The Complete Series
A provision in Utah’s Medicaid waiver that allows the state to close enrollment at any time has significant implications for health coverage. An enrollment cap in Utah’s Medicaid program could discourage people from changing jobs or adding work hours, as they might have trouble regaining coverage.
Timely access to family planning can reduce the occurrence of pregnancy-related deaths, which are increasing significantly in the U.S. in contrast to most other developed nations. But federal and state policies — driven partly by a political opposition to abortion rights — are putting women’s access to comprehensive health care at risk.
A new federal initiative is seeking to reduce children’s out-of-home placements in foster care, residential treatment, and inpatient settings in order to improve health outcomes and reduce Medicaid spending.
Regulations in place since 2016 that allowed state Medicaid programs flexibility to use managed care contracting and payments to drive reform in how health care is delivered and paid for are likely to remain largely intact. However, certain provisions will weaken standards designed to ensure a sufficient network of health providers is available to serve enrollees.
With congressional proposals to make sweeping changes to the Medicaid program stalled, federal executive actions have moved to the forefront. This post is the first in a series exploring how these actions may affect ongoing Medicaid delivery reforms.
While new Medicaid waiver policies, such as work requirements, have been fervently debated, relatively little attention has been paid to how these policies might affect state delivery system reform efforts aimed at improving health and bending the cost curve. The court decision invalidating Kentucky’s work requirements — and the Centers for Medicare and Medicaid Services’ decision to reopen the comment period on the Kentucky demonstration — offers an opportunity to think about the intersections of waivers and delivery system reform.
There are still gaps in Medicaid coverage of substance use disorder treatment. Fifteen states do not yet cover all three forms of medication-assisted treatment. Moreover, states have historically been precluded under federal law from using federal Medicaid funds to provide care to beneficiaries between ages 21 and 64 residing in Institutions for Mental Disease (IMDs), which are hospitals or residential facilities that care for people with mental illnesses or substance use disorders. The SUPPORT Act takes some important steps to address these issues.
By disrupting coverage for so many people, the "public charge" rule also will have a significant impact on the delivery system, reducing Medicaid support for health care providers and driving up uncompensated care. Safety-net providers and health care providers in communities with large immigrant populations will be particularly hard-hit, affecting not only their fiscal health but their ability to serve the broader community.