Access to Care

Medicaid final rules improve care access for managed care, FFS beneficiaries

April 23, 2024 - CMS has finalized policies to improve access to Medicaid and the Children’s Health Insurance Program (CHIP) managed care and boost coverage quality. The Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality Final Rule and the Ensuring Access to Medicaid Services Final Rule address state payments,...

Read More


More Articles

23% of disenrolled Medicaid beneficiaries remain uninsured, KFF finds

by Victoria Bailey

Nearly one in four people who were disenrolled from Medicaid remain uninsured, citing costs as barriers to coverage, according to a KFF poll. Since states resumed conducting Medicaid eligibility...

Expanding Medicaid eligibility in GA would reduce uninsurance by 28%

by Victoria Bailey

Expanding Medicaid eligibility in Georgia would help reduce uninsurance among non-elderly individuals by almost 300,000 people, according to a report from the Urban Institute and the Robert Wood...

Humana and Baptist Health reach contract agreement for in-network coverage

by Victoria Bailey

Kentucky-based Baptist Health Medical Group and Humana have reached a new contract agreement, restoring in-network coverage for Medicare Advantage and commercial patients. The multi-year agreement...

Utilization Restrictions on Medicare Part D Drugs Increased, Study Finds

by Victoria Bailey

Utilization restrictions on Medicare Part D drugs, including prior authorization and formulary restrictions, increased over time between 2011 and 2020, according to a Health Affairs study. Pharmacy...

Care Access, Coverage Value Similar in Medicare Advantage and Medicare

by Victoria Bailey

Coverage and care experiences were generally similar for Medicare Advantage and traditional Medicare beneficiaries, but instances of care delays and health assessments differed, a survey from the...

CareSource Partnership Boosts Access to Substance Use Disorder Treatment

by Victoria Bailey

CareSource has partnered with CKF Addiction Treatment to improve member access to substance use disorder treatment in Central Kansas. “Our shared commitment to decreasing substance use disorder...

Dental Coverage in Medicare Advantage Plans Varies by Demographic

by Victoria Bailey

Almost a third of beneficiaries had a Medicare Advantage plan that didn’t offer dental coverage in 2019, but coverage was more common among historically underserved populations, a study published...

7 Out of 10 Americans Struggling With Medical Debt Owe Over $1,000

by Kelsey Waddill

One in twelve adult Americans owe medical debt, largely those who are uninsured, low-income, or disabled, according to a report from the Peterson-KFF Health System Tracker. Research on rampant medical...

How Payers and Pharmacy Benefit Managers Work Together to Lower Costs

by Victoria Bailey

As prescription drug spending rises in the United States, healthcare stakeholders and policymakers constantly look for ways to curb costs. Many payers turn to pharmacy benefit managers (PBMs), which aim to negotiate lower drug prices with...

How Do Payers Cover COVID-19 Vaccines, Treatments, and Tests Post-PHE?

by Victoria Bailey

After the public health emergency (PHE) ended, many federal regulations that facilitated access to COVID-19 vaccines, treatments, and tests expired. While some policies may still apply, coverage...

OOP Costs Greater for Cancer Patients in High-Deductible Health Plans

by Victoria Bailey

Patients with cancer enrolled in high-deductible health plans had higher out-of-pocket medical costs compared to those in traditional health plans, according to a study published in JAMA...

UnitedHealthcare Platform Improves Member Access to Well-being Programs

by Victoria Bailey

UnitedHealthcare has launched a platform to facilitate member access to health and well-being programs and lower costs for employers. The UHC Hub offers a network of more than 20 health and well-being...

What Utilization Management Strategies Do Payers Use to Lower Costs?

by Victoria Bailey

As healthcare spending rises in the United States, stakeholders are constantly working to address the drivers of high costs. The overutilization of healthcare services—including the provision of low- or no-value care—not only...

NY Medicaid Section 1115 Waiver Amendment Improves Access to Care

by Victoria Bailey

CMS has approved an amendment to New York State’s Medicaid section 1115 waiver that will address health disparities and improve access to primary and behavioral healthcare, Governor Kathy Hochul...

Most Employers Offering Retiree Health Plans Use Medicare Advantage

by Kelsey Waddill

Most large employers used to offer retiree health plans, but in 2023, only a fifth of them did, according to a KFF brief. Among those that do, many have turned to Medicare Advantage to supply these...

What Health Plans Are Available For People With Disabilities?

by Victoria Bailey

Public and private payers alike offer a multitude of benefits for people living with disabilities. According to the CDC, up to 27 percent of adults in the United States have some type of disability, including mobility, cognition,...

How Employers Can Promote Cardiovascular Care, Women’s Health

by Kelsey Waddill

Cardiovascular, diabetes, and obesity treatments are a critical part of women’s health, and employers can take steps to ensure that women have access to information and care related to their...

How Do Payers Cover Prenatal, Postpartum Care for Pregnant People?

by Victoria Bailey

Prenatal, perinatal, and postpartum care help ensure healthier pregnancies and better birth outcomes for pregnant people. Access to this essential care comes easier with adequate health insurance. Pregnant people are almost guaranteed...

Blue Cross Blue Shield of MA Eliminates More Prior Authorizations

by Kelsey Waddill

Blue Cross Blue Shield of Massachusetts (“Blue Cross”) joined other payers in eradicating prior authorizations for certain services as part of an effort to accelerate members’ access...

Recent Articles