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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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%.

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.”

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.