Medicaid Integration

The State Medicaid Integration Tracker© is published by ADvancing States and focuses on the status of the following state actions: Managed Long-Term Services and Supports (MLTSS), State Demonstrations to Integrate Care for Dual Eligible Individuals and other Medicare-Medicaid Coordination Initiatives, Other LTSS Reform Activities, including: Medicaid State Plan Amendments under §1915(i), Community First Choice Option under §1915(k), and Medicaid Health Homes.

On July 25, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid and CHIP Mental Health (MH) and Substance Use Disorder (SUD) Action Plan Overview and Guide, outlining the agency's strategies for enhancing treatment and support for enrollees with these conditions. Key areas of focus include enhancing coverage and integration to expand access to prevention and treatment services, promoting engagement in care through increased availability of home and community-based services, and extending coverage to non-traditional services and settings. Additionally, the plan aims to improve the quality of care for individuals with MH conditions and SUDs.

On July 13th, CMS published several proposed CY 2024 physician and hospital Medicare payment rules with comments due on September 11, 2023. The proposed rules are: CY 2024 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS 1786-P). CMS proposes updating OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.8%....

The Centers for Medicare & Medicaid Services (CMS) posted an expanded Report to Congress for Non-Emergency Medical Transportation (NEMT) in Medicaid. This new report supplies data from the Transformed Medicaid Statistical Information System (T-MSIS) from 2018-2021. This report provides a detailed analysis of Medicaid coverage of NEMT such as the types of medical services accessed when using NEMT by beneficiary subgroup, a comparison by delivery model of the volume of NEMT services used by states, and monthly trends in the use of NEMT versus telehealth services.

On June 7, Justice in Aging published an issue brief titled “An Equity Framework for Evaluating and Improving Medicaid Home and Community Based Services.” In recent decades, long-term care has shifted from institutional settings to home and community-integrated settings. While access to HCBS has been steadily increasing over time, systemic inequalities due to racism, sexism, ageism, classism, etc. have led to large disparities in HCBS for diverse communities. This issue brief evaluates several ways in which the current setup of HCBS can cause inequities to arise. This includes program design, provider availability, awareness of HCBS, implicit bias in services, and provision of HCBS...

Today, the Department of Health and Human Services, through CMS, announced 43 prescription drugs covered under Medicare Part B that may have lower beneficiary coinsurances. From July 1, 2023, through September 30, 2023, some people with Medicare who take these drugs may save between $1 and $449 per average dose, depending on the beneficiary’s coverage. Under the Inflation Reduction Act, signed into law in August 2022, drug companies that raise their drug prices faster than the rate of inflation are required to pay a rebate to Medicare. Starting July 1, 2023, Medicare beneficiaries may pay a lower coinsurance for certain Part B drugs if the drug’s price increased faster than the rate of inflation in a benchmark quarter.

The Centers for Medicare & Medicaid Services has released a set of resources aimed at supporting state Medicaid and partner agencies in designing and delivering supports and services to meet the needs of adults with intellectual and developmental disabilities (I/DD), as well as their aging parents and caregivers. These resources cover a variety of topics, including strategies for how state Medicaid agencies can anticipate the needs of adults with I/DD, ways states can design and implement person-centered planning to support adults with I/DD, and state policies and practices to support aging caregivers of adults with I/DD.

The Centers for Medicare & Medicaid Services has released a set of resources aimed at supporting state Medicaid and partner agencies in designing and delivering supports and services to meet the needs of adults with intellectual and developmental disabilities (I/DD), as well as their aging parents and caregivers. These resources cover a variety of topics, including strategies for how state Medicaid agencies can anticipate the needs of adults with I/DD, ways states can design and implement person-centered planning to support adults with I/DD, and state policies and practices to support aging caregivers of adults with I/DD.

The Centers for Medicare & Medicaid Services has released a set of resources aimed at supporting state Medicaid and partner agencies in designing and delivering supports and services to meet the needs of adults with intellectual and developmental disabilities (I/DD), as well as their aging parents and caregivers. These resources cover a variety of topics, including strategies for how state Medicaid agencies can anticipate the needs of adults with I/DD, ways states can design and implement person-centered planning to support adults with I/DD, and state policies and practices to support aging caregivers of adults with I/DD.

The CMS OMH report, “Disparities in Health Care in Medicare Advantage Associated with Dual Eligibility or Eligibility for a Low-Income Subsidy and Disability”, presents summary information on the performance of Medicare Advantage plans on specific measures of quality of health care reported in 2021, which corresponds to care received in 2020. Specifically, this report compares the quality of care for four groups of Medicare Advantage enrollees that are defined based on the combination of two characteristics: (1) dual eligibility for Medicare and Medicaid or eligibility for a Part D Low-Income Subsidy (LIS) and (2) disability...