Medicaid eligibility redetermination

Federal Health Policy Update for December 7

The following is the latest health policy news from the federal government for December 1-7. Some of the language used below is taken directly from government documents. Congress While Congress has more than a month before the next federal funding deadline of January 19, committees are working to prepare and pass health care legislation. On the House calendar for floor votes next week is H.R. 5378, the Lower Costs, More Transparency Act. This bill would eliminate the pending cuts to Medicaid DSH for two years (those cuts are temporarily suspended through January 19); introduce site-neutral payments for drug administration services [...]

joe2023-12-07T21:50:17+00:00December 7, 2023|340b, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Feds Tackles State Medicaid Redetermination Problems With Penalties

The Centers for Medicare & Medicaid Services has unveiled plans to penalize states that fail to comply with federal standards for redetermining the eligibility of individuals who enrolled in their Medicaid programs during the COVID-19 emergency. Under a new CMS regulation, states that fail to report on their Medicaid eligibility efforts and comply with current requirements face penalties that include civil penalties and reductions in the rate at which the federal government matches state Medicaid expenditures. According to a new interim final rule, CMS is implementing … reporting requirements and enforcement authorities in the Social Security Act (the Act) that [...]

joe2023-12-05T16:30:03+00:00December 6, 2023|COVID-19, Medicaid|

Federal Health Policy Update for August 31

The following is the latest health policy news from the federal government for August 25-31. Some of the language used below is taken directly from government documents. No Surprises Act For the second time in less than a month a court has rejected how federal agencies are implementing the Independent Dispute Resolution process of the No Surprises Act. A federal court concluded that the process for establishing the Qualifying Payment Amount, or QPA – the median rate insurers pay for in-network services and a critical factor in settling payment disputes – inappropriately permits insurers to depress that rate and unfairly [...]

admin2023-08-31T16:09:59+00:00August 31, 2023|Centers for Medicare & Medicaid Services, Medicaid, Medicare, MedPAC|

Some States Struggling With Medicaid Eligibility Redeterminations

As many as 12 states have struggled to comply with federal guidelines for redetermining eligibility of their Medicaid population – enough so that the federal government has had to intervene. The Centers for Medicare & Medicaid Services has reportedly halted Medicaid eligibility redeterminations in six states since April and worked closely with six more after concluding that they were not complying with its guidelines for how to go about redetermining the eligibility of the nearly 94 million Americans who were on the Medicaid rolls when the COVID-19 public health emergency ended. During that emergency, many people became newly eligible for [...]

admin2023-07-24T06:00:49+00:00July 24, 2023|Centers for Medicare & Medicaid Services, COVID-19, Medicaid|

Most Medicaid Participants Don’t Know About Looming Eligibility Redetermination

With the COVID-19 pandemic’s continuous Medicaid eligibility set to expire in a little more than a month, nearly two-thirds of the current Medicaid population is unaware their continued participation in the program will soon be subject to review and could result in their loss of health care benefits. According to a survey conducted for the Robert Wood Johnson Foundation, “In December 2022, more than 6 in 10 adults in Medicaid-enrolled families were not aware of an upcoming return to the regular Medicaid renewal processes…” This could pose a major challenge both for those who lose their Medicaid coverage and may [...]

admin2023-02-23T06:00:41+00:00February 23, 2023|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. [...]

admin2019-04-30T06:00:02+00:00April 30, 2019|Medicaid|