Medicaid
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HHS: Medicaid/CHIP Coverage To Be Reinstated for 500K People
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
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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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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Is Medicaid Expansion Still a Political Wedge Issue?
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
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
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
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
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
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
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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Applying Remote Patient Monitoring to Surgery Prep and Recovery, Oncology and Women’s Health
Join us to learn about the latest trends in remote monitoring and how to extend its benefits beyond chronic conditions to more patients – all while using fewer staff resources.
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35% of Medicaid Beneficiaries Say Their Health Plan Hasn’t Reached Out About Renewing Coverage
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
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
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
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
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
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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Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
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Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.
