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Medicaid › Patient Access › Healthcare

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Manatt, Phelps & Phillips, LLP

New Guidance on Family Planning in Medicaid: Takeaways for States, Plans, and Providers

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For states, managed care organizations, and providers—who all play a vital role in ensuring access to family planning services and supplies for the nearly 20 million women ages 18-44 enrolled in Medicaid1—the CIB reiterates...more

Manatt, Phelps & Phillips, LLP

Maryland PDAB Releases Draft Upper Payment Limit Action Plan

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On August 9, Maryland’s Prescription Drug Affordability Board (PDAB) released its draft action plan for establishing upper payment limits (UPLs) for drugs identified as causing or likely to cause affordability challenges. The...more

Manatt, Phelps & Phillips, LLP

New CMS Guidance on the Provision of Medicaid and CHIP Services to Incarcerated Children and Youth

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This is an excerpt from a recent Manatt article published on State Health & Value Strategies. Click here to download insight. On July 23, 2024, the Centers for Medicare & Medicaid Services (CMS) released a State Health...more

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Maryland Expands Access to Gender-Affirming Care

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On January 1, 2024, Maryland’s Trans Health Equity Act (THEA) went into effect, requiring the state’s Medicaid program to cover all medically necessary gender-affirming services, including services that were not previously...more

Stotler Hayes Group, LLC

The Great Unwinding And Its Effect On Skilled Nursing Facilities

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Following the termination of the Public Health Emergency (“PHE”) as a result of COVID-19, and the continuous enrollment provisions put in place to ensure that Medicaid beneficiaries were able to receive Medicaid benefits...more

Manatt, Phelps & Phillips, LLP

CMS Approves Montana’s Reentry Services, Contingency Management, and Tenancy Supports 1115 Waiver

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On February 26, 2024, Montana received Centers for Medicare and Medicaid Services (CMS) approval to provide contingency management, tenancy supports, and Reentry Initiative services under its Section 1115 Healing and Ending...more

Whiteford

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

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Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more

Manatt, Phelps & Phillips, LLP

FY 2025 Executive Budget Women’s Health Highlights

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Earlier this week, Governor Kathy Hochul released her Executive Budget proposal totaling $233 billion for State Fiscal Year 2025. The budget proposes several initiatives targeted at improving access to, quality of, and...more

Manatt, Phelps & Phillips, LLP

Advancing Health Equity: State Medicaid Actions to Ensure Access to Gender-Affirming Care

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The transgender, or trans, community experiences stark health disparities resulting from discrimination, violence, stigma and a lack of culturally competent providers. Compared with the general U.S. population, trans...more

Manatt, Phelps & Phillips, LLP

Leveraging Medicaid to Support Children and Youth Living With Complex Behavioral Health Needs - Framework and Strategies

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Executive Summary - The COVID-19 pandemic exacerbated the already-growing mental health and substance use disorder (SUD) (behavioral health) crisis gripping children and youth in the United States. It has spurred federal,...more

Manatt, Phelps & Phillips, LLP

Issue Spotting Common Policy and Operational Barriers to Ex Parte Renewals: State Assessment Tool

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Introduction - Many states are actively working to make changes to their systems to enable ex parte renewals at the individual level and implement mitigation strategies to ensure eligible Medicaid and Children’s Health...more

Manatt, Phelps & Phillips, LLP

Increasing Community Health Workers’ Role in Supporting Medicaid Members

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Community health workers (CHWs) are frontline public health workers who come from and/or have deep roots in the communities they serve. Many states are leveraging CHWs to build trusting relationships with patients, including...more

King & Spalding

OIG Publishes Strategic Plan for Managed Care Oversight on New Featured Webpage

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On August 28, 2023, OIG released a new webpage on managed care oversight, which features the HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid. OIG has designated oversight of managed care as a...more

Manatt, Phelps & Phillips, LLP

Access to Care for Justice-Involved Pregnant People With a Substance Use Disorder

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There is a critical need to increase access to evidence-based care for justice-involved pregnant people with a substance use disorder (SUD)—and connect them to continued coverage and care upon release—according to national...more

Manatt, Phelps & Phillips, LLP

CMS Approves WA’s 1115 Waiver with Health-Related Social Needs & Justice-Involved Initiatives

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On June 30, 2023, the Centers for Medicare & Medicaid Services (CMS) approved Washington’s five-year Section 1115 demonstration renewal, the Medicaid Transformation Project 2.0 (MTP 2.0 or Demonstration). Through its renewed...more

Foley Hoag LLP - Medicaid and the Law

The Supreme Court’s Talevski Decision: Medicaid Private Enforcement under Section 1983 Lives to See Another Day

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Today’s post provides an important update on the Supreme Court case Health & Hospital Corporation of Marion County (HHC) v. Talevski. As readers will remember, our blog has been following this case since it made its way to...more

Nossaman LLP

CMS Attempts to Reduce Appointment Times for Medicaid and CHIP Patients - How Will This Impact Your Managed Care Plan?

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A recent survey found that the average wait time for a new patient to see a physician in 15 of the largest cities in the U.S. was 26 days, up from 24.1 days in 2017.  Timely access to health care providers has long been an...more

Manatt, Phelps & Phillips, LLP

Prenatal Vaccines in Medicaid and CHIP: Coverage, Reimbursement, and State Policy Solutions to Increase Access

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Prenatal vaccines—those administered during a pregnancy—provide crucial protections to pregnant women and/or newborns against communicable diseases such as whooping cough and influenza. Additional prenatal vaccines are in...more

Bodman

The Expiration of the COVID-19 Public Health Emergency: Part II – Impact on the Provision of Medical Services via Telehealth

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As announced by the White House on January 30, 2023, the public health emergency (PHE) is set to end on May 11, 2023. The end of the PHE also brings an end to several flexibilities that were implemented that impact telehealth...more

Manatt, Phelps & Phillips, LLP

Executive Summary: Tracking Telehealth Changes State-by-State in Response to COVID-19 - April 2023 #2

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As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Telehealth is an essential tool in ensuring patients are able to access...more

Fenwick & West Life Sciences Group

A Complex Regulatory Landscape Emerges for Telemedicine

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Every year, Rock Health surveys the digital health landscape, noting the changing trends related to adoption by providers, patients and payers of these innovative new technologies....more

Burr & Forman

Hot Topics in Health Care - November 2022

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Physician Groups Voice Strong Opposition to Proposed Expanded Scope of Practice for Non-Physician Practitioners - The American Medical Association and over 80 other physician industry groups have come out in strong...more

Burr & Forman

Hot Topics in Health Care – September 2022

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Physicians and Pharmacists Concerned Over Post Dobbs State Laws Limiting Independent Medical Judgment - On September 8, 2022, the American Medical Association (AMA), American Pharmacists Association (APhA), American...more

Manatt, Phelps & Phillips, LLP

In Pursuit of Whole-Person Health: An Update on DOH Initiatives in Medicaid Managed Care Contracts

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Editor’s Note: There is mounting evidence that addressing the social and economic factors that drive the majority of health outcomes, often called social drivers of health (DOH), can improve health, promote health equity and...more

Manatt, Phelps & Phillips, LLP

Improving Ex Parte Renewal Rates: State Diagnostic Assessment Tool

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Editor’s Note: In a new expert perspective prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, Manatt Health provides a table that states can use to examine current ex parte processes...more

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