Under long-standing immigration law and guidance, individuals who are likely to become a “public charge”—or likely to rely on the government for financial support—can be denied admission to the United States or, if they are...more
Under long-standing immigration law and guidance, individuals who are likely to become a “public charge”—or likely to rely on the government for financial support—can be denied admission to the U.S. or, if they are already in...more
Following the Trump administration’s encouragement to states to consider new Medicaid waiver policies that allow restrictions on coverage, 19 states have approved or pending waivers with coverage limitations, including...more
In January 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance setting forth the standards it will apply in granting state waivers conditioning Medicaid eligibility on compliance with work and community...more
A new report prepared for the California Health Care Foundation reviews California’s Medicaid rate-setting process and offers recommendations for adjustments to that process to encourage health plan investments in...more
Medicaid has entered a period of volatile change, unprecedented in its 51-year history.
With 74 million members nationwide,1 Medicaid provides health coverage to more than one in four Americans, ensuring access to...more
Low-income adults who need and use long-term services and supports (LTSS) are among the most complex, expensive, and fast-growing populations covered by Medicaid. The challenges of organizing and paying for this much needed...more
The Senate is poised to vote today, July 25, 2017, on a motion to proceed (MTP) to debate on repealing and possibly replacing the Affordable Care Act (ACA). The MTP allows the Senate to consider the House repeal and replace...more
Congressional action on repeal and replace took a number of significant turns in the past few days, and next steps still remain uncertain. On Monday evening, Senators Mike Lee (R-UT) and Jerry Moran (R-KS) joined Senators...more
The State of Wisconsin recently proposed a Medicaid waiver that includes a number of precedent-setting features, including a 48-month time limit on enrollment (with the limit paused for periods of employment or job training),...more
Editor’s Note: While the American Health Care Act (AHCA)—the bill that would replace the Affordable Care Act—does not include explicit changes to Medicare, it could have a profound impact on the 11 million Medicare...more
In a new chart pack commissioned by the Blue Cross Blue Shield of Massachusetts Foundation for the Massachusetts Coalition for Coverage and Care, Manatt Health provides an overview of proposals to cap federal Medicaid funding...more
Since its inception, Medicaid has been fi nanced jointly by the federal and state governments. There are no caps on the federal government’s fi nancial obligations; federal funding is guaranteed as a share (known as a...more
Securing the Safety Net for America's Vulnerable Populations -
Editor's Note: America's population is aging rapidly. By 2029, 75 million baby boomers will have reached age 65 and older, and older adults will represent...more
2/22/2017
/ Aetna ,
Affordable Care Act ,
Anthem Insurance ,
Antitrust Provisions ,
Caregivers ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
CIGNA ,
Department of Justice (DOJ) ,
FMAP ,
HCQIA ,
Health Insurance ,
Humana ,
Lead Poisoning ,
Medicaid ,
Medicare Advantage ,
Mergers ,
Opioid ,
Private Sector ,
Substance Abuse ,
Whistleblower Protection Policies ,
Whistleblowers
President-elect Donald Trump and Republican congressional leadership have called for a repeal of the Affordable Care Act (ACA) and a fundamental overhaul of the Medicaid program that would include imposing caps on federal...more
Balancing Gene Therapy’s Promise and Price -
Editor’s Note: Exciting advances in science have led to developing treatment breakthroughs, such as gene scripting therapies, that could represent the first potential cures...more
12/20/2016
/ Affordable Care Act ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
Final Rules ,
Healthcare Reform ,
Hospice ,
MCOs ,
Medicaid ,
Medicare ,
Non-Discrimination Rules ,
OCR ,
OIG ,
Safe Harbors ,
Telehealth
President-elect Trump and leaders in Congress have proposed a major restructuring of the Medicaid program, but very significant changes to Medicaid coverage and financing could be adopted even before that debate begins as...more
Real-Time Data Analytics in Government Investigations and Reducing Exposure -
It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more
6/24/2016
/ ACOs ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Government Investigations ,
Healthcare Fraud ,
HEAT ,
Hospital Mergers ,
IRS ,
MCOs ,
Medi-Cal ,
Medicaid ,
Medicare Advantage ,
OIG ,
Section 340B
Over the past few years, California’s Medicaid program, known as Medi-Cal, has been catapulted into a new role. It has evolved from a program designed to provide health coverage to a subset of low-income individuals and help...more
Editor's Note: This Manatt on Medicaid is the third in a series of updates focused on CMS's new Medicaid/CHIP managed care regulations. In the coming weeks, Manatt will be exploring key provisions of the regulations and...more
Medicaid continues to gain scale and importance nationally – as both the leading source of health coverage for Americans, and as a change agent within the healthcare marketplace.
With the number of Americans obtaining...more
On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved California's request to renew its waiver under Section 1115 of the Social Security Act. A significant component of the waiver is the Delivery...more
Medicaid continues to gain scale and importance nationally – as both the leading source of health coverage for Americans, and as a change agent within the healthcare marketplace.
With the number of Americans obtaining...more
Editor’s note: Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs into the nation’s largest health insurer. Medicaid’s 50th birthday is a fitting time to...more
10/27/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Eligibility ,
Enrollment ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Healthcare ,
Healthcare Costs ,
Healthcare Reform ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Public Health Insurance Marketplace ,
State Medicaid Programs ,
Tax Credits ,
Value-Based Purchasing ,
Waivers
Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs to the nation’s largest health insurer. The occasion of Medicaid’s 50th birthday is a fitting time to...more
9/30/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Enrollment ,
Health Insurance ,
Information Technology ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Public Health Insurance Marketplace ,
State Medicaid Programs ,
Waivers