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]

Foster Care and Medicaid

Under the Affordable Care Act (ACA), youth who were in foster care and receiving Medicaid on their 18th birthday are categorically eligible for Medicaid until their 26th birthday, regardless of their income. The provision in the law aligned with the extended coverage of young adults whose parents have private health insurance. On October 18, 2016, Columbia University’s School of Public Health released a policy brief reporting that an estimated 180,000 young people who have aged out of foster care are eligible for extended health care coverage. [More]

HHS proposes new rules on Medicaid fraud control units

On September 20, 2016, the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), jointly proposed new rules governing state Medicaid fraud control units (MFCUs). The proposed rules would require that MFCUs and state Medicaid agencies establish, review, and periodically update memoranda of understanding (MOUs) on coordination between these state agencies. [More]

HHS report shows Medicaid expansion affects QHP premiums

On August 25, 2016, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE), released a report showing that premiums for qualified health plans (QHPs) offered through Exchanges were on average about seven percent lower in 2015 for states that had expanded Medicaid for persons with incomes up to 138 percent of the Federal poverty level (FPL) versus states that had not. As actuarial risk pools, hence premiums, vary based on many local area factors, the report focuses on QHP benchmark premiums in 94 paired counties on opposite sides of borders between expansion states and non-expansion states that had used Federal exchanges in 2015. [More]