Medicaid

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Medicaid: State Directed Payments in Managed Care

When states use a Medicaid managed care delivery system, the contracted managed care organizations (MCOs) generally determine provider payment rates. However, in certain circumstances states may direct payments to providers through the MCOs in accordance with state-set criteria. In this report, GAO describes (1) the use of state directed payments in Medicaid, and (2) CMS's changes to guidance and oversight of these payments.

Short URL: http://www.advancingstates.org/node/74002

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Call for Applications: Medicaid Pathways Program, Class of 2023

CHCS has announced a nine-month leadership development program designed to support a cohort of senior Medicaid leaders in developing skills to lead a complex organization like Medicaid, as well as improve outcomes for enrollees by enhancing state capacity. The Medicaid Pathways aims to help Medicaid leaders who are new to their leadership role and/or are interested in advancing to a more senior role in the future, especially individuals with diverse backgrounds, including people of color, people with disabilities, and individuals with personal experience with Medicaid or another publicly financed program.

Short URL: http://www.advancingstates.org/node/73990

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June 2022 Report to Congress on Medicaid and CHIP

MACPAC has released its June 2022 Report to Congress on Medicaid and CHIP. The report recommends measures that Congress can take to better monitor access to care for Medicaid beneficiaries, improve the oversight and transparency of managed care directed payments, increase access to vaccines for adults enrolled in Medicaid, encourage the uptake of health information technology in behavioral health, and better integrate care for Medicaid and Medicare dual-eligibles. The commission also offers policy levers that states and the federal government can use to promote equity in Medicaid.

Short URL: http://www.advancingstates.org/node/73981

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Diversifying Medicaid’s Leaders to Better Address Health Equity

To best meet the health-related needs of Medicaid and CHIP beneficiaries, and address equity within these programs and services, Medicaid leaders should reflect the varied populations they serve. Medicaid leaders are more likely to relate to the needs and challenges of their members when they share the identities of enrollees. This blog post and infographic from CHCS highlight key strategies for diversifying the Medicaid leadership pipeline, drawing from a CHCS report developed with support from the Robert Wood Johnson Foundation.

Short URL: http://www.advancingstates.org/node/73944

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States Want to Integrate Medicare and Medicaid, But They Need Federal Resources and Flexibilities

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.

Short URL: http://www.advancingstates.org/node/73920

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Integrated Care Planning for Medicaid Members with Complex Needs: Lessons from MassHealth

This brief outlines lessons from the Center for Health Care Strategies’ MassHealth Care Planning Learning Collaborative, where Massachusetts Accountable Care Organizations and Community Partners integrated care planning across their organizations to improve care for Medicaid members with complex needs. This brief can inform providers, payers, and community partners in other states seeking to improve care for people with complex health and social needs.

Short URL: http://www.advancingstates.org/node/73909

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Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules

CMS has released a new proposed rule with several provisions related to dual eligible individuals and would impact states. The proposed rule includes provisions to: Limit retroactive Medicare Part B premium liability for states to 36 months, Retire the old stand-alone buy-in agreements and specify that the provisions of a state buy-in agreement shall be set forth in the state’s Medicaid state plan, Extend the Medicare Savings Programs (MSPs) to cover premiums and cost sharing for individuals enrolling in the new Medicare immunosuppressive drug benefit. CMS is currently requesting comments on the proposed rule.

Short URL: http://www.advancingstates.org/node/73876

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Preparing for Medicaid Changes When the Public Health Emergency Expires

When the federal declaration of a public health emergency (PHE) expires, many of the flexibilities initiated during COVID-19 will need to be rolled back, including changes in Medicaid enrollment and eligibility. ACL has developed a fact sheet to help grantees prepare for these changes ahead and continue to support older adults and people with disabilities who currently rely on Medicaid Coverage.

Short URL: http://www.advancingstates.org/node/73792

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The Doctor Will Hear You Now: Audio-Only Telehealth and the Promise of Access, Equity, and Engagement in Medicaid

The COVID-19 pandemic has forced many providers to transition to telehealth when it became the only way patients could access health services. Medicaid agencies now have an opportunity to support phone-based telemedicine in primary care beyond the pandemic, and many are already doing so. This blog post explores strategies that Medicaid agencies can use to suport audio-only telehealth moving forward, including extending payment parity for telehealth visits and using value-based payment models.

Short URL: http://www.advancingstates.org/node/73781

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State Policy Choices About Medicaid Home and Community-Based Services Amid the Pandemic

This brief shares data on state policy choices about Medicaid HCBS, including target populations, functional eligibility criteria, financial eligibility criteria, waiver waiting lists, benefit packages, out-of-pocket costs, use of capitated managed care, self-direction opportunities, covered provider types, electronic visit verification systems, and provider reimbursement rates.

Short URL: http://www.advancingstates.org/node/73714

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