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This analysis examines 12 Medicaid managed care state websites' transparency of enrollment, payment, and quality data specific to young children to measure their performance.
This blog reviews examples of state partnerships with public housing authorities (PHAs) that support public housing to improve health and social outcomes.
This brief reviews discussions with experts on how the Medicaid Equity Monitoring Tool (MET) can address the effects of systemic racism in Medicaid.
This commentary reviews key updates to health-related social needs (HRSN) compared to those previously outlined in the past bulletin.
This toolkit can inform planning related to implementing continuous enrollment policies, adopting alternative payment models to encourage providers to embrace innovative pediatric care delivery practices, and developing an oversight and quality improvement strategy to promote improved health and wellbeing outcomes for young children.
This blog shares resources detailing how Medicaid, policymakers, plans, and healthcare providers increasingly engage community members to inform program design and implementation.
This toolkit includes materials state agencies can use to recruit members for the Beneficiary Advisory Council (BAC), including a recruitment flyer, template social media graphics, core messages, website copy, and newsletter copy.
This blog reviews key strategies for effective planning and underscores planning as a foundational activity for resilient and adaptable health departments.
This webinar highlights state approaches addressing health-related social needs (HRSN) in Medicaid managed care programs, followed by a discussion with state Medicaid officials.
This blog connects evidence and implementation resources with emerging state and federal policies about behavioral health to better support patients.
These customizable resources support state agencies in recruiting members for the Beneficiary Advisory Council (BAC).
This toolkit includes resources designed to help states effectively promote information about Marketplace enrollment and health plan options to consumers during the annual open enrollment period.
This blog highlights the new Oregon Project Independence Medicaid (OPI-M) waiver, which allows more at-risk Medicaid-eligible older adults and people with disabilities to receive long-term services and supports.
This blog reviews the significance of promoting Early and Periodic Screening, Diagnostic and Treatment (EPSDT) awareness.
This expert perspective provides an overview of CMS’ new Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidance, which represents CMS’ most comprehensive discussion of EPSDT requirements in over a decade.
This customizable slide deck template supports internal state agency communication about the Beneficiary Advisory Council (BAC) and Medicaid Advisory Committee (MAC) and a summary of the new advisory groups' functions, objectives, composition, and outcomes.
This blog explores changes in national-level coverage rates by demographic characteristics such as age, employment, race and ethnicity, immigration status, poverty status, and Medicaid expansion status.
This blog reviews what CMS expects from states and how CMS will assess states' Medicaid/CHIP renewal progress to comply with the new requirements.
This blog examines CMS guidance to implement Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements.
This webinar gathered Medicaid stakeholders from communities and state agencies to discuss practical steps to address health literacy through improved communications, national cultural and language access standards (such as CLAS), and community engagement.
This blog examines the following steps to strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA) in Medicaid and CHIP.
This blog examines MODRN's early contributions to quality measurements and how it benefits states and university partners.
This blog highlights the aftermath of the Medicaid unwinding and state efforts to smooth coverage transitions.
This blog examines how state implementation choices will impact the success of multi-year continuous eligibility for children.
This blog walks through state-level findings regarding different types of health insurance and changes by age category.
The Tennessee lawsuit alleged four major types of failures by the state.
This dual-language toolkit provides families with information on Medicaid and CHIP and how to apply or re-apply.
This blog post reviews and links to the CMCS Informational Bulletin (CIB) and accompanying slide deck.
This blog examines community-based assistance programs and resources in each state.
This blog explores the new integrated health partnership program and how it impacts communities in Minnesota.
This infographic highlights the unique healthcare challenges people in the LGBTQ+ community face and how Medicaid agencies can support high-quality LGBTQ+ healthcare.
This blog reviews the Government Accountability Office's (GOA) report entitled: “Medicaid: Federal Oversight of State Eligibility Redeterminations Should Reflect Lessons Learned after COVID-19.”
This report reviews and explains how the Access and Managed Care Rules will significantly improve access to care, data and payment transparency, and beneficiary engagement in healthcare.
This blog highlights key details from the new resources published by the state of Tennessee to help stakeholders assist families who may be eligible for the new diaper benefit.
This blog highlights recent Medicaid Drug Rebate Program (MDRP) policy developments.
This blog examines the assumptions and justifications behind the 2025 premium increases for individual and small-group market health plans in the District of Columbia (DC), Maine, Maryland, Oregon, and Vermont.
This blog examines CMS’s decision to post state Managed Care Program Annual Reports (MCPARs) and the transparency of continuing to do so going forward.
This state toolkit intended to support decision-making in states interested in, actively pursuing, or implementing section 1115 demonstrations to provide continuous enrollment (CE) to Medicaid and CHIP populations, with a focus on multi-year CE for young children.
This blog highlights current language and accessibility supports on state websites and suggests how states can make improvements.
This blog discusses how the proposed rule would establish baseline organizational standards, include emergency services requirements, and provide Medicaid reimbursement for certain services outside a clinic.
This episode of the Medicaid Leadership Exchange podcast explores how Medicaid can better serve tribes by establishing clear lines of communication between tribal communities and Medicaid staff, featuring perspectives from two tribal leaders and an Arizona Medicaid leader.
That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This blog examines what State Directed Payments are, how they can be used to improve access to care, and some changes in how CMS will allow and regulate them.
This blog reviews how many states across the nation are using videos to demonstrate helpful concepts related to enrolling in and renewing Medicaid and CHIP coverage.
This brief highlights key considerations to shape Medicaid policies that enhance health outcomes and quality of care for LGBTQ+ individuals.
This blog discusses how MCPs can partner with homeless service providers to enhance care and services for people experiencing homelessness.
This episode of the Medicaid Leadership Exchange podcast explores how Medicaid agencies can better serve children with special healthcare needs and their families.
This blog reviews six key design choices in The Center for Health Care Strategies’ new resource, Developing Primary Care Population-Based Payment Models in Medicaid: A Primer For States.
This podcast episode shares the story of a parent advocate working with Ohio Medicaid to break down silos and improve communication across state agencies serving families, especially those who have complex needs.
This report examines states’ use of Medicaid section 1115 demonstrations to cover housing, nutrition, and other HRSN services and supports for pregnant and postpartum individuals and young children who are experiencing or at risk of unmet HRSN.
This fact sheet can help Medicaid agencies, health plans, providers, and other healthcare organizations involve community members more effectively in program and policy decision-making.
This blog details why state agencies can and should post relevant enrollment and eligibility information on social media platforms to connect with those eligible for Medicaid/CHIP.
Part Three in this series of webinars provides a detailed overview of provisions in the Access Rule that aim to enhance access to HCBS, standardize quality measures and reporting requirements, and help address long-standing shortages in the direct care workforce.
This commentary reviews changes beginning in fiscal year (FY) 2025 requiring states to report a subset of Child and Adult Core Set measures by race and ethnicity, sex, and geography. By requiring data disaggregation for key populations of interest, policymakers, advocates and researchers will have a new tool to measure, monitor and inform policies and practices that focus on health equity.
This expert perspective highlights an MMC approach newly added to the Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity.
This blog reviews CMS marketplace enrollment data from February 2024, which was after the 2024 Open Enrollment Period had ended in nearly all states.
This blog reviews changes to the Medicaid and CHIP programs to streamline enrollment for eligible individuals.
This blog post highlights three key lessons for agencies to consider when embarking on an organizational development journey in Medicaid.
This podcast highlights the need to better address maternal health disparities, particularly for Black, American Indian, Alaskan Native women, and people living in rural communities.
This commentary examines what states will need to create and support a Beneficiary Advisory Council (BAC) composed solely of current and former Medicaid enrollees, their family members, and paid and unpaid caregivers under the Access Rule.
This podcast explores the importance of integrating benefits for dual eligibles to create more person-centered care and services for members.
The first blog in this new series identifies landing pages for online Medicaid, CHIP, and marketplace application portals in each state and links to the application that can be printed and returned by mail.
This blog reviews changes to the Managed Care Rule, where the CMS updated the definition and oversight of ILOS in important ways that should both increase the flexibility to use ILOS as a tool for improving health and increase the integrity of ILOS spending.
This blog post reviews the new provisions related to documentation of access to care and service payment rates from the Access Rule.
This brief explores approaches to incorporating health equity in value-based payment design, creating payment models that positively impact health disparities, outcomes, and costs in Medicaid.
This episode of the Medicaid Leadership Exchange podcast highlights the need to better address maternal health disparities, particularly for Black, American Indian, and Alaskan Native women, and people living in rural communities.
This blog details the Beneficiary Advisory Councils (BACs) established by the rule representing a historic opportunity to leverage the experiences of people enrolled in Medicaid to improve state Medicaid programs.
This blog takes a closer look at the provisions of the rule relating to the adequacy of MCO provider networks: searchable provider directories, analyses of payments to network providers, appointment wait time standards, secret shopper surveys, and remedy plans.
This blog reviews new data on the share of children with Medicaid/CHIP coverage of more than 7,000 school districts nationwide and the importance these coverage programs have to students.
This commentary summarizes the provisions of the new Department of Health and Human Services regulation and discusses the implications for states.
This inaugural post highlights state activity from March and April 2024.
During this webinar, experts from Manatt Health provided an overview of the provisions in both rules regarding access monitoring, enrollee engagement, provider payment transparency, and HCBS.
This blog examines new data for January 2024, which was the last month of the 2024 Open Enrollment Period in nearly all states.
This blog post reviews existing regulations on nursing home staffing and breaks down CMS’ new staffing requirements, including how states will need to respond.
This first episode in a new season of the podcast highlights the importance of Medicaid to the millions of people living in rural communities across the country.
This blog provides a high-level summary of the Managed Care Rule.
This latest update to the resource includes descriptions of the approaches 26 states are taking within MMC to promote health equity, examples of what states are doing examples, and excerpts from state contracts and procurement documents.
This blog uses data from the U.S. Census Bureau’s Household Pulse Survey to track trends in adult health insurance coverage rates as states “unwind” Medicaid continuous coverage and restart standard redetermination procedures.
This blog examines research on continuous Medicaid coverage and mental health among mothers and infants in the postpartum year.
This blog examines which states nationwide have taken steps toward Medicaid coverage for doula care.
This report summarizes and examines the content of the most recent final rule from CMS.
The survey series provides an in-depth view of health plans’ responses regarding risk mitigation, disenrollment, and outreach.
During this webinar, experts from Manatt Health reviewed key Medicaid and CHIP provisions in the final rule and discussed considerations for state policymakers.
On April 2, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters (NBPP) for 2025. This annual rule governs core provisions of the Affordable Care Act (ACA), including operation of the health insurance Marketplaces, standards for health plans, insurance brokers (including web-brokers), and the risk adjustment program. This blog focuses on provisions of the final rule of interest to state officials.
This blog examines increases in Marketplace enrollment among people losing Medicaid coverage during the unwinding.
This blog examines the first batch of call center data provided by CMS from March and its shortcomings.
In this blog, The Georgetown University Center for Children and Families outlines and expands on the 10 "Do Nots" outlined in the bulletin.
In this blog, the Center for Health Care Strategies examines how state agencies employ health literacy strategies to improve health equity.
CMS recently added new questions on the topic of sexual orientation and gender identity (SOGI) to the application used by HealthCare.gov and released guidance for states that want to add the same questions to their Medicaid and Children’s Health Insurance Program applications. This brief summarizes the guidance and presents several considerations for states as they look to improve their collection of sexual orientation and gender identity data.
CMS released an updated State Medicaid and CHIP Telehealth Toolkit on issues from billing best practices to strategies for using telehealth in schools. This blog shares a toolkit that includes state best practices and strategies, information such as a state checklist, a Medicaid telehealth assessment plan, and telehealth communication strategies.
This blog shares a “Medicaid Churn Toolkit” to guide Medicaid agencies and their partners in the design and implementation of efforts to reduce churn.
That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This blog compared states' ex parte rates from their first month of unwinding to the most recent to identify whether progress has been made.
That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This blog highlights findings from a rapid message test conducted to gauge the persuasiveness of Medicaid renewal message themes.
This blog discusses how policymakers are addressing access to care through telehealth, safety net and emergency services, and adjusted reimbursement rates to Medicaid-enrolled providers.
This blog reviews FAQs from the Georgetown Center on Health Insurance Reforms' Navigator Resource Guide related to the conclusion of the annual open enrollment period.
This blog from State Health & Value Strategies (SHVS) examines new HRSN highlights from states across the country and reviews recent updates to SHVS' HRSN Toolkit.
This webinar explored successful practices for data coordination between SNAP and Medicaid agencies gleaned from a 50-state survey and three state case studies.
This blog highlights a new Commonwealth Fund post, which assesses the status of state efforts to smooth coverage transitions during the unwinding and discusses the need for more timely and accurate data.
This blog reviews SBMs reporting of Marketplace transition outcome data, state variations in reporting, and considerations for presenting outcomes data.
This webinar explores successful practices for data coordination between SNAP and Medicaid.
This blog shares stories from public sector leaders across the country as they navigate day-to-day operations.
This blog summarizes a number of new and ongoing policy changes that will impact the Marketplace as the annual open enrollment period for Affordable Care Act Marketplace coverage kicks off November 1 in most states.
This blog shares new CMS data on Marketplace enrollment and transitions, and separate CHIP enrollment.
This blog examines variations in states' reporting of indicators and data highlights.
This blog reviews how Medicaid programs in Connecticut, Massachusetts and Rhode Island have engaged with commercial payers, providers, patients, advocates and other parties to create and adhere to multi-payer aligned measure sets.
This blog provides a high-level overview of key provisions included in the final rule that will facilitate enrollment and retention of Medicare Savings Program coverage.
This blog discusses states' approaches to support coverage through the unwinding period.
This report shares findings with policy implications for how counts of the uninsured should be interpreted while highlighting the importance of policies that promote Medicaid enrollment and retention.
This blog discusses available options states can adopt to improve ex parte rates.
That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This brief examines whether neighborhood conditions vary with children who rely on Medicaid or CHIP for coverage.
This brief describes existing payment barriers and opportunities for primary care providers serving children to work toward financially sustaining care transformation.
This blog shares the findings of CHIR's research into the rate requests from select states with early rate filing deadlines to see what’s behind the premiums consumers could be facing in 2024, both on- and off-Marketplace.
This toolkit identifies opportunities and explores strategies to improve call center functionality.
This publication explores how Medicaid enrollees searching for new health plans on the private market are facing aggressive and misleading marketing of limited benefit products that often fail to protect consumers from the steep cost of healthcare.
In this podcast, public officials from Wisconsin and Arizona share how their state’s Medicaid programs are partnering with the housing sector to tackle the challenges faced by people experiencing homelessness.
This brief identifies ways in which states can leverage their Medicaid managed care programs to advance their health equity goals.
This blog examines trends in adult health insurance coverage rates as states “unwind” the Medicaid continuous coverage requirement and restart standard redetermination procedures.
This blog examines states' use of data dashboards to monitor progress on coverage transitions during the unwinding.
This blog discusses how data dashboards allow states to make proactive decisions about what data to release and on what schedule.
This commentary shares how Medicaid supported Carolyn in accessing disability coverage after she fell in her home and injured her hip.
This blog examines two case studies that highlight how the profile can support the enrollment efforts of local organizations and departments.
This blog discusses how states are approaching helping their residents secure coverage.
This blog discusses how data dashboards can be useful for states to make proactive decisions about what data to release and on what schedule and then organize that data in an easy-to-digest visual format that facilitates the interpretation of key coverage trends.
This commentary shares how Medicaid supported Susan in accessing lifesaving care to treat her high blood pressure and kidney disease.
Addressing Health Related Social Needs (HRSN) in 1115 demonstrations can help states improve coverage, access, and equity. This blog examines innovative state demonstrations and implications for cross agency partnerships.
This blog discusses federal support for states looking to expand postpartum coverage through Medicaid.
This report examines how states coordinate across Medicaid and the Supplemental Nutrition Assistance Program.
This blog examines how two newly-released proposed rules from CMS could reshape the federal regulatory landscape for Medicaid and the Children’s Health Insurance Program.
This blog aims to summarize the access rule which includes changes to Payment for Services, Medicaid Advisory Committees, and Home and Community-Based Services.
This blog discusses that, while there are many factors that may affect the scale of coverage losses from procedural disenrollments, one of the significant concern is notices.
This blog discusses how new CMS approvals in Oregon and Washington will protect health coverage for children and families during this Medicaid unwinding, minimizing coverage disruptions and easing transitions to new sources of health coverage.
This blog examines Georgia’s efforts to address maternal mortality, partly through Medicaid postpartum coverage extension.
This commentary discusses how Medicaid supported Sonia whose adopted son Amir who has developmental disabilities.
The blog discusses parameters for reentry 1115 demonstrations.
This blog explores the updated model and its' three primary goals to risk adjustment.
This blog examines issues including network adequacy, door-to-door enrollment assistance, re-enrollment decision hierarchies, and standardized plans.
This webinar explores a new opportunity to improve access to care and services for people returning to the community from state prisons, county jails, and youth correctional facilities.
This commentary shares how South Dakota's decision to expand Medicaid eligibility will support Sarah, who had to leave her full-time job to care for her son, and her family in accessing needed care.
This blog shares how CMS guides researchers and other consumers in their use of T-MSIS data through production of data quality assessments of the race and ethnicity data along with other data such as enrollment, claims, expenditures, and service use.
This commentary discusses how Medicaid supported Ashley in taking control of her health and getting the help she needed after she unexpectedly lost her private health coverage. That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This blog examines how the Consolidated Appropriations Act of 2023 will strengthen the CHW workforce and improve patient care.
This Q&A style blog discusses ex parte redeterminations in which Medicaid officials attempt to make a redetermination of an individual’s eligibility based on available data, without requiring additional information from the individual.
On December 12, 2022, the Centers for Medicare & Medicaid Services released its proposed Notice of Benefit & Payment Parameters for plan year 2024. This blog assess provisions of the proposed rule that are of interest to state-based marketplaces regulators.
This blog delves into specific actions states can take to minimize gaps in coverage for consumers who become ineligible for Medicaid.
This commentary shares how Medicaid supports individuals with cerebral palsy.
This report breaks down the estimate that if the PHE expires in April 2023, 18.0 million people will lose Medicaid coverage in the following 14 months.
This blog reviews considerations for California's Medi-Cal managed care plans as they fortify provider networks to ensure that older adults and people with disabilities have their health and social needs met.
This commentary shares how Colorado’s Medicaid program supports small business owners.
This commentary explores how Medicaid supports individuals who have grown up in the foster system.
This report can help states design and implement effective Medicaid PBP models.
This commentary shares insights from a physician who serves a rural community.
In this webinar, experts from Bailit Health reviewed a new resource, Addressing Health-Related Social Needs Through Medicaid Managed Care, which describes approaches to require and/or incentivize Medicaid plans to address health-related social needs.
This blog is part of a series on unwinding strategies for states and highlights ideas from earlier works on issues like continuity of care, health equity implications, etc., and offers new ones for states to consider to support continuity of coverage.
This commentary shares how Medicaid supported a family whose daughter was diagnosed with type-1 spinal muscular atrophy.
This survey offers findings and insights that can help inform efforts led by Medicaid health plans and state agencies to meet enrollees' needs post-COVID.
This commentary shares the story of Natalie and her family. Natalie was born with a disability but access to Medicaid has allowed her to live her best life possible, at home with her parents.
This commentary shares how Medicaid supported Milly throughout her pregnancy. That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This brief includes a checklist of eight key questions that can help state purchasers and other payers develop a robust payment and spending strategy focused on advancing health equity.
This commentary shares how Medicaid allowed Chrystal to access the healthcare she needed while she pursued her college degree in Milwaukee.
This blog discusses how Benefits Data Trust is supporting North Carolina and Washington over the next two years in achieving the ambitious goals they have set to increase access to Medicaid and social service benefits.
This commentary tells Paul's story and how Medicaid supported him in receiving a kidney transplant.
This blog discusses how, given gaps in access to dental insurance and providers, state health policy is an important area for achieving oral health equity.
This commentary discusses how Medicaid supported Susie when she learned her young daughter Tymia was diagnosed with sickle cell disease.
This blog analyzes the new rule's ability to close gaps and extend best practices identified by CMS and states in the course of preparing for the end of the Medicaid continuous coverage requirement under the federal public health emergency (PHE).
This blog discusses the contents of the Public Charge Final Rule.
That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This issue brief reviews proactive strategies that states can deploy to support postpartum individuals in maintaining health coverage and access to care when the Medicaid continuous coverage guarantee ends and beyond.
This commentary tells the story of how Medicaid guided Alicia through her pregnancy and the birth of her son while incarcerated.
The blog analyzes Medicaid community-based palliative care benefits that several states are developing to advance palliative care.
This commentary explores how Medicaid saved Laticia's life who battled with gastrointestinal problems and mental health issues. Medicaid provided healthcare visits, medication and therapy for her anxiety and depression.
This blog identifies strategies for state-based Marketplaces, in partnership with Medicaid agencies, departments of insurance, consumer assisters, and participating insurers, to help maintain continuity of care.
This commentary tells the story of Danielle, whose small business struggled in the opening months of the COVID-19 pandemic. In addition to trying to keep her business afloat, Danielle also had to care for her son and home school him. Medicaid provided Daneille with the mental health support needed to keep moving forward during an incredibly challenging period.
That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
This blog explores how states can coordinate and prepare communications related to the end of the Medicaid continuous coverage requirement with clear messaging to inform enrollees, help to reduce churn, and maximize coverage renewal, retention, and transition.
This report provides excerpts of health disparities and health equity language from Medicaid managed care (MMC) contracts and requests for proposals (RFPs) from 17 states and the District of Columbia. The criteria for inclusion in this compendium are contracts and RFPs that explicitly address health disparities and/or health equity.
This blog reviews ways states can support the identification and implementation of tech-enabled innovations to Medicaid systems.
This commentary tells the story of Adrian, who works with the Medicaid-funded Mississippi Youth Programs Around the Clock program. Adrian's work provides youth and their families with needed "wraparound" services to cultivate healthier communities.
That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.
With new budget initiatives, a California Momnibus Act, and a new Medicaid transformation initiative, the state is seeking to advance more whole-person care for pregnant and birthing people, and to ensure and expand access to reproductive health care, including abortion services.
This commentary tells the story of Naomi who enrolled in Medicaid after she lost her job when pregnant with her son, who was born prematurely. Medicaid provided in-home attendants, a wheelchair, medications and other necessities to help improve her son's quality of life.
This new episode of the Medicaid Leadership Exchange podcast explores the inner workings of Medicaid’s workforce recovery and the opportunity to build a more diverse, equitable, and inclusive work culture.
This commentary tells the story of Regina, who is able to help provide her daughter with physicals, immunizations, dental visits and medication—which the family couldn’t obtain without Medicaid coverage.
The podcast episode features Medicaid leaders discussing the need for agency leadership to engage in self-observation and recognize bias when committing to advance equity within their agencies and for enrollees.
The webinar aimed to bring together those in states who have implemented social risk factor screening measures for incentive use in managed care contracts.
This blog explores how states can use Medicaid data to quantify tobacco use within this population, identify related best practices, and make recommendations for scaling.
This blog explores the 1902(e)(14) waiver to help support states in their efforts to successfully “unwind” from the Medicaid continuous coverage requirement.
In this brief, researchers explore what will happen to healthcare spending if the American Rescue Plan Act Premium Tax Credits expire.
This toolkit contains a table that can be used by a state to examine current ex parte processes and identify and deploy additional strategies that could increase their ex parte rates.
This blog, the first in a two-part series, outlines strategies state Medicaid agencies can take to identify people with high health needs and provide them with additional support to retain or transition their health coverage in order to maintain access to essential healthcare services.
This blog analyzes the Centers for Medicare & Medicaid Services' final rules for provider network adequacy standards in the federal healthcare marketplaces and Medicaid.
This blog compares the standards for network adequacy in Medicaid with those in the marketplaces.
This commentary tells the story of Theresa. At an early age, she was diagnosed with Spastic Quadriplegia Cerebral Palsy, a disorder that affects a person’s ability to maintain balance and posture. Now in her 40s, Medicaid allows her to work and live independently. It also provides her with speech, physical and occupational therapies, a wheelchair and the help of personal care attendants who assist with basic needs such as meal preparation, cleaning, dressing, and laundry.
In this podcast, Medicaid Leadership Exchange, former Medicaid directors explore what they would prioritize now and into the future when the Medicaid public health emergency unwinds — and where blind spots may lie.
In this Health Affairs blog post, Nancy Archibald, MHA, MBA, CHCS’ Associate Director for Federal Integrated Care Programs, outlines perspectives from state Medicaid officials on the federal policies that have advanced Medicare-Medicaid integration, and areas where they believe additional federal policy actions are needed.
This commentary tells the story of Alicia, a pregnant woman looking for maternal support while incarcerated and pregnant with her second child. Thanks to Medicaid, she was assigned a doula who guided her through the rest of her pregnancy and the birth of her son.
This update to the methodology documentation for the Urban Institute’s Health Insurance Policy Simulation Model explains how they estimated health coverage in 2023, taking into account major uncertain issues such as Medicaid enrollment after the HHS public health emergency and the potential expiration of enhanced premium tax credits for Marketplace coverage in 2023.
This page provides communications resources designed to support states as they prepare for the various stages of work needed to inform stakeholders and consumers about the upcoming end of the Medicaid continuous coverage requirement. The end of the Medicaid continuous coverage requirement presents states with tremendous opportunities to keep individuals enrolled in Medicaid or transition to another form of health coverage.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period. (Under the Families First Coronavirus Response Act, Medicaid enrollees who typically lose coverage after 60 days postpartum cannot be disenrolled until the end of the month in which the public emergency period ends.)
This toolkit is designed to help state and local WIC agencies leverage data from Medicaid and SNAP to measure enrollment gaps and increase enrollment using tools to plan, launch, and/or strengthen data matching and targeted outreach to eligible families who are not receiving WIC benefits.
At the end of the Pubic Health Emergency, more than 15 million people may become uninsured if they cannot secure alternate sources of health coverage. This blog provides actions states should carefully consider to ensure that stakeholders, including insurers, are facilitating these critical transitions.
This blog discuss the important role that ACA marketplaces will play in mitigating coverage losses as they prepare for the end of the Public Health Emergency and identifies basic as well as more innovative strategies marketplaces can adopt to help consumers make a smooth transition to affordable, comprehensive coverage.
This toolkit highlights opportunities for states to leverage managed care plans to support unwinding the Medicaid continuous coverage requirement.
This toolkit is intended to assist state officials in evaluating their current estate recovery policies and understanding where they may have flexibility to make the policies less burdensome for affected low-income families.
A cost-growth benchmark program is a cost-containment strategy that limits how much a state’s health care spending can grow each year. This chart provides a snapshot of programs across the country including state efforts to improve care quality and outcomes in the program.
This blog explores how Iowa Medicaid program implemented a town hall program that successfully integrates member and stakeholder perspectives into it's program and policy design.
This report summarizes the different elements of California’s initiative, which provides a model for other states seeking to expand housing services and whole person care through Medicaid.
This interactive map summarizes state Medicaid reimbursement policies for all types of midwives including certified nurse-midwives and midwives who pursue alternative pathways to licensure, often referred to as certified professional midwives, certified midwives, or direct entry midwives depending on state regulations.
This brief reviews the regulatory framework for network adequacy for Medicaid Managed Care Organizations and Marketplace qualified health plans and identifies policies and practices to ensure their networks include the number and mix of providers that enrollees need.
This blog explores strategies on how to invest in the development of Medicaid leaders to help states and territories improve the health and well-being of people served by publicly financed care.
Key tips include:
Always have a plan b, plan c, and plan d.
Build relationships and find a common thread.
Fill the void.
And more.
This blog explores how telehealth can support services like telematernity and behavioral health visits and its potential to meet health needs and improve health equity.
This brief summarizes key findings from a new study led by Dr. Hannah Neprash which provides direct answers about how clinicians responded to the Medicaid expansion.
This blog summarizes key takeaways laid out in the new CMS guidance related to timelines and operational strategies states can leverage to mitigate churn when the federal Medicaid continuous coverage requirement ends.
This Databook provides a comprehensive, detailed look at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through November 2021 and enrollment detail by state across four eligibility categories:
Expansion adults
Children (including those enrolled in CHIP)
Non-expansion adults
Aged, blind, and disabled individuals
This brief projects Medicaid enrollment for the population under age 65 and federal and state Medicaid spending for 2022 and 2023, assuming the PHE is extended through the first, second, or third quarters of 2022.
This blog summarizes practical steps and recommendations for alternative payment models to help state Medicaid agencies make care more accessible and equitable, and drive better health outcomes.
This blog profiles Indiana’s plans to launch Medicaid managed long-term services and supports in 2024, under which a majority of participants are expected to be dually eligible individuals.
This blog explores value-based, alternative payment models as employer-sponsored health insurance costs have increased by 6.3 percent in the United States since 2010, with additional increases projected.
This issue brief examines the current status of data collection to assess Medicaid enrollment and retention, summarizes potential forthcoming reporting requirements, and describes some of the best practices states should consider when developing a data dashboard to display this type of information.
This commentary shares the story of Ashley, who unexpectedly lost the private health insurance she received under her father’s health plan when she moved to New Mexico.
This blog provides Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality initiatives, and procurement processes, to promote health equity and address health disparities.
This blog explores text messaging as a mechanism for outreach for state Medicaid and Children’s Health Insurance Program (CHIP) agencies to directly contact Medicaid and CHIP enrollees and communicate important information.
This blog examines some of the key factors and decision points states may want to consider as they build out mobile mental health crisis services and systems that qualify for enhanced federal medical assistance percentage funding; engaging a cross-agency team and a broad range of external stakeholders can help ensure full consideration of diverse state crisis needs.
This blog examines recent happenings with insurer participation in the Affordable Care Act marketplace.
This chart summarizes temporary Medicaid and CHIP flexibilities enacted by the federal government to help states respond to the ongoing COVID-19 pandemic. The chart includes effective dates and expiration dates as dictated by law or agency guidance.
This toolkit highlights opportunities for states to leverage managed care plans to support unwinding the Medicaid continuous coverage requirement.
This brief examines provisions of the Notice of Benefit and Payment Parameters for the plan year 2023 related to the state-based marketplaces and state insurance regulators.
This blog post sheds light on how Pennsylvania has taken steps to better understand how to mitigate the racial bias by collecting information on how Medicaid Managed Care Organizations are using algorithms, the types of proxies being used, and the outcomes as a method to develop their health equity strategies.
This informative chart details key components and features of states’ Medicaid doula benefits.
This extensive report provides a communications planning guide and template communications resources designed to support state Medicaid agencies as they prepare for the upcoming end of the continuous coverage requirement.
This commentary tells the story of Tania, who through Medicaid not only receives mental health care but is also approved to visit specialists who care for her autoimmune disorder, something that would be unaffordable otherwise.
This commentary tells the story of Alicia, whose Medicaid-assigned doula guided her through pregnancy while in incarceration and the birth of her son.
This blog post describes how the COVID-19 pandemic has created historically large disruptions to the economy and health insurance coverage at a time when having access to health care is especially important.
This report examines how many immigrant families have avoided safety net and pandemic relief programs in recent years over concerns that their participation would have adverse immigration consequences.
This commentary tells the story of Alicia, who was able to access a doula through Medicaid while incarcerated and pregnant with her second child.
This commentary tells the story of Becky, whose Medicaid covers her medical visits and medication, as well as home-based assistance to help manage her multiple sclerosis.
The brief focuses on actions Medicaid agencies can pursue through their managed care programs or directly with provider organizations and highlights state interventions and collaborations that demonstrate promise in reducing disparities and begin to center equity in birth-related health policies.
This commentary is the story of Theresa, who developed Spastic Quadriplegia Cerebral Palsy and whose Medicaid allows her to work and live independently, and do activities she enjoys such as swimming.
This chart presents efforts by state insurance purchasers using reimbursement rates paid by Medicare as a reference-point to inform their programs’ hospital payments.
This commentary tells the story of Nicholas, who was born with autism and whose Medicaid coverage helps with household services and transportation to his job.
This issue brief presents a sustainable, hybrid coverage and funding approach for mobile crisis services in light of the new federal funding opportunities for states to improve access to behavioral health crisis services.
This brief explores how states propose using American Rescue Plan Act funds to bolster the workforce that provides home- and community-based services, including increasing reimbursement rates, providing new opportunities for professional advancement, and offering recruitment and retention incentives.
This expert perspective highlights observations about the factors impacting rate changes in the Affordable Care Act Marketplaces this year and the kind of variations that exist among states.
This report aims to estimate the Medicaid enrollment trends once the COVID-19 public emergency ends and policies prohibiting disenrolling beneficiaries are nullified.
This report finds that generous funding to support policies related to home- and community-based services (HCBS) eligibility, caregiver wages, and services could drastically improve the lives of people in need and the workers who serve them.
This commentary presents strategies for state-based marketplaces to improve consumer outreach, provide enrollment assistant and clearly communicate with consumers with what health coverage options are available for them in 2022.
This paper includes considerations and approaches to promote equity and improve public health capacity to prevent, detect and respond to HIV, viral hepatitis, STDs and TB during the public health emergency and beyond.
This commentary tells the story of Naomi, whose Medicaid coverage helps provide critical services for her son born with chronically and medically complex conditions.
This report provides updated excerpts of health disparities and health equity language from Medicaid managed care contracts and requests for proposals from 15 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California.
This guide describes recommended process steps for states to integrate a focus on health equity in their Medicaid managed care programs.
This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.
This map and chart highlight dental benefits for general adults and pregnant populations enrolled in Medicaid.
This blog post explores seven key considerations for health care organizations, Medicaid programs, and advocacy organizations to facilitate family engagement in program and policy design and implementation.
This blog examines how states and other stakeholders have another chance to weigh in on Tennessee’s 10-year Medicaid funding demonstration which was approved by the Centers for Medicare & Medicaid Services in early January during the final days of the Trump administration.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period.
This op-ed provides arguments for Medicaid expansion in Wyoming from the perspective of provider organizations.
This op-ed argues for Medicaid Expansion in the North Carolina, highlighting the success Virginia had in extending access to health care through its expansion.
This op-ed argues the need for Kansas to expand its Medicaid program to close the "coverage gap".
This brief highlights the stories of people with Down syndrome who have benefited from Medicaid coverage.
The blog highlights updates to a compendium providing Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality programs, and procurement processes, to promote health equity and address health disparities.
This commentary tells the story of Maria, whose Medicaid coverage helps her to provide critical services to her daughter born with Down syndrome and other medical conditions.
This National Academy for State Health Policy’s Appendix K interactive map, supported by The John A. Hartford Foundation, tracks each state’s new flexibilities in modified 1915 (c) and 1115 waivers and includes information about flexibilities in COVID-19 Public Health Emergency Demonstration 1115 waivers.
These digital tools examine and compare physician acceptance of new Medicaid patients at the state level and by physician and practice characteristics.
This guide is comprised of three tools to help state officials with the language they use to discuss and write about race and health equity.
This report highlights key findings from a survey, interviews, and literature scan to identify pathways to Medicaid leadership positions, challenges, and opportunities for developing a more diverse pool of future Medicaid executives, and the skills necessary to succeed in these roles.
This blog examines how Minnesota’s Medicaid expansion was a crucial resource during the COVID-19 pandemic for those who lost their jobs and/or their employer-sponsored health insurance coverage. It is estimated that approximately 29,500 Minnesotans lost their private health insurance coverage between April 2020-July 2020.
This podcast talks about the COVID-19 pandemic, ensuing recession, and amplification of issues related to health equity that have forced state Medicaid agencies to evaluate their budgets and investments to better serve Medicaid enrollees.
This podcast describes how the past year has seen many sectors of health care increasingly pursue diversity, equity, and inclusion efforts as health equity becomes a more prominent topic.
This podcast describes how critical conversations about health equity can be productive when there is a shared and agreed-upon language amongst Medicaid agencies.
This presentation examines the affect of the COVID-19 pandemic on historically under-served populations and strategies to increase Medicaid outreach and enrollment within these communities.
This commentary examines how in late June, the U.S. Department of Health and Human Services (HHS) issued its first proposed rule governing the health insurance markets and marketplaces.
This report examines how a public option that typically pays Medicare rates would considerably reduce the cost of increasing coverage in the Medicaid gap.
This report assesses racial disparities in the quality of inpatient care using 11 patient safety indicators that measure rates of adverse patient safety events of hospital-acquired illnesses or injuries.
This podcast covers how effective data measurement is critical for Medicaid programs seeking to advance health equity and better understand different experiences of populations served by the program.
This commentary examines how recent approval of the Alzheimer’s drug Aduhelm under the U.S. Food & Drug Administration’s Accelerated Approval Program is controversial for a range of reasons, including its projected impact on state Medicaid budgets which will be required to cover the drug, priced at $56,000 a year, despite inconclusive evidence of its clinical effectiveness.
This commentary analyzes how the U.S. Departments of Health & Human Services and Treasury have released a proposed rule governing the Affordable Care Act health insurance marketplaces and insurance standards for the plan year 2022.
This expert perspective summarizes the Interim Final Rule (IFR) of the No Surprises Act, the comprehensive federal law banning balance bills in emergency and certain non-emergency settings.
This commentary tells the story of Ben, born with cerebral palsy, whose Medicaid coverage has helped him access a wheelchair and other essential equipment.
This chart details the amounts and required oversight of COVID-19 federal funds allocated to hospitals, providers, and states by the Families First Coronavirus Response Act (Families First Act), the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Paycheck Protection Program and Health Care Enhancement Act (HR 266), the Consolidated Appropriations Act, 2021, and the American Rescue Plan Act of 2021.
This chart demonstrates how states are using a variety of approaches to provide doula services within their Medicaid programs to address inequities.
This commentary explains how Medicaid leaders have significant opportunities to impact the health and well-being of millions but must balance a myriad of federal and state priorities related to fiscal stewardship, quality assurance, program integrity, and more.
This commentary tells the story of Silvia, who created a therapy organization in her rural community that provides services to Medicaid populations.
This brief describes Nevada's new public option that is intended to provide consumers with comprehensive, but lower cost health insurance.
This blog post highlight's the Virginia Department of Medicaid Services' efforts, successes, and challenges in building a culture of equity.
This commentary tells the story of Maddy, who was born with Asperger syndrome and whose Medicaid coverage helps provide transportation to her two part-time jobs.
This brief highlights the stories of people with heart conditions who have benefited from Medicaid coverage.
This commentary tells the story of Nancy, whose Medicaid coverage allowed her to access mental health care to manage past trauma.
This report outlines promising state examples of accountable care organizations’ incentives or requirements that can be used to advance health equity.
This blog outlines the Center for Health Care Strategies' recent interview with internist and pediatrician Nathan Chomilo, MD, Medical Director of Minnesota Medicaid and MinnesotaCare to get his perspectives on priority opportunities for addressing health equity for people served by the state’s Medicaid program.
This updated brief describes the American Rescue Plan Act’s home and community-based services enhanced federal medical assistance percentage (FMAP) provision, CMS’s recent implementation guidance, and considerations and next steps for state policymakers.
This issue brief documents how states are collecting information about race, ethnicity, and language on their Medicaid applications.
This commentary tells the story of Brook, whose Medicaid coverage helps her provide critical services for her son born with cystic fibrosis.
This podcast features Lynnette Rhodes, executive director of medical assistance plans at the Georgia Department of Community Health, and Cindy Beane, commissioner at the West Virginia Bureau for Medical Services, discussing leadership challenges and successes they have faced in developing equitable vaccine distribution strategies and the status of their respective states’ vaccine rollout.
This commentary tells the story of Adrian, who serves as assistant director at a Medicaid-funded program to help youth and families receive critical services.
This commentary tells the story of Matthew, who was born with Down syndrome and whose Medicaid coverage helps him to live an independent life.
This webinar features early childhood and Medicaid experts highlighting efforts used to support young children with development and learning needs throughout the COVID-19 pandemic.
This report examines how the pandemic and related economic downturn affected the need for safety net supports; actions states are taking to mitigate the immense hardship the pandemic has caused; implications for racial equity; and challenges, opportunities, and questions facing state leaders.
This report examines how state Medicaid and other health programs responded to the COVID-19 pandemic and its related economic downturn.
This brief highlights the stories of people who have benefited from Medicaid coverage during the COVID-19 pandemic.
This brief summarizes the time frames for emergency measures for Medicaid and Children's Health Insurance Program flexibilities during the COVID-19 pandemic.
This commentary draws from examples of states participating in the Aligning Early Childhood and Medicaid program and additional states to explore strategies for leveraging cross-agency collaborations and strengthening Medicaid to support early childhood and parental mental health during the COVID-19 pandemic crisis and beyond.
This presentation outlines the key provisions of the Medicaid program.
This report includes a collection of summarized evidence on how Medicaid can improve the health of states' residents and communities.
This commentary tells the story of Laticia, who grew up in the foster care system and was able to access Medicaid coverage that helped her get the mental health care she needed.
This report describes the American Rescue Plan Act's (ARPA) Medicaid matching rate provision and also assesses its fiscal impact for each of the states that have not yet expanded Medicaid, while comparing the available new federal dollars to the cost of expansion.
This commentary tells the story of Kerstin, who was born with cerebral palsy and relies on Medicaid coverage for her extensive medical needs.
This brief describes the American Rescue Plan Act's home- and community-based services federal medical assistance percentage increase provision, the requirements for states receiving the enhanced federal funding, and considerations and next steps for state policymakers.
This commentary features discussions with several state Medicaid officials to learn more about how their agencies—and specifically their Medicaid managed care organizations—are leveraging partnerships and data to advance their vaccination efforts.
This commentary tells the story of Juan, who was born with cerebral palsy and whose Medicaid coverage helps him to work and live an independent life.
This commentary tells the story of Matthew, who was born with fetal alcohol syndrome and whose Medicaid coverage has many covered medical and behavioral needs.
This report outlines key factors for governors and state leaders to consider when balancing state budgets and making difficult decisions about funding Medicaid during the COVID-19 crisis and subsequent economic downturn.
This report analyzes states’ experiences trying to resolve surprise medical payment disputes between health care providers and insurers.
This series of policy briefs include evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure a fair and just opportunity for health.
This commentary tells the story of John, whose emergency surgery for a hernia was covered by Medicaid.
This commentary tells the story of Robert, who was able to recover from addiction and receive mental health care services through Medicaid.
This toolkit looks at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through January 2021.
This webinar features discussions on how states can use performance rates and disparities analyses from Medicaid managed care programs in other states to determine where disparities are likely to exist in their own state and develop interventions.
This report provides excerpts of health disparities and health equity contract language from Medicaid managed care contracts and requests for proposals from 12 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California.
This commentary outlines four recommendations for states to engage their managed care plans to assist in efforts to successfully and rapidly vaccinate the Medicaid population for COVID-19.
This commentary tells the story of Theresa, who was able to care for her daughter's health needs as she transitioned to a new job.
This toolkit outlines state options to address Medicaid spending without harming enrollee health and provider stability and access to care.
This commentary tells the story of Kaui, whose daughter's complex medical needs were covered by a Medicaid waiver that allowed the family to access a health aide, ventilator, and other essential care services.
This commentary tells the story of Michael, who supported his family with Medicaid coverage after 26 years as an educator with employer-sponsored insurance.
This commentary tells the story of Jamie, whose daughter was born with a genetic syndrome that led to complex medical needs. Medicaid covers her daughter's health needs so that she is able to continue living at home with her family.
This report assesses awareness of and experiences with publicly subsidized coverage options among adults who were uninsured in September 2020.
This commentary tells the story of Nicole. Nicole has autism, anxiety, and a number of other health challenges, which Medicaid helps her manage so she can work.
This brief provides a high-level summary of the Center for Medicare and Medicaid Services guidance related to: (1) conducting redeterminations for Medicaid enrollees who were continuously enrolled; (2) terminating, or extending where appropriate, temporary flexibilities; and (3) developing a consumer and provider communication strategy.
This commentary tells the story of Maria and her son Tyler. Tyler was diagnosed with Sotos syndrome shortly after his birth, a condition that can result in overgrowth and delayed development.
This commentary tells the story of Jessica, a mother who contracted cytomegalovirus which resulted in her daughter Natalie being born with a disability.
The ten most-visited resources on StateNetwork.org during 2020.
This commentary explores Utah’s Medicaid and public health partnership and its efforts to expand Medicaid coverage of the state’s asthma home visiting program.
This commentary explores Michigan’s efforts in improving access and adherence to asthma medications and devices, as well as promoting the use of evidence-based interventions to improve access to important asthma devices and services.
This brief summarizes key learnings from conversations with 50 leaders of state Medicaid programs across 14 states about implementing strategies to improve consumer engagement in policy and program planning.
This commentary tells the story of Aliyah. A college graduate and social worker in her mid-20s, spent part of her youth in the Louisiana foster care system, which allowed her to access Medicaid services.
This commentary tells the story of Chrystal. Medicaid was her only option for health coverage when she was a full-time student in Milwaukee, but she was almost denied it when her scholarships and education grants were counted as income.
This commentary describes the legal authority that permits states to continue to authorize Medicaid reimbursement for audio-only telehealth after the public health emergency ends.
This commentary tells the story of Jessica. While pregnant she contracted cytomegalovirus and it resulted in her daughter Natalie being born with a disability.
This commentary tells the story of Maria. When her son Tyler was diagnosed with Sotos syndrome shortly after his birth, his parents signed up for Medicaid through assistance at the hospital and the program has supported him since.
This commentary tells the story of Leah, who runs an organization to help many low-income Medicaid recipients in her community with needed services.
This commentary tells the story of Brianna, who signed up for Medicaid in 2016 and was able to receive diagnostic procedures that eventually determined that she suffers from endometriosis and fibromyalgia.
This report explores key considerations and outlines promising tactics for states to use in evaluating new Medicaid policies.
This podcast explores strategies public-sector leaders have implemented in response to the COVID-19 pandemic.
This map current state activity related the Affordable Care Act’s Section 1332 waivers.
This podcast episode examines how good public administration works applies in practice, featuring the experiences of two Medicaid directors.
This brief explores the ways in which various organizations worked together to improve access to and use of tobacco cessation benefits among Minnesota's Medicaid population with the goal of reducing commercial tobacco use in this population.
This report explores the ways in which Medicaid and CHIP largely transfer funding from higher-income states to lower-income states.
This brief explores the response to the COVID-19 crisis, taking stock of what we have learned and how we have changed.
This commentary explores the complex question of which health care payers will cover the costs of COVID-19 vaccine administration.
This brief provides an introduction to screening for social risk factors, the first step most states are taking through their Medicaid managed care programs to address how social determinants of health influence enrollees' health status and spending.
This commentary tells the story of Gene. After an accident left him quadriplegic at age 17, Medicaid covers needed help with his daily activities.
This commentary tells the story of Estie, whose lifesaving care was covered by Medicaid when her lungs collapsed when she was three months old.
This commentary tells the story of Susan, who enrolled in Medicaid after losing her job of 21 years due to the COVID-19 pandemic.
This commentary tells the story of an innovative program in Oregon that provides Medicaid and low-income patients access to healthy produce from local farms.
This commentary tells the story of Raevin, whose daughter's medical issues were covered by Medicaid.
This commentary tells the story of Milly, whose Medicaid coverage provided the care she needed to get through her breast cancer diagnosis.
This blog describes some of the limited actions states may take to alleviate fiscal pressure due to the COVID-19 pandemic through the management of their contracts with Medicaid managed care organizations.
This report examines how Medicaid agencies in 40 states select managed care organizations to contract with, how contract terms are set, and how performance is evaluated.
This commentary provides suggestions states can use to improve the completeness of Medicaid data on enrollee race, ethnicity, and language.
This commentary tells the story of Latrice, an early learning educator, and her daughter Makayla, who was born with heart complications. Medicaid serves as secondary insurance for the first year of Makayla's life.
This commentary tells the story of John, a counselor for a nonprofit AIDS support organization. Medicaid helps cover his HIV medication as well as manage his diabetes, lupus, and heart problems.
This commentary tells the story of Susie and her daughter Tymia, who has sickle cell disease. Medicaid covers Tymia's prescription drugs and life-saving surgeries.
This commentary tells the story of Kile, who manages his developmental disabilities with the support of services covered by Medicaid.
This commentary tells the story of Steve and Erin, whose growing family was covered by Medicaid while Steve studied to become a pastor.
This commentary tells the story of Steve, a Kentucky resident whose family was covered by Medicaid as he put himself through seminary school.
This report examines Kentucky and Virginia's adapted outreach efforts to help make enrollment as easy as possible to ensure access to critical coverage and care.
This commentary examines the impact that recent postal delays, COVID-19-related housing and economic crises, and natural disasters have had on state Medicaid and Children’s Health Insurance Program agencies.
This commentary explores the potential fiscal impact of the COVID-19 pandemic on Medicaid and early childhood services and offers opportunities to sustain critical services.
This webinar features experts reviewing examples of specific strategies states implemented between April and August 2020 to increase payments to providers in financial distress as a result of decreased health care utilization.
This commentary explores the key role Medicaid programs play in helping the health care system make the transition to the new normal of the COVID-19 crisis.
This webinar walks through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization.
This commentary tells the story of Linda, a high school teacher whose job does not provide health insurance benefits, and is therefore covered by Medicaid.
This commentary tells the story of Jim, who overcomes the challenges of living with cerebral palsy through services covered by Medicaid.
This report examines examples from two state Medicaid programs and a nonprofit quality measurement and reporting organization of the data sources used to identify patients’ social risk factors when risk-adjusting payments or measuring quality.
Sarah, a Michigan resident with multiple sclerosis, was covered by Medicaid during pregnancy.
Noah enrolled in Medicaid in Maryland when he lost his job and health coverage due to the COVID-19 pandemic.
Espri is a self-employed farmer whose family is covered by Medicaid in Indiana.
This commentary explores how states have been required to make numerous changes to their eligibility and enrollment systems, operations, and policies, in order to comply with the enhanced Federal Medicaid Assistance Percentages.
This commentary provides an overview of how COVID-19 is affecting state budgets and state health programs.
This commentary recommends specific steps for state Medicaid programs to ensure state residents receive needed services during the COVID-19 pandemic, with a specific focus on Medicaid managed care organization (MCO) enrollees.
This commentary discusses how state Medicaid, children’s health insurance programs, and health insurance marketplaces prepare for an expected increase in demand due to COVID-19, an economic downturn and ensuing budget crises, and unpredictable federal relief efforts.
In this podcast, Medicaid experts share five tips for leaders to address today’s VUCA (volatility, uncertainty, complexity, and ambiguity) challenges within their organizations.
This brief highlights how Nebraska’s Medicaid agency and its Division of Public Health partnered to share antibiotic prescribing information between Medicaid claims and evaluation and management codes to determine where targeted education and outreach efforts were needed.
In this podcast, Medicaid experts discuss how vision coherence is important for effective leadership.
In this webinar, experts present key findings from a new COVID-19 state resource guide on federal and state Medicaid flexibilities and how they are being deployed to help ensure access to long-term services and supports.
This commentary provides a snapshot of how states are navigating fiscal challenges of the COVID-19 pandemic, given declining revenues and rising spending demands.
This dataset examines projected changes in federal and state Medicaid and CHIP expenditures for scenarios during the COVID-19 pandemic.
This report provides excerpts of health disparities and health equity contract language from Medicaid Managed Care contracts from five states, Washington, D.C., and the contract for California’s Health Exchange, Covered California.
Stakeholders in six states assess the impact of Medicaid insurers increasing dominance in the ACA marketplaces.
This brief provides an overview of New Hampshire’s recent directed payment to six types of essential Medicaid providers in order to help them keep their doors open during the COVID-19 pandemic.
This brief provides a chart describing the effective dates of various federal provisions to allow for temporary flexibilities in the Medicaid and Children's Health Insurance Program programs.
This toolkit is intended to serve as a resource for states as they begin to strategize about reopening and plan for the next phase of the COVID-19 pandemic.
This commentary outlines three key policy steps to help health centers survive in the short term and thrive beyond the COVID-19 crisis.
This commentary outlines how continuity between Medicaid and the marketplace is more important than ever.
In this webinar, experts reviewed the current telehealth policy landscape and considerations for states as they design their post-apex telehealth policies.
This report uses new enrollment data to examine insurer type enrollment trends from 2016-2018.
This commentary provides an overview of CMS relief guidance and flexibility to state hospitals, facilities, and providers on reporting measures for value-based purchasing and quality reporting programs.
This commentary explains how, due to the loss of employer-sponsored insurance from the economic fallout of COVID-19, states may continue to see an increase in Medicaid enrollment.
This webinar presented results from a financial model examining the Medicaid fiscal implications of the interaction between the COVID-19 pandemic, the emerging economic downturn, and recent policy changes.
This report shows how the additional levels of unemployment insurance provided through the Federal Pandemic Unemployment Compensation program affects eligibility for subsidized coverage in expansion and nonexpansion states.
In this podcast episode, Ed O’Neil, PhD, MPA, a leadership development expert, speaks with Hilary Kennedy, program director for Medicaid leadership at the National Association of Medicaid Directors, about strategies Medicaid leaders can use to continue developing their staff at a distance.
This commentary identifies actions federal and state policymakers have taken to address the impact of COVID-19 on their managed care performance incentive programs.
This report outlines potential IT investments in responding to COVID-19 and strategies for states to support these investments, and to secure current and future IT investments that enable ongoing Medicaid program operations and advance health information exchange.
This webinar reviews potential information technology (IT) investments in responding to COVID-19 and strategies for states to support these investments to secure current and potential IT investments that enable ongoing Medicaid program operations and advance health information exchange.
This commentary provides an overview of strategies that states can consider to help address gaps in coverage to ensure as many people as possible get access to comprehensive care as the country continues to respond and recover from the COVID-19 health and economic crisis.
This webinar discussed the models that have been published of where individuals are expected to gain Medicaid and Marketplace coverage over the next 18 months.
In this webinar, experts review strategies states can use to manage and process an increased number of Medicaid applications, and the federal authorities that permit states to do so.
This document provides examples of potential Medicaid messaging states can use during the COVID-19 pandemic.
This infographic highlights what states need to consider when providing pregnancy-related services to Medicaid enrollees through telehealth during the pandemic.
This brief provides an overview of Children Health Insurance Program (CHIP) Health Services Initiatives (HSIs) and identifies ways that states can leverage them as part of their targeted response to the COVID-19 pandemic.
This commentary discusses the 1115 waiver applications submitted by states that have the potential to safeguard access to care and increase support for children during the COVID-19 pandemic.
This Q&A responds to questions received regarding the April 9 Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis Webinar and corresponding Toolkit.
In this report, researchers estimate the fiscal impacts of several approaches for increasing federal Medicaid matching rates, providing state-level estimates for each approach.
This Q&A provides a moment-in-time update in response to questions about the federal government’s response to the COVID-19 pandemic.
This webinar discuses the impact of COVID-19 on Medicaid Managed Care Performance Incentives.
This commentary discusses the states that have rapidly amended their Medicaid home- and community-based services for older adults and their family caregivers to ensure access to long-term services and supports during the COVID-19 crisis.
This commentary discusses the steps states are taking during the COVID-19 pandemic to protect pregnant women and their infants during delivery.
Valerie and her husband Christopher wanted to adopt two sons from foster care, both with challenging health conditions, but were not sure if they could afford the medical bills. Valerie learned both children were automatically covered by South Dakota Medicaid because of their time in foster care.
April was born with sickle cell anemia, a genetic blood disorder that is deeply painful and must be managed with proper medication. Medicaid covered April’s treatment and her electric wheelchair, which empowers her in her new everyday life.
This brief addresses how Medicaid Managed Care Organizations (MCOs) and states can individually and collectively play a role in responding to the COVID-19 pandemic.
This commentary discusses new federal and state laws that are making significant steps to eliminate consumer cost-sharing for coronavirus (COVID-19) testing, diagnosis, and prevention.
This commentary includes some of the options available to states to ensure that individuals with complex medical conditions and their families have access to necessary home- and community-based services during the coronavirus (COVID-19) crisis through waiver and state plan amendment applications.
This resource library provides key guidance, reference materials, and tools for states as they try to lessen the impact of COVID-19 on Medicaid populations.
This webinar walks through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization. An accompanying toolkit is included that identifies the immediately available tools for states.
This report assesses the cost of Medicaid relative to private insurance in the health insurance landscape under the Affordable Care Act (ACA).
This perspective discusses strategies state Medicaid and CHIP agencies can pursue as part of their emergency preparedness planning for, and response to, COVID-19.
In this webinar, experts explore the key health care provisions in the Families First Coronavirus Response Act and the implications for states.
This brief examines the Families First Coronavirus Response Act that was signed into law to provide resources to help states address the effects of COVID-19.
This Q&A examines what the Families First Coronavirus Response Act is doing to help states address the COVID-19 pandemic.
This brief is a compilation of communication examples from state departments and agencies during the COVID-19 pandemic.
This report examines the kinds of health insurance unemployed workers have and how coverage patterns have shifted under the Affordable Care Act (ACA).
This commentary reviews key information for states about the recent federal medical assistance percentage (FMAP) increase and conditions states must meet to qualify for it.
The federal government has offered Medicaid waivers to give states flexibility to quickly increase their health care workforces in response to the COVID-19 pandemic.
This brief examines the effect of a recently announced federal program allowing states to apply for Medicaid block grants or per capita caps in exchange for new flexibility to limit enrollment and benefits.
This report examines the Families First Coronavirus Response Act and its implications for Medicaid and the Children's Health Insurance Program (CHIP).
This podcast discusses the many ways that states are working to address the challenges surrounding maternal and infant mortality, specifically the significant disparity experienced by black women,
This report describes select policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement.
This podcast discusses the strategies and challenges faced while developing meaningful consumer engagement strategies for Colorado and Washington State Medicaid.
Carolyn was working two jobs without health insurance when she fell in her home and cracked her hip. Unable to afford out-of-pocket expenses, Carolyn received disability coverage through Medicaid.
Alecia was born with Down Syndrome, a lifelong condition that comes with physical and developmental challenges. Iowa’s Medicaid coverage empowers her to live independently.
This report focuses on how Medicaid programs can use data from the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity.
This report studies New Hampshire’s Medicaid work requirement program to understand how it was implemented and why it appears to fail to protect coverage and promote work.
This report reviews the key features of the proposed capped funding demonstrations and highlights the considerations for states. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) inviting states to apply for Section 1115 demonstration projects that would impose caps on federal Medicaid funding for the adult expansion and some other adult populations in exchange for new programmatic flexibility.
In this podcast, three individuals from the Wisconsin Department of Health Services discuss how they have created an environment that values transparency and staff well-being.
This report gives an overview of the federal authorities under which states are able to cover nonclinical housing-related services for high-need Medicaid enrollees, and also details how states are using these authorities to invest in supportive housing for diverse high-need Medicaid populations.
In this podcast, Connecticut’s Medicaid director Kate McEvoy and chief financial officer Mike Gilbert discuss their experiences working with partners in the executive and legislative branches to build trust and a shared vision for sustaining critical programs.
These were the ten most-visited resources on StateNetwork.org during 2019
This blog from the Delta Center illustrates five key insights related to program design and evaluation from the productive partnership between the Partnership HealthPlan of California (PHC) and local community health centers (CHCs) to create a care coordination (CCM) program.
This issue brief draws from the experiences of states that were among the first to implement their substance use disorder waivers to profile how the American Society for Addiction Medicine (ASAM) Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.
This report analyzes commercial insurers’ experiences competing in marketplaces with managed care organizations, which only offered coverage within public programs prior to ACA implementation.
Paul needed a kidney transplant to save his life, and couldn't have afforded the costs without Medicaid.
When Stacia needed treatment for substance use and mental health, Medicaid covered her care.
When Sheila's daughter was born with birth defects, Sheila couldn't afford her care. Then she found Medicaid.
This issue brief examines how state Medicaid agencies, families, advocates, providers and other stakeholders can partner to improve access to services for Medicaid-enrolled children with special health care needs.
This report provides an overview of the behavioral health system’s engagement in Medicaid value-based payment (VBP) models and provides policy recommendations to support VBP adoption.
When Jennifer and Jerry welcomed their daughter into the family, Medicaid gave her a healthy start.
When Hannah and Martin's son was born, he needed immediate open-heart surgery. Medicaid covered their son’s birth, surgery, and follow-up care.
Soon after Gail was diagnosed with breast cancer, she lost her job and her health insurance. Medicaid was a lifeline.
To stay alive, Bridget must receive dialysis for four hours a day, three times each week. Medicaid is an essential part of her health care coverage, and helps her to lead a normal life.
LaVerne was covered by Medicaid while she earned her bachelor's degree in nursing, opening the door for her service in the U.S. Army Nurse Corps.
Laura's high-risk pregnancy, and a car accident that left her husband Jed permanently disabled, threw her family's life off course. Learn how Medicaid helped Laura and Jed get it back on track.
This report describes preliminary observations regarding implementation of Medicaid housing support demonstrations in California, Maryland, and Washington.
When Shari's disease worsened, she knew she needed more assistance. Learn how Medicaid helped her maintain her independence, so she could help others in need.
Tom was a successful insurance agent with a college degree and a six-figure salary, when personal tragedy sent him spiraling. Learn how Medicaid helped him get back on his feet.
This short video explains the difference between Medicaid and Medicare.
This short video explains how Medicaid has expanded its coverage to cover roughly 1 in 5 Americans.
This short video explains the effect of Medicaid on children's health.
These tip sheets provide general guidance to help state agency leadership develop and refine the necessary skills and expertise to successfully lead their state programs.
These resources describe the core roles of state Medicaid and public health agency staff when partnering to implement evidence-based prevention interventions.
This blog reflects on the value of Medicaid and the critical role of Medicaid directors since the program's inception more than 50 years ago.
In this blog, two former state medicaid directors demystify the distinct yet complementary roles of public health and health care — and how these state agencies can align efforts around prevention strategies to impact health and costs.
This issue brief provides examples from a handful of states that have begun the work of identifying, evaluating, and reducing health disparities within their Medicaid managed care programs.
This study assesses potential barriers facing Medicaid enrollees in meeting work requirements through employment on a sustained basis, using pooled data from the September 2018 and March 2019 Health Reform Monitoring Survey.
A new podcast series, Medicaid Leadership Exchange, is launching to help Medicaid directors and their senior management teams steer the course.
This table highlights new programs and federal initiatives to combat the opioid crisis.
This report examines ACA marketplace participation by insurers that participated in Medicaid but not in private insurance markets prior to the ACA.
The webinar highlights six key questions that state policymakers need to consider when choosing a buy-in model, designing its features, and introducing a Medicaid buy-in program.
The issue brief identifies the key questions for states pursuing Medicaid buy-in programs to consider as they seek to design and implement their proposals.
This issue brief explores the “next generation” practices that states are deploying to address social factors using Medicaid 1115 waivers and managed care contracts.
This report examines monitoring and evaluation of work/CE demonstrations and reviews the data assets and infrastructure necessary to support states and their researcher partners in robust monitoring and evaluation efforts.
In this interview with Louisiana's Medicaid Director Jen Steele, she shares her approach to leveraging Medicaid’s role to improve health outcomes and health equity.
Eight states will join Aligning Early Childhood and Medicaid, a multi-state initiative aimed at improving the health and social outcomes of low-income infants, young children, and families through cross-agency collaboration.
This brief reviews considerations for policymakers assessing their state Medicaid managed care programs and exploring strategies for advancing cost, quality, and accountability goals.
This brief reviews a number of Medicaid strategies states are implementing to prevent and treat substance use disorder and support long-term recovery.
This brief reviews the role that social and economic factors--such as housing, healthy food, and income--play in a “whole person” approach to health care, especially among Medicaid’s low-income enrollees.
This brief reviews the opportunities state policymakers have to affect the health—and future well-being and productivity—of their youngest residents through their Medicaid programs.
This brief reviews the growing body of research on Medicaid's health and economic impacts, including access to care; self-reported health status; preventive health screenings; delaying care because of costs; hospital and ED utilization; and mortality rates.
This brief outlines the basics of the Medicaid program, including financing and eligibility, for new state policymakers in order to lay the groundwork for considering the challenges and opportunities that lie ahead.
This brief highlights priority issues for consideration and potential action, including: the structure of the Medicaid agency; enabling coverage and access; addressing the needs of special populations; and value-based payment policies.
This report finds between 2006 and 2017, growth in spending per enrollee in Medicare and Medicaid was much slower than in private insurance.
This webinar examines the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment.
This study analyzed linked maternal and infant Medicaid claims data and infant birth records in three states to assess treatments and outcomes on maternal and infant health.
MACPAC's 2018 Medicaid and CHIP Data Book is a collection of federal and state statistics regarding the Medicaid and CHIP programs.
This report outlines the activities of three pilot sites pursuing Medicaid-driven strategies to support young children and their families, to help inform other cross-sector partnerships at varying stages of development.
This webinar discusses state considerations for developing a Medicaid buy-in proposal, as well as evolving models.
These were the five most-visited resources on StateNetwork.org during 2018.
This national scan summarizes the health care reforms and innovations that newly-elected governors promoted in their campaigns and may become policy in 2019.
The Senate passed H.R. 6, The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the “SUPPORT Act”) on October 3, 2018. This reviews major health provisions of the new law and implications for states.
This resource highlights articles published since January 2018 that report on the impact of Medicaid expansion in 33 states and DC, organized by health access and outcomes, economic impacts, and coverage impacts.
This State Health Policy Highlight profiles two issue briefs and a webinar on how state Medicaid programs can address social determinants of health.
This chart compares the social determinants 11 states targeted in their Medicaid contracts and contract guidance documents to enhance population health, as well as how states monitored outcomes and funded these efforts.
CMS approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire; and additional states have submitted or are poised to submit similar waivers. This series of charts outlines the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program.
This report investigates the work patterns of Medicaid beneficiaries in Kentucky who are are potentially subject to Medicaid work requirements. It finds that the structure of Kentucky’s Medicaid waiver does not seem to align with the reality of some working enrollees’ lives, and that working enrollees losing coverage may not have access to an employer plan.
This webinar reviews the Stewart v. Azar decision and potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. The court’s findings may shape what analysis will be necessary to demonstrate that future waivers advance the Medicaid statute's objectives.
This webinar provided an overview of Centers for Disease Control and Prevention's 6|18 Initiative and highlighted recent accomplishments from participating Medicaid-public health teams. The CDC 6|18 Initiative is a framework to guide Medicaid-public health collaboration.
State officials can align prevention strategies with value-based payment goals through a variety of mechanisms outlined in this brief, which draws from state-based 6|18 Initiative implementation efforts to help Medicaid and public health officials make the case for investing in prevention strategies and aligning these efforts to achieve state VBP goals.
Webinar discusses the status of state efforts to secure waivers to use federal Medicaid funding to provide care in Institutions for Mental Disease (IMD), including the requirements states must meet to secure an IMD waiver; the status of requests and approvals; and issues and opportunities arising as states pursue and increasingly implement the IMD waiver.
States continue to identify and pursue strategies to further reduce the number of uninsured to make coverage more affordable for consumers and to improve access to care. This issue brief presents two possible models for a Medicaid buy-in program for states, and details the design considerations and authorities needed to implement each model.
This map tracks state Medicaid expansion decisions and approaches states are taking for expanding eligibility to 138 percent of the Federal Poverty Level. It also includes information on state legislative activity around Medicaid expansion, governors’ stances on the issue, and fiscal and demographic analyses from the state or other institutions. For states that are expanding Medicaid, but using an alternative to traditional expansion, the map also contains brief descriptions of these demonstration waivers.
In January 2018, the Centers for Medicare & Medicaid Services issued a new policy allowing states to implement work and community engagement requirements for certain Medicaid enrollees. States are permitted to seek federal approval to require non-elderly, non-pregnant, and non-disabled adults to participate in these types of activities to qualify for Medicaid or certain aspects of Medicaid coverage. This chart summarizes states’ pending and approved Section 1115 waivers, waiver renewals, and waiver amendments to implement work and community engagement requirements.
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet, only 1 in 5 people suffering from an OUD receive treatment. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.
This article explores efforts by nine state Medicaid and public health agency teams to implement 6|18 interventions related to asthma control, tobacco cessation, and unintended pregnancy prevention. It was published in the Journal of Public Health Practice and Management and covers Colorado, Georgia, Louisiana, Massachusetts, Michigan, Minnesota, New York, Rhode Island, and South Carolina.
State Medicaid programs are increasingly requiring their Medicaid managed care organizations (MCO) to implement APMs. It is important for states to develop ways to ensure that their MCOs are complying with the APM requirements within their contract, and monitoring the progress and challenges with the implementation of APM strategies with Medicaid providers. This report focuses on different ways in which states may set standard APM definitions to track MCO progress toward meeting state APM goals, and support comparison of APM implementation within a state and nationally.
This brief provides an analysis of legislation recently introduced in the U.S. Senate that would create a mechanism for states to offer their residents the opportunity to buy a Medicaid-based public insurance option.
On January 11, 2018, CMS released guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. Both the new guidance and recent waiver approval represent a significant departure from past Administrations’ positions. This webinar reviews the new guidance and discusses state legal, policy, and operational considerations.
RWJF’s SHVS together with experts from Manatt Health, host this webinar that highlights and defines potential policy options, including the “Medicaid Buy-in,” that states may consider to leverage Medicaid to achieve their goals with respect to coverage availability and affordability. Conditions that make each option more or less favorable for a state, and implementation issues or other considerations in play for states are discussed.
Uncertainty about the future of health insurance options and concern about the ability of Affordable Care Act (ACA) marketplaces to offer adequate competition and choice have spurred states to look for new coverage approaches. Innovative strategies states are proposing include allowing consumers to buy into state Medicaid programs and developing state-specific coverage options within the ACA’s framework.
This webinar features the Urban Institute's Dr. Fred Blavin, whose SHARE-funded research asks how medical spending burdens for near-poor families in non-expansion states would change if the states were to expand Medicaid.
CMS released two informational bulletins detailing a new, streamlined approach for the review and management of Section 1115 demonstrations and state plan amendments and 1915 waivers. The streamlined approach may enhance states' ability to design innovative health care delivery initiatives in their Medicaid programs. These changes come at a critical time as states develop new approaches to reduce health care costs and stem the opioid epidemic.
This toolkit is designed to assist states interested in implementing value-based purchasing approaches with their Medicaid managed care organizations (MCOs). Using a value-based purchasing approach can mean significant and ongoing changes for a state Medicaid agency and its MCOs.
The Administration signaled a willingness to give states more flexibility to address health and prevention in new and innovative ways under Section 1115 of the Social Security Act, allowing the Department of Health and Human Services to approve experimental and innovative projects that promote the goals of Medicaid. This comes at a pivotal time when many states are developing new ways to improve health care, reduce costs, and address health-related social needs such as housing.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. Social determinants include a broad array of social and environmental risk factors such as poverty, housing stability, early childhood education, access to primary care, access to healthy food, incarceration and discrimination. This report digs into opportunities that states have to account for SDOH in Medicaid programs.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. This report digs into opportunities that states have to account for SDOH in Medicaid programs.
CMS has signaled a willingness to evaluate new types of Medicaid proposals from states, such as Medicaid waiver applications that include programs to connect individuals to employment or incorporate features of private market coverage. In response to CMS’ letter, some states have developed proposals that include these types of requirements for certain individuals covered by the Affordable Care Act’s Medicaid expansion—and a few states are seeking similar changes for their non-Medicaid expansion populations.
Under the authority of Section 1115 demonstrations, some states have implemented DSRIP programs to improve care, improve health, and lower costs. DSRIP programs restructure Medicaid funding into a pay-for-performance arrangement in which providers earn incentive payments outside of capitation rates for meeting certain metrics or milestones based on state-specific needs and goals, which are used to measure success.
This report explores Louisiana’s permanent supportive housing program. The program, administered jointly by the state’s Medicaid agency and housing authority, is a cross-agency partnership that braids funding to serve vulnerable cross-disability populations, address homelessness, reduce institutionalizations, and save money for the state.
Medicaid can play a unique and critical role in responding to public health emergencies and health crises. This brief explores the role Medicaid has played in responding to events such as the opioid and HIV/AIDS epidemics, the 2001 World Trade Center attacks, the Flint, Michigan lead contamination crisis, and Hurricane Katrina.
Driven to improve care coordination and contain costs by moving away from a volume-based payment model, an increasing number of states are implementing risk-based managed care programs to deliver long-term services and supports (LTSS). As the primary payer for LTSS, state Medicaid programs have a significant interest in ensuring that entities with which they contract deliver high quality and cost-effective care to members. This report identifies ways states can learn from value-based payment models being applied elsewhere to create more accountability for the quality and cost of LTSS.
While the focus of debate regarding repeal of the Affordable Care Act (ACA) has been on Marketplaces and the Medicaid expansion, myriad other provisions of the ACA are at risk of repeal—including those that streamline Medicaid eligibility and enrollment systems and implement a national, simplified standard for income eligibility. As of January 2016, 37 states are able to complete an eligibility determination in real time, defined as less than 24 hours, and among these, 11 states report that at least half of their applicants receive an eligibility determination in real time. The future of the ACA’s streamlined eligibility and enrollment-related provisions and the system improvements states have invested in to implement them are the subject of this issue brief.
State agencies across the country, from Medicaid to public health, to social services and corrections, are deeply engaged in multi-sector initiatives to reduce infant mortality. And for good reason: the United States ranks 25th among industrialized countries in infant mortality with a disproportionate number of being African Americans.
In order to assist states in the facilitation of Medicaid enrollment and renewal for eligible SNAP participants, this webinar presents some of the necessary considerations for leveraging these data for enrollment purposes.
This report stems from technical assistance provided to California’s Department of Health Care Services (DHCS). The technical expert facilitated webinars and meetings with DHCS staff and medical directors of contracted MCOs, in order to share information about housing resources and emerging practices for improving care and achieving savings by linking more Medicaid beneficiaries with permanent supportive housing.