Medicaid

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...

June 5-11th marks the celebration of Medicare Fraud Prevention Week (MFPW), and the Senior Medicare Patrol (SMP) is actively participating in raising awareness and combating fraud. With Medicare fraud costing an estimated $60 billion annually and impacting beneficiaries' well-being, the SMP is dedicated to educating and empowering individuals to protect themselves against scams. Throughout the week, each day will be specifically targeted to a group of people who can help to prevent fraud, including: Medicare beneficiaries Caregivers Families Partners and professionals Health care providers Community members

The Kaiser Family Foundation (KFF) has released a brief that gauges Medicaid enrollee’s knowledge of and preparedness for the Medicaid renewal process and possible disenrollment from the Medicaid program. The findings are based on a survey of health insurance consumers fielded between February 21, 2023, and March 14, 2023. Key findings indicate that most Medicaid enrollees were not aware that states are now permitted to resume disenrolling people from the Medicaid program, and nearly half of the Medicaid enrollees indicated they have not been through a renewal process, including two-thirds of older adults. The brief also notes that fewer older adults indicate they have provided updated contact information to their state Medicaid agency.

CMS’ recent rule, released on May 23, proposes to lower the cost of prescription drugs covered by Medicaid by increasing price transparency. The proposed regulation would give CMS and states additional tools, like a drug price verification survey, which would verify drug prices to increase transparency about why the costs of certain drugs are expensive for Medicaid and help states better negotiate what the Medicaid program pays for high-cost drugs. CMS also proposes that contracts between states, Medicaid-managed care plans, and third-party contractors, such as pharmacy benefit managers (PBMs), reflect transparent reporting of drug payment information among third-party contractors...

The latest resource from Justice in Aging focuses on Medicare and LGBTQ+ older adults, addressing the challenges they face in accessing and utilizing their Medicare benefits. The publication includes two fact sheets to provide essential information and tips for LGBTQ+ older adults with Medicare and their advocates. The first fact sheet, "Marriage, Medicare, and Medicaid: What Same-Sex Couples Need to Know," covers Medicare coverage rules for spouses and the impact of spousal income on programs affecting Medicare costs. The second fact sheet, "Medicare & Transgender Older Adults: What Transgender People Need to Know," addresses critical issues related to gender identification, surgeries, transition-related drugs, and sex-specific procedures.

Arnold Ventures has introduced a new project titled "Melissa & Ann: Navigating America's Tangled Health Care Safety Net," a compelling photo essay featuring the lives of two women living in Southern California who are dually enrolled in Medicare and Medicaid. Through the lens of award-winning photographer Isadora Kosofsky, this project sheds light on the daily triumphs, challenges, and complexities faced by older adults and people with disabilities navigating the health care system. By sharing these intimate stories, Arnold Ventures aims to inspire policymakers to prioritize improving care for the diverse population of low-income older adults and people with disabilities who are dual-eligible for Medicare and Medicaid.

The Centers for Medicare & Medicaid Services (CMS) has determined that power seat elevation equipment on Medicare-covered power wheelchairs falls within the benefit category for durable medical equipment (DME) based on the Social Security Act and relevant regulations. After considering public comments, CMS has expanded coverage beyond the proposed decision, finding that power seat elevation equipment is reasonable and necessary for individuals using complex rehabilitative power-driven wheelchairs, subject to specific conditions.

On May 11th, The Centers for Medicare & Medicaid Services (CMS) released updated 2023 SSI and spousal impoverishment standards. Certain Medicaid income and resource standards are adjusted annually in accordance with changes in the SSI federal benefit rate and the Consumer Price Index, reflecting an effective date of January 1, 2023. Additionally, per section 1924 of the Social Security Act, the community spouse’s minimum monthly maintenance needs allowance (MMMNA) is adjusted based on changes to the federal poverty level and reflects a July 1, 2023 effective date. Additionally, the community spouse’s monthly housing allowance, calculated based on a percentage of the MMMNA, is adjusted each July 1st.

KFF unveiled their “Medicaid Enrollment and Unwinding Tracker” featuring state-level Medicaid/CHIP enrollment data for the 50 states and the District of Columbia as well as any unwinding or monthly renewals, disenrollments, and other measures that may be available for states. The tracker also provides information on state-specific Medicaid renewal policies, eligibility policies, and system capacity measures. The tool includes national data on Medicaid enrollment as reported by the Centers for Medicaid and Medicare Services (CMS); however, these data lag by several months and do not provide a current picture of net changes in Medicaid enrollment.

CMS created consumer fact sheets that provide information on Medicare, Medicaid, and private insurance coverage of COVID-19 tests following the end of the PHE on May 11, 2023. The fact sheets are available in both English and Spanish. Centers for Medicare & Medicaid Services (CMS)