10 Things to Know About Medicaid Managed Care March 1, 2023 Issue Brief 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.
As Debate Heats Up in Washington Over Possible Entitlement Cuts, A New KFF Analysis Details the 30% of Federal Spending That Goes to Health Care Programs March 1, 2023 News Release As some policymakers in Washington are pushing to reduce the federal deficit and debt, a new KFF resource provides a concise explanation of federal spending for domestic and global health programs and services, which could be part of any conversation about curbing federal spending. Federal spending on health programs and…
Medicare Advantage Insurers Report Much Higher Gross Margins Per Enrollee Than Insurers in Other Markets February 28, 2023 News Release A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured…
Health Insurer Financial Performance in 2021 February 28, 2023 Issue Brief Using health insurer financial data for 2021, we find that Medicare Advantage insurers reported gross margins that were at least twice as high as those reported by insurers in the individual/non-group, fully-insured group/employer, and Medicaid managed care markets. The four markets report similar simple medical-loss-ratios.
Rural Hospitals Have Fared Worse Financially in States that Haven’t Expanded Medicaid Coverage February 23, 2023 News Release Rural hospitals fared worse financially in states that have not expanded their Medicaid programs under the Affordable Care Act than in states that expanded Medicaid, a new KFF analysis finds. Nearly one third of all rural hospitals nationally are in the 11 states that have not approved the expansion of…
Rural Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid February 23, 2023 Issue Brief This data note examines rural hospitals’ operating margins in recent years. After seeing higher margins early in the pandemic, likely due to government relief funds, rural hospitals now face renewed challenges, especially in states that have not expanded Medicaid.
A Look at Recent Medicaid Guidance to Address Social Determinants of Health and Health-Related Social Needs February 22, 2023 Blog This policy watch discusses the new opportunities available to states to address health-related social needs through managed care and through Section 1115 demonstration waivers.
CMS Prior Authorization Proposal Aims to Streamline the Process and Improve Transparency February 21, 2023 Issue Brief This brief explains a new proposed federal regulation aimed at reducing administrative hassles involved in obtaining prior authorization for care and sets out key policy questions, including how the proposal could impact the patient experience and data privacy.
Prescriptions to Treat Opioid Overdoses and Opioid Use Disorder Among Medicaid Enrollees Rose Sharply in the Years Leading Up to the Pandemic February 17, 2023 News Release State Medicaid programs saw a doubling of prescriptions for medications used to treat Opioid Use Disorder (OUD) or rapidly reverse opioid overdoses from 2016 to 2019, finds a new KFF analysis. KFF analysts studied the latest available Medicaid claims data — detailed and comprehensive administrative data that can help answer…
A Look at Changes in Opioid Prescribing Patterns in Medicaid from 2016 to 2019 February 17, 2023 Issue Brief This analysis builds on previous KFF work by using Medicaid claims data for 2016-2019 to explore how prescriptions for opioids used to treat pain and those used to treat OUD or rapidly reverse overdose changed across states and Medicaid enrollee demographic groups over time.