This brief provides an overview of how Medicaid managed care organization (MCO) capitation rates are developed and approved, highlights options available to states to adjust current rates and/or risk sharing mechanisms, describes how MCOs pay providers, and outlines state options to direct MCO payments to providers in response to conditions created by the COVID-19 pandemic.
The coronavirus pandemic has resulted in financial strain for Medicaid providers. We provide an overview of how states currently reimburse providers and the challenges for Medicaid providers that have emerged from the pandemic and state budget issues. We have data on recent state actions to help bolster Medicaid providers and discuss support available for providers from the federal relief fund.
Information on approved Medicaid emergency authorities to address the COVID-19 Coronavirus emergency. We include details on Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 Waivers; Section 1135 Waivers; and 1915 (c) Waiver Appendix K strategies.
States are taking aggressive action to slow down the spread of the novel coronavirus and prepare their health care systems for dealing with those who become ill with COVID-19, the disease the virus causes. This tool features state-level data on COVID-19 cases and deaths, state policy actions, and data about health coverage and provider capacity within each state.
The economic impacts of COVID-19 have contributed to food insecurity, especially among lower-income people on Medicaid. Among Medicaid adults, 23 percent reported that their households sometimes or often didn’t have enough to eat in the week ending July 21.
Following a successful ballot measure on Aug. 4, Missouri became the 38th state (plus D.C.) to adopt the Affordable Care Act’s Medicaid expansion. The approved measure adds Medicaid expansion to the state’s constitution. Missouri is the second state to expand Medicaid during the coronavirus pandemic, after a ballot measure passed in Oklahoma in June. Twelve states have not adopted expansion.
Millions of Americans rely on Medicaid drug coverage both for treating acute problems and for managing ongoing chronic or disabling conditions. Though optional, all states provide pharmacy benefit coverage in Medicaid and administer the benefit in different ways within federal guidelines. Our state fact sheets offer a snapshot of the administration and delivery of Medicaid pharmacy benefits in each state. They are based on data from a survey of states conducted between June and December 2019.
Most (62%) of the 22 million adults with Medicaid coverage in the U.S. who are not eligible for both Medicare and Medicaid, and who do not receive federal disability payments, are already working full- or part-time. We highlight data related to the work status and financial security of Medicaid adults prior to the coronavirus pandemic as well as findings from focus groups conducted with Medicaid enrollees in January 2020.