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CMS Report on Access to Coverage and Care in Medicaid and CHIP

A new report from the Centers for Medicare & Medicaid Services (CMS) summarizes public comments in response to the 2022 Request for Information: Access to Coverage and Care in Medicaid and CHIP, including comments from America’s Essential Hospitals. CMS will use the responses to develop a multifaceted strategy to help ensure equitable access to health care for people enrolled in Medicaid and CHIP across all care delivery systems.

In the report, CMS highlighted the following common themes among responses.

Eligibility and Enrollment 

CMS should prioritize streamlining the application process for Medicaid and CHIP to ensure timely, accurate, and equitable eligibility determinations. Respondents encouraged CMS to leverage Section 1115 demonstration waiver submissions and renewal processes, as well as provide technical assistance and state-to-state learning, to incent states to implement policies to streamline eligibility determinations and enrollment.

Access to Hospital Services

In developing standards for potential access to care, CMS should consider incorporating social risk factors
and social determinants of health. Additionally, CMS should stablish minimum standards for serving communities in ways that consider cultural competency and language preferences.

Payments

A large proportion of respondents suggested prioritizing policies to address what they viewed as low payment for services in Medicaid and CHIP and the programs’ roles as primary drivers of insufficient provider participation and network adequacy. Respondents also described the opportunity to expand reimbursement to a broader range of providers to meet Medicaid and CHIP goals. In addition to direct payments, several respondents suggested opportunities to leverage Medicaid and CHIP financing to support the training of clinicians who might be more likely to serve people enrolled in these programs.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Faridat Animashaun is a policy associate at America's Essential Hospitals.

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