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Drawing from KFF’s 50-state survey of state Medicaid HCBS officials, conducted between May and August of 2023, this issue brief describes how states used the PHE authorities to strengthen their HCBS programs, changes as the PHE ends, and the role of family caregivers in providing HCBS.
This issue brief analyzes the percentage and characteristics of facilities that would meet the rule’s proposed requirements for the minimum number of RN and nurse aide hours to better understand the implications of the rule.
State Medicaid unwinding data show procedural disenrollment rates are high across most states. This policy watch provides insights for interpreting the data and describes steps the Centers for Medicare and Medicaid Services (CMS) and states are taking to reduce procedural disenrollments.
This brief examines the share of children with obesity, how obesity screening and treatment is covered under Medicaid for children, and what recent changes may mean for Medicaid programs and enrollees in the future.
Some states are prioritizing Medicaid renewals for enrollees flagged as likely to be ineligible. Early data from Arizona, Idaho, and Pennsylvania show disenrollment rates for flagged enrollees are higher than for other enrollees. This analysis considers why different state approaches to renewals may explain some – but not all – variation in disenrollment rates across the U.S.
CDC’s provisional data for 2022 show a record high of 49,369 suicide deaths, coming after modest declines in 2019 and 2020. In 2022, provisional data indicates the highest number of gun-related suicides on record; increases in firearm suicides are driving the increases in overall suicide deaths in recent years. Suicide death rates in 2021 were highest among American Indian and Alaska Native people, males, and people who live in rural areas. Suicide deaths are increasing fastest among people of color, younger people, and those who live in rural areas with many groups seeing increases of 30% or more from 2011 to 2021. Suicide death rates varied considerably by state in 2021, as did the rate of change between 2011 and 2021.
People who are dually eligible for both Medicare and Medicaid coverage can get their Medicare coverage in a variety of ways. The brief breaks out the data for traditional Medicare, Medicare Advantage plans that are available to all Medicare beneficiaries, and plans that are designed specifically for dual-eligible beneficiaries.
This issue brief examines the most recent trends in children’s routine vaccinations, including COVID-19, and explores what to watch as children head back to school this year.
Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied, Medicaid enrollees can appeal, but it’s not always straightforward and many appeals don’t change the initial decision. Unlike in Medicare Advantage, if a Medicaid MCO upholds its original denial, there is no automatic, independent external medical review. OIG found that state Medicaid agency oversight of prior authorization denials is limited. The OIG report underscores concerns about prior authorization and access in Medicaid managed care, keeping this issue at the forefront of ongoing policy discussions.
Federal policies governing substance use disorder treatment have undergone rapid changes during the pandemic; however, the extent to which these changes can address the surge in opioid overdose deaths is unclear. Some of these policy adjustments are permanent, while others could revert to pre-pandemic regulations. In this brief, we examine the following 5 key federal policies and implications for access and treatment for OUD.
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