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Archive for Federal Medicaid issues

Court Rebuffs CMS on Medicaid DSH

A federal court has rejected the manner in which the Centers for Medicare & Medicaid Services collects certain Medicaid data from states in a ruling that has potential implications for eligible hospitals’ Medicaid disproportionate share hospital payments (Medicaid DSH). In a case that challenged how CMS told hospitals to report third-party payments for Medicaid patients, the court ruled against CMS in two different ways:  first, it found that CMS had not interpreted a 2003 law in a manner consistent with congressional intent; and second, it ruled that CMS could not clarify its interpretation through a published FAQ rather than through regulations. As a result of the ruling, some hospitals may get extra room under their hospital-specific Medicaid DSH limit.  For … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments

MACPAC Issues Annual Report, Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has published its annual report and recommendations to Congress. MACPAC’s report addresses three primary areas:  Medicaid managed care, telehealth, and Medicaid disproportionate share payments (Medicaid DSH). With 80 percent of Medicaid beneficiaries now enrolled in managed care plans, MACPAC offers three major recommendations for improving Medicaid managed care efforts: permit states to require all of their Medicaid beneficiaries to enroll in a managed care plan extend Medicaid managed care section 1915(b) waivers from two to five years permit states to obtain waivers to waive freedom of choice and selective contracting restrictions MACPAC notes the growing use of telehealth by state Medicaid programs and encourages states to continue this expansion while learning more … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

Addressing Socio-Economic Challenges Through Medicaid Payment Policies

Amid the growing awareness of the impact of social factors on health, policy-makers are increasingly interested in finding ways to address those factors through state Medicaid programs. In a new blog post, the journal Health Affairs offers six ways for states to address social determinants of health through Medicaid managed care programs. classify certain social services as covered benefits under the state’s Medicaid plan explore additional flexibility afforded states through section 1115 waivers use value-based payments to support investment in social interventions use incentives and withholds to encourage plan investment in social interventions integrate efforts to address social issues into quality improvement activities reward plans with effective investments in social interventions with higher rates Learn more about how states can … Read More

Posted in Federal Medicaid issues

New Report Details Key Health Care Provisions in February Budget Bill

The Congressional Research Service has published a new report describing the health care-related provisions in the Bipartisan Budget Act of 2018 that Congress passed last month to fund the federal government. A major part of that law was the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, and the new report includes descriptions of the Medicare, Medicaid, CHIP, public health, and other health care aspects of the law. Go here to find the Congressional Research Service report Bipartisan Budget Act of 2018 (P.L. 115-123): Brief Summary of Division E—The Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act.

Posted in Federal Medicaid issues, Medicare

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met in Washington, D.C. last week to discuss a number of Medicaid and CHIP meetings.  The following is MACPAC’s summary of this meeting. MACPAC’S March 2018 meeting began with a review of two draft chapters with recommendations that will be included in MACPAC’s June 2018 report, the first to improve operation of the Medicaid drug rebate program and the second to improve the clarity of substance use disorder (SUD) confidentiality regulations. At the opening session the Commission reviewed a draft chapter on Medicaid drug policy and later voted to approve two recommendations presented at its December 2017 meeting to (1) close a loophole in current law that allows drug manufacturers … Read More

Posted in Federal Medicaid issues

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well. Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including: establishing time limits on how many months or years individuals may be enrolled in Medicaid; locking out for a specified period of time Medicaid recipients who have not gone through annual eligibility redetermination or have failed to pay Medicaid … Read More

Posted in Federal Medicaid issues

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. to discuss a variety of Medicaid and Children’s Health Insurance Program issues. MACPAC, the non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the administration, and the states, addressed a number of issues during the meeting.  Among them it discussed Medicaid managed long-term services and supports (MLTSS) and voted to recommend that states be given the opportunity to seek permission to make Medicaid beneficiary enrollment in managed care plans mandatory through revisions of their state plan amendment rather than by seeking Medicaid waivers. The commission also heard presentations on and discussed: the integration of substance use disorder treatment with other … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

Medicaid in the Spotlight

State-option work requirements. A cap on federal spending. New flexibility for states to address eligibility, benefits, and provider payments. Rolling back the Affordable Care Act’s eligibility expansion. Medicaid is under the policy microscope in Washington these days in ways it has not been for many years as the new administration continues to work to put its stamp on the federal government’s major program to provide health care to low-income Americans. These and other possible changes are of great interest to Pennsylvania’s safety-net hospitals because these hospitals care for so many more Medicaid and low-income patients than the typical community hospital. What are policy-makers considering and what are the potential implications of their efforts?  Learn more in the new Health Affairs … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

A New Use for Section 1115 Medicaid Waivers?

Historically, states have pursued section 1115 Medicaid waivers as a means of expanding Medicaid eligibility. But the Centers for Medicare & Medicaid Services now appears to be looking at granting 1115 waivers to help states reduce their Medicaid populations. According to a new report published by the Commonwealth Fund, CMS is encouraging states – both Medicaid expansion and non-expansion states – to launch demonstration programs designed to reduce enrollment in “means-tested public assistance” programs such as Medicaid.  In their efforts to cut spending and reduce Medicaid enrollment, states are expected to seek section 1115 waivers to experiment with means of doing so such as: establishing monthly premiums for Medicaid recipients eliminating retroactive eligibility imposing lifetime limits on how long individuals … Read More

Posted in Federal Medicaid issues

Administration Lays Groundwork for Medicaid Work Requirements

The Centers for Medicare & Medicaid Services has issued guidelines for states interested in adding a work requirement component to their Medicaid programs. With nearly a dozen states applying to implement controversial Medicaid work requirements, CMS has issued a guidance letter to state Medicaid directors outlining the criteria it will use when considering such applications. The new policy does not mandate work requirements in state Medicaid programs; it only presents the parameters CMS will use when considering the applications of states wishing to impose such requirements. For  more information about the new policy, see the following resources: CMS’s news release announcing the new policy The letter CMS sent to state Medicaid directors explaining the new policy A CMS FAQ on … Read More

Posted in Federal Medicaid issues
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