medicaid unwinding

Federal Health Policy Update for December 5

The following is the latest health policy news from the federal government for November 22 – December 5. Some of the language used below is taken directly from government documents. Congress The House has posted its session calendar for 2025. Find that calendar here. Yesterday, House Republicans made an offer to House Democrats regarding health care provisions to be included in the continuing resolution (CR) that must pass before December 20. The offer is a conversation-opener and very few details are available. Although most of the proposed policies have bipartisan support, there are some tangible policy differences, including House Democrats’ [...]

joe2024-12-05T17:14:33-05:00December 5, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Federal Update, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update|

Federal Health Policy Update for September 26

The following is the latest health policy news from the federal government for September 20-26. Some of the language used below is taken directly from government documents. Congress Yesterday, Congress passed a continuing resolution to fund the federal government when the new federal fiscal year begins on October 1. The continuing resolution will extend funding for federal agencies at current levels through December 20 of this year. The bill did not include other significant policy provisions. President Biden will sign the bill this week and avoid a shutdown of the federal government. Find the bill text here. Following passage of [...]

joe2024-09-26T16:49:25-04:00September 26, 2024|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Medicaid Enrollment Exceeds Pre-Pandemic Levels

While 25 million Americans have lost their Medicaid eligibility as a result of the post-pandemic “Medicaid unwinding” process, enrollment in the program today exceeds its pre-COVID level. Currently, Medicaid enrollment nationwide is 10 million more than it was in February of 2020, right before COVID struck. In all, 56 million people have had their Medicaid eligibility renewed while 25 million people were removed from the program’s rolls. The current situation varies from state to state; some states have seen enrollment rise while others have experienced enrollment declines. In some states, the status of enrollment gains and losses differs between adults [...]

joe2024-09-25T12:51:45-04:00September 26, 2024|Medicaid|

Feds Set End Date for “Medicaid Unwinding”

States need to complete their “Medicaid unwinding” activities by the end of 2026, the Centers for Medicare & Medicaid Services informed state Medicaid programs in a recent memo. According to the agency, … all states are required to complete a compliance assessment, demonstrate compliance with federal Medicaid and CHIP renewal requirements described at 42 C.F.R. §§ 435.916 and 457.343, and submit a plan outlining steps and milestones for addressing identified areas of non-compliance to CMS by December 31, 2024. Compliance plans will detail how states will achieve compliance with all applicable requirements no later than December 31, 2026. “Medicaid unwinding” [...]

joe2024-09-24T16:50:11-04:00September 25, 2024|Medicaid|

Federal Health Policy Update for August 30

The following is the latest health policy news from the federal government for August 23-30. Some of the language used below is taken directly from government documents. 340B Johnson & Johnson, the pharmaceutical, biotechnology, and medical technologies company, told health care providers this week that it would shift from the long-time 340B upfront discount approach to a rebate model for two of its drugs and that eligible 340B hospitals and other providers will need to purchase the prescription drugs Stelara and Xarelto at list price and then, after dispensing them to patients, will need to submit 340B rebate claims to [...]

joe2024-08-30T15:03:18-04:00August 30, 2024|340b, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health|

Number of Uninsured on the Rise

The number of uninsured Americans has risen significantly over the past year: from 25 million in March of 2023 to 27 million in March of 2024, according to new data from the Centers for Disease Control and Prevention (CDC), with the uninsured rate rising from a record low of 7.7 percent to 8.2 percent. The rise in the number of uninsured people results primarily from individuals who became eligible for Medicaid during the COVID-19 public health emergency, a period during which states could not redetermine eligibility without losing some of the additional funding they were receiving from the federal government [...]

joe2024-08-08T08:46:58-04:00August 7, 2024|Affordable Care Act, Medicaid|

Federal Health Policy Update for June 6

The following is the latest health policy news from the federal government for May 31-June 6. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services The deadline for stakeholders to submit comments on CMS’s proposed FY 2025 Medicare inpatient prospective payment system and long-term-care hospital prospective payment system regulation is Monday, June 10. Go here for further information about the proposed rule and how to submit comments. CMS has posted a bulletin describing billing changes in the Medicare hospital outpatient prospective payment system that will take effect on July 1. Find [...]

joe2024-06-06T20:37:05-04:00June 6, 2024|Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for May 17

The following is the latest health policy news from the federal government for May 10-17. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has announced a further extension of deadlines for fulfilling certain Medicaid unwinding requirements. Some current deadlines will be extended to December 31, 2024 and others through June 30, 2025. States also may seek to extend selected COVID-19-related flexibilities through June 30, 2025. Among the deadlines affected by this announcement are those for using ex parte information to determine eligibility; permitting Medicaid managed care organizations to help [...]

joe2024-05-17T20:18:34-04:00May 17, 2024|Centers for Medicare & Medicaid Services, health equity, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, social determinants of health|

Medicaid Unwinding Extended

The federal government is giving states more time to complete their Medicaid unwinding process – and people still on the Medicaid rolls more time to apply to retain their Medicaid eligibility. In a memo to state Medicaid programs, the Centers for Medicare & Medicaid Services wrote that To continue supporting states’ efforts to establish and update income and eligibility determination systems that maximize states’ ability to ensure that eligible individuals retain coverage, CMS is further extending these unwinding-related…waivers through June 30, 2025. When the Families First Coronavirus Response Act’s prohibition against removing people from state Medicaid rolls ended with the [...]

joe2024-05-15T17:07:11-04:00May 15, 2024|COVID-19, Medicaid|

MACPAC to Talk Medicaid Financing, Supplemental Payments, More

Members of the Medicaid and CHIP Payment and Access Commission will meet publicly on Thursday, April 11 and Friday, April 12. Subjects on the two-day session’s agenda include: Medicaid and children’s health insurance program (CHIP) financing access to home- and community-based services supplemental Medicaid hospital payments such as Medicaid disproportionate share (Medicaid DSH) Medicaid unwinding recommendations for MACPAC’s June report to Congress Go here for a closer look at the MACPAC meeting agenda and for information about how to participate in the meeting.

joe2024-04-09T18:26:20-04:00April 10, 2024|hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH|