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  • Claims Denials and Appeals in ACA Marketplace Plans in 2024

    Issue Brief

    This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.

  • Medicaid Postpartum Coverage Extension Tracker

    Issue Brief

    This page tracks recent state actions to extend Medicaid postpartum coverage, including approved and pending 1115 waivers, legislation that will require the state to seek federal approval through a SPA or 1115 waiver, submitted and approved SPAs, and coverage financed solely with state funds.

  • What to Know About Medicare Coverage of Telehealth

    Issue Brief

    Congress has repeatedly extended several pandemic-era flexibilities around Medicare coverage of telehealth, but with a few key exceptions most pandemic-era telehealth flexibilities remain temporary. This brief provides answers to key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and policy considerations that lie ahead.

  • CMS’ New Approach to Federal Medicaid Spending in Cases of Potential Fraud

    Issue Brief

    CMS has recently announced 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.

  • 5 Key Facts About Medicaid Prescription Drugs

    Issue Brief

    To provide context for emerging debates about federal actions to address prescription drug costs, this issue brief highlights five key facts about Medicaid prescription drug coverage, payment, and administration.