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Jan 23, 2025 | 
kff.org | Robin Rudowitz |Alice Burns |Elizabeth Hinton |Jennifer Tolbert
At the start of 2025, many issues are at play that could affect Medicaid coverage, financing, and access to care. Medicaid is the primary program providing comprehensive health and long-term care to one in five low-income Americans. While Medicaid was not discussed much on the campaign trail, there are expectations that big changes will likely be proposed through executive actions by the Trump administration and as part of a tax and spending debate in Congress.
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Aug 19, 2024 | 
kff.org | Elizabeth Hinton |Akash Pillai |Amaya Diana
In April 2023, the Centers for Medicare and Medicaid Services (CMS) released guidance encouraging states to apply for a new Section 1115 demonstration opportunity to test transition-related strategies to support community reentry for people who are incarcerated. This demonstration allows states a partial waiver of the “inmate exclusion policy,” which prohibits Medicaid from paying for services provided during incarceration (except for inpatient services).
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Jul 1, 2024 | 
kff.org | Akash Pillai |Elizabeth Hinton |Robin Rudowitz |Samantha Artiga
Racial and ethnic disparities in health remain persistent in the United States, driven by inequities in access to and utilization of health care and social and economic factors that drive health, often referred to as social determinants of health (SDOH), that are rooted in historic and ongoing racism and discrimination. As a major source of health coverage for people of color, Medicaid programs are an important potential mechanism to address racial health disparities.
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Apr 16, 2024 | 
kff.org | Elizabeth Hinton |Akash Pillai |Amaya Diana
In April 2023, the Centers for Medicare and Medicaid Services (CMS) released guidance encouraging states to apply for a new Section 1115 demonstration opportunity to test transition-related strategies to support community reentry for people who are incarcerated. This demonstration allows states a partial waiver of the inmate exclusion policy, which prohibits Medicaid from paying for services provided during incarceration (except for inpatient services).
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Mar 4, 2024 | 
kff.org | Elizabeth Hinton |Amaya Diana
In December 2022, the Centers for Medicare and Medicaid Services (CMS) announced a Section 1115 demonstration waiver opportunity to expand the tools available to states to address enrollee health-related social needs (or “HRSN”). In November 2023, CMS released a detailed Medicaid and CHIP HRSN Framework accompanied by an Informational Bulletin (CIB).
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Feb 14, 2024 | 
kff.org | Elizabeth Hinton |Jennifer Tolbert |Amaya Diana
The pandemic continuous enrollment provision and other research show that continuous eligibility reduces Medicaid disenrollment and “churn” rates and helps to ensure stable coverage. Guaranteeing 12-month continuous coverage for children has long been an option in Medicaid and CHIP without a waiver, but not for adults. The Consolidated Appropriations Act required all states to implement 12-month continuous eligibility for children beginning on January 1, 2024.
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Feb 2, 2024 | 
kff.org | Robin Rudowitz |Jennifer Tolbert |Elizabeth Hinton |Alice Burns
As the start of 2024, many issues are at play that will affect Medicaid coverage, financing, and access. Medicaid is the primary program providing comprehensive health and long-term care coverage to one in five low-income Americans. The unwinding of the Medicaid continuous enrollment provision started on April 1, 2023, and will continue to be the dominant Medicaid policy issue in 2024.
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Aug 30, 2023 | 
kff.org | Robin Rudowitz |Alice Burns |Elizabeth Hinton |Maiss Mohamed
Medicaid is the primary program providing comprehensive coverage of health care and long-term services and supports to more than 90 million low-income people in the United States. The COVID-19 pandemic profoundly affected Medicaid spending and enrollment. In 2023, Medicaid programs are facing new challenges and millions of enrollees are at risk of losing coverage as states unwind the continuous enrollment provision that was put in place early in the pandemic to ensure stable coverage.
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Jul 27, 2023 | 
kff.org | Heather Saunders |Elizabeth Hinton
Medicaid managed care organizations (MCOs) deliver care to more than two-thirds of all Medicaid enrollees nationally. Managed care plans often require patients to obtain approval of certain health care services or medications before the care is provided—an insurance practice commonly referred to as “prior authorization” (or PA). This allows the health plan to evaluate whether care is covered and medically necessary.
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Jun 30, 2023 | 
kff.org | Robin Rudowitz |Alice Burns |Elizabeth Hinton |Maiss Mohamed
Medicaid is the primary program providing comprehensive coverage of health care and long-term services and supports to more than 90 million low-income people in the United States. The COVID-19 pandemic profoundly affected Medicaid spending and enrollment. In 2023, Medicaid programs are facing new challenges and millions of enrollees are at risk of losing coverage as states unwind the continuous enrollment provision that was put in place early in the pandemic to ensure stable coverage.
