A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes
This report highlights key policy priorities and issues state Medicaid programs focused on in FY 2025 and are prioritizing in FY 2026.
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North Carolina’s Effort to Relieve Medical Debt
Policy WatchThis policy watch examines the burden of medical debt in North Carolina and the state’s new plan to leverage the Medicaid program to provide debt relief and support access to care for low- and middle-income North Carolinians.
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As Pandemic-Era Policies End, Medicaid Programs Focus on Enrollee Access and Reducing Health Disparities Amid Future Uncertainties
ReportThis report highlights certain policies in place in state Medicaid programs in FY 2024 and policy changes implemented or planned for FY 2025, which began on July 1, 2024 for most states.
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Medicaid Managed Care Network Adequacy & Access: Current Standards and Proposed Changes
Issue BriefThis brief describes current network adequacy and availability standards for Medicaid managed care plans, presents related findings from KFF’s 22nd annual Medicaid budget survey, and summarizes proposed changes to network adequacy and access rules in the Managed Care NPRM.
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What You Need to Know About Medicaid Managed Care, Amid the New Federal Rules
News ReleaseManaged care is the most common delivery system for Medicaid. Most states (42, including DC) use comprehensive managed care plans to provide care to at least some of their Medicaid enrollees, according to KFF’s updated explainer.
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10 Things to Know About Medicaid Managed Care
Issue BriefOur updated explainer provides an overview of comprehensive managed care, the most common way states deliver Medicaid services to enrollees.
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Abismo en el financiamiento de Medicaid: Implicaciones para los sistemas de atención de salud de Puerto Rico y las Islas Vírgenes de los EE.UU.
Issue BriefEste resumen ofrece una descripción general del estado de los sistemas de atención médica y los programas de Medicaid en Puerto Rico y las Islas Vírgenes de los EE.UU. (USVI) aproximadamente un año y medio después que los huracanes Irma y María azotaran las islas, en septiembre de 2017. Después de las tormentas, los programas de Medicaid de los territorios han servido como recursos importantes para atender las necesidades de atención médica de los residentes, pero han operado bajo desafíos financieros de larga data. Este resumen se enfoca en esos desafíos e incluye el análisis de KFF de las consecuencias para las finanzas de los programas de Medicaid de los territorios, ya que la mayoría de los fondos federales de Medicaid provistos a través de la Ley de Cuidado de Salud a Bajo Precio (ACA), y la asistencia para desastres, expirarán a fines de septiembre de 2019. Los otros territorios de los EE.UU. (Samoa Americana, el Commonwealth de las Islas Marianas del Norte y Guam) también enfrentan retos relacionados con el vencimiento programado de los fondos de ACA. Este resumen se basa en trabajos anteriores y en informes públicos recientes, y en entrevistas con funcionarios de los territorios en los lugares afectados, con proveedores, con responsables de planes de salud de Puerto Rico y beneficiarios.
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CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes
Issue BriefOn November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a wholesale revision of the 2016 regulations but adopts changes in areas including network adequacy, beneficiary protections, quality oversight, and rates and payment.
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The Pandemic Has Exacerbated Long-Standing Health Care Challenges Faced By Puerto Rico and Other U.S. Territories as the End of Temporary Federal Medicaid Funding Approaches
News ReleaseA new KFF analysis examines how the coronavirus pandemic is affecting U.S. territories as well as issues related to the upcoming expiration of temporary Medicaid funding for the territories at the end of September. Prior to the pandemic, the U.
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Challenges in the U.S. Territories: COVID-19 and the Medicaid Financing Cliff
Issue BriefMore than a year into the public health emergency, the COVID-19 pandemic continues to impact the lives of Americans including those living in the U.S. territories. Differences in Medicaid financing, including a statutory cap and match rate, have contributed to broader fiscal and health systems challenges for the territories. While additional federal funds have been provided over the statutory caps, these funds are set to expire at the end of September 2021. Without additional Congressional action, the territories will lose the vast majority of Medicaid financing which could result in reductions in coverage, services, and provider rates which could negatively impact the territories as they deal with the long-term health and economic consequences of the pandemic. This brief looks at how the pandemic is affecting the territories as well as issues related to the upcoming Medicaid fiscal cliff.