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This 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.
Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. While there are limits, states can use Medicaid – which, by design, serves a primarily low-income population with greater social needs – to address social determinants of health. This brief outlines the range of Medicaid authorities and flexibilities that can be used to add benefits and design programs to address the social determinants of health.
Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Key Medicaid issues to watch in 2020 include: Medicaid expansion developments; Section 1115 waiver activity; enrollment and spending trends; benefits, payment and delivery system reforms, and the implications of the 2020 elections.
Our updated explainer provides an overview of comprehensive managed care, the most common way states deliver Medicaid services to enrollees.
This brief provides an overview of how Medicaid managed care organization (MCO) capitation rates are developed by states and approved by CMS, 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.
On 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.
Six months after hurricanes Irma and Maria made landfall across Puerto Rico and the U.S. Virgin Islands, local officials described progress but also a long road to full recovery of the U.S. territories’ health care systems, economies and infrastructure during a public briefing Monday at the Kaiser Family Foundation’s Washington D.C. offices.
A new national survey conducted by the Kaiser Family Foundation and George Washington University finds few of the nation’s community health centers report they can handle a significant increase in patients. Less than one in five clinics report that they could increase their patient caseload by 25 percent or more in the next year.
A new nationally-representative survey of women from the Kaiser Family Foundation finds that coverage rates for women are at all-time highs and use of preventive services is on the rise, but many women still face a wide range of affordability and other access challenges.
Community health centers play a major role in furnishing reproductive health care to women living in low-income and medically underserved communities. Along with independent freestanding family planning clinics including Planned Parenthood health centers (which also may receive Title X funding), and local public health agencies, community health centers are part of a publicly supported provider network that serve an estimated one in three low-income women. This report, an update of an earlier study conducted in 2011, presents the key findings of a national survey of community health centers and their role in the provision of family planning and related services to low-income women, men, and teens.
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