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KFF recently released a policy watch titled “What Are the Implications of the Recent Elimination of the Medicaid Prescription Drug Rebate Cap?” As of January 1, 2024, the American Rescue Plan Act (ARPA) lifted the cap on the total amount of rebates that Medicaid could collect from manufacturers who raise drug prices substantially over time. Anticipating the implementation of this policy, drug manufacturers have made various changes allowing them to avoid increased rebates resulting from the lifting of the cap. Recent changes that have garnered attention include price cuts for insulin, used to treat diabetes, and the discontinuation of Flovent, a frequently used asthma inhaler....

KFF recently published a policy watch examining the challenges faced by states during the unwinding of continuous Medicaid enrollment, resulting in over 14 million disenrollments, primarily due to procedural issues. To assist states in meeting federal renewal requirements, CMS has granted temporary waivers under "1902(e)(14)(A)," categorized into four buckets: options to increase ex parte renewals, support for enrollees in completing renewal forms, updating enrollee contact information, and facilitating re-enrollment for individuals disenrolled due to procedural terminations. As of January 12, 2023, CMS had approved a total of 392 waivers for 49 states and the District of Columbia...

The AARP Public Policy Institute's latest report in their Rx Price Watch series highlights the impact of prescription drug price increases on consumers, employers, private insurers, and taxpayers, affecting programs like Medicare and Medicaid. The report presents annual and 15-year cumulative price changes, until the end of 2020, for a comprehensive set of 943 prescription drugs widely used by older adults, emphasizing the potential long-term consequences on health care coverage costs, taxes, and public programs.

The Center for Medicare Advocacy (CMA) recently released a tip sheet providing guidance to Medicare Advantage (MA) enrollees facing difficulty obtaining in-network care. This article addresses the complexities of MA plans, which can restrict enrollees to contracted networks of healthcare providers. Despite strengthened regulations by the Centers for Medicare & Medicaid Services (CMS) requiring MA plans to cover necessary care outside the network under specific circumstances, recent reports indicate issues with network adequacy. CMA emphasizes the importance of MA enrollees and advocates utilizing consumer protections, reporting difficulties in obtaining necessary care, and urging CMS to publicize and enforce these rights.

KFF recently released an issue brief titled “Unwinding of Medicaid Continuous Enrollment: Key Themes from the Field,” exploring the implications of the end of Medicaid continuous enrollment on March 31, 2023. As continuous enrollment comes to an end, states will be required to complete an eligibility renewal for all Medicaid and CHIP enrollees by May 2024 – a process commonly referred to as “unwinding.” This brief examines the perspectives of state officials and others involved in the unwinding process. KFF worked with PerryUndem to conduct interviews with representatives from Medicaid managed care plans, primary care associations, legal aid and other advocacy organizations, and navigator organizations in four states...

On January 18, the U.S. Department of Labor (DOL) announced that its Employee Benefits Security Administration (EBSA) released a proposed regulation on automatic portability transactions under SECURE 2.0 Act of 2022. The goal of automatic portability transactions is to help workers keep track of their retirement savings accounts and improve retirement security by reducing cash-outs when they change jobs. According to the most recent annual Form 5500 data, there are an estimated 635,000 defined contribution plans in the United States, covering an estimated 86.6 million participants with account balances totaling $9.3 trillion in assets...

On January 19, the U.S. Department of Labor (DOL) announced today that its Employee Benefits Security Administration, the Department of the Treasury, the IRS, and the Pension Benefit Guaranty Corporation (PBGC) will jointly issue a Request for Information (RFI) soliciting public input as the federal government reviews the effectiveness of existing reporting and disclosure requirements for retirement plans, as required by the SECURE 2.0 Act of 2022. The Employee Retirement Income Security Act and the Internal Revenue Code include requirements on the information about retirement plan benefits and features that must be reported to the agencies and provided to plan participants and beneficiaries. In the SECURE 2.0 Act, Congress directed the age

The U.S. Department of Health and Human Services (HHS) recently announced the 2024 federal poverty guidelines, also loosely referred to as federal poverty levels or lines (FPLs). The poverty guidelines are a simplified version of the federal poverty thresholds used for administrative purposes — for instance, determining financial eligibility for certain federal programs. They are issued each year in the Federal Register by the Department of Health and Human Services (HHS). The January 2024 poverty guidelines are calculated by taking the 2022 Census Bureau’s poverty thresholds and adjusting them for price changes between 2022 and 2023 using the Consumer Price Index (CPI-U). The poverty thresholds used by the Census Bureau...

On January 20, FEMA’s Office of Disability Integration and Coordination announced updates to their Individual Assistance Program that will help them markedly shorten the disaster cycle for people with disabilities and other access and functional needs through greater flexibility and streamlined processes that reflect the people-first intent in their work. With the increased frequency of extreme weather events fueled by climate change, these updates will provide survivors with faster and easier access to resources they need after disasters. FEMA developed these new forms of assistance based on direct feedback from survivors and in response to the threats the nation faces due to our changing climate...

The Center for Medicare & Medicaid Innovation (CMS Innovation Center) recently announced a new state-based model, Innovation in Behavioral Health (IBH), to test approaches for addressing behavioral and physical health, as well as health-related social needs among the Medicaid and Medicare populations. The IBH Model’s goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder by connecting them with the physical, behavioral, and social supports needed to manage their care. The model will also promote health information technology capacity building through infrastructure payments and other activities...