Although the topic of Medicaid was largely left out of both campaigns this election cycle, the incoming Trump administration is expected to make some major policy changes to the safety net health program now covering 69 million Americans.
Medicaid and the Children's Health Insurance Program (CHIP) are likely bargaining chips to make...
After Trumps presidential victory, U.S. regulatory agencies should expect shakeups, future ACA Marketplace enrollees could shoulder more premium costs, Medicare Advantage may see a bump in federal enthusiasm and Medicaid beneficiaries may be subject to work requirements. The three-biggest names in Medicare Advantage saw an immediate bump...
The Medicaid and CHIP Payment Access Commission (MACPAC) published an issue brief on the updated regulations for oversight of Medicaid managed care and state allowances for the direction of managed care organizations (MCOs).
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued a rule for the directed payment...Arizona News
Insurance company Centene defied the odds for the third quarter and overcame issues with Medicaid reimbursement for higher returns than investors had anticipated.
Centene reported $713 million in profit for Q3 on $42 billion in revenue, up from $469 million and $38 billion last year. Following the Medicaid redetermination period, more...Arizona News
Vice President Kamala Harris and former President Donald Trump delivered their final pitches to the American public this week ahead of election day on November 5. Both candidates refined their positions on healthcare policy and the people they'd entrust with health matters should they win the White House.
Throughout the campaign...
Researchers found the average Medicaid payment covered about 82% of reported costs, meaning nursing homes typically received 82 cents for each dollar spent on Medicaid residents' care.
Using Medicaid payment data from individual states and Medicare cost reports for freestanding nursing homes in 44 states, ASPE researchers...
The latest issue brief from the Assistant Secretary for Planning and Evaluation (ASPE) outlines Medicaid’s positive effects on low-income children and non-elderly adults while emphasizing how expanded eligibility benefits the country’s health and economy.
Medicaid, established in 1965, is the largest health insurer in the U.S.,...
This week, the National Committee for Quality Assurance (NCQA) announced a partnership with the Arizona Health Care Cost Containment System (AHCCCS) to support participants in the Targeted Investments (TI) 2.0 Program.
The partnership pledges to support health equity accreditation by addressing health disparities on the population...National News
A Republican-controlled Congress coupled with a second Trump presidency could spell Medicaid cuts and bigger barriers to Medicaid access.
After the second presidential debate, KFF couldn't help but notice that the future of Medicaid was never raised in a question to either former President Donald Trump or Vice President Kamala Harris....
The Issue brief defines prior authorization and how this process used by Medicaid fee-for-service programs and managed care organizations (MCOs) requires approval before providing specific items, services, or medications.
Prior authorization (PA) aims to prevent unnecessary utilization, limit improper, fraudulent, and wasteful...
This week in Medicaid a judge sides with the Centers for Medicare and Medicaid Services (CMS) against work requirements, the North Carolina Medicaid expansion remains on pace for over 600,000 additional members and the status of 1115 Waiver renewals nationwide.
The Georgia Pathways to Coverage program was the only one in the nation...Arizona News
The U.S. Department of Justice announced that it has taken action to end a healthcare fraud scheme in Arizona that preyed on elderly patients and defrauded health payers $1.6 billion.
The DOJ announced it had charged 193 people with healthcare fraud in the sweep, all affiliated with companies Apex Mobile Medical LLC, Apex Medical LLC,...National Reports & Surveys
The uninsured rate is likely to climb over the next decade according to projections from the Congressional Budget Office (CBO).
The CBO said that it expects the rise in uninsured Americans was elevated to a higher rate when 23 million people lost benefits during the Medicaid redetermination period last year. More could lose insurance...National News
National health spending continues to skyrocket and is expected to eclipse one fifth of the total U.S. economy by 2032, according to projections released last week by the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary.
The Office of the Actuary estimates that national health spending rose to $4.8 trillion in...National News
The U.S. is in a maternity care crisis with some of the highest rates of maternal mortality in the world and ever-worsening access to reproductive healthcare services and providers due to punitive abortion restrictions and low reimbursement. The Medicare program wants to fix that.
Time reports that the health are system is failing the...
The Task Force on Maternal Mental Health that was ordered by the Biden-Harris Administration last September has issued a national strategy to improve maternal mental healthcare and submitted a report to Congress on their policy recommendations.
The National Strategy is not limited to recommendations for the U.S. Department of Health...
GLP-1 agonist medications are the hot topic of the health world, as the drugs that were initially designated to treat diabetes have demonstrated efficacy in producing significant weight loss. But as more Americans are accessing these drugs, the price tag for the manufacture and distribution of the highly-sought treatment remains a big...CMS Rules
The Biden administration's nursing home minimum staffing rule could have a major impact on states' Medicaid programs, adding another layer of complexity to the highly anticipated and very controversial rule.
The nursing home minimum staffing rule is estimated to cost the residential care home industry up to $6.5 billion in additional...Arizona News
The Biden administration finalized a rule that will allow recipients of the Deferred Action for Childhood Arrivals (DACA) program to receive healthcare under the Affordable Care Act.
More than 100,000 previously uninsured DACA recipients, also known as Dreamers, are anticipated to enroll in the ACA Marketplace and the Basic Health...CMS Rules
The Biden administration finalized rules that would increase transparency and increase protections for Medicaid members in managed care plans. It also finalized the Ensuring Access to Medicaid Services Rule on Monday that requires home care providers to use a minimum of 80% of Medicaid payments to pay aides and nurses.
The new...
