
Medicaid
Members of America’s Essential Hospitals typically serve communities with many low-income, minority, and other vulnerable populations. More than a third of our hospitals’ patients are enrolled in Medicaid and more than half are Medicaid beneficiaries or uninsured.
For more than 50 years, Medicaid has provided a lifeline for struggling Americans. The program, a federal-state partnership, provides access to high-quality health care services at a lower per-beneficiary cost than private insurance and Medicare. The program has continually evolved, as well, into a modern, flexible, and accountable program for patients.
Medicaid Covers Nearly 40 Percent of Essential Hospitals’ Inpatients
Source: Essential Data; Our Hospitals, Our Patients. 2018
But the program’s growth has caused some policymakers to call for changes to restrain federal Medicaid spending. Proposals now on the table include two that have surfaced periodically over the past 20 years: block grants to states and per-capita caps on federal contributions.
Block grants provide states with a lump sum of funding to cover all Medicaid-eligible individuals, while per-capita caps would provide a set federal contribution for each beneficiary. Past proposals for both block grants and per-capita caps would have, over time, dramatically cut federal spending on the Medicaid program – as much as $1 trillion over 10 years, by some estimates.
Substantial cuts to the Medicaid program would ultimately reduce the care available to vulnerable people, which means they would be denied coverage and benefits at a time when they need them the most. Medicaid cuts of the magnitude likely with block grants or per-capita caps would be unsustainable for essential hospitals, which already operate with no margin.
To meet their mission of caring for the most vulnerable, essential hospitals depend on a robust Medicaid program. America’s Essential Hospitals offers itself and its members as resources for lawmakers as the debate on Medicaid continues.
CMS Lifts COVID-19 Vaccination Mandate for Health Care Workers
June 2, 2023 ||CMS says the withdrawal of the mandate, effective immediately, aligns with the agency’s approach to other infectious diseases.
view more »On the Hill: DSH Cuts Relief Passes Key House Committee
May 31, 2023 ||The House Committee on Energy and Commerce approved a measure to eliminate $16 billion of cuts to Medicaid disproportionate share hospital funding as part of a package that also includes measures for pricing transparency and site-neutral payments.
view more »Medicaid Drug Rebate Program Proposed Rule
May 31, 2023 ||The proposed rule targets drug misclassification, along with drug pricing and product data misreporting, by manufacturers.
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CMS Seeks to Monitor Access to Care with FFS Rate Transparency, Updates HCBS Requirements
May 25, 2023 ||The proposed rules are part of CMS’ response to executive orders directing federal agencies to review existing guidance for opportunities to strengthen and improve access to health care coverage, including through Medicaid.
view more »CMS Issues FAQs on Return to Normal Medicaid Operations
May 23, 2023 ||The FAQs guide state Medicaid and Children’s Health Insurance Program agencies as they begin terminating enrollment for those who no longer qualify.
view more »On the Hill: House Panel Marks Up Bill with DSH Cut Relief
May 23, 2023 ||Language to avert an $8 billion cut to Medicaid disproportionate share hospital payments passed the House Committee on Energy and Commerce Health Subcommittee by a 27-0 vote as part of the panel’s consideration of 17 health-related bills.
view more »CMS Proposes Significant Changes to Directed Payments in Managed Care Rule
May 22, 2023 ||The proposed rule changes directed payment policy; access standards and monitoring; in lieu of service and setting requirements; medical loss ratio policy and reporting; and quality strategies, improvements, and reviews.
view more »On the Hill: 231 Lawmakers Call on House Leaders to Stop Medicaid DSH Cut
May 16, 2023 ||A bipartisan group of House members sent a letter to the House speaker and Democratic leader urging them to avert an $8 billion cut to Medicaid disproportionate share hospital payments on Oct. 1. America’s Essential Hospitals helped build momentum for the letter signing campaign.
view more »On the Hill: Association Weighs in on Medicaid Work Requirement Proposal
May 9, 2023 ||America’s Essential Hospitals calls on Senate leaders to reject a House proposal to impose work requirements for Medicaid as part of negotiations to raise the nation’s debt limit, saying the plan would jeopardize access to care and harm communities.
view more »CMS Proposes to Expand Health Coverage for DACA Recipients
May 5, 2023 ||If CMS finalizes the proposed rule, DACA recipients would be eligible to apply for coverage through the health care marketplaces, Basic Health Programs, and some Medicaid and Children’s Health Insurance Programs.
view more »GAO Appoints New MACPAC Members, Vice Chair
May 5, 2023 ||The six new members will review Medicaid and CHIP access and payment policies and make recommendations to Congress, the administration, and states.
view more »CMS Proposes Requirements to Align Medicaid, CHIP Access Standards
May 2, 2023 ||Two proposed rules establish access standards and standardize review and assessment of Medicaid payment rates across states; comments are due to CMS July 3.
view more »CMS Releases Guidance on Reentry Section 1115 Waiver Opportunity
May 1, 2023 ||The agency encourages states to leverage a new Section 1115 demonstration to implement a service delivery system that facilitates reentry transitions for Medicaid-eligible individuals leaving prisons and jails.
view more »Association Comments on Section 203 Proposed Rule
April 25, 2023 ||The association urged CMS to work with Congress to avoid unintended cuts to Medicaid disproportionate share hospital payments imposed by Section 203.
view more »On the Hill: Bipartisan Bill to Stop Medicaid DSH Cuts
April 24, 2023 ||Responding to association advocacy, four House lawmakers introduced legislation to eliminate $16 billion in Medicaid disproportionate share hospital (DSH) cuts in fiscal years 2024 and 2025. In a statement, America’s Essential Hospitals called on all House members to support the bill.
view more »CMS Issues FY 2024 IPPS Proposed Rule
April 24, 2023 ||The proposal includes numerous policy and payment changes to Medicare’s Inpatient Prospective Payment System for fiscal year 2024, including a 2.8 percent increase in inpatient payment rates.
view more »Urge Your House Members to Back Supporting Safety Net Hospitals Act
April 19, 2023 ||Please urge your House members now to support a bipartisan bill to eliminate two years of looming Medicaid DSH cuts for FYs 2024 and 2025.
view more »Bipartisan House Bill Would Eliminate $16B in DSH Cuts
April 19, 2023 ||The Supporting Safety Net Hospitals Act would eliminate devastating cuts to Medicaid disproportionate share hospital funding in fiscal years 2024 and 2025.
view more »CMS Releases Guidance on Reentry Section 1115 Waiver Opportunity
April 18, 2023 ||A new Section 1115 demonstration will support service delivery systems that facilitate reentry transitions for Medicaid-eligible individuals leaving prisons and jails.
view more »Medicaid Coverage Changes Effective April 1
April 3, 2023 ||On April 1, CMS began decreasing the temporary federal medical assistance percentage increase, and five states began disenrolling Medicaid beneficiaries.
view more »Oklahoma Becomes 30th State to Extend Medicaid Postpartum Coverage
March 31, 2023 ||The state has extended postpartum coverage from 60 days to 12 months through the state plan authority established by the American Rescue Plan Act in 2021.
view more »North Carolina Becomes 40th State to Expand Medicaid
March 28, 2023 ||The expansion includes individuals who make up to 138 percent of the federal poverty level and is contingent upon state budget passage and CMS approval.
view more »MACPAC Issues Annual DSH Analysis
March 21, 2023 ||The report reviews how COVID-19 public health emergency policies affected hospital finances and includes state-specific projections for the Medicaid disproportionate share hospital funding cuts scheduled to take effect Oct. 1.
view more »CMS Posts States’ Medicaid Unwinding Timelines
March 7, 2023 ||States may start initiating Medicaid renewals between February and April and terminating enrollment for individuals who no longer qualify as early as April 1.
view more »CMS Publishes Medicaid DSH Third-Party Payer Proposed Rule
March 3, 2023 ||The proposed rule implements Section 203 of the 2021 Consolidated Appropriations Act, altering the rules for considering the costs and payments associated with Medicare and commercial dually eligible patients when calculating a hospital’s Medicaid DSH uncompensated care limit.
view more »Essential Hospitals Rely on Medicaid DSH
Feb. 24, 2023 ||Unless Congress acts, $32 billion in DSH cuts over the next four years will undermine essential hospitals and could push some to the brink. The scheduled DSH cuts include an $8 billion reduction on October 1, 2023 — more than two-thirds of all federal DSH spending annually.
view more »Essential Hospital Designation
Feb. 24, 2023 ||Our proposal would codify a designation of essential hospitals in statute, allowing lawmakers to better target support to improve access to care and public health.
view more »CMS Publishes Section 203 Proposed Rule
Feb. 24, 2023 ||The proposed rule implements Section 203, which alters the process for calculating the Medicaid disproportionate share hospital uncompensated care limit.
view more »New Bulletin on Medicaid, Health Care–Related Taxes
Feb. 23, 2023 ||The bulletin advises that arrangements among providers to redistribute Medicaid payments violate the hold harmless provisions of the law.
view more »CMS Update on COVID-19 Blanket Waivers and Flexibility
Feb. 7, 2023 ||The updated fact sheets share when specific waivers will end and whether they will continue after the public health emergency’s end on May 11.
view more »CMS Guidance for States to Maintain Increased FMAP
Feb. 6, 2023 ||The guidance informs states how to maintain the temporary increased federal medical assistance percentage while returning to normal Medicaid operations.
view more »CMS Announces Marketplace Special Enrollment Period during Medicaid Unwinding
Jan. 31, 2023 ||Qualified individuals and their families who lose Medicaid or CHIP eligibility once the continuous enrollment requirement ends can apply for marketplace coverage between March 31, 2023, and July 31, 2024.
view more »Health Affairs Podcast Explores Financial Strain on Essential Hospitals
Jan. 24, 2023 ||In a new podcast series by a physician at association member NYC Health + Hospitals, Beth Feldpush, DrPH, the association’s senior vice president of policy and advocacy, unpacks the complex patchwork of payments that keep essential hospitals afloat.
view more »New Requirements for Managed Care Coverage of In Lieu of Services
Jan. 13, 2023 ||A CMS letter to state Medicaid directors clarifies how in lieu of services (ILOS) can be used to mitigate health disparities, limits ILOS expenditures, and adopts documentation and review requirements.
view more »Association Comments On Proposed 2024 Notice of Benefit and Payment Parameters
Jan. 13, 2023 ||The association supports CMS’ work to simplify enrollment and asks the agency to ensure equitable access to beneficiaries’ preferred health care providers.
view more »CMS Updates Key Dates for Medicaid Redeterminations
Jan. 10, 2023 ||After the omnibus bill decoupled Medicaid redeterminations from the end of the COVID-19 public health emergency, CMS updates key redetermination dates.
view more »CMS Updates Guidance for Coverage of Interprofessional Consultation
Jan. 9, 2023 ||Medicaid and CHIP coverage of interprofessional consultation is permissible as long as the consultation is for the beneficiary’s direct benefit.
view more »CMS Report on Access to Coverage and Care in Medicaid and CHIP
Jan. 3, 2023 ||The report summarizes responses to a 2022 request for information, which focus on eligibility and enrollment, access to hospital services, and payment.
view more »FY 2023 Omnibus Spending Bill Includes Essential Hospital Advocacy Priorities
Dec. 21, 2022 ||The $1.66 trillion package would extend funding for government operations through Sept. 30, 2023, including $120.7 billion for the Department of Health and Human Services, $9.9 billion more than the FY 2022 enacted level, and numerous provisions important to essential hospitals.
view more »Contact Congress Now to Support Funding for Hospitals Serving a Safety Net Role
Dec. 16, 2022 ||Lawmakers and staff are currently negotiating the final text for a year-end spending package. Targeted, financial assistance for hospitals serving a safety net role is on the table.
view more »Post-Election Medicaid Expansion Outlook
Nov. 21, 2022 ||After South Dakota voters elected to expand Medicaid eligibility, attention now turns to the 11 states that have yet to expand the program.
view more »Association Comments on Proposed Updates to Medicaid Eligibility, Enrollment Policies
Nov. 8, 2022 ||The association urges CMS to educate and provide funding for essential hospital staff to conduct Medicaid and CHIP eligibility and enrollment activities.
view more »CMS Approves Arkansas HRSN Section 1115 Waiver
Nov. 4, 2022 ||The amendment establishes “Life360 HOMEs” coordinating care for rural residents, pregnant individuals, and young adults at risk for long-term poverty.
view more »Medicaid Trends in FY 2023 State Budgets
Nov. 1, 2022 ||A recent Kaiser Family Foundation survey highlights common trends in health equity, telehealth access and quality, and coverage expansion initiatives.
view more »Georgia and Pennsylvania Expand Postpartum Medicaid and CHIP Coverage
Oct. 31, 2022 ||Currently, 26 states have extended Medicaid and Children’s Health Insurance Program coverage from 60 days to 12 months postpartum.
view more »CMS Extends Arizona Section 1115 Waiver with Housing Focus
Oct. 25, 2022 ||The waiver provides temporary housing to Medicaid beneficiaries experiencing or at risk of homelessness who have a significant health need or are enrolled in long-term care.
view more »CMS Extends Two Section 1115 Waivers
Oct. 17, 2022 ||Section 1115 waivers in Massachusetts and Oregon aim to test improvements in coverage, access, and quality and target unmet health-related social needs.
view more »DHS Finalizes New Public Charge Definition
Oct. 3, 2022 ||The new final rule narrows the types of benefits considered in public charge determinations by excluding nonemergency Medicaid and other in-kind benefits that were in the 2019 final rule.
view more »CMS Seeks Input on Health Equity, Program Efficiency
Sept. 12, 2022 ||The agency requests information on health care access and equity, provider experiences, and the effect of policies introduced in response to COVID-19.
view more »Proposed Rule Streamlines Medicaid, CHIP Enrollment
Sept. 1, 2022 ||An Aug. 31 CMS proposed rule aims to streamline Medicaid and CHIP enrollment and ensure continuous coverage throughout the renewal process.
view more »Expanding the Health Care Workforce through Medicaid GME
Aug. 29, 2022 ||In a new state policy brief, America’s Essential Hospitals outlines opportunities to expand the health care workforce through Medicaid graduate medical education funding.
view more »Inflation Reduction Act: An Analysis for Essential Hospitals
Aug. 18, 2022 ||Notable for essential hospitals, the bill contains an extension of Affordable Care Act advance premium tax credits, and historic drug pricing provisions that give the federal government power to negotiate drug prices on behalf of Medicare beneficiaries.
view more »California to Cover Health Care for All Low-Income Immigrants
July 19, 2022 ||The expansion of the state’s Medi-Cal program will provide health care coverage for an additional 764,000 people by 2024.
view more »GAO Releases Study on Medicaid Directed Payments
July 5, 2022 ||The GAO reviewed recent and planned actions to enhance oversight of state-directed payments and found the effectiveness of these actions is unknown and information gaps remain.
view more »NASBO Semiannual Report: Spending Growth Slows for FY 2023
June 28, 2022 ||Amid strong financial conditions, state Medicaid spending is forecasted to grow at a slower rate in FY 2023 compared with FY 2022, based on proposed budgets.
view more »CMS Approves Colorado Option
June 28, 2022 ||CMS approved Colorado’s Section 1332 waiver application to create a state-based standard health benefit plan.
view more »MACPAC Shares Directed Payment Recommendations, Commitment to Health Equity
June 20, 2022 ||In its June report to Congress, the Medicaid and CHIP Payment and Access Commission considers oversight of managed care directed payments and examines Medicaid’s role in advancing health equity.
view more »Supreme Court Dismisses States’ Effort to Defend Trump Public Charge Rule
June 20, 2022 ||The Supreme Court’s dismissal of the appeal does not touch on the legality of the public charge rule but only on the ability of the 13 states to intervene in defense of the rule.
view more »CMS Releases New Medicaid Tool: Top 10 Ways to Unwind
June 14, 2022 ||The tool compiles existing guidance to help states prepare to return to regular Medicaid operations after the COVID-19 public health emergency ends.
view more »CMS Outlines Behavioral Health Care Strategy
June 7, 2022 ||The agency’s strategy to strengthen behavioral health care focuses on improving access, equity, quality, and data integration.
view more »Four States Expand Postpartum Medicaid Coverage
May 27, 2022 ||CMS on May 25 approved proposals in four states to extend postpartum Medicaid coverage from 60 days to one year after birth.
view more »CMS Launches New Medicaid, CHIP Renewal Webpage
May 24, 2022 ||The webpage includes renewal instructions for eligible beneficiaries and guidance for ineligible beneficiaries to secure insurance through the marketplaces.
view more »New CMS Resource on Medicaid Eligibility and Enrollment Processing Requirements
May 24, 2022 ||A new CMS resource highlights federal requirements for program renewals, verifications, applications, and oversight amid the anticipated COVID-19 public health emergency unwinding.
view more »Association Comments on Public Charge Proposed Rule
May 3, 2022 ||The association thanked the administration for taking steps to reverse the damaging 2019 broadened definition of public charge and made recommendations for developing and implementing a new definition.
view more »Leveraging Section 1115 Demonstrations to Drive Equity in Medicaid
April 29, 2022 ||In a white paper, the association encourages CMS to develop policies that reduce disparities and incorporate equity into waiver approval and evaluation processes.
view more »CMS Releases Health Equity Action Plan
April 22, 2022 ||The action plan includes goals to close gaps in health care access, quality, and outcomes through data collection, outreach, and community engagement.
view more »Association Comments on Medicaid Access
April 19, 2022 ||The association made recommendations on payment rates, workforce development, eligibility and enrollment policies, and measuring access to hospital services.
view more »New Tools for Medicaid Fair Hearings, PHE Unwinding
April 8, 2022 ||CMS shares tools to mitigate an anticipated increase in Medicaid fair hearing requests and resume normal operations after the COVID-19 public health emergency ends.
view more »Association Makes Equity Measurement Recommendations to CMS
April 4, 2022 ||Recommendations for Medicare and Medicaid equity measures under development focus on standardized data collection and opportunities for testing and feedback.
view more »On the Hill: Biden’s FY 2023 Budget Takes Center Stage
March 29, 2022 ||Congressional panels will review President Joe Biden’s fiscal year 2023 budget request. Sens. Robert Casey Jr. (D-Pa.) and Ron Wyden (D-Ore.) have asked the Government Accountability Office to investigate low vaccination rates among Medicaid beneficiaries.
view more »MACPAC Issues Annual DSH Analysis
March 21, 2022 ||In its March report to Congress, the Medicaid and CHIP Payment and Access Commission examines the relationship between Medicaid disproportionate share hospital (DSH) allotments, uncompensated care costs, and services for low-income, uninsured populations.
view more »Protect and Strengthen Our Health Care Safety Net
March 15, 2022 ||Ensuring a reliable safety net, one ready to meet the moment in any crisis, means robustly protecting and bolstering the mechanisms and ideals that make the safety net function.
view more »DHS Issues Proposed Rule on Public Charge
March 11, 2022 ||The proposed rule limits the types of benefits considered in public charge determinations to exclude nonemergency Medicaid and other in-kind benefits that were in the 2019 final rule.
view more »House Passes Omnibus Spending Bill
March 10, 2022 ||The House-passed bill does not allocate additional COVID-19 relief for providers on the front lines of the pandemic. An initial version of the legislation included $15.6 billion in COVID-19 related spending — a scaled-back version of the $22.5 billion requested by the Biden administration.
view more »CMS Releases PHE Unwinding Guidance for Medicaid Renewals
March 8, 2022 ||A State Health Official letter includes guidance for states to prepare for the COVID-19 public health emergency unwinding and return to regular Medicaid program operations.
view more »On the Hill: Association Seeks Fix for Unintended DSH Cuts
March 1, 2022 ||The association seeks hospital feedback on unintended cuts to disproportionate share hospital payments that resulted from Section 203 of the Consolidated Appropriations Act of 2021. President Joe Biden nominated Judge Ketanji Brown Jackson as the 116th associate justice of the Supreme Court.
view more »State Policy Snapshot: Carving Out the Pharmacy Benefit from Medicaid Managed Care
Feb. 28, 2022 ||States argue shifting pharmacy benefits from managed care to Medicaid fee-for-service can lead to savings, but removing 340B Drug Pricing Program benefits for managed care drugs can jeopardize essential hospitals’ 340B savings — a critical source of support.
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DHS Proposes New Public Charge Definition
Feb. 24, 2022 ||The Department of Homeland Security proposed rule is a step toward withdrawing and replacing the controversial public charge regulation issued by the Trump administration. The new definition would include only cash benefits and long-term institutionalization. Comments are due April 25.
view more »CMS Seeks Information on Medicaid, CHIP Access to Care and Coverage
Feb. 18, 2022 ||Through a request for information, the Centers for Medicare & Medicaid Services hopes to better understand enrollees’ barriers to coverage and access to care to inform future policies and regulatory actions. A 60-day public comment period began Feb. 17.
view more »CMS to Award $49M to Increase CHIP, Medicaid Enrollment
Jan. 31, 2022 ||Each awardee will receive up to $1.5 million for a three-year period to reduce the number of uninsured children by advancing Medicaid and Children’s Health Insurance Program enrollment and retention. Grant applications are due March 28.
view more »CMS Outlines Supplemental Payment Rules; DSH Requirements Remain Unclear
Dec. 17, 2021 ||A letter to state Medicaid directors defines supplemental payments and designates a system to submit required supplemental payment reports. CMS also notes a lack of data to determine the application of an exception to new rules on Medicaid disproportionate share hospital uncompensated care limits.
view more »States Expand Access to Behavioral Health via Telehealth
Dec. 16, 2021 ||A Medicaid budget survey by the Kaiser Family Foundation highlights notable trends in expanding access to behavioral health care using telehealth services. As of July, 45 states covered mental health and substance use disorder care via telehealth.
view more »Guidance on Supplemental Payments Reporting, Medicaid Shortfall Calculations
Dec. 13, 2021 ||A Centers for Medicare & Medicaid Services letter to state Medicaid directors outlines new supplemental payment reporting and Medicaid disproportionate share hospital requirements under the Consolidated Appropriations Act.
view more »Report, Hospital Designation Coincide with Maternal Health Call to Action
Dec. 8, 2021 ||As part of Vice President Kamala Harris’ call to reduce maternal mortality and morbidity, a Department of Health and Human Services report highlights the impact of extending postpartum Medicaid coverage. In addition, CMS intends to propose a “Birthing-Friendly” hospital designation.
view more »CMS Releases State Guidance on Maintaining Medicaid, CHIP Coverage
Dec. 7, 2021 ||CMS released guidance to help states maintain Medicaid and Children’s Health Insurance Program coverage as they return to normal operations when the COVID-19 public health emergency ends. Many strategies in the documents require support from outside organizations that work with beneficiaries.
view more »Medicaid DSH Cuts: Myth Versus Facts
Nov. 30, 2021 ||Cutting the DSH program — especially with hospitals still on the front lines of COVID-19 — is misguided. Our latest Our View dispels common misconceptions about these proposed DSH cuts.
view more »House Passes ‘Human Infrastructure’ Bill
Nov. 19, 2021 ||The House voted 220–213 to pass the $1.75 trillion Build Back Better Act. It contains essential hospital priorities related to Medicaid, maternal health, and the health care workforce but also includes harmful cuts to Medicaid disproportionate share hospital and uncompensated care pool payments.
view more »On the Hill: House Sets Up ‘Human Infrastructure’ Vote
Nov. 9, 2021 ||The House passed the $1 trillion bipartisan physical infrastructure bill after agreeing on a path forward for the $1.75 trillion “human infrastructure” bill. New language in the human infrastructure measure calls for Medicare to negotiate certain drug prices and retains Medicaid DSH cuts.
view more »Medicaid Directors Survey Examines COVID-19 Impact, Equity Efforts
Nov. 2, 2021 ||The Kaiser Family Foundation’s annual survey of Medicaid directors finds significant changes to Medicaid programs related to COVID-19, as well as increased state efforts to address social determinants of health and improve health equity. A companion survey examined Medicaid spending trends.
view more »On the Hill: ‘Human Infrastructure’ Package Makes Headway
Nov. 2, 2021 ||President Joe Biden last week announced a $1.75 trillion framework for “human infrastructure” reconciliation legislation; the House subsequently released updated legislative text for its human infrastructure bill that aims to close the Medicaid coverage gap.
view more »Structural Racism and Chronic Underfunding of Medicaid
Sept. 14, 2021 ||In this first white paper of a new series, America’s Essential Hospitals discusses the chronic underfunding of Medicaid as a form of structural racism and provides recommendations to ensure the program is an effective tool to improve equity.
view more »DHS releases ANPRM on Public Charge
Aug. 24, 2021 ||The Department of Homeland Security released an advance notice of proposed rulemaking to gather data and feedback on the public charge ground of inadmissibility. Public comments are due Oct. 22; DHS will host public listening sessions on Sept. 14 and Oct. 5.
view more »Administration Advises States on Change to Public Charge Rule
July 27, 2021 ||A bulletin from the Center for Medicaid and CHIP Services notes the withdrawal of the 2019 public charge rule and addresses states’ role in safeguarding applicant and beneficiary information. The public charge rule was vacated and is no longer in effect, retroactive to March 2, 2021.
view more »CMS Grant Opportunity for Crisis Care
July 20, 2021 ||CMS announces $15 million for state Medicaid agencies to launch mobile crisis intervention services, as authorized by the American Rescue Plan.
view more »Association Seeks Engagement on Supplemental Payment Reporting
June 14, 2021 ||America’s Essential Hospitals and 11 additional national groups sent a letter to the Centers for Medicare & Medicaid Services urging the agency to partner with stakeholders who can offer technical expertise and context in developing the supplemental payment reporting system.
view more »On the Hill: Senate Confirms CMS Administrator
May 25, 2021 ||The Senate confirmed Chiquita Brooks-LaSure as head of the Centers for Medicare & Medicaid Services. Several Senate committees last week examined issues of importance to essential hospitals, including telehealth, hospital consolidation, and the medical supply chain.
view more »MACPAC Issues Annual DSH Analysis
March 23, 2021 ||In an annual report to Congress, the Medicaid and CHIP Payment and Access Commission finds an increase from 2018 to 2019 in the number of uninsured and in charity care and bad debt. The report includes state-specific projections of the Medicaid disproportionate share hospital allotment.
view more »HHS Brief Examines Medicaid Section 1115 Policies
March 18, 2021 ||In response to an executive order, a new issue brief reviews four policy areas under Section 1115 demonstrations and their impact on Medicaid coverage and access to care. The brief notes all examined areas create barriers to enrollment and reduce coverage, leading to adverse health effects.
view more »Policy Assembly Advocacy Materials Now Available
March 16, 2021 ||The association will convene its virtual spring Policy Assembly March 16. Whether or not you join us, these resources are available to encourage your legislators to protect access to care.
view more »DHS Formally Reverses 2019 Public Charge Rule
March 16, 2021 ||Effective March 9, the Department of Homeland Security reverted to enforcing the narrower 1999 definition of public charge, which excludes many of the benefits added by the 2019 rule. Our latest Action Update details the changes and next steps.
view more »President Biden Signs American Rescue Plan Act
March 15, 2021 ||The legislation includes $8.5 billion in funding for certain rural providers that serve Medicare and Medicaid beneficiaries and a a temporary increase in Medicaid disproportionate share hospital allotments.
view more »COVID-19 Protections and Support for Essential Hospitals
March 12, 2021 ||Essential hospitals lead the nation in the battle against COVID-19 but new challenges—including COVID variants, vaccination distribution management, and long-term hospitalizations—show more help is needed to ensure providers on the front lines can maintain access to care.
view more »New Guidance on Provider Relief Fund, Medicaid DSH Payments
March 9, 2021 ||The guidance clarifies how hospitals receiving Medicaid disproportionate share hospital payments can use Provider Relief Fund general and targeted distribution payments.
view more »Association Advocates for Priorities with Biden Administration
Feb. 16, 2021 ||America’s Essential Hospitals sent a letter to President Joe Biden and his administration detailing key priorities for essential hospitals, including issues related to structural racism, COVID-19, Medicaid, the 340B Drug Pricing Program, site-neutral payment policies, immigration, and other topics.
view more »Biden Signs Executive Order to Strengthen Medicaid, ACA
Feb. 1, 2021 ||President Biden released an executive order to strengthen Medicaid and the Affordable Care Act. The order calls for a special enrollment period on the federally facilitated exchange for uninsured or underinsured individuals — particularly those hardest hit by the COVID-19 pandemic.
view more »CMS Outlines SDOH Opportunities in Medicaid, CHIP
Feb. 1, 2021 ||In a recent letter to state health officials, CMS outlines opportunities for states to better address social determinants of health. The letter outlines flexibility under current law and includes examples from states already engaging in such initiatives.
view more »CMS Issues Guidance on Medicaid Directed Payments
Jan. 29, 2021 ||The Centers for Medicare & Medicaid Services issued new guidance to states on directed payments in Medicaid managed care programs. In conjunction with the guidance, CMS issued a revised version of the agency’s preprint application for directed payments.
view more »Biden Administration Freezes Pending Regulations
Jan. 26, 2021 ||The regulatory freeze could affect rules directing health clinics to pass certain 340B discounts on to patients, establishing minimum standards in Medicaid state drug utilization review, and modifying Health Insurance Portability and Accountability Act privacy arrangements.
view more »CMS Approves Tenn. Medicaid Block Grant
Jan. 15, 2021 ||This is the first approval of its kind and will allow the state to have more control over financing its Medicaid program.
view more »CMS Encourages States to Address Social Determinants
Jan. 15, 2021 ||A new notice encourages states to improve health outcomes, reduce disparities, and lower costs within Medicaid and the Children’s Health Insurance Program. It describes how states might address social determinants of health using flexibility available under current law.
view more »CMS Announces New Direct Contracting Model for Dual Eligibles
Jan. 12, 2021 ||Managed care organizations can participate in direct contracting for their populations dually eligible for Medicare and Medicaid. The model builds on direct contracting opportunities that test risk-sharing arrangements to reduce Medicare expenditures while preserving or enhancing quality of care.
view more »CMS Finalizes Rule on Value-Based Payments for Medicaid Drugs
Jan. 12, 2021 ||A new Centers for Medicare & Medicaid Services final rule addresses minimum standards in Medicaid State Drug Utilization Review, creates value-based purchasing arrangements with manufacturers, and outlines minimum standards to reduce opioid prescribing–related fraud and abuse.
view more »CMS Proposes to Streamline Prior Authorization, Patient Access to Data
Jan. 5, 2021 ||The proposed rule builds on a CMS final rule on interoperability and patient access; it would leverage application programming interfaces to improve patients’ access to their electronic health information and reduce burden on providers related to prior authorization.
view more »DSH Relief, Other Essential Hospital Wins in Year-End Spending Bill
Dec. 23, 2020 ||The $2.3 trillion package to fund the government, provide new COVID-19 relief, and stimulate the economy would eliminate a $4 billion cut to Medicaid disproportionate share hospital payments and add $3 billion to the Provider Relief Fund, among numerous other changes.
view more »On the Hill: CR Extends Government Funding through Dec. 18
Dec. 15, 2020 ||The continuing resolution delays until Dec. 19 a scheduled $4 billion cut to Medicaid disproportionate share hospital payments. Meanwhile, lawmakers introduce a new, two-part $908 billion legislative proposal for COVID-19 relief, as well as a deal on legislation regarding surprise medical bills.
view more »CMS, OIG Finalize Changes to Stark Law and Anti-Kickback Statute
Dec. 4, 2020 ||The two rules, finalized Nov. 20, aim to eliminate barriers to care coordination and undue burden under current fraud and abuse laws. One provides exceptions to the physician anti-referral law, and one modifies existing safe harbor protections under the anti-kickback statute.
view more »NASBO Annual Report: State Medicaid Spending Up
Dec. 1, 2020 ||The National Association of State Budget Officials’ annual state expenditures report found total Medicaid spending in state budgets increased 4.4 percent and federal government Medicaid spending increased 8.9 percent in fiscal year 2020.
view more »On the Hill: Time Running Out to Fund Government, Avert DSH Cut
Dec. 1, 2020 ||Without congressional action, the government on Dec. 12 will enter a shutdown and $4 billion will be cut from Medicaid disproportionate share hospital payments. Meanwhile, negotiations are deadlocked on additional COVID-19 relief.
view more »On the Hill: Just Weeks Remain to Stop DSH Cut, Avert Shutdown
Nov. 24, 2020 ||In the lame-duck session, Congress will focus on stopping a Medicaid DSH funding cut, averting a government shutdown, and providing COVID-19 relief. The House passed bipartisan bills to enhance research on minority health disparities, address the opioid crisis, and support trauma centers.
view more »CMS Streamlines Medicaid Managed Care Regulations
Nov. 23, 2020 ||On Nov. 9, CMS issued a final rule largely adopting policies overhauled by the Obama administration in 2016. The final rule reflects the agency’s broader strategy to relieve regulatory burden, support state flexibility, and promote transparency and innovation in the delivery of care.
view more »Association Addresses New Administration, Outlines Priorities
Nov. 20, 2020 ||In its first letter to President-elect Joseph Biden and his transition team, America’s Essential Hospitals noted a desire to work together to stabilize the nation’s health care safety net and described several administrative policy priorities and paths of partnership.
view more »CMS Releases Final Medicaid Managed Care Regulation
Nov. 17, 2020 ||The Medicaid and Children’s Health Insurance Plan managed care final rule includes provisions to help reach Medicaid goals, increase network adequacy for managed care plans, and align quality rating approaches.
view more »Association Asks CMS to Formally Withdraw MFAR
Nov. 10, 2020 ||In mid-September, CMS Administrator Seema Verma withdrew the Medicaid Fiscal Accountability Regulation (MFAR) via a tweet, citing stakeholder concerns. America’s Essential Hospitals asserts formally withdrawing MFAR would be the best course of action both for CMS and stakeholders.
view more »Court Invalidates Public Charge Rule; Enforcement Continues
Nov. 10, 2020 ||The decision of the U.S. District Court for the Northern District of Illinois marks the first time a court ruled in favor of the plaintiffs on the merits of the legal challenges to the public charge rule. DHS immediately appealed the case, allowing continued enforcement while the appeal is pending.
view more »Survey: State Medicaid Spending Rises Amid COVID-19
Oct. 20, 2020 ||A Kaiser Family Foundation annual survey finds states expect to see Medicaid enrollment spike more than 8 percent in fiscal year 2021 due to the COVID-19 public health crisis.
view more »Medicaid DSH Third-Party Payer Litigation Concludes
Oct. 20, 2020 ||Following the Supreme Court’s denial of hospitals’ appeal petition, the D.C. Circuit’s decision upholding CMS’ third-party payer final rule will stand. This allows CMS to require the offset of third-party payments in calculating the hospital-specific disproportionate share hospital payment limit.
view more »New Guidance on Advancing Value-Based Care
Sept. 21, 2020 ||In a letter to state Medicaid directors, CMS outlines lessons learned from previous initiatives, offers a comprehensive toolkit and examples of value-based care models, and highlights changes to existing flexibility.
view more »States Respond to COVID-19: 1115 Waiver Program Enhanced Calif.’s Pandemic Response
Sept. 15, 2020 ||With community partnerships already underway through California’s Whole Person Care initiative — part of its Section 1115 Medicaid waiver — localities in California found it easier to reach vulnerable communities at high risk for contracting COVID-19.
view more »CMS Bulletin on Third-Party Payers in Uncompensated Care Calculations
Aug. 25, 2020 ||CMS issued an information bulletin outlining two approaches for states to reflect third-party payer payments in calculations of uncompensated care costs used to determine hospital-specific Medicaid disproportionate share hospital limits.
view more »Association, Other National Groups Urge CMS to Withdraw MFAR
Aug. 11, 2020 ||America’s Essential Hospitals, along with five other national associations, calls for withdrawal of the proposed Medicaid Fiscal Accountability Regulation. In a letter, the groups note that the rule, if finalized, would exacerbate public health and economic uncertainty resulting from the pandemic.
view more »Court Blocks Public Charge Rule During Pandemic
Aug. 3, 2020 ||A federal district court blocked for the duration of the public health emergency the nationwide implementation, application, and enforcement of a Department of Homeland Security rule expanding the types of public benefits immigration officials consider in making a public charge determination.
view more »On the Hill: Republicans Release New COVID-19 Package
July 28, 2020 ||The highly anticipated bill would add $25 billion to the Provider Relief Fund and extend Medicare telehealth flexibility. It would not block the Medicaid Fiscal Accountability Regulation or delay the Medicaid disproportionate share hospital payment cut scheduled for Dec. 1.
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Proposed Rule Supports Value-Based Payments for Medicaid Drugs
June 23, 2020 ||The proposed rule, issued by CMS, aims to advance Medicaid prescription drug value-based purchasing arrangements between states and manufacturers, set standards to promote safe opioid prescribing, and amend regulations related to the Medicaid drug rebate program.
view more »States Respond to COVID-19: Medicaid Expansion for Undocumented Older Adults
June 16, 2020 ||Illinois is the first state to extend Medicaid coverage to low-income residents ages 65 and older, regardless of immigration status, due to the COVID-19 public health crisis. Meanwhile, Pennsylvania heightened security measures to protect staff and providers against the spread of COVID-19.
view more »HHS Directs $25B of COVID-19 Aid to Hospitals, Other Safety-Net Providers
June 9, 2020 ||The Department of Health and Human Services June 9 announced additional, targeted allocations from the Provider Relief Fund for hospitals filling a safety-net role and sole Medicaid and Children’s Health Insurance Program providers.
view more »GAO Report on State Medicaid Administration Challenges
June 9, 2020 ||The report, requested by Republican representatives, details challenges states face in administering Medicaid programs, including with coverage exclusions and care coordination, coverage benefits and eligibility, and Medicare and Medicaid alignment.
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