Shortly following the end of the COVID-19 public health emergency, pandemic-era restrictions on Medicaid redetermination ended. In that time, over 500,000 people have been disenrolled, interrupting their coverage and impacting their access to healthcare. Some states have kicked off more beneficiaries than others, with Florida taking the lead.
COVID-era policies expanded access to Medicaid and Marketplace plans for millions of people in the US, resulting in the lowest rates of uninsured status ever. However, these policies are set to expire soon, resulting in many people under 65 losing their coverage. In a new Health Affairs article, learn more about the state of insurance coverage of people under 65 years of age and how it’s set to change in the coming decade.
The US Centers for Medicare and Medicaid Services (CMS) has announced a new proposal to help lower prescription drug prices for Medicaid. The rule would establish a survey for drugmakers about drug manufacturing costs and would ensure that Medicaid payments for therapeutics, especially high-price cell and gene therapies, are reasonable via the Medicaid Drug Rebate Program (MDRP).
Dual eligible special needs plans often run up against significant difficulties coordinating care for beneficiaries. A recent analysis by the Kaiser Family Foundation (KFF) examined how states accomplish this complex task, finding that many use managed care, a Financial Alignment Initiative (FAI), or rely upon the Program of All-Inclusive Care for the Elderly (PACE).
Research released by the Robert Woods Johnson Foundation finds that Medicaid supplement payments are inefficiently distributed, requiring a significant overhaul to fix. For example, disproportionate share hospital payments are based on figures from 1992 and leave some states receiving less than $100 for uninsured patients, much less than the $1,500 that others receive per uninsured patient.
With the COVID-19 public health emergency on its way out, states are set to start up the redetermination for Medicaid beneficiaries. Among the millions who will lose healthcare coverage in this process are children, who make up the majority of Medicaid recipients. The number of children to be dropped is still uncertain, but it is estimated to be around 1/3 of kids on the program.
A new analysis from Finch Ratings finds that non-profit hospitals’ bottom lines will be hurt by upcoming Medicaid disenrollment triggered by the imminent end of the COVID-19 public health emergency. Many patients going to not-for-profit hospitals were covered by Medicaid expansions. Since a large number of these patients will be disenrolled, Finch predicts that they will have to receive charity care that hospitals will not be paid for, hurting their revenue.
Just as US states begin the Medicaid redetermination process, a new report by Moody’s Investors Services finds that 28 states will see enrollment drop to numbers equivalent to pre-pandemic levels. Some states, the report notes, will settle on enrollment levels higher than those seen before the pandemic-era Medicaid redetermination pause.
With the imminent end to the COVID-19 public health emergency looming large, pandemic-era Medicaid expansions are set to kick millions off the program in the US. A newly published report from the Urban Institute and Robert Wood Johnson Foundation predicts that up to 18 million people are set to be dropped from Medicaid in the coming weeks and months. Examine this at the state-by-state level in a new Becker’s Payer Issues article.
In a new letter to the Centers for Medicare and Medicaid Services (CMS), representatives from the American Dental Association have asked for increased transparency regarding medical loss ratio (MLR) reporting from Medicaid managed care plans. The authors pointed out that many states were missing substantial chunks of MLR data in recent years.
Patients, providers, and payers alike are anticipating the release of new gene therapies for conditions like cancer and sickle cell disease. The US Centers for Medicare and Medicaid Services (CMS) released an experimental outcomes-based payment model to help manage the high prices of these therapies. Payouts would be based on patient outcomes, like symptom reduction or remission.
As the Medicare redeterminations and the end of the COVID PHE approach, many Medicaid managed care plans are ill-equipped to inform all their members about their status. A recent survey released by the Kaiser Family Foundation found that nearly a third of Medicaid plans have up-to-date contact information for 75% or more of their members.
A recent survey by the Kaiser Family Foundation (KFF) found Medicaid officials from several US states were looking to make telehealth expansions enacted during the pandemic permanent. The survey was made available to Medicaid officials in every state, with several saying they would continue monitoring telehealth utilization for future analysis and decision-making.
The US state of North Carolina will soon vote on whether to expand Medicaid coverage within the state, thereby potentially leaving the ranks of states that have not expanded Medicaid to 10. Republican opposition to the expansion has shifted in the state legislature, with some top former opponents flipping sides.
Social determinants of health (SDoH) like housing instability and food insecurity dramatically impact patient health outcomes. To address these factors, the US Centers for Medicare and Medicaid Services (CMS) has issued a new guidance that allows states to offer benefits for nonmedical services, under the classification of “in lieu of services and settings.”
Changes in the US dual eligible landscape, patients who qualify for both Medicare and Medicaid, have complicated things for payers looking to crack into the market. In a new article on Health Payer Intelligence, Kelsey Waddill discusses 5 important things for payers interested in the dual eligible market to consider beforehand to ensure market success. The first is the increasingly picky dual eligible special need plan enrollment process.
A new article in Bloomberg Government highlighted the role of Meena Seshamani, director of the US Centers for Medicare & Medicaid Services (CMS), in developing the drug pricing reform. Seshamani is working to ensure that the Inflation Reduction Act actually reduces drug prices. Her efforts are being closely watched by the opposition and the pharma industry.
The law mandates that Medicaid must pay for any drugs approved by the US Food and Drug Administration (FDA). This includes high-price drugs approved through accelerated processes, which come with limited data that often negatively impacts reimbursement decisions with other payers. In a recent commentary in JAMA Health Forum, authors describe 4 novel ways that policymakers can handle the problem.
A newly published report from the Robert Wood Johnson Foundation finds that most US adults with a family member on Medicaid are unaware of impending eligibility redeterminations. The redeterminations are set to hit after the COVID-19 public health emergency is ended by the federal government. Many current Medicaid recipients are at risk of losing coverage.
A paper published in JAMA Dermatology late last month found that HPV vaccinations are covered for most people on Medicaid plans, including people with dermatological conditions that put them at-risk for negative health outcomes from HPV infections. The researchers looked at late-2021 data covering Medicaid plans in every US state.
The Institute for Medicaid Innovation released results from its fifth annual “Medicaid Health Plan Survey, ” revealing that 83% of larger Medicaid managed care plans had some strategy in place, compared to one-third of smaller plans. The data, which comes from nearly all US states, shows that most plans account for race and ethnicity in equity strategies.
After the recent approvals of expensive biologics, the impact on Medicaid is unclear. Medicaid must pay for drugs that have been approved by the US Food and Drug Administration (FDA), although Medicare will likely pay the lion’s share of the cost. Other potential blockbusters in the pipeline are also looming large.