Medicaid and CHIP
Posted on March 7, 2014
The Centers for Medicare and Medicaid Services (CMS) released a final rule and payment notice for the Basic Health Program (BHP). Under the Affordable Care Act (ACA), many individuals will have an income too high to qualify for Medicaid, yet subsidies may not make their health insurance affordable. BHP, a program aiming to reduce churning between Medicaid and private coverage, helps to ensure continuity of care for individuals with fluctuating incomes. The rule allows for states to receive funding for BHP beginning in 2015.
Posted on February 27, 2014
The Centers for Medicare and Medicaid Services (CMS) issued the funding allocation for disproportionate share hospitals (DSH) for FY 2014. DSH payments are typically provided to hospitals that treat a disproportionate number of uninsured or under-insured patients. The Affordable Care Act (ACA) originally called for a cut in DSH payments, as more Americans would presumably be insured under Medicaid. The Supreme Court ruling that made Medicaid expansion optional, however, ultimately coerced CMS to delay DSH cuts for two years.
Posted on February 20, 2014
The Government Accountability Office (GAO) released a new report citing how Medicaid spends a third of their funds on a small sect of high-expenditure Medicaid beneficiaries. The report, Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries, found that states spent 31.6% of all Medicaid expenditures on 4.3% of the Medicaid population. Furthermore, the report stated that certain characteristics, such as residing in a long-term care facility, contributed to individuals being deemed high-expenditure Medicare beneficiaries.
Posted on January 28, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a bulletin and question-and-answer explaining hospital presumptive eligibility. The documents are intended to aid hospitals in determining individual eligibility for Medicaid, or presumptive eligibility, under the Affordable Care Act (ACA). The documents provide relevant information on eligible populations, entities that can make coverage determinations, qualification standards, and federal matching assistance that may be relevant for hospitals that may treat patients without insurance. All states are expected to include an amendment to their Medicaid State Plans implementing the new presumptive eligibility standards.
Posted on January 24, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a new report chronicling the numbed of individuals deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) during the first three months of open enrollment. The report stated that 6.3 million Americans enrolled in Medicaid or CHIP in state-based Marketplaces or in-person at state Medicaid offices. The report does not, however, provide numbers for Medicaid enrollment in federally-facilitated Marketplaces, nor does it differentiate between individuals that are newly eligible for Medicaid as a result of expansion and those that were previously eligible under the original Medicaid criteria.
Posted on January 13, 2014
This updated map reflects the recent acceptance of Wisconsin’s 1115 demonstration waiver to permit childless adults earning up to 100% of the federal poverty level (FPL) to receive health coverage from Wisconsin’s Medicaid program, BadgerCare.
Posted on January 13, 2014
Last week. the Centers for Medicare and Medicaid Services (CMS) approved a 1115 demonstration waiver for Wisconsin to expand the state’s Medicaid program, BadgerCare. The waiver expands Medicaid to childless adults earning up to 100% of the federal poverty level (FPL). Individuals previously enrolled in Wisconsin’s BadgerCare Plus program and those deemed newly eligible for Medicaid under the Affordable Care Act’s (ACA) criteria will be placed on the federal health insurance Marketplace operating in Wisconsin. The waiver went into effect on January 1st, 2014.
Posted on January 2, 2014
A new report from the Government Accountability Office (GAO) examined Children’s Health Insurance Program (CHIP) plans from five states and compared these plans to each state’s respective benchmark Qualified Health Plan (QHP) offered through the Affordable Care Act (ACA). Overall, GAO found the CHIP plans were comparable to the benchmark plans in terms of the services covered and the limitations placed upon those services. The cost of these services to the consumers, however, was generally less for the CHIP plans than for the benchmark plans. Plan usage for certain services was one difference detected between the two plans. For instance, CHIP beneficiaries reported more usage of emergency room services compared to individuals with private insurance.
Posted on December 13, 2013
A new report from the Georgetown University Health Policy Institute Center for Children and Families discusses some of the issues with premium administration for public and subsidized insurance programs from the perspective of low-income individuals and families. The report, Handle with Care: How Premiums Are Administered in Medicaid, CHIP and the Marketplace Matters, describes how the absence of policy alignment between Medicaid, the Children’s Health Insurance Program (CHIP), and insurance subsidies from the Affordable Care Act (ACA) can be very detrimental to low-income individuals enrolling in and maintaining coverage. Some of the specific policies addressed by the brief include payment and collection options, grace periods, and cancellation rules.
Posted on December 9, 2013
The Congressional Research Service (CRS) recently published a report about Medicaid disproportionate share hospital (DSH) payments. Since FY1993, DSH payments have been provided to hospitals that serve a high proportion of both uninsured and underinsured patients. Care provided to these patients is often uncompensated or compensated at low rates, rendering DSH payments necessary to help mitigate some of the financial strain associated with treating this patient population. The Affordable Care Act (ACA) was designed to help reduce the uninsured population, and as a result, a provision to reduce DSH payments was included in the law. The 2012 Supreme Court ruling, which made Medicaid expansion optional for states, did not change the DSH payment reduction provision. The final rule outlining the DSH reduction methodology does not take into account a state’s decision on Medicaid expansion, so some states may experience a reduction in DSH payments without the intended accompanied increase in insured individuals. The new CRS report provides an overview of DSH payments, including allocation methodology, current trends in DSH spending, and implications on states after full implementation of the ACA.