Medicaid

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)

On the 60th anniversary of Older Americans Month, the White House has issued a proclamation recognizing the invaluable contributions of our Nation's seniors. The proclamation celebrates the progress made through programs such as Medicare and Social Security in raising many seniors out of poverty and providing affordable healthcare. However, it also acknowledges the need for continued efforts to ensure seniors can age with dignity and financial security. Specifically, President Biden calls on Congress to improve accessibility to high-quality care and support for caregivers, increase funding for nutrition services, and improve the quality and safety of nursing homes to help ensure that all older adults are supported.

On Friday, April 28th, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of January 2023, over 65.5 million people are enrolled in Medicare; more than 33.9 million are enrolled in fee-for-service Medicare and nearly 31.6 have a Medicare Advantage plan. Over 93 million enrollees have Medicaid and CHIP; more than 85.9 million individuals have Medicaid and nearly 7.1 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.

This Health Affairs article, written by Katie McEvoy of the National Association of Medicaid Directors argues for structural stability and continued federal financial support for Medicaid. The article highlights the importance of Medicaid in supporting older adults and people with disabilities, its important role in Health Care Infrastructure And State Economies, and the public support for the program.