CMS

Starting on Thursday, March 28, CMS is extending a temporary special enrollment period (SEP) to help people who are no longer eligible for Medicaid or CHIP transition to Marketplace coverage in states using HealthCare.gov. The end date of this “Unwinding SEP” will be extended from Wednesday, July 31, 2024, to Saturday, November 30, 2024. This will help more people leaving Medicaid or CHIP secure affordable, comprehensive coverage through the start of the next open enrollment period. This extension will be crucial to ensuring people remain covered, including in states that have given people additional time to renew their coverage, as CMS has recommended, to help eligible people stay enrolled.

On January 17, the Centers for Medicare & Medicaid Services (CMS) released the “CMS Interoperability and Prior Authorization Final Rule” (CMS-0057-F) to improve the electronic exchange of health information and prior authorization process for medical items and services. The final rule applies to Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs). This final rule establishes requirements for certain payers to streamline the prior authorization process generally starting January 2026 and complements the Medicare...

The Centers for Medicare & Medicaid Services (CMS) recently shared information on national health expenditures in 2022, highlighting a 4.1% growth in U.S. health care spending to $4.5 trillion. This growth, while faster than the increase of 3.2% in 2021, was notably slower than the substantial increase of 10.6% witnessed in 2020. CMS noted the growth in 2022 reflected strong growth in Medicaid and private health insurance spending that was somewhat offset by continued declines in supplemental funding by the federal government associated with the COVID-19 pandemic. The fact sheet also notes that in 2022, the insured share of the population reached a historic high of 92%...

On January 31, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of October 2023, over 66.6 million people are enrolled in Medicare; more than 34 million are enrolled in fee-for-service Medicare, and close to 32.6 million are enrolled in Medicare Advantage or other health plans. Over 87.2 million enrollees have Medicaid and CHIP. More than 80.2 million individuals have Medicaid and over 7 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

The Centers for Medicare & Medicaid Services (CMS) recently released a report detailing their efforts to address health care disparities faced by individuals living in rural, tribal, and geographically isolated communities. This report outlines CMS’ six key priorities for advancing health equity in these communities: (1) applying a community-informed geographic lens to CMS programs and policies, (2) increasing the collection and use of standardized data to improve health care, (3) strengthening and supporting Health Care Professionals, (4) optimizing medical and communication technology, and (6) driving innovation and value-based care....

On November 21, the Centers for Medicare & Medicaid Services (CMS) released the first Biweekly National Snapshot for 2024 Marketplace Open Enrollment Data. CMS reports that nearly 4.6 million Americans have signed up for 2024 individual market health insurance coverage through the Marketplaces since the start of the 2024 Marketplace Open Enrollment Period (OEP) on November 1. This includes 4.1 million plan selections in the 32 states using the HealthCare.gov platform for the 2024 plan year, through November 18, 2023 (Week 3), and 502,000 plan selections in the 17 states and the District of Columbia with State-based Marketplaces (SBMs) that are using their own eligibility and enrollment platforms, through November 11, 2023 (Week 2)...

Medicare’s annual open enrollment period ends Thursday, December 7. During this time, people with Medicare can compare coverage options, like Traditional Medicare and Medicare Advantage, and choose health and drug plans for 2024. Medicare Advantage and Part D plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices and decide on the options that best meet their health needs. Coverage changes made during the open enrollment period take effect January 1, 2024.

Recently, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Supplemental Security Income (SSI) and Spousal Impoverishment Standards, and the 2024 Medicare Savings Program resource standards. Certain Medicaid income and resource standards are adjusted beginning each January in accordance with changes in the SSI federal benefit rate (FBR) and the Consumer Price Index (CPI). The MSP groups are mandatory Medicaid eligibility groups that provide coverage of some or all Medicare Part A and B premiums and cost-sharing for low-income Medicare beneficiaries. The resource standards for the MSP groups are based on the SSI resource standard, which is set forth in statute...

On November 16, the Centers for Medicare & Medicaid Services (CMS) released the CMCS Informational Bulletin (CIB), "Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program (CHIP)." This guidance outlines a framework of services and supports to address health-related social needs (HRSN) that CMS considers allowable under specific Medicaid and CHIP authorities. These flexibilities, and accompanying safeguards to protect program and fiscal integrity, provide opportunities for states to improve consistent access to needed care, health outcomes, and health equity among Medicaid and CHIP enrollees by addressing HRSN in a manner that complements...

On November 15, the Centers for Medicare & Medicaid Services (CMS) released a final rule that will implement portions of section 6101 of the Affordable Care Act, requiring the disclosure of certain ownership, managerial, and other information regarding Medicare skilled nursing facilities and Medicaid nursing facilities, commonly known as nursing homes. It also defines the terms private equity company and real estate investment trust, about which information must be disclosed on the Medicare enrollment application. Section 6101(a) of the Affordable Care Act added section 1124(c) to the Social Security Act, establishing requirements for the disclosure of information about nursing home ownership and oversight...