Newsletters

11.11.24

Policy Strategies to Increase Access to Prenatal Vaccines in Medicaid and CHIP: New White Paper

Despite the demonstrated effectiveness of prenatal vaccines, uptake remains low. This puts mothersi and babies at risk. Vaccines administered prenatally (i.e., during a pregnancy) provide protective antibodies to pregnant women and their unborn children.


10.10.24

CMS Releases Guidance on Health Coverage Requirements for Children and Youth Enrolled in Medicaid

On September 26, the Centers for Medicare and Medicaid Services (CMS) released comprehensive guidance to states that reinforces and clarifies federal Medicaid requirements regarding Early and Periodic Screening, Diagnostics, and Treatment (EPSDT).


08.27.24

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

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 Medicaid—the CIB reiterates existing state and managed care organization requirements and ...


08.14.24

States Challenge CMS Rule Making DACA Recipients Eligible for Marketplace Subsidies

On August 8, a coalition of 15 state attorneys general sued CMS in the North Dakota federal court seeking to overturn a May 2024 CMS final rule making Deferred Action for Childhood Arrivals (DACA) recipients eligible for premium tax credits on the Marketplace.


07.24.24

CMS Releases Technical Guidance to States on Complying with Medicaid Access Final Rule

On July 12, CMS released a companion guide to the Ensuring Access to Medicaid Services final rule (the “Access Final Rule”).


07.17.24

D.C. Court Strikes Down Indiana 1115 with Premiums and Coverage Restrictions

On June 27, the D.C. District Court struck down CMS’ 2020 approval of a 10-year renewal for the Healthy Indiana Plan (HIP) 2.0 Medicaid Section 1115 demonstration (Rose v. Becerra).


06.24.24

Reimbursing Physicians and Pharmacists for Adult Vaccines: Excerpt from a Recent Study

This is an excerpt from a recently published study in AJMP Focus, “State Medicaid Coverage and Reimbursement of Adult Vaccines Administered by Physicians and Pharmacists as of 2022”, which was supported by Merck.


06.05.24

GAO Recommends Oversight of Medicaid MCOs’ Prior Authorization for Pediatric Care

On May 29, E&C Ranking Member Frank Pallone (D-NJ) announced the release of a report that he previously requested from the Government Accountability Office (GAO) on prior authorization practices for pediatric services by Medicaid


03.27.24

HHS Announces Medicaid and Medicare Flexibilities, Investigations post-Change Healthcare Cyberattack

Since becoming aware of the cyberattack on Change Healthcare in late February, the Centers for Medicare & Medicaid Services (CMS) has announced a number of flexibilities to support affected providers that have experienced disruptions to prior authorization, claim processing, and data ...


01.30.24

CMS Final Rule Requires Payers to Modify Prior Authorization, Create New APIs

In the federal government’s latest effort to promote interoperability in the health care sector, on January 17 the Centers for Medicare & Medicaid Services (CMS) released a final rule that expands the requirements for electronic exchange of information between federally funded health ...