Medicaid

This infographic provides information on coverage and costs for individuals with Medicaid and Medicare. The infographic describes people with both Medicaid and Medicare, complex health care needs of those dually eligible and spending, limited coordinated care between the programs, and ways to improve coordination.

On September 26th, The Biden-Harris Administration released guidance on health coverage requirements for children and youth enrolled in Medicaid and the Children's Health Insurance Program (CHIP). The guidance serves as support for states in ensuring children with Medicaid and CHIP coverage receive the full range of health care services they require. Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements provide comprehensive health coverage for children and youth. The guidance reinforces the EPSDT requirements and includes strategies and best practices for states in implementing the requirements. Included is an explanation for statutory and regulatory EPSDT requirements. Read CMS's release to learn more.

The Centers for Medicare & Medicaid Services released an informational bulletin that provides information on the timing and expectations for all states to achieve compliance with all federal renewal requirements. All states are required to complete a compliance assessment, demonstrate compliance with federal Medicaid and CHIP renewal requirements described at 42 C.F.R. §§ 435.916 and 457.343 and submit a plan outlining steps and milestones for addressing identified areas of non-compliance to CMS by December 31, 2024. CMS also released a compliance template, which states should use to submit the compliance plan and a slide deck to serve as an additional resource on renewal compliance guidance.

The KFF released a report reviewing Medicaid and CHIP eligibility, enrollment, and renewal policies throughout the unwinding of continuous enrollment. The report highlights state actions to improve automated renewal rates, streamline the renewal process, and steps being taken to improve coverage for children. The report focuses on polices for children, pregnant individuals, parents, and other non-elderly adults whose eligibility is based on Modified Adjusted Gross Income (MAGI) financial eligibility rules. States report that the biggest challenges faced during unwinding are unclear federal guidance, workforce issues, and the volume of work. Read the report to learn more.

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2024 Report to Congress on Medicaid and CHIP on June 11, 2024, with recommendations to Congress for increased transparency in Medicaid and the State Children’s Health Insurance Program (CHIP) financing, tools that states can use to optimize state Medicaid agency contracts (SMACs), enrollment trends in Medicare Savings Programs (MSPs), and improvements to demographic data collection in Medicaid.

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.

KFF released an updated version of their "Medicaid Enrollment and Unwinding Tracker" on May 10. This tracker provides state-level data on Medicaid/CHIP enrollment, unwinding, renewals, and other measures. Please note that while the tool includes national data reported by CMS, it has a lag of several months and may not reflect the most current Medicaid enrollment status.

On January 11, Mathematica published a blog titled “A Quick Guide to Choosing Federal Medicaid Authorities to Address Health-Related Social Needs.” This blog explores the three most common federal Medicaid authorities that enable states to offer health-related social needs (HRSN) services to Medicaid-enrolled individuals: Section 1915 HCBS waivers, Managed Care In Lieu of Services (ILOS), and Section 1115 demonstrations. It also discusses key factors to contemplate as a state Medicaid official when choosing how to cover HRSN services, emphasizing considerations such as the intended population, types of services, and program features.

The Medicaid and CHIP Payment and Access Commission (MACPAC) recently released the 2023 edition of their “MACStats: Medicaid and CHIP Data Book,” which presents the most current data available on Medicaid and the State Children’s Health Insurance Program (CHIP). These programs provide a safety net for low-income populations who otherwise would not have access to health care coverage and cover services other payers often do not. This data book compiles the broad range of Medicaid and CHIP statistics that MACPAC regularly updates on macpac.gov into a single, end-of-year publication. MACPAC’s purpose is to bring together in one place federal and state data on Medicaid and CHIP that come from multiple data sources...

Last week, the U.S. Department of Health and Human Services (HHS) launched a new online resource hub with Medicaid and CHIP Renewal and Transition Resources for Partners. This virtual hub provides key resources in one centralized location so all partners (e.g., states, beneficiary and provider organizations, and advocates among others) can better assist people with Medicaid or Children’s Health Insurance Program (CHIP) renew their health coverage or find other coverage options that may be a better fit for them. This hub contains the following resources: Resources to help others with coverage Outreach materials by population category Key government actions taken to support Medicaid renewals and transitions...