims. Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity Of Billing And [...]

iqtsupport2018-04-05T06:00:27-04:00April 5, 2018|Medicaid|

MACPAC Issues Annual Report, Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has published its annual report and recommendations to Congress. MACPAC’s report addresses three primary areas: Medicaid managed care, telehealth, and Medicaid disproportionate share payments (Medicaid DSH). With 80 percent of Medicaid beneficiaries now enrolled in managed care plans, MACPAC offers three major recommendations for improving Medicaid managed care efforts: permit states to require all of their Medicaid beneficiaries to enroll in a managed care plan extend Medicaid managed care section 1915(b) waivers from two to five years permit states to obtain waivers to waive freedom of choice and selective contracting restrictions MACPAC [...]

iqtsupport2018-03-20T06:00:31-04:00March 20, 2018|Medicaid, Medicaid managed care|

New Report Details Key Health Care Provisions in February Budget Bill

The Congressional Research Service has published a new report describing the health care-related provisions in the Bipartisan Budget Act of 2018 that Congress passed last month to fund the federal government. A major part of that law was the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, and the new report includes descriptions of the Medicare, Medicaid, CHIP, public health, and other health care aspects of the law. Go here to find the Congressional Research Service report Bipartisan Budget Act of 2018 (P.L. 115-123): Brief Summary of Division E—The Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act.

iqtsupport2018-03-14T06:00:47-04:00March 14, 2018|Medicaid, Medicare|

Study Looks at Medicaid and Managed Care

A new Commonwealth Fund study examines how managed care plans have tackled serving new members in Affordable Care Act-authorized Medicaid expansion states. According to the report, these managed care organizations have …focused on identifying and helping high-risk populations and addressing the social determinants of health. MCOs are testing value-based payment strategies that link payment with performance and are increasingly focused on engaging patients in their care. Leaders report common challenges: setting appropriate payment rates; managing members whose needs differ from traditional Medicaid beneficiaries; ensuring access to specialty care; and effectively implementing payment reform and practice transformation. Learn more about how [...]

iqtsupport2018-03-13T06:00:58-04:00March 13, 2018|Affordable Care Act, Medicaid, Medicaid managed care|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met in Washington, D.C. last week to discuss a number of Medicaid and CHIP meetings. The following is MACPAC’s summary of this meeting. MACPAC’S March 2018 meeting began with a review of two draft chapters with recommendations that will be included in MACPAC’s June 2018 report, the first to improve operation of the Medicaid drug rebate program and the second to improve the clarity of substance use disorder (SUD) confidentiality regulations. At the opening session the Commission reviewed a draft chapter on Medicaid drug policy and later voted to approve [...]

iqtsupport2018-03-08T06:00:35-05:00March 8, 2018|MACPAC, Medicaid, Medicaid long-term services and supports, Medicaid regulations for the disabled|

States Adopt New Tools to Control Rising Medicaid Drug Costs

Faced with continued increases in the cost of prescription drugs in their Medicaid programs, states are pursuing new approaches in attempts to control those rising costs. In the past states have employed approaches such as beneficiary prescription limits, negotiating supplemental rebates from manufacturers, requiring prior authorization, implementing state maximum allowable cost programs, and operating preferred drug lists. Recently, however, states are turning to a number of new mechanisms to limit the growth of Medicaid prescription drug costs, including: introducing spending growth caps for Medicaid prescription drug costs, with unplanned increases in spending triggering a closer look at overall drug spending [...]

iqtsupport2018-02-27T06:00:14-05:00February 27, 2018|Medicaid|

GAO: CMS Needs to Do Better Job on Demonstration Evaluations

The federal government needs to do a better job of evaluating Medicaid demonstration programs, according to the U.S. Government Accountability Office. Demonstration programs, on which the federal government spends more than $300 billion a year, exempt states from selected federal Medicaid requirements and regulations so they can test new approaches to providing and paying for care for their Medicaid population. As part of waiving these requirements, the Centers for Medicare & Medicaid Services requires the states to perform or commission evaluations of the effectiveness of those new approaches. According to a new GAO study, however, those reports are not always [...]

iqtsupport2018-02-22T06:00:25-05:00February 22, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well. Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including: establishing time limits on how many months or years individuals may be enrolled in Medicaid; locking out for a [...]

iqtsupport2018-02-09T06:00:25-05:00February 9, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|