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CMS is taking a new approach to fraud that will rely more heavily on options to pause or withhold significant amounts of federal funding in cases of potential fraud, which could have broad implications for states and enrollees. This issue brief explains the new approach.
This brief summarizes the history, rationale, and policy issues related to the federal government's key vaccine injury compensation programs, known as the Vaccine Injury Compensation Program (VICP) and Countermeasures Injury Compensation Program (CICP).
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act, which would partially pay to extend expiring tax cuts by cutting Medicaid. The Congressional Budget Office (CBO) estimates that the bill would reduce federal Medicaid spending by $793 billion over ten years and 10.3 million fewer people would be enrolled in Medicaid in 2034, including 1.3 million people with Medicare, otherwise known as “dual-eligible individuals”.
State Medicaid and public health agencies both work to advance the health of their communities, often pursuing similar priorities and serving similar populations. This brief examines findings from KFF's 25th annual Medicaid budget survey, which asked state Medicaid directors about new or enhanced initiatives involving public health in FY 2025 or planned for FY 2026.
This brief examines recent state trends in Medicaid behavioral health coverage and payment and state coverage of select treatment models for people with serious mental illness—a population that has historically faced significant barriers to care. This includes details about coverage of Certified Community Behavioral Health Clinics (CCBHCs) (as a provider type), Assertive Community Treatment (ACT), and Coordinated Specialty Care for First Episode Psychosis (CSC-FEP).
Nineteen percent of adolescents experience moderate to severe anxiety and 2 million have a substance use disorder. This analysis covers the latest data on adolescent mental illness, suicide and drug overdose trends, and access to care.
This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE Model, and potential impacts on beneficiaries and program budgets.
This issue brief provides background on the GENEROUS model, examines the factors that will contribute to the model’s overall impact on Medicaid drug costs, and illustrates how savings will depend on model details that are confidential or uncertain at this time.
This brief reviews the case now before the Supreme Court, Louisiana v. FDA, and provides an overview of the other pending litigation involving mifepristone, and the mounting tension between states seeking to protect abortion and the states banning the provision of abortion.
Amid the growing use of artificial intelligence (AI) in the claims review cycle, this brief discusses the types of consumer protections for use of AI in prior authorization and claims review, describes the Trump administration’s general approach to AI , and highlights areas to watch as Congress considers AI legislation.
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