Public Payers News

Proposed Rule May Prevent Coverage Losses for Dual Eligible Beneficiaries

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The CMS proposed rule to streamline the Medicaid eligibility process could potentially prevent coverage losses for around a third of dual eligible beneficiaries, according to data from the Kaiser...

NCQA Confers Health Equity Accreditation on Elevance Health Medicaid Plans

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Elevance Health announced that 21 Medicaid plans have achieved health equity accreditation from the National Committee for Quality Assurance (NCQA). “Advancing health equity is a priority for...

How Health Insurance Coverage Varies Across, Within Families

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The Affordable Care Act (ACA) increased access to Medicaid and group health insurance, but the family glitch created a barrier to non-group coverage, leading to variations in health insurance coverage...

Immigrants’ Premium Contributions Exceed Payer Spending on Care

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Immigrants’ premium contributions in 2017 were $58.3 billion higher than what private insurers and public programs spent on their healthcare, suggesting that immigrants help subsidize the US...

Early 2023 Affordable Care Act Marketplace Enrollment Exceeds 2022 Trends

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Since enrollment season began on November 1, the number of signups on the Affordable Care Act marketplace for the 2023 plan year has significantly outpaced the enrollment levels from the same timeframe...

62% of Adults Are Unaware of Medicaid Renewals Resuming Post-PHE

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More than half of adults who are enrolled in or have a family member enrolled in Medicaid were unaware of upcoming Medicaid renewals set to resume after the COVID-19 public health emergency (PHE) ends,...

Top 4 Medicare Advantage Penetration, Access Trends in 2023 Open Enrollment

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Medicare Advantage beneficiaries will have more health plan options available to them now than they have at any point in over a decade, according to data from the Kaiser Family Foundation....

Medicaid Expansion Reduced Medicare Hospitalizations During Dialysis

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Medicaid expansion may help minimize Medicare spending, as it was associated with reduced hospitalizations and hospital days for Medicare beneficiaries with kidney failure who initiated dialysis, a...

ACHP Offers 5 Recommendations For CHIP, Medicaid During PHE Unwinding

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The Alliance of Community Health Plans (ACHP) had five recommendations for CMS regarding how to streamline processes in Medicaid, Children’s Health Insurance Program (CHIP), and the Basic Health...

OUD Treatment Coverage, Prior Authorizations Common in Medicaid FFS

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Medicaid fee-for-service (FFS) programs were more likely to cover medications for opioid use disorder (MOUD) but imposed more prior authorizations for the treatments compared to Medicaid managed care...

2020 Medicare Open Enrollment Saw Low Rates of Plan Comparison

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During 2020 Medicare open enrollment which took place in 2019, less than a third of Medicare beneficiaries compared their health plans with other available Medicare plans, according to an issue brief...

HHS: Over Half of States Have Extended Medicaid Postpartum Coverage

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Following Georgia and Pennsylvania’s recent approvals to expand Medicaid postpartum coverage, beneficiaries in more than half of all states can now access maternal healthcare services for 12...

2022 Marketplace Enrollment Grew Significantly for Black, Latino Enrollees

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Marketplace enrollment through HealthCare.gov grew significantly between 2020 and 2022, with Latino and Black enrollees seeing the highest respective increases of 53 percent and 49 percent, according...

CMS Expects More Americans Will Qualify for Affordable Care Act Coverage in 2023

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Consumers can start checking out Affordable Care Act marketplace health plans ahead of the 2023 open enrollment season, the Biden Administration announced. “All families have the right to...

Outreach from State-Based Marketplaces Increased 2022 ACA Enrollment

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State-based marketplaces employed several outreach methods during the 2022 open enrollment period to boost health plan enrollment among uninsured individuals, including data-based efforts and...

Medicaid Directors Project 12.5% Total Medicaid Spending Growth in FY 2022

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Medicaid directors identified enrollment and the end of flexibilities tied to the public health emergency as major influences on Medicaid spending, according to a report compiled by Health Management...

Medicare Advantage Contract Terminations Worsen Racial Health Disparities

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Medicare Advantage contract terminations may exacerbate racial health disparities, as contracts that were terminated between 2011 and 2020 served higher rates of Black beneficiaries, a study published...

Community-Based Orgs Can Help Manage Post-PHE Medicaid Coverage Changes

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Through collaborating with community-based organizations, family-led organizations, and individuals with lived experiences, states can help guide their communities through Medicaid coverage changes...

Personalized Phone Calls, Emails Boosted ACA Enrollment Rate in CA

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Personalized phone calls combined with email reminders were an effective outreach method for former Medicaid beneficiaries transitioning to Affordable Care Act (ACA) coverage, as the approach led to a...

Brokers, Assisters Share Affordable Care Act Marketplace Consumer Trends

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Assister programs and brokers found that consumers lacked awareness about Marketplace subsidies and rules and experienced delays in receiving their final eligibility determination, according to a...