Medicaid Payment and Reimbursement

CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled

CMS says a recent edict to state Medicaid programs has partially stanched the ongoing wave of disenrollments in the program, with about 500,000 beneficiaries set to regain coverage they had lost and “many” others protected from disenrollment going forward. As described in a Sept. 21 summary, 29 states plus Washington, D.C., have acknowledged a systemic…

Nick Hut September 25, 2023

As clock ticks toward massive Medicaid disproportionate share hospital cuts, proposed bill would bring relief

A congressional bill that would impose additional transparency requirements on providers also would offer a respite from a sizable cut to a key supplemental payment. A $32 billion reduction to Medicaid disproportionate share hospital (DSH) payments is scheduled to span four years, beginning when federal FY24 gets underway Oct. 1. The Lower Costs, More Transparency…

Nick Hut September 19, 2023

A crisis of faith regarding value-based care

As the movement to reduce or eliminate fee-for-service payment in favor of value-based payment plods along, some in the industry are voicing doubts that it is ever going to happen or that it is even necessary.  An HFMA survey conducted in February and March for the “Healthcare 2030” series of special reports finds some of…

Paul Barr, MS, MBA August 31, 2023

‘Concerns about access to care’ raised by OIG findings on prior authorization policies in Medicaid managed care

A year after highlighting problems with prior authorization in Medicare Advantage (MA), the HHS Office of Inspector General (OIG) has shined a spotlight on the same issue in Medicaid managed care. In the title of a new report, OIG says high rates of prior authorization denials by some Medicaid health plans “raise concerns about access…

Nick Hut August 1, 2023

How leveraging artificial intelligence in utilization management can enhance your revenue cycle

This white paper dives into how AI will help make healthcare sustainable and provide more of a focus on patient care. The goal is to decrease industry challenges and create new efforts to reduce the administrative cost of healthcare.

HFMA July 27, 2023

Medicaid Drug Misclassification Proposed Rule Summary

The rule proposes to implement policies in the Medicaid Drug Rebate Program (MDRP) related to legislative requirements addressing drug misclassification, as well as drug pricing and product data misreporting by manufacturers.

HFMA June 20, 2023

As anticipated, the start of the Medicaid unwinding process has taken a toll on coverage

Fears among healthcare policymakers that the end of the COVID-19 public health emergency would sow chaos in Medicaid have been realized, leading the Biden administration to intensify its mitigation efforts. The end of Medicaid continuous-enrollment provisions is affecting the program in many states. In 21 states that had begun the “unwinding” process since April 1,…

Nick Hut June 15, 2023

Ensuring Access to Medicaid Services Proposed Rule Summary

On May 3, 2023, CMS published in the Federal Register a proposed rule entitled “Medicaid Program; Ensuring Access to Medicaid Services” (88 FR 27960-28089). The rule proposes policies that take a comprehensive approach to improving access to care, quality and health outcomes, and better addressing health equity issues in the Medicaid program across fee-for-service, managed care delivery…

HFMA June 5, 2023

Beyond the News: What the end of the PHE means for Medicaid

HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the end of the public health emergency and what it means for Medicaid as well as a recent blog post from Stack on price transparency.

Erika Grotto April 3, 2023

Highlights of the Administration’s FY 2024 Budget

HFMA presents a summary of healthcare-related proposals included in the President’s budget for fiscal year 2024, released by the Biden Administration on March 9, 2023.

HFMA March 21, 2023
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