Managed Medicaid
Expert articles and analysis related to managed medicaid.
AI Summary — Last 7 Days
Managed Medicaid activity this week centered on states and plans preparing for tighter eligibility and delivery-system constraints: Medicaid work requirements are raising operational risk around exemptions, documentation, churn, and member navigation, especially for farmworkers, direct care workers, and other low-wage populations whose coverage stability underpins VBC attribution and risk management. At the same time, behavioral health and long-term services remain pressure points for Medicaid payment reform, with scrutiny of CMS’ ACCESS model economics and new evidence from SUD IMD 1115 waiver evaluations underscoring the tension between expanding access to high-need services and making value-based or managed care financing work for providers and states (Avalere on work-requirement exemptions; KFF on SUD IMD waiver evaluations). For ACOs, MCOs, and safety-net providers, the near-term mandate is to hardwire eligibility surveillance, exemption support, behavioral health capacity, and home/community-based workforce strategy into population health operations before policy variability translates into avoidable coverage loss, utilization spikes, and quality-performance deterioration.
Related Articles
Navigating State Variability in Medicaid Work Requirements
A Look at 1115 Waiver Evaluations for Medicaid Payments to Institutions of Mental Disease (IMD) for Substance Use Disorder
As SUD IMD waiver evaluations and renewals are becoming available, states face a shifting Medicaid and policy and waiver landscape. This brief examines findings from the first available summative eval...
Medicaid Work Requirements: Understanding Exemptions and Protecting Patients
Minnesota Medicaid recovers $495K from CVS in insulin billing settlement
Minnesota Medicaid recovers $495K from CVS in insulin billing settlement Healthcare Finance News
They Harvest the Nation’s Food, but a New Rule May Strip Them of Health Insurance
New Medicaid work requirements could make a complex system even harder for farmworkers to navigate.
Who Are Direct Care Workers and How Might Federal Policy Changes Impact the Workforce?
This analysis uses the 2024 American Community Survey (ACS) to provide an overview of demographic and socioeconomic characteristics of the direct care workforce, including home health aides, personal ...
CMS scraps ‘fast-track’ process for certain Medicaid waivers: 6 things to know - beckerspayer.com
CMS scraps ‘fast-track’ process for certain Medicaid waivers: 6 things to know beckerspayer.com
CMS eliminates ‘fast-track’ process for certain Medicaid section 1115 waivers
CMS eliminates ‘fast-track’ process for certain Medicaid section 1115 waivers American Hospital Association
Demographic Characteristics of Medicaid Beneficiaries Enrolled in the Program of All-Inclusive Care for the Elderly - MACPAC - Advising Congress on Medicaid and CHIP Policy (.gov)
Demographic Characteristics of Medicaid Beneficiaries Enrolled in the Program of All-Inclusive Care for the Elderly MACPAC - Advising Congress on Medicaid and CHIP Policy (.gov)
States push new hospital funding arrangements
States are implementing a growing number of initiatives to provide funding for rural or otherwise financially struggling hospitals. This push comes amid data showing that a record number of hospitals ...