CMS releases BHP final rule
Posted by Nikki Hurt 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.
GAO report finds states spend one-third of Medicaid dollars on few beneficiaries
Posted by Nikki Hurt 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.
When Does Medicaid Coverage Amount to Minimum Essential Coverage Under the Affordable Care Act? An Update on the Treasury/IRS Rules Defining Minimum Essential Coverage
Posted by Nikki Hurt on February 11, 2014
A January 27, 2014 proposed rule in the Federal Register (79 Fed. Reg. 4302-4308) published by Treasury/IRS would add further clarification to the question of under what circumstances the agencies will classify Medicaid as minimum essential coverage (MEC) for purposes of satisfying the Affordable Care Act’s requirement to maintain MEC or pay a shared responsibility tax. Comments are due by April 28, 2014; the agencies also intend to hold a public hearing on the NPRM which covers Medicaid as well as other types of coverage.
CMS finds 6.3 million eligible for Medicaid or CHIP
Posted by Nikki Hurt 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.
Update: Medicaid Expansion Map
Posted by Nikki Hurt 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.
New brief outlines issues with premium administration
Posted by Nikki Hurt 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.
CRS issues report on DSH payments
Posted by Nikki Hurt 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.
CMS allows “flat files” to be used as enrollment applications for Medicaid
Posted by Nikki Hurt on November 29, 2013
In a letter sent to State Medicaid Directors, the Centers for Medicare and Medicaid Services (CMS) stated the agemcy would allow states to use “flat files,” or files with very little information about new Medicaid enrollees, to intermittently count as full applications in terms of enrolling individuals into state Medicaid programs under the Affordable Care Act (ACA). The ACA permits states, if they so choose, to expand their Medicaid population, and provides the opportunity for individuals to enroll in Medicaid through the health insurance Exchanges. Currently, the federal government cannot transfer complete Medicaid applications to states, which prevents states from enrolling their constituents into Medicaid in a timely fashion. CMS is addressing this issue by allowing the “flat files” to count as enrollment applications so that states may ensure these new enrollees have Medicaid coverage by January 2014. This fix is a transitional policy, and states must apply for a waiver in order to use the flat files for enrollment.
Update: Ohio expands Medicaid
Posted by Nikki Hurt on October 22, 2013
After the measure to expand Medicaid failed in the Legislature this summer, the Ohio Controlling Board voted 5-2 to approve Medicaid expansion under the Affordable Care Act (ACA). This decision, which will likely be met by a multitude of legal challenges in the coming months, makes Ohio the 25th state to accept enhanced federal funding to help insure the state’s most impoverished residents. Our map has been updated to reflect these changes.
Medicaid Map Update: Expansion likely in Ohio
Posted by Nikki Hurt on October 14, 2013
The HealthReformGPS map documenting the current status of Medicaid expansion and Marketplace structure has been updated to reflect the likelihood that Ohio will be the newest state to expand Medicaid under the Affordable Care Act (ACA).