Public Payers News

Lacking Medicaid Supplemental Insurance Tied to Racial Care Disparities

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Losing eligibility for Medicaid supplemental insurance was associated with racial care disparities among beneficiaries with incomes above 100 percent of the federal poverty level (FPL), a study...

Personalized Outreach Impacts ACA Enrollment Among Low Income Households

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Personalized outreach could improve enrollment in the lowest-cost Affordable Care Act plans among low-income households, a study published in Health Affairs found. Using the Covered California...

AHIP: More Medicare Beneficiaries Have Medicare Supplement Insurance

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More Medicare beneficiaries are purchasing Medicare Supplement insurance, as the share of individuals with the additional coverage option grew from 38 percent to 41 percent in 2021, an AHIP report...

Extended Medicare Advantage VBID Model Will Address SDOH, Health Equity

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CMS has extended the Medicare Advantage value-based insurance design (VBID) model for an additional five years, with plans to implement changes that address beneficiaries’ social determinants of...

Medicaid Expansion Could Prevent Coverage Loss During Redeterminations

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Total Medicaid expansion could prevent massive coverage losses in nonexpansion states as Medicaid redeterminations restart, an issue brief from the Kaiser Family Foundation found. The researchers used...

Medicare Advantage Final Rule Addresses Prior Authorization, Health Equity

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CMS has finalized a Medicare Advantage rule that aims to increase marketing oversight, streamline prior authorization requirements, and improve access to affordable prescription drugs. “The...

Community Health Centers Seek Enrollment Support Amid Medicaid Redeterminations

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Community health centers serve the communities that are most likely to experience widespread coverage loss once Medicaid redeterminations are underway and they are looking for help in maintaining...

Medicare Advantage Has Lower Healthcare Use, Higher Clinical Quality

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Healthcare utilization was lower in Medicare Advantage compared to traditional Medicare, but clinical quality performance was higher in the private program, a study published in Health Affairs...

Update on the Massachusetts Medicaid Redetermination Process

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MassHealth is pursuing a multi-pronged approach to reducing coverage loss during the Medicaid redetermination process, an issue brief from Manatt Health explained. The researchers noted that...

Insurer Competition Contributes to Affordable Care Act Benchmark Premiums

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The benchmark premium on the Affordable Care Act marketplace rose between 2022 and 2023 after years of decreasing, a study from the Urban Institute found. Observing Affordable Care Act health...

Medicaid Eligibility Status Remains Elusive as Continuous Coverage Ends

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As the era of continuous coverage under the coronavirus public health emergency draws to a close, Medicaid beneficiaries remain unsure about the future of their Medicaid eligibility. “Medicaid...

Vertical Integration Raises Spending for Medicare Advantage Plans

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Owning related businesses was associated with higher healthcare expenditures for Medicare Advantage plans, pointing to some of the consequences of vertical integration, a report from the USC-Brookings...

MA Beneficiaries Satisfied With Coverage but Face Financial Barriers

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Medicare Advantage beneficiaries face more financial barriers than Medicare Supplement beneficiaries, but plan satisfaction is high for both groups, an eHealth report found. The report reflects survey...

OIG Finds CMS Overpaid Geisinger Medicare Advantage Plan by Over $566K

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The Office of the Inspector General (OIG) found that most of the audited diagnosis codes that Geisinger Health Plan sent to CMS for its Medicare Advantage plan were non-compliant. The office audited...

Medicaid Expansion Tied to Higher Coverage Gains, Fewer Disparities

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While insurance coverage rates improved for Black, Hispanic, and White adults during the first two years of the COVID-19 pandemic, the gains were more significant in states that had implemented...

States Plan Various Continuity of Coverage Strategies Post-PHE

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States are responding to the public health emergency unwinding in a variety of ways, with some states placing greater emphasis on continuity of coverage than others, a Kaiser Family Foundation (KFF)...

Medicaid Waivers Reduced Disenrollment Among Autistic Adolescents

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Medicaid waivers that focus on individuals with autism spectrum disorder (ASD) can help reduce disenrollment rates among autistic adolescents, a study published in JAMA Network Open found. Autistic...

MedPAC Calls on Congress to Modify Medicare Advantage Payment Policies

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As Medicare Advantage enrollment grows, the Medicare Payment Advisory Commission (MedPAC) is calling on Congress to address payment and coding differences between Medicare Advantage and Medicare...

How Medicaid Covered Behavioral Health Services in 2022

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Medicaid coverage of behavioral health services in 2022 varied across states, but the majority of state Medicaid programs reported covering at least half of all services, according to an issue brief...

Growing ESRD Enrollment Prompts MA Plans to Form Value-Based Arrangements

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Beneficiaries with end-stage renal disease (ESRD) are increasingly shifting from Medicare fee-for-service (FFS) to Medicare Advantage, leading more Medicare Advantage plans to form value-based...