Medicaid and CHIP
Posted on June 19, 2013
This Implementation Brief Update discusses CMS’ May 17, 2013, State Health Official Letter, the purpose of which is to advise states on options to facilitate Medicaid and CHIP enrollment and renewal. The letter lays out “optional strategies that can help make significant progress toward reducing the number of uninsured individuals” as well as “optional tools to help states manage the transition to their new eligibility and enrollment systems and coverage of new Medicaid enrollees.” The letter is intended to help states make the transition to the simplified Medicaid and CHIP enrollment system that must be in place in all states beginning January 1, 2014, in accordance with ACA §2201. The mandatory nature of the enrollment simplification requirement was not affected by the United States Supreme Court’s decision in NFIB v Sebelius, which permits states to opt out of the adult Medicaid eligibility expansion group…
Posted on June 13, 2013
For thirty years, the Medicare and Medicaid programs have furnished additional payments to hospitals that furnish a disproportionate share of services to low income populations. Despite the fact that the two disproportionate share hospital (DSH) programs share a common mission, they function differently in terms of how the funds actually move to hospitals and in the formulas used to make DSH payments. The Affordable Care Act makes significant adjustments in both DSH programs beginning in 2014 in anticipation of a significant expansion in the proportion of people who have health insurance coverage. With the United States Supreme Court’s decision in 2012 in NFIB v Sebelius, which permits states to opt out of the Medicaid expansion without risking the loss of federal funding for their existing Medicaid programs, the downward DSH payment adjustments become an even more significant matter for hospitals that treat large volumes of low income patients…
Interview of Phyllis Borzi, Assistant Secretary of Labor of the Employee Benefits Security Administration (EBSA), United States Department of Labor
Posted on June 11, 2013
Recently, Sara Rosenbaum, the Hirsh Professor of Health Law and Policy at the GW Department of Health Policy, had an opportunity to interview Phyllis Borzi, the federal official in charge of overseeing the Employee Benefits Security Administration (EBSA), for Health Reform GPS. EBSA is an agency of the United States Department of Labor responsible for administering, regulating and enforcing the provisions of Title I of the Employee Retirement Income Security Act of 1974 (ERISA), and the agency is playing an important role in the implementation of the Affordable Care Act….
Posted on June 7, 2013
There are several barriers in place that decrease access to specialty care for many Medicaid beneficiaries. Some of these deterrents to specialty care include low physician reimbursements, administrative burdens of treating Medicaid patients, and non-medical challenges often experienced by Medicaid beneficiaries. A new study released by The Commonwealth Fund examines six models that are currently being used by safety-net hospitals, community health centers, and state Medicaid programs to help Medicaid patients gain access to specialty services. Some of the strategies in these models include: delivering specialty care at primary care facilities, expanding the role of primary care physicians, and hiring staff that coordinate care among different providers for Medicaid beneficiaries.
Posted on June 7, 2013
The Congressional Budget Office (CBO) published a report describing the characteristics and costs associated with dual-eligible beneficiaries. A dual-eligible beneficiary, or dual, is someone that is eligible to receive benefits from both Medicare and Medicaid. Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies uses data from 2009 to examine the different payment systems used in both Medicare and Medicaid to pay for dual benefits, as well as methods by federal and state governments to integrate the payments systems and better coordinate care for this growing population.
Posted on June 3, 2013
An article published in the June issue of Health Affairs indicated that states opting out of Medicaid expansion would prohibit 3.6 million Americans from gaining insurance and would miss out on $8.4 billion in federal payments. The analysis, performed by RAND, evaluated 14 states that had originally denied the opportunity to expand their Medicaid-eligible population to 138% of the federal poverty level. RAND determined that forgoing expansion will increase the cost of caring for the uninsured individuals in these states by $1 billion in 2016. Irrespective of the financial implications, the RAND study also found that not expanding Medicaid may result an additional 19,000 deaths per year in the 14 states studies.
Posted on May 29, 2013
A new report from the Urban Institute, funded by the Robert Wood Johnson Foundation, interviewed health care stakeholders in eight states to determine if Medicaid managed care programs were prepared for the imminent influx of beneficiaries resulting from the Affordable Care Act’s (ACA) Medicaid expansion. Researchers found that managed care programs generally possess a strong organizational and operational structure that would permit them to readily absorb new beneficiaries. In an effort to mitigate the negative implications of churn, the study also found that some states will choose to offer private plans similar to those of Medicaid. One challenge addressed by the report was the ability of each state’s health information technology to uptake a vast increase of new enrollees and eligibility processes.
CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps
Posted on May 22, 2013
The interaction between Medicaid and Exchanges around eligibility determination issues represents one of the most important and complex aspects of the ACA. An estimated 28 million adults, along with 19 million children, can be expected to transition at least once annually between insurance affordability programs, as Medicaid and premium subsidies are termed under implementing CMS regulations. Collaboration between Medicaid agencies and Exchanges is essential in order to avert unnecessary delays in eligibility determinations and breaks in coverage that in turn can affect not only the affordability of care but access itself, given the link between coverage and health care access through plans’ provider networks…
Posted on May 20, 2013
The Centers for Medicare and Medicaid Services (CMS) released a letter to state health officials and Medicaid Directors regarding enrollment of uninsured individuals into Medicaid and CHIP. With the looming enactment of the Affordable Care Act’s (ACA) provision on Medicaid expansion, CMS intends to assist states by providing optional tools that will aid in their transition to the new eligibility and enrollment models. The letter specifically addresses and provides guidance on these five enrollment strategies:
- Implementing the early adoption of Modified Adjusted Gross Income (MAGI)-based rules;
- Extending the Medicaid renewal period so renewals that would otherwise occur during the first quarter of calendar year 2014 will occur later;
- Enrolling individuals into Medicaid based upon Supplemental Nutrition Assistance Program (SNAP) eligibility;
- Enrolling parents into Medicaid based upon children’s income eligibility; and
- Adopting 12-month continued eligibility for parents and other adults.
CMS purports that states choosing to utilize one of these outlined approaches will be met with a streamlined review and approval process.
Posted on May 15, 2013
The Congressional Budget Office (CBO), in conjunction with the Joint Committee on Taxation (JCT), issued updated budget projections for fiscal years 2014-2023, which include updated impact estimates of the insurance provisions in the Affordable Care Act (ACA). Slower than anticipated growth in health care spending, particularly in programs such as Medicare and Medicaid, is one of several factors that influenced the revised estimates…