Medicaid and CHIP
Posted on March 28, 2015
The Government Accountability Office (GAO) issued a report finding that coverage of services in the selected State Children’s Health Insurance Program (CHIP) plans was generally comparable to that of the selected private qualified health plans (QHP) under the Affordable Care Act (ACA). However, GAO found notable exceptions with pediatric dental and certain enabling services, such as translation and transportation services, which were covered more frequently by CHIP plans. Selected CHIP plans and QHPs were also similar in terms of the services on which they imposed day, visit, or dollar limits, although the five selected CHIP plans generally imposed fewer limits than the selected QHPs. Additionally, GAO found that consumers’ costs for services (deductibles, copayments, coinsurance, and premiums) were almost always less in the selected CHIP plans when compared to their respective QHPs, despite the application of subsidies authorized under the ACA that reduce these costs.
Posted on February 17, 2015
The Government Accountability Office (GAO) issued a report examining (1) the extent to which Medicaid enrollees have private insurance, and (2) state and CMS initiatives to improve third-party liability (TPL) efforts. GAO found that 7.6 million Medicaid enrollees (13.4 percent) had private health insurance in 2012. Additionally, the number of Medicaid enrollees with private health insurance is expected to increase with the expansion of Medicaid. To combat this issue, GAO recommends that the Centers for Medicare and Medicaid Services (CMS) routinely monitor and share across all states information regarding key TPL efforts and challenges, as well as provide guidance on state oversight of TPL efforts conducted by Medicaid managed care plans.
Posted on August 29, 2014
The Centers for Medicare and Medicaid Services (CMS) approved Pennsylvania’s waiver application to receive matching funds under the Affordable Care Act (ACA) for extending Medicaid eligibility to residents who earn up to 133 percent of the federal poverty level. Although substantially revised from the original proposal, the approved waiver creates a five-year Medicaid demonstration, entitled “Healthy Pennsylvania.” Starting in January, as many as 600,000 Pennsylvanians could be eligible for new coverage on the private market, according to Pennsylvania Governor Tom Corbett’s office..
Posted on July 17, 2014
A new Government Accountability Office (GAO) report finds that eight states spent at least $10,500 per Medicaid recipient in 2008, while the majority of states were clustered in the $6,000-$8,000 range, per enrollee. For Fiscal Year (FY) 2013 Medicaid spending is estimated at $267 billion, a figure that is expected to nearly double by FY 2024. The GAO’s report assessed why there is so much variation in per-enrollee spending across states and how states account for those differences when setting Medicaid managed care rates.
Posted on June 26, 2014
A new study published in Health Affairs found that open enrollment for the Affordable Care Act (ACA) should coincide with the tax filing season. The researchers argued that consumers are more likely to make better decisions with their health coverage when taxes are on their minds, not the stresses associated with holiday spending. Currently, ACA open enrollment for 2015 is scheduled for November 15, 2014 to February 15, 2015.
Another study from the Urban Institute indicates that Medicaid expansion was associated with a reduction in the number of uninsured individuals as of March 2014. The study, which relied upon data from Urban’s Health Reform Monitoring Survey, found that states expanding Medicaid saw a drop in the uninsurance rate by 4%, whereas states that did not expand Medicaid saw a 1.4% reduction. Unlike the ACA open enrollment period, individuals eligible for Medicaid can enroll in the program at any point in a year.
Posted on May 8, 2014
A final rule released by the Centers for Medicare and Medicaid Services (CMS) is designed to loosen policies that could save hospitals up to $3.2 billion over the next five years. One policy addressed removes the requirement that a physician must be present at a rural health center every two weeks, which was implemented to help combat the shortage of rural health providers. The rule also relaxes supervision requirements for some providers, such as dieticians. Easing regulations under this rule follows suit with the administration’s “regulatory lookback” that began in 2012.
Posted on April 22, 2014
A new study released by the National Bureau of Economic Research (NBER) indicates that including adult dental benefits in Medicaid plans can have a multitude of positive results. The study, How Do Providers Respond to Public Health Insurance Expansions? Evidence from Adult Medicaid Dental Benefits, found that covering dental benefits resulted in more dentists participating in Medicaid without decreasing the number of privately insured patients these dentists see. Additionally, the study reported that dentists participating in Medicaid were able to make greater use of dental hygienists while only mildly increasing patient wait times.
Posted on April 11, 2014
Click here to see an updated version of our HealthReformGPS map that provides a comprehensive depiction of each state’s status on Medicaid expansion, Marketplace operations, and Navigator laws. Note that partnership marketplaces are considered federally-facilitated marketplaces for the purposes of this map.
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.