Medicaid Archives - MedCity News https://medcitynews.com/tag/medicaid/ Healthcare technology news, life science current events Thu, 21 Sep 2023 22:57:56 +0000 en-US hourly 1 https://wordpress.org/?v=6.3.1 https://medcitynews.com/uploads/2021/03/cropped-mblue-32x32.png Medicaid Archives - MedCity News https://medcitynews.com/tag/medicaid/ 32 32 40682243 HHS: Medicaid/CHIP Coverage To Be Reinstated for 500K People https://medcitynews.com/2023/09/hhs-medicaid-chip-coverage-cms/ https://medcitynews.com/2023/09/hhs-medicaid-chip-coverage-cms/#respond Thu, 21 Sep 2023 22:57:56 +0000 https://medcitynews.com/?p=649509 Medicaid, coverage,

Thirty states have been conducting Medicaid and CHIP automatic renewals incorrectly, leading to many individuals being wrongly removed from coverage. Because of this, nearly 500,000 children and other individuals will have their coverage reinstated.

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Civil Rights Groups File Complaint Against Florida for Medicaid Redeterminations Process https://medcitynews.com/2023/09/civil-rights-complaint-medicaid-redeterminations-florida/ https://medcitynews.com/2023/09/civil-rights-complaint-medicaid-redeterminations-florida/#respond Fri, 15 Sep 2023 17:42:33 +0000 https://medcitynews.com/?p=648696

More than a dozen civil rights organizations alleged in a new complaint that Florida uses administrative practices that are preventing underserved communities from renewing their Medicaid coverage.

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Is Medicaid Expansion Still a Political Wedge Issue? https://medcitynews.com/2023/09/medicaid-expansion-political-democrats-republicans/ https://medcitynews.com/2023/09/medicaid-expansion-political-democrats-republicans/#respond Thu, 14 Sep 2023 21:27:47 +0000 https://medcitynews.com/?p=648453 Medicaid, coverage,

When Medicaid expansion was first enacted, it was a hot topic debate between Democrats and Republicans. But more and more states are starting to expand Medicaid, including several conservative states.

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Two Value-Based Care Initiatives That Could Shift the Alternative Payment Model Landscape [Sponsored] https://medcitynews.com/2023/09/two-value-based-care-initiatives-that-could-shift-the-alternative-payment-model-landscape/ https://medcitynews.com/2023/09/two-value-based-care-initiatives-that-could-shift-the-alternative-payment-model-landscape/#respond Wed, 06 Sep 2023 11:30:43 +0000 https://medcitynews.com/?p=646152 Dementia or brain damage and injury as a mental health and neurology medical symbol with a thinking human organ made of crumpled paper torn in pieces as a creative concept for alzheimer disease.

The Centers for Medicare and Medicaid Services has announced two value-based care alternative payment models set to launch in July 2024, one focused on dementia and one on primary care.

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CMS Requires States To Assess Medicaid Disenrollment Process https://medcitynews.com/2023/08/cms-medicaid-renewals-disenrolled-chip/ https://medcitynews.com/2023/08/cms-medicaid-renewals-disenrolled-chip/#respond Wed, 30 Aug 2023 22:00:02 +0000 https://medcitynews.com/?p=647160 Medicaid, coverage,

Some states may not be following federal requirements for the Medicaid renewal process, resulting in many individuals being wrongly removed from coverage, CMS said. Children may especially be affected.

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The Kids Are Not Alright: Why Pediatricians Need to Take Action to Prevent Medicaid Unwinding https://medcitynews.com/2023/08/the-kids-are-not-alright-why-pediatricians-need-to-take-action-to-prevent-medicaid-unwinding/ https://medcitynews.com/2023/08/the-kids-are-not-alright-why-pediatricians-need-to-take-action-to-prevent-medicaid-unwinding/#respond Thu, 24 Aug 2023 21:25:33 +0000 https://medcitynews.com/?p=643203

Pediatricians and anyone who works with children should proactively reach out to their patients with resources and information about how to maintain coverage. Ask them to make sure their contact information is updated in state databases. Tell them to expect and respond to any communication from the state about their enrollment status.

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Floridians Sue Florida Over Medicaid Redeterminations Process https://medcitynews.com/2023/08/medicaid-redeterminations-lawsuit-florida/ https://medcitynews.com/2023/08/medicaid-redeterminations-lawsuit-florida/#respond Wed, 23 Aug 2023 21:04:48 +0000 https://medcitynews.com/?p=646236

Two Florida families allege that tens of thousands of Floridians are being terminated from Medicaid coverage without sufficient information as to why. This comes as the U.S. continues the unwinding of the Medicaid continuous enrollment requirement, which stopped states from disenrolling Medicaid enrollees during the Covid-19 public health emergency.

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Congressman Launches Investigation into Medicaid Prior Authorization Denials https://medcitynews.com/2023/08/congressman-investigation-medicaid-prior-authorization-denials/ https://medcitynews.com/2023/08/congressman-investigation-medicaid-prior-authorization-denials/#respond Thu, 17 Aug 2023 22:26:14 +0000 https://medcitynews.com/?p=645732

U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.

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House Reps Introduce Bill To Ease State Medicaid Staffing Shortages Amid Redeterminations https://medcitynews.com/2023/08/medicaid-redeterminations-bill-house-staffing-shortages/ https://medcitynews.com/2023/08/medicaid-redeterminations-bill-house-staffing-shortages/#respond Mon, 14 Aug 2023 22:30:40 +0000 https://medcitynews.com/?p=645288 Medicaid, coverage,

The Medicaid Staffing Flexibility and Protection Act was introduced by Representative Earl L. “Buddy” Carter (R-Georgia) and Representative Neal Dunn (R-Florida). It would allow state Medicaid agencies to hire outside contractors to help with Medicaid redeterminations, as many agencies don’t have the workforce to handle the return to the redetermination process.

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35% of Medicaid Beneficiaries Say Their Health Plan Hasn’t Reached Out About Renewing Coverage https://medcitynews.com/2023/08/medicaid-renewals-redeterminations-health-plan/ https://medcitynews.com/2023/08/medicaid-renewals-redeterminations-health-plan/#respond Sun, 06 Aug 2023 13:35:04 +0000 https://medcitynews.com/?p=644160

Many Medicaid enrollees are not receiving the information they need from health plans during the return to Medicaid renewals, a new survey shows. Older Medicaid enrollees are especially struggling.

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Medicaid MCOs Denied 1 out of 8 Prior Authorization Requests in 2019 https://medcitynews.com/2023/07/medicaid-prior-authorization-denials-oig/ https://medcitynews.com/2023/07/medicaid-prior-authorization-denials-oig/#respond Wed, 19 Jul 2023 22:32:26 +0000 https://medcitynews.com/?p=642129

Medicaid managed care organizations deny prior authorization requests at high rates, according to a recent report by the Office of Inspector General. Of the 115 MCOs the OIG analyzed, 12 had prior authorization denial rates above 25%.

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‘This Is Almost Biblical in Its Impact’: Providers Push Back Against CMS’ New Proposed Rules https://medcitynews.com/2023/07/cms-healthcare-inflation-reimbursement/ https://medcitynews.com/2023/07/cms-healthcare-inflation-reimbursement/#respond Fri, 14 Jul 2023 19:16:01 +0000 https://medcitynews.com/?p=641679 handcuffs, law, lawyer, charge, fraud, legal

CMS recently revealed its proposals to raise reimbursement rates for hospital outpatient departments and cut payments for physicians. Next year, the agency is planning to decrease physicians’ pay by 1.25% and increase outpatient payment rates by 2.8%. Provider groups are unhappy with the news — AMA President Dr. Jesse Ehrenfeld said the new physician fee schedule will be “almost biblical in its impact.”

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Health Net Invests $46M To Support Unhoused in California https://medcitynews.com/2023/07/housing-homelessness-unhoused-california-medicaid-investment/ https://medcitynews.com/2023/07/housing-homelessness-unhoused-california-medicaid-investment/#respond Fri, 14 Jul 2023 18:37:25 +0000 https://medcitynews.com/?p=641655

Health Net is making a $46 million investment that will be spread out across 26 counties in California, and will support Continuum of Care programs, which are regional or local planning bodies that help those experiencing homelessness find housing and other services.

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Health Connect America Gets Fined $4.6M for Wrongful Billing of Medicaid https://medcitynews.com/2023/07/mental-health-children-fined-medicaid-improper-billing/ https://medcitynews.com/2023/07/mental-health-children-fined-medicaid-improper-billing/#respond Tue, 11 Jul 2023 22:29:28 +0000 https://medcitynews.com/?p=641325

Health Connect America, a mental health company, improperly billed Virginia Medicaid for three different behavioral health services for children, according to the U.S. Attorney’s Office of Western District of Virginia.

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Report: 1.5 Million Medicaid Enrollees Have Been Disenrolled from Coverage https://medcitynews.com/2023/07/medicaid-disenrolled-continuous-enrollment-redeterminations/ https://medcitynews.com/2023/07/medicaid-disenrolled-continuous-enrollment-redeterminations/#respond Wed, 05 Jul 2023 23:18:53 +0000 https://medcitynews.com/?p=640614 Medicaid, coverage,

Due to the end of the Medicaid continuous enrollment provision, at least 1.5 million Medicaid enrollees have lost coverage as of June 29, according to KFF. About 71% of those who were disenrolled from Medicaid were disenrolled for procedural reasons.

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It’s Not Just Work Requirements; Food Insecurity is a Multidimensional Issue https://medcitynews.com/2023/06/work-requirements-food-insecurity-snap/ https://medcitynews.com/2023/06/work-requirements-food-insecurity-snap/#respond Thu, 22 Jun 2023 21:14:35 +0000 https://medcitynews.com/?p=638865

Twelve short years ago I was a single mother, pregnant and surviving off of food stamps where I relied on the support of the SNAP program. Now, I’ve been given the opportunity to build a platform where I can give a voice to those in similar positions that I once was in and advocate for their needs.

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How Walgreens Is Supporting Patients During Medicaid Redeterminations https://medcitynews.com/2023/06/walgreens-medicaid-redeterminations-pharmacy-renewals/ https://medcitynews.com/2023/06/walgreens-medicaid-redeterminations-pharmacy-renewals/#respond Thu, 15 Jun 2023 22:22:05 +0000 https://medcitynews.com/?p=638433 Medicaid, coverage,

Now that Medicaid redeterminations have resumed, Walgreens is supporting patients by educating them about renewals and helping them navigate through the process, execs said at AHIP 2023 in Portland.

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How State Medicaid Programs Are Responding to the Behavioral Health Crisis https://medcitynews.com/2023/05/medicaid-behavioral-mental-health-crisis/ https://medcitynews.com/2023/05/medicaid-behavioral-mental-health-crisis/#respond Fri, 26 May 2023 17:48:33 +0000 https://medcitynews.com/?p=636100

The Substance Abuse and Mental Health Services Administration identifies three core crisis services that should be available to those in need of behavioral health support: crisis hotlines, mobile crisis units and crisis stabilization. However, 33 state Medicaid programs don’t cover all of these services, a new analysis by the Kaiser Family Foundation found.

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Most Medicaid Enrollees Are Unaware About the Return to Eligibility Renewals https://medcitynews.com/2023/05/medicaid-eligibility-renewal-redetermination/ https://medcitynews.com/2023/05/medicaid-eligibility-renewal-redetermination/#respond Thu, 25 May 2023 22:11:03 +0000 https://medcitynews.com/?p=636037 Medicaid, coverage,

The Medicaid continuous enrollment provision ended March 31, meaning states are resuming the renewal process for Medicaid and disenrolling those who no longer qualify for coverage or don’t renew coverage. Most Medicaid enrollees are unprepared for this, a survey from the Kaiser Family Foundation showed.

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New Analysis Shows 9 Key Metrics That Will Support Medicaid Coverage During Redeterminations https://medcitynews.com/2023/04/medicaid-renewal-redeterminations/ https://medcitynews.com/2023/04/medicaid-renewal-redeterminations/#respond Wed, 26 Apr 2023 22:08:41 +0000 https://medcitynews.com/?p=632652 Medicaid, coverage,

Between eight to 24 million people could lose Medicaid coverage during the redetermination process, which began April 1, according to Kaiser Family Foundation. To mitigate losses, several states have implemented policies like taking the full year to complete renewals and automating the process.

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Biden Administration Introduces Plan To Expand Medicaid, ACA Coverage to DACA Recipients https://medcitynews.com/2023/04/biden-administration-introduces-plan-to-expand-medicaid-aca-coverage-to-daca-recipients/ https://medcitynews.com/2023/04/biden-administration-introduces-plan-to-expand-medicaid-aca-coverage-to-daca-recipients/#respond Sun, 16 Apr 2023 14:42:06 +0000 https://medcitynews.com/?p=631380 Medicare for All

By the end of the month, the Department of Health and Human Services (HHS) is expected to release a proposed rule that would allow DACA recipients to apply for healthcare coverage through the Health Insurance Marketplace or through their state Medicaid organization.

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Zocdoc Adds FQHCs to Marketplace To Support Medicare, Medicaid Beneficiaries https://medcitynews.com/2023/04/zocdoc-adds-fqhcs-to-marketplace-to-support-medicare-medicaid-beneficiaries/ https://medcitynews.com/2023/04/zocdoc-adds-fqhcs-to-marketplace-to-support-medicare-medicaid-beneficiaries/#respond Mon, 10 Apr 2023 17:47:16 +0000 https://medcitynews.com/?p=630645

Zocdoc, a healthcare marketplace, is adding Federally Qualified Health Centers (FQHCs) to its platform. Patients are now able to find and book appointments with FQHCs working with Zocdoc on the company’s website or app, and can filter based on factors like specialty and location.

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Stop, Drop and Reenroll: How Medicaid Redeterminations, Renewals, and Disenrollment Can Affect the Revenue Cycle https://medcitynews.com/2023/04/stop-drop-and-reenroll-how-medicaid-redeterminations-renewals-and-disenrollment-can-affect-the-revenue-cycle/ https://medcitynews.com/2023/04/stop-drop-and-reenroll-how-medicaid-redeterminations-renewals-and-disenrollment-can-affect-the-revenue-cycle/#respond Mon, 03 Apr 2023 21:50:04 +0000 https://medcitynews.com/?p=629175 Medicaid, coverage,

Florida healthcare providers are prone to experience unpredictable changes in the revenue cycle when Medicaid plans begin the redetermination, renewal, and disenrollment process.

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What Gives 3 Execs Comfort and Concern About Medicaid Redeterminations https://medcitynews.com/2023/03/what-gives-3-execs-comfort-and-concern-about-medicaid-redeterminations/ https://medcitynews.com/2023/03/what-gives-3-execs-comfort-and-concern-about-medicaid-redeterminations/#respond Sun, 26 Mar 2023 14:46:10 +0000 https://medcitynews.com/?p=628476 Medicaid, coverage,

During a panel at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum, three executives were asked what gives them comfort about the return to Medicaid redeterminations, as well as what worries them. One CMS official said she’s pleased that states are ramping up communication efforts for Medicaid enrollees, but is concerned about the “insurmountable task” ahead.

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Bipartisan Legislation Efforts Build Against PBMs https://medcitynews.com/2023/03/bipartisan-legislation-efforts-build-against-pbms/ https://medcitynews.com/2023/03/bipartisan-legislation-efforts-build-against-pbms/#respond Mon, 20 Mar 2023 21:31:25 +0000 https://medcitynews.com/?p=628146

A bipartisan group of House representatives introduced the Drug Price Transparency in Medicaid Act on Friday. The bill would ban spread pricing in Medicaid programs.

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AHIP-led Coalition Aims To Reduce Coverage Losses Amid Pending Medicaid Redeterminations https://medcitynews.com/2023/03/ahip-led-coalition-aims-to-reduce-coverage-losses-amid-pending-medicaid-redeterminations/ https://medcitynews.com/2023/03/ahip-led-coalition-aims-to-reduce-coverage-losses-amid-pending-medicaid-redeterminations/#respond Mon, 13 Mar 2023 21:02:23 +0000 https://medcitynews.com/?p=626910 Medicaid, coverage,

AHIP and several other healthcare organizations launched the Connecting to Coverage Coalition last week in an effort to make the upcoming Medicaid redetermination process run smoothly. The coalition’s website includes studies on Medicaid redeterminations and frequently asked questions for enrollees. AHIP also released a report that shows 53.6% of those who will lose coverage will transition to employer-sponsored insurance and 21.2% will become uninsured.

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Medicaid Expansion Isn’t All That Impactful Without Proper Education, OSF Research Finds https://medcitynews.com/2023/03/medicaid-expansion-isnt-all-that-impactful-without-proper-education-osf-research-finds/ https://medcitynews.com/2023/03/medicaid-expansion-isnt-all-that-impactful-without-proper-education-osf-research-finds/#respond Thu, 09 Mar 2023 00:04:35 +0000 https://medcitynews.com/?p=626817 Medicaid

Results from a recent study conducted by OSF Healthcare and Bradley University show that expanding Medicaid to more people hasn’t increased underserved populations’ access to healthcare as much as lawmakers have hoped. The findings shone a light on where hospitals should focus their outreach efforts for Medicaid education.

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Medicaid/CHIP Enrollment Will Grow To Nearly 95M by the End of March, Analysis Predicts https://medcitynews.com/2023/03/medicaid-chip-enrollment-will-grow-to-nearly-95m-by-the-end-of-march-analysis-predicts/ https://medcitynews.com/2023/03/medicaid-chip-enrollment-will-grow-to-nearly-95m-by-the-end-of-march-analysis-predicts/#respond Mon, 06 Mar 2023 22:24:40 +0000 https://medcitynews.com/?p=626451

By the end of March, Medicaid/CHIP enrollment will have grown by 23.3 million members since the start of the pandemic, according to a Kaiser Family Foundation report. This is largely due to the continuous enrollment provision enacted during the pandemic, which barred states from disenrolling members and is set to expire March 31.

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64% of Medicaid Enrollees Are Unaware of Redeterminations. How Can the Industry Help? https://medcitynews.com/2023/03/64-of-medicaid-enrollees-are-unaware-of-redeterminations-how-can-the-industry-help/ https://medcitynews.com/2023/03/64-of-medicaid-enrollees-are-unaware-of-redeterminations-how-can-the-industry-help/#respond Sun, 05 Mar 2023 14:30:45 +0000 https://medcitynews.com/?p=626109 Medicaid, coverage,

After three years of not having to renew Medicaid coverage, redeterminations are set to return April 1. Yet, more than 64% of enrollees are unaware. Constant repetition and outreach from healthcare players will be needed to combat this, one payer expert said.

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Why Blue Shield of California Made Its Wellvolution Platform Available to Medi-Cal Members https://medcitynews.com/2023/02/why-blue-shield-of-california-made-its-wellvolution-platform-available-to-medi-cal-members/ https://medcitynews.com/2023/02/why-blue-shield-of-california-made-its-wellvolution-platform-available-to-medi-cal-members/#respond Tue, 21 Feb 2023 23:18:36 +0000 https://medcitynews.com/?p=624805

Blue Shield of California’s Wellvolution platform includes programs for mental health, diabetes reversal, addiction and nutrition. Last month, the payer made the platform available to its Medi-Cal members, a process that took two years.

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