Under Section 1115 of the Social Security Act, the Secretary of Health and Human Services (HHS) is permitted to waive certain federal Medicaid requirements to allow a state to undertake an experimental, pilot or demonstration...more
On August 22, 2018, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director Letter (SMDL) memorializing its long-standing budget neutrality policies requiring that waivers under Section 1115 of...more
In January 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance to states as to the circumstances under which CMS would approve Section 1115 demonstration waivers making work/community engagement (CE)...more
Introduction -
The Trump administration (the Administration) has called for a reduction in drug spending. In May, the Administration released a “blueprint” to reduce drug prices that included proposals for cutting Medicaid...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
Part 1: Megatrends Reinventing How Patients Think -
Editor’s Note: In a recent webinar for PharmaVOICE, Manatt Health revealed the megatrends reinventing the life sciences industry—and how they relate to new thinking by...more
Massachusetts Waiver Amendment Requests Partial Expansion and Closed Formulary -
On September 8, 2017, Massachusetts submitted a waiver amendment request to the Centers for Medicare & Medicaid Services (CMS) to modify its...more
Next steps regarding Congressional action on repeal and replace remain uncertain, with the President again supporting repeal coupled with replace, members attempting to bridge their differences over the Better Care...more
BCRA Implications: Affordability of Coverage -
In making the case for repealing and replacing the Affordable Care Act (ACA), the president and congressional leadership have cited “rising premiums,” “unaffordable...more
On April 25, 2017, the Maine Department of Health and Human Services released for public comment a draft Section 1115 waiver application to implement new eligibility and coverage requirements for MaineCare, the State’s...more
5/2/2017
/ 1115 Waivers ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Fee-for-Service ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicaid Work Requirements ,
Premiums
The Future of Essential Health Benefits -
Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more
3/24/2017
/ Affordable Care Act ,
Antitrust Immunity ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Essential Health Benefits ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Reform ,
Insurer Liability ,
Medicaid ,
Premiums ,
Repeal ,
Trump Administration
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
Editor's Note: This “Manatt on Medicaid” is the fourth 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
Editor's note: Medicaid is the largest healthcare payer in virtually every state. States are increasingly leveraging that position to drive payment and delivery system reform efforts. One powerful tool to enable...more
On January 5, 2016, New Hampshire secured a five-year, $150 million Medicaid 1115 waiver to transform the state's delivery system for Medicaid beneficiaries with mental health and substance use disorders. Known as the...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 17, 2015, the Centers for Medicare and Medicaid Services (CMS) approved Michigan’s request to amend its Healthy Michigan Section 1115 demonstration, through which the State provides coverage for more than 594,000...more
On November 2, 2015, the Centers for Medicare and Medicaid Services (CMS) approved Montana's request under Section 1115 of the Social Security Act to implement its Medicaid expansion. Referred to as the Health and Economic...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
Overview -
On August 18, 2015, Arizona released the Modernizing Arizona Medicaid proposal for a new 1115 waiver to implement coverage and delivery system reforms in its Medicaid program, the Arizona Health Care Cost...more
9/21/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Cost-Sharing ,
Health Savings Accounts ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
New Legislation ,
Premiums ,
State Medicaid Programs ,
Waivers
On April 29, 2015, Montana Governor Steve Bullock signed Senate Bill 405, referred to as the Montana Health and Economic Livelihood Partnership Act (HELP Act), which expands Medicaid to cover an estimated 70,000 new adults....more
Managed care is the dominant delivery model in state Medicaid programs, and is rapidly growing with the Affordable Care Act bringing over 8 million new beneficiaries into Medicaid in 2014. Today, 39 states (including the...more
On January 27, 2015, the Centers for Medicare and Medicaid Services (CMS) approved Indiana’s waiver request under Section 1115 of the Social Security Act to implement its Medicaid expansion. Referred to as the Healthy Indiana...more
On August 28, 2014, the Centers for Medicare and Medicaid Services (CMS) approved Pennsylvania’s application under Section 1115 of the Social Security Act to implement a Medicaid expansion effective January 1, 2015, through a...more