States Are Bargaining For Medicaid Waivers To Divert Cash To Other Needs
New York recently became the latest state to receive a Section 1115 Demonstration waiver from the federal government, with a goal of narrowing health disparities and reducing long-term spending. Meanwhile, Republican-controlled states are pushing for employment requirements in Medicaid.
Medicaid Waivers Allow States To Spend Billions On Social Needs
State Medicaid programs are bargaining with the federal government to cover some of the costs of non-medical care for high-risk patients in a bid to narrow health disparities and reduce long-term spending. Earlier this month, New York became the most recent state to receive a Section 1115 Demonstration waiver from the Biden administration. Such waivers grant Medicaid agencies certain flexibilities under federal law and expanded funding opportunities to test programs that could reduce negative health outcomes for enrollees and lower costs. (Hartnett, 1/23)
Red States Revive Push For Employment Requirements In Medicaid
Republican-controlled states are making a fresh push to tie employment to Medicaid eligibility ahead of a presidential election that could usher in a new administration receptive to the idea. Rules requiring some low-income adults to work, attend school or volunteer as a condition of coverage could force more people off the Medicaid rolls at a time when millions have been dropped from the program following the expiration of pandemic-era coverage protections. (Goldman, 1/24)
In Medicare news —
Medicare Advantage: Elevance Says One Phone Call Cost It $190 Million
A single bungled phone call cost one of the largest US health insurance companies $190 million, the company is arguing in a lawsuit that highlights how dependent health insurers have become on US government programs. The US Medicare program uses a five-star rating system intended to steer older Americans into plans that do a better job improving their health. Now Elevance Health Inc. is arguing that regulators used flawed methods to determine crucial ratings that send billions of public dollars each year to insurers operating private Medicare Advantage health plans for seniors. (Tozzi, 1/23)
Medicare Advantage Marketing Scrutinized In Sen. Wyden’s Letter
An ongoing Senate investigation into Medicare Advantage marketing is now targeting online insurance brokerages. Finance Committee Chair Ron Wyden (D-Ore.) sent letters to eHealth, GoHealth, SelectQuote, Agent Pipeline and TRANZACT on Tuesday requesting information on how they identify potential customers, advertise and direct older adults to choose specific Medicare Advantage plans. (Tepper, 1/23)
How CMS’ Prior Authorization Rule Will Affect Insurers
Health insurance companies will have to invest in technology and update their administrative processes to comply with new prior authorization requirements. The Centers for Medicare and Medicaid Services last week finalized a rule requiring government-sponsored health plans to respond to non-urgent preapproval requests within seven days and to urgent requests within 72 hours. Insurers also will have to provide a reason for why they denied care requests and publicly disclose data on their decisions. (Tepper, 1/23)
KFF Health News:
Listen To The Latest 'KFF Health News Minute'
This week on the KFF Health News Minute: Workers in smoky casinos say they shouldn’t have to gamble with their health on the job, and some Medicare Advantage enrollees feel trapped in their plans as they get older and sicker. (1/23)