CMS proposes reductions in Medicaid allotments to states for hospitals’ uncompensated care

On July 28, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to implement $43 billion in reductions in federal Medicaid allotments to state Medicaid agencies for payment adjustments to hospitals serving a disproportionate share of low-income persons. The reductions in such allotments under the proposed rule will apply to federal fiscal years 2018-2025. Reductions nationwide will start at $2 billion in FY 2018 and will reach $8 billion per year in FY 2024 and FY 2025. [More]

National Academy of Medicine outlines strategies for high-need patients

On July 6, 2017, the National Academy of Medicine released a valuable report entitled, “Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health.” The report describes key characteristics of high-need patient populations, tools that can be adopted to identify evidence-based models of care for them, and strategies to promote successful implementation of such models in collaboration with a broad range of stakeholders at the federal, state, and community level. It stresses the importance of behavioral health issues, social determinants of health, and community-based supports for high-need patients who often struggle at home with functional limitations associated with aging, disabilities, and a wide range of long-term diseases examined in the report. [More]

Medicaid Member Engagement: One Size Does Not Fit All

There’s a certain catch-phrase going around related to Medicaid members: they need to have “skin in the game.” This phrase seems to imply that individuals receiving Medicaid are somehow different than other individuals—those who have private insurance—but they’re not. Individuals receiving healthcare through Medicaid are just like you and me. They want their children to be healthy and happy. They want to improve their health. They want to live happy and productive lives. However, due to life circumstances, some of them may need a little more assistance than others in understanding the role they play in their healthcare. Effective member engagement can help guide individuals through the complex Medicaid system of care. Medicaid’s population is very diverse and serves individuals from different socioeconomic backgrounds—the aged, blind, disabled, children, pregnant women, relatives taking care of children, and childless adults can qualify for Medicaid if they meet state specific guidelines. Activities to engage Medicaid members in their healthcare need to be as diverse as the population. Mass mailings to the entire population may not be as effective as specific information targeted to a select group of individuals. [More]

PCG creates summary of the House-passed health care bill

The American Health Care Act (“the bill”) passed the House of Representatives on May 4, 2017. As outlined in greater detail in the PCG summary, the bill does not repeal the Affordable Care Act (ACA) in full, but rather proposes changes primarily focused on the ACA’s insurance affordability, Medicaid expansion, coverage requirements and revenue provisions. It also proposes changes to Medicaid funding more generally and allows states to waive medical underwriting prohibitions. [More]

What you need to know about modularity

If you work in state Medicaid or health information technology (HIT), chances are you have seen the term modularity discussed with increasing frequency lately. Countless articles have been written about it, and it has been a focus at some of the largest Medicaid and HIT conferences over the past year including MESC, HIMSS, and the Health IT Connect Summit. For all of the coverage it has gotten, defining what modularity truly means has been an ongoing debate among states, the Centers for Medicare and Medicaid Services (CMS), and the vendor community. [More]

Proposed ACA repeal legislation would impose new restrictions on state Medicaid programs

On March 6, 2017, the U.S. House of Representatives released its initial draft legislation to “repeal and replace” the Affordable Care Act (ACA). The initial draft legislation would impose significant new restrictions on state Medicaid programs. The legislation would impose annual per capita caps on federal financial participation (FFP) in state Medicaid expenditures beginning with the federal fiscal year (FFY) 2020 (October 1, 2019 – September 30, 2020). The Centers for Medicare and Medicaid Services (CMS) would impose separate per capita caps for six Medicaid eligibility categories: the aged, blind, disabled, children, Medicaid expansion adults, and non-expansion adults.
For FFY 2020, CMS would... [More]

Patient Freedom Act of 2017

On January 23rd, Senators Bill Cassidy and Susan Collins introduced the Patient Freedom Act of 2017 to largely repeal and replace Title 1 of the Affordable Care Act (ACA), which includes insurance reforms. Certain ACA provisions would remain, including changes to the Medicaid program (e.g., Medicaid expansion) and Medicare and ACA revenue provisions. [More]

Inauguration Day – Get up to speed on Medicaid Block Grants

With Inauguration Day upon us, the discussion on the future of healthcare in the US and specifically the Affordable Care Act (ACA) will continue to be a major headline as the new administration focuses its efforts to ‘repeal and replace’ the ACA. While much of the attention has been on the plans of the Republican administration and Republican-led Congress to ‘repeal and replace’ the ACA, the discussion on the future of healthcare in the US has included the possibility for a major shift in the funding for the Medicaid program. [More]

CMS issues final rule on eligibility, appeals, and enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), and Exchanges pursuant to the Affordable Care Act (ACA)

On November 30, 2016, a final rule issued by the Center for Medicare and Medicaid Services (CMS) was published in the Federal Register (81 Fed. Reg. 86382), which, according to the preamble of the regulation, “continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the ACA.” [More]

Massachusetts wins CMS renewal of demonstration waivers

On November 4, 2016, the Commonwealth of Massachusetts won approval from the Centers for Medicare and Medicaid Services (CMS) for a five-year renewal of its $52.4 billion MassHealth demonstration waiver program. The waiver renewal authorizes MassHealth to pioneer an innovative Medicaid accountable care organization (ACO) model, under which ACOs will partner with community-based organizations to integrate health care and social services, to address social determinants of health, and to achieve patient-centered, outcomes-based care. The renewal includes $1.8 billion in new, up-front investments under a delivery system reform incentive program (DSRIP) initiative to support transition throughout the Commonwealth to the new ACO model, under which provider-led ACOs will be accountable for costs and quality of care. [More]