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Tag Archives: Medicaid
As the Medicaid program is wrapped up in the battle of expansion and work requirements, the Centers for Medicare & Medicaid Services (CMS) is quickly pushing along its efforts to increase oversight of the program as well, and Managed Care Organizations (MCOs) should be prepared.
Supreme Court Justice Kennedy’s decision this week to retire will set in motion a battle royal to fill his seat. Many are focused on the implications of a stacked conservative court for abortion rights, but a new right-wing justice handpicked by Trump likely will also reach much further into healthcare issues. We need to start thinking about what Kennedy’s retirement means for Medicaid work requirements, Medicaid expansion, and even the very legality of the Affordable Care Act (ACA).
This has shaped up to be an extremely active year for Medicaid. From fighting off proposals to cutting funding from the program, to the Trump Administration’s efforts to change Medicaid administratively as we know it, to active state legislatures and, in a couple of cases, citizen referendums, to changing their states approach to Medicaid, this is arguably the most active time since the fallout of the NFIB vs. Sebelius case, which decided the federal government could not mandate state participation in Medicaid expansion.
The Center for Connected Health Policy (CCHP) released its now biannual report on state telehealth policies and Medicaid. While many states are beginning to expand telehealth reimbursement, others continue to restrict and place limitations on telehealth-delivered services. Although each state’s laws, regulations, and Medicaid program policies differ significantly, certain trends are evident when examining the various policies. Live video Medicaid reimbursement, for example, continues to far exceed reimbursement for store and forward and remote patient monitoring (RPM).
On March 23, 2018, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would provide for a reduction of administrative burden with states that have high rates of Medicaid managed care enrollment. In the past, states with high enrollment have raised concerns regarding administrative burden when they have to determine whether Medicaid payments in Fee-for-Service systems are sufficient to enlist providers to ensure beneficiary access to covered care and services consistent with the statute.
In the January 11, 2018, letter published by the Centers for Medicare & Medicaid Services (CMS) giving the green light for states to pursue adding work requirements to their Section 1115 waiver programs, the Trump administration, through CMS, has looked to push the envelope as to how far they can modify the Medicaid program as we know it. Changes have not only included typical proposed structural changes, such as turning Medicaid into a block grant program, but new proposals are aimed at the very heart of what Medicaid means—and these proposed changes are being led by the states.
As expected, on January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) released its guidance around implementing work requirements through 1115 waivers. Ten states have applied for such a waiver and have pending proposals at CMS.