medicaid unwinding

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|

Medicaid Unwinding After One Year

The process known as “Medicaid unwinding” has now been under way for a year. When Congress expanded Medicaid eligibility in response to the COVID-19 pandemic it also banned states from removing participants from their Medicaid rolls; the penalty for doing so was reduced federal Medicaid funding, a price no state was willing to pay. During the course of the pandemic, nationwide Medicaid enrollment rose 22 million, to 94 million last March. But a year ago states were directed to begin reviewing the eligibility of those then on their Medicaid rolls and to remove those who no longer met eligibility criteria. [...]

joe2024-04-02T20:56:42-04:00April 3, 2024|COVID-19, Medicaid|

Federal Health Policy Update for March 21

The following is the latest health policy news from the federal government for March 15-21. Some of the language used below is taken directly from government documents. The White House The White House has announced new actions to advance women’s health research and innovation and issued an executive order in support of that objective. The order directs executive branch agencies to integrate women’s health across the federal research portfolio; prioritize investments in women’s health research; pursue new research on women’s midlife health; and assess unmet needs to support women’s health research. Learn more from this White House fact sheet, which [...]

Looming Medicaid Challenges

State Medicaid programs are facing significant financial challenges in the coming years. Among them: less federal Medicaid matching money, a continued call by providers for increased payments, and a growing demand to use Medicaid to help address behavioral health challenges. In addition, proponents of investing more Medicaid money in home- and community-based services can be expected to ask state Medicaid programs to cover more services while those programs face a growing demand to use Medicaid resources to address social determinants of health such as poor housing and hunger. At the same time, large numbers of individuals continue to fall off [...]

joe2024-02-13T19:59:13-05:00February 15, 2024|Medicaid, Medicaid and homelessness, Medicaid and housing, social determinants of health|

Millions Dropped From Medicaid Rolls

With the two-year “Medicaid unwinding” process nearly half complete, 9.5 million Americans have lost their Medicaid coverage – among them more than 3.7 million children. To date, 48 million of the 71 million people enrolled in Medicaid at pandemic’s end have had their eligibility reviewed. So far, many of those who were at first ruled ineligible were dropped for procedural reasons, such as failing to file paperwork on time, but many of those people eventually had their benefits restored. Still, estimates that 15 million people would lose their Medicaid eligibility by the time the process ended appear to be overlying [...]

joe2024-02-08T22:22:10-05:00February 13, 2024|Medicaid|