Delivery system and payment reform are dynamic and ever-evolving policy areas of state Medicaid programs; virtually every state has initiatives underway. This interactive is designed to provide users with an environmental scan of the activity.
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Medicaid Managed Care Plans Can Help Enrollees Maintain Coverage as the Public Health Emergency Unwinds
Throughout the pandemic, states have worked with managed care plans to respond to changing public health conditions and new developments. After the PHE ends, state Medicaid agencies will need to complete a large number of eligibility and enrollment tasks and actions, including processing renewals, redeterminations (based on changes in circumstance), and post-enrollment verifications. Medicaid managed care plans can assist state Medicaid agencies in communicating with enrollees, conducting outreach and assistance, and ultimately, in improving coverage retention (including facilitating transitions to the Marketplace where appropriate).
The COVID-19 pandemic has highlighted and exacerbated longstanding racial and ethnic disparities in health and health care. In the past year, the federal government and many states have identified advancing health equity as a key priority for the Medicaid program, which is a major source of health coverage for people of color. This issue brief provides greater insight into the role Medicaid can play in advancing racial health equity.
As California ramps up its CalAIM initiative, the state will incorporate and transition its Whole Person Care pilot program’s services statewide through the state’s Medicaid managed care system. This brief examines the lessons from those pilots in coordinating and integrating physical health, behavioral health, and social services.
This brief describes 10 themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights significant data and trends. Understanding these trends provides important context for the role managed care organizations (MCOs) play in the Medicaid program overall as well as during the ongoing COVID-19 public health emergency (PHE) and in its expected unwinding.
State Delivery System and Payment Strategies Aimed at Improving Outcomes and Lowering Costs in Medicaid
State Medicaid programs are using managed care and an array of other service delivery and payment system reforms, financial incentives, and managed care contracting requirements to help achieve better outcomes and lower costs. This brief examines what delivery system and payment reform initiatives are in place across states; how are states linking financial incentives and using transparency to improve quality and outcomes; and how are states leveraging managed care plan contracts to advance delivery system and payment reform initiatives.
On KFF’s 21st annual Medicaid budget survey, all responding states reported at least one initiative to expand behavioral health care in Medicaid, including crisis service and other benefit expansions, initiatives to expand telehealth and address equity, and managed care changes.
Annual Survey of Medicaid Directors Finds States Continue to Adopt Policies to Respond to the Pandemic and Are Addressing Issues Related to Social Determinants of Health and Health Equity
More than 18 months into the COVID-19 pandemic, state Medicaid programs around the country continue to reshape policy in response to the public health emergency and at the same time advance broader initiatives and priorities, including efforts to address the social determinants of health and health equity, finds a new…
States Respond to COVID-19 Challenges but Also Take Advantage of New Opportunities to Address Long-Standing Issues: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2021 and 2022
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings are drawn from the 21st annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report highlights policies in place in state Medicaid programs in FY 2021, particularly those related to the COVID-19 pandemic, as well as policy changes implemented or planned for FY 2022.
Extensive research and the pandemic have elevated the importance of addressing social determinants of health (SDOH) to improve health and reduce longstanding disparities in health and health care. Social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. This brief describes options and federal Medicaid authorities states may use to address enrollees’ social determinants of health and provides state examples, including initiatives launched in response to the COVID-19 pandemic. The focus of this brief is on state-driven Medicaid efforts to address social determinants for nonelderly enrollees who do not meet functional status or health need criteria for home and community-based services (HCBS) programs.