Medicaid managed care, as it varies state-to-state, is a complex and dynamic umbrella of care delivery. The National Association of Medicaid Directors (NAMD) published an in-depth explainer on Medicaid managed care to illuminate the program's intricacies.
Medicaid agencies contract with managed care organizations (MCOs), usually...
A new report by healthcare research firm ATI Advisory determined that the Centers for Medicare and Medicaid Services (CMS) is not doing enough to reconcile incongruities between the Medicare and Medicaid programs for dually eligible beneficiaries in long-term care.
The ATI Report found that the over one million full benefit...
Last week, the Medicaid and CHIP Payment and Access Commission (MACPAC) held its annual meeting where the draft of the annual March Report to Congress on Medicaid and the Children's Health Insurance Program (CHIP) was presented.
In the meeting, the commission discussed and voted on seven recommendations to change the mechanism for...National News
Last week, the Supreme Court heard arguments in two cases that challenge the precedent set by Chevron v. National Resources Defense Council in 1984 that determined courts should generally defer to the wisdom of a state or federal agency when interpreting federal statute.
This precedent, now referred to as Chevron deference, appears to...National Reports & Surveys
The annual report published this month can serve as an essential reference when compiling and analyzing Medicaid & CHIP data including enrollment, expenditures, state spending, beneficiary demographics, income and health status, and more.
In 2022, more than 30% of the U.S. population was enrolled in Medicaid or the State...National News
Governors in Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas received a letter his week urging them to adopt additional federal strategies and flexibilities to help prevent children and their families from losing coverage due to red tape. All nine states account for about 60% of the decline in...Arizona News
More fraudulent sober living home operators were charged by the state of Arizona this week for patient referral kickback schemes. Arizona Health Care Cost Containment System (AHCCCS) Cabinet Executive Officer Carmen Heredia is calling for an overhaul of the state Medicaid system after spending the first year of her position focusing on...CMS Rules
This week, federal regulators issued an interim final rule that would take action against states that have not complied with the federal Medicaid eligibility rules or reporting requirements during the redetermination period.
The rule says that the Centers for Medicare and Medicaid Services (CMS) will require noncompliant states to...Arizona News
Gene therapies, which treat diseases at the genetic level, are becoming increasingly popular for pharmaceutical manufacturers as the efficacy of directly working with the human genome shows promise for effective health outcomes. But as the U.S. Food and Drug Administration approves them for use in the U.S., these drugs carry a hefty...Arizona News
About a third of Arizona Medicaid members (128,960) were disenrolled for procedural reasons, which means although the Arizona Health Care Cost Containment System (AHCCCS) had information the member was ineligible, they failed to respond to the agency's request for information during the renewal process.
The unwinding from the...Arizona News
The Arizona Attorney General's Office is continuing its massive investigation into fraudulent substance abuse recovery homes that target Native Americans.
Last week, the AG's office announced that the Better You Wellness Center LLC's two owners and its biller were indicted on charges of fraudulently billing the Arizona Health Care...National News
The National Conference of State Legislatures (NCSL), a nonpartisan association for sitting state legislators, which seeks to educate legislators on procedures, state flexibilities and standards of conduct, published the second installation in an ongoing series on Medicaid Managed Care (MMC) programs.
The report, "The Life Cycle of...Arizona News
Between April 2023 and March 2024, eligibility for every AHCCCS member will be redetermined with more than 650,000 expected to lose coverage. Members who are factually or procedurally ineligible will be disenrolled, and those factually ineligible will be referred to the federal Marketplace.
With the “great unwinding” looming over...CMS Rules
States will now be required to report health quality measures for Medicaid beneficiaries including children's health, adult behavioral health and health home data to the Centers for Medicare and Medicaid Services (CMS).
The Core Set of Children's Health Care Quality Measures for Medicaid and the Children's Health Insurance Program...Open
AHCCCS has attempted to renew 1.1 million Arizona Medicaid beneficiaries since the Great Unwinding began April 1, 2023. Since then 200,000 people have lost AHCCCS coverage in the state (18%) leaving about 460,000 renewals still in process and about 450,000 approved.
The state's Medicaid agency, the Arizona Health Care Cost Containment...
On June 15, 2023, the Medicaid and CHIP Payment and Access Commission (MACPAC) issued its June Report to Congress which includes recommendations for DSH payments, delivering on the promise of dual integration and access to Medicaid coverage for released prisoners. MACPAC is an independent, non-partisan commission composed of experts in...
Beginning next week, every skilled nursing facility in the country will undergo a five-claim audit as the Centers for Medicare and Medicaid Services (CMS) aims to get improper payments under control. Meanwhile, nursing homes are expressing concern about the effects that Medicaid redeterminations and subsequent disenrollment's could have...
The Biden administration issued a proposed rule through the Centers for Medicare and Medicaid Services that aims to increase transparency of prescription drug costs and managed care plan operations for Medicaid enrollees.
It would do this by implementing a new drug price verification survey tool and requiring the inclusion of drug...Arizona News
Last week, the Arizona Senate voted to approve federal funding for Arizona's Medicaid program. Senators voted 26-3 to allocate $3.36 billion to the Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid program. However, the Senate Appropriations Committee failed to pass a bill that would continue the program through...
