Archive for Medicaid managed care


Federal Health Policy Update for Thursday, June 30

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, June 30.  Some of the language used below is taken directly from government documents.

White House

The White House has unveiled its “White House Blueprint for Addressing the Maternal Health Crisis.”

Monkeypox Update

  • The White House has announced the first phase of its national monkeypox vaccine strategy, a part of its monkeypox outbreak response.  The major components of the strategy include expanded efforts to vaccinate those most at risk, expanded testing supply and availability, and greater engagement with community leaders and stakeholders.  Learn more about the White House’s plan from this fact sheet.
  • HHS has announced an enhanced nationwide vaccination strategy to mitigate the spread of monkeypox.  The strategy includes vaccinating and protecting those at risk of monkeypox, prioritizing vaccines for areas with the highest numbers of cases, and providing guidance to state, territorial, tribal, and local health officials to aid their planning and response efforts.  HHS will provide 296,000 doses of monkeypox vaccine.  Of that amount, 56,000 doses will be made available immediately and an additional 240,000 doses will be made available in the coming weeks.  HHS expects more

Relatively Few Docs Treating Medicaid Patients

Just a small portion of the providers theoretically available to serve individuals enrolled in Medicaid managed care plans are actually caring for such patients, a new study has found.

According to a report in Health Affairs, 25 percent of the primary care physicians serving patients in selected managed care plans are providing 86 percent of the primary care to those plans’ members while 16 percent of those plans’ listed primary care providers have gone more than a year without filing a single claim.

Similarly, 25 percent of the medical specialists participating in the plans provided 75 percent of the plans’ specialty services while one-third of the plans’ primary care physicians and specialists saw fewer than 10 Medicaid patients in a given year.

As the Health Affairs study concluded, “Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries’ preferences and physicians’ willingness to serve Medicaid patients.”  Healthcare Dive reviewed the same numbers and took its conclusion a step further, suggesting “… that private insurers may be ‘padding’ the Medicaid managed care networks with physicians, some of whom may be unwilling to treat program beneficiaries.”

Learn more about the …

Federal Health Policy Update for Thursday, April 28

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, April 28.  Some of the language used below is taken directly from government documents.

White House

  • The White House has announced a series of steps designed to increase the availability of oral treatments for COVID-19.  Those steps include nearly doubling the number of places oral antivirals are available in the coming weeks; launching a new effort to establish federally-supported test-to-treat sites; supporting medical providers with more guidance and tools to understand and prescribe treatments; and communicating to the public that safe, effective treatments are widely available.  Learn more from this White House fact sheet and from the transcript of a briefing the White House held for reporters on this initiative.
  • White House press secretary Jen Psaki and White House COVID-⁠19 response coordinator Dr. Ashish Jha recently briefed the press on several aspects of the administration’s response to COVID-19.  Find a transcript of that briefing here.
  • The White House has released its “National Drug Control Strategy,” which it says “…proposes bold, targeted, and consequential actions to bend the curve on overdose deaths in the immediate term and reduce drug use and its damaging


The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

During the April 2022 Medicaid and CHIP Payment and Access Commission meeting, the Commission voted to approve a package of recommendations to:

  • create a new approach for monitoring access to care for Medicaid beneficiaries;
  • improve vaccine access for adult Medicaid beneficiaries;
  • improve the oversight and transparency of directed payments in Medicaid managed care; and
  • encourage the adoption of health information technology (IT) in behavioral health.

The recommendations will appear in MACPAC’s June report to Congress.

The meeting began with a review of recommendations and a draft chapter for the June report to Congress on a new approach for monitoring access to care for Medicaid beneficiaries. Staff presented a draft chapter with a package of five recommendations for a new access monitoring system. The chapter discusses the challenges and limitations of the current monitoring approach, the goals and key elements for a new system, and the rationale and implications for Commission recommendations that call on the Centers for Medicare & Medicaid Services (CMS) to develop a robust and ongoing access monitoring system.

Next, the Commission

Medicaid as a Tool for Addressing Racial Health Inequities

Medicaid can be an important tool for addressing racial health inequities, the Kaiser Family Foundation suggests in a new issue brief.

Among the measures involving Medicaid that might be undertaken to address racial health inequities and addressing social determinants of health, the brief suggests (in words taken directly from the issue brief):

  • One significant action that would help close coverage disparities for people of color is adoption of the ACA Medicaid expansion in the 12 non-expansion states.
  • Other expansions of Medicaid eligibility could also address racial disparities in coverage and access to care.
  • Making it easier for eligible people to enroll in and maintain Medicaid coverage may also help close coverage gaps for people of color.
  • The Biden Administration and states may pursue equity-related initiatives through Section 115 waivers.
  • States can leverage managed care contracts to help address racial disparities and social determinants of health.
  • States can also adopt health plan and provider payment options to incentivize reductions in racial health disparities.
  • Expansions of Medicaid benefits and telehealth may increase access to care for all enrollees, including the disproportionate share of people of color covered by Medicaid.
  • It will be important to help prevent the end of the COVID-19 public