Medicaid redeterminations are underway, and many experts say the process is going worse than expected.
Here are the latest updates on Medicaid redeterminations and other important updates on the program Becker's has reported since April 25.
- With Medicaid redeterminations underway nationwide, CMS is urging states to ensure they do not terminate coverage for eligible individuals. Daniel Tsai, CMS deputy administrator and director of the Center for Medicaid and Children's Health Insurance Program, told reporters "a substantial portion of the terminations that we've seen in April were due to folks not responding, or red tape." In Indiana, Florida and Arkansas, more than 80 percent of disenrollments were for procedural reasons, a KFF analysis found.
- In Florida, officials are defending their Medicaid redetermination process after health advocacy groups asked Gov. Ron DeSantis for a pause after about 250,000 residents were disenrolled from the program.
- Medicaid work requirements were not included in the debt ceiling deal between President Joe Biden and House Speaker Kevin McCarthy. Proposed requirements could have resulted in an estimated 600,000 people losing Medicaid coverage nationwide, according to the Congressional Budget Office.
- CMS is proposing a new rule for drug manufacturers, pharmaceutical benefit managers and managed care plans to increase drug price transparency in Medicaid. In the proposal, the agency laid out plans to increase transparency by requiring manufacturers to disclose some pricing information through a price survey and requiring PBMs to disclose more pricing details to managed care plans.
- Centene topped the list of six major payers for Medicaid membership and growth in the first quarter of 2023. Here's how six major payers stacked up on Medicaid membership, according to first quarter earnings reports.
- Arkansas terminated Medicaid coverage for almost 73,000 people in April, including 44,667 people who had their eligibility extended during the COVID-19 public health emergency. The most common reason coverage was terminated was individuals failing to return renewal forms.
- Arizona was one of the first states to begin unwinding continuous Medicaid coverage. Becker's spoke with Marla Bauer, director of growth and marketing for Blue Cross Blue Shield of Arizona's individual ACA business, to understand how the company is navigating redeterminations and steering disenrolled individuals toward other coverage options.
- Most private payers do not cover new drugs meant to treat obesity, but Medicaid programs in a few states do. Here are 10 states where Medicaid has broad coverage for weight loss drugs, according to Bloomberg.
- CMS proposed two new rules that would establish national standards of care provided through fee-for-service Medicaid/CHIP and managed care plans, along with a requirement to publicly disclose provider payment rates online.
- HHS unveiled its proposed rule that, if finalized, would expand healthcare coverage access to an estimated 129,000 previously uninsured Deferred Action for Childhood Arrivals program recipients.The proposed change applies to ACA marketplaces, the Basic Health Program and some Medicaid and Children's Health Insurance Program plans.