Medicaid

On Monday, January 31st, CMS issued a final rule for the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The MA RADV program is used to identify improper risk adjustment payments made to Medicare Advantage Organizations (MAOs) for claims made to Medicare without supporting evidence from a beneficiary’s medical record. Payments to MAOs are adjusted based on the health status of a MAO’s enrollees using medical diagnoses reported by the insurer. The new policy will apply to plan contracts since 2018.

The KFF recently published two analyses on demographics and program enrollment and spending of Medicare and Medicaid dually eligible beneficiaries or dual eligibles. The article, “A Profile of Medicare-Medicaid Enrollees”, analyzes the demographic, socioeconomic, and health characteristics of dual eligibles using data from the 2020 Medicare Current Beneficiary Survey. The second article, “Enrollment and Spending Patterns Among Medicare-Medicaid Enrollees (Dual Eligibles)”, examines national and state-level data on enrollment and spending for Medicare-Medicaid enrollees. The authors used data from the 2019 and 2020 Medicare Beneficiary Summary Files and the 2019 Transformed Medicaid Statistical Information System for this analysis.

The KFF recent analysis, “As States Prepare to “Unwind” the Medicaid Continuous Enrollment Provision, Past Patterns Show that Most People Who are Disenrolled from Medicaid Become Uninsured for All or Part of the Next 12 Months”, indicates that many individuals currently enrolled in Medicaid may go without health insurance coverage for several months.

KFF’s “Medicaid: What to Watch in 2023” issue brief provides information on issues and considerations affecting Medicaid this year, including Medicaid Coverage and Financing; Access and Health Equity; and, Enrollment and Access Among People Eligible for Medicaid through Age or Disability.

This publication finds meaningful variation in disenrollment and churn across Medicaid beneficiary categories. Specifically, beneficiaries with Supplemental Security Income-related eligibility have low rates of disenrollment and high rates of reenrollments. In this research, Mathematica uses data from the Transformed Medicaid Statistical Information System Analytic File to examine rates of disenrollment, churn, and continuous coverage among categories of children and adult Medicaid beneficiaries whose eligibility is related to a disability.

The Center for Health Care Strategies has released a summary of its top 10 resources from 2022 that outline opportunities to strengthen the U.S health care system, particularly for Medicaid beneficiaries.

The Commonwealth Fund has published a compilation of state successes in transforming long-term care as a resource to support policymakers. This policy guide is the result of a nine-month partnership between CSG and the Commonwealth Fund. Subject matter experts and stakeholders from Arizona, Georgia, Hawaii, Indiana, Minnesota, New York, Pennsylvania and Virginia examine the following focus areas in long-term care: Addressing State Regulation of Long-Term Services and Supports Facilities; Optimizing American Rescue Plan Act Spending on Home- and Community-Based Services Under Medicaid; and Revitalizing the Direct Care Workforce and Supporting Family Caregivers.

On January 5, 2023 CMS released an Informational Bulletin providing further guidance on the Medicaid eligibility provisions in the recently-enacted Federal budget (Consolidated Appropriations Act of 2023). The CAA permits states to begin terminating Medicaid eligibility for current recipients on April 1, 2023 and provides gradually-decreased FMAP increases through December, 2023. This IB is the first in a series of written guidance from CMS on these provisions, focusing first on revised key due dates for certain state eligibility redetermination deliverables and activities.

On December 20, 2022 CMS released a report summarizing the public comments it received in response to the 2022 Request for Information (RFI): Access to Coverage and Care in Medicaid & CHIP. CMS framed the RFI questions across three dimensions of health care access: (1) enrolling in coverage, (2) maintaining coverage, and (3) accessing services and supports. This report includes counts of comments, types of respondents, summaries of common themes across objectives, and cross-cutting findings.

The Medicaid and CHIP Payment and Access Commission (MACPAC) released the 2022 edition of the MACStats: Medicaid and CHIP Data Book, with updated data on national and state Medicaid and State Children’s Health Insurance Program (CHIP) enrollment, spending, benefits, and beneficiaries’ health, service use, and access to care. As of July 2022, almost 90 million people were enrolled in Medicaid or CHIP.