Medicaid managed care

Federal Health Policy Update for December 15

The following is the latest health policy news from the federal government for the week of December 12-15. Some of the language used below is taken directly from government documents. White House The White House has unveiled its “COVID-19 Winter Preparedness Plan,” the major components of which are expanding easy access to free COVID-19 testing options in the winter; making vaccinations and treatments readily available as cases rise; preparing personnel and resources; and focusing on protecting the highest-risk Americans. Learn more about the plan from this White House fact sheet and go here for a transcript of the White House [...]

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 December 2022 MACPAC meeting began with a Commission discussion on two potential recommendations for improving Medicaid race and ethnicity data reporting. As part of its commitment to prioritizing health equity in all of its work, the Commission is focused on how to improve Medicaid race and ethnicity data collection and reporting. In October, staff presented findings from a literature review and key stakeholder interviews, as well as possible approaches for improving the collection [...]

iqtsupport2022-12-15T06:00:20-05:00December 15, 2022|hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care|

Results of Annual Survey of State Medicaid Programs

The Kaiser Family Foundation has published the results of its annual survey of state Medicaid programs for the 2022 and 2023 fiscal years. Among the survey’s findings (in language taken directly from the Kaiser report): More than 3/4 of states that contract with MCOs [managed care organizations] enroll ≥75% of all beneficiaries in MCOs Some states reported newly implementing or expanding MCO programs States also report continued use of other service delivery and payment system reforms Two-thirds of states are using strategies to improve race, ethnicity, and language data About one-quarter of states are tying MCO financial incentives to health [...]

iqtsupport2022-10-27T06:00:07-04:00October 27, 2022|COVID-19, Medicaid, Medicaid long-term services and supports, Medicaid managed care, social determinants of health, Telehealth|

Federal Health Policy Update for Thursday, July 7

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, July 7. Some of the language used below is taken directly from government documents. The Courts Hospitals may sue state Medicaid programs for failing to ensure that private insurers – such as Medicaid managed care plans – pay hospitals in a timely manner for the care they provide to their Medicaid patients, a federal appeals court has ruled. See the court’s decision in this case. Centers for Medicare & Medicaid Services CMS has proposed a series of changes in the Medicare cost [...]

iqtsupport2022-07-07T16:56:58-04:00July 7, 2022|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Medicaid, Medicaid managed care, Medicare, Medicare reimbursement policy|

Relatively Few Docs Treating Medicaid Patients

Just a small portion of the providers theoretically available to serve individuals enrolled in Medicaid managed care plans are actually caring for such patients, a new study has found. According to a report in Health Affairs, 25 percent of the primary care physicians serving patients in selected managed care plans are providing 86 percent of the primary care to those plans’ members while 16 percent of those plans’ listed primary care providers have gone more than a year without filing a single claim. Similarly, 25 percent of the medical specialists participating in the plans provided 75 percent of the plans’ [...]

iqtsupport2022-05-10T06:00:21-04:00May 10, 2022|Medicaid, Medicaid managed care|

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. During the April 2022 Medicaid and CHIP Payment and Access Commission meeting, the Commission voted to approve a package of recommendations to: create a new approach for monitoring access to care for Medicaid beneficiaries; improve vaccine access for adult Medicaid beneficiaries; improve the oversight and transparency of directed payments in Medicaid managed care; and encourage the adoption of health information technology (IT) in behavioral health. The recommendations will appear in MACPAC’s June report to [...]

iqtsupport2022-04-13T06:00:07-04:00April 13, 2022|Alternative payment models, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations|

Medicaid as a Tool for Addressing Racial Health Inequities

Medicaid can be an important tool for addressing racial health inequities, the Kaiser Family Foundation suggests in a new issue brief. Among the measures involving Medicaid that might be undertaken to address racial health inequities and addressing social determinants of health, the brief suggests (in words taken directly from the issue brief): One significant action that would help close coverage disparities for people of color is adoption of the ACA Medicaid expansion in the 12 non-expansion states. Other expansions of Medicaid eligibility could also address racial disparities in coverage and access to care. Making it easier for eligible people to [...]

iqtsupport2022-03-25T06:00:31-04:00March 25, 2022|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, Medicaid, Medicaid managed care, Medicaid regulations|

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 March 2022 meeting began with a follow-up discussion on directed payments in managed care. This presentation reviewed a package of five proposed recommendations related to: improving the transparency of existing directed payment approval documents, rate certifications, and evaluations; collecting new provider-level data on directed payment spending; further clarifying directed payment goals and their relationship to network adequacy requirements; providing guidance for more meaningful, multi-year assessments of directed payments; and improving the coordination of [...]

iqtsupport2022-03-08T10:50:01-05:00March 8, 2022|MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid upper-payment limit|

How Medicaid Managed Care Cuts Costs

Low-cost Medicaid managed care plans mostly cut their costs by reducing how much care, and how much high-quality care, their members receive. That is the conclusion of a new study published by the National Bureau of Economic Research. According to the study, Medicaid managed care plans succeed in reducing costs less by cost-sharing, negotiating lower provider rates, employing narrow networks, and doing a better job of managing their members’ high-cost chronic medical conditions than they do by leading their members to use fewer high-value, low-cost services such as cancer and diabetes screenings and fewer high-value drugs. The researchers note that [...]

iqtsupport2020-09-02T06:00:59-04:00September 2, 2020|Medicaid|

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report. According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially. The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices. Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers [...]

iqtsupport2019-01-09T14:43:28-05:00January 9, 2019|Medicaid managed care|