June 22, 2016

Medicaid News, Information, and Resources


New Medicaid and CHIP Newsletter from CMS

The Center for Medicaid and CHIP Services (CMCS), part of the Centers for Medicare and Medicaid Services (CMS), has just launched the Stakeholder Newsletter, a forum through which CMCS plans to share news, as well as information about updates to the Medicaid.gov website. It will also use the newsletter to announce upcoming webinars, including the Medicaid managed care series (which has been temporarily suspended due to technical problems). To subscribe to the Stakeholder Newsletter, click here, and feel free to pass along this information to others who might be interested.


New Proposed Requirements for Hospitals

On June 13, the Centers for Medicare & Medicaid Services (CMS) announced a proposed update to the requirements (Conditions of Participation) that hospitals and critical access hospitals must meet in order to participate in Medicare and Medicaid. Some of the new requirements relate to:

  • Reducing barriers to care;
  • Reducing the incidence of hospital-acquired conditions (including healthcare-associated infections);
  • Improving the use of antibiotics (including the potential for reduced antibiotic resistance);
  • Addressing workforce shortage issues;
  • Improving patient protections; and
  • Prohibiting discrimination on the basis of race, color, religion, national origin, sex (including gender identity), sexual orientation, age, or disability.

There is a 60-day comment period on the proposed rule.


Medicaid State Profiles on Medicaid.gov


New state-by-state profiles have been added to the Medicaid.gov "By State" section. The new state profiles are organized differently than they were in the past, and are more streamlined to highlight state-specific information instead of national aggregate data. For the first time the profiles contain state-specific information from the adult and child core quality measures reports. Additionally, there are updates to the eligibility levels for each state.

[To access this information go to www.Medicaid.gov and place your cursor over the Medicaid button, then place cursor on "By State" and click. Once the U.S. map appears, you just click on your state of interest and the new information is there. By clicking on the "more" button in each of the Eligibility, Enrollment and Quality of Care information boxes you are provided with additional data on each topic.] 

Resource on Enrolling and Retaining Eligible Children in Medicaid and CHIP

CMS has issued an informational bulletin on strategies to enroll and retain eligible children in Medicaid and CHIP. The informational bulletin is available here, on Medicaid.gov (see 6/13/16).

Medicaid/CHIP Managed Care Regulation

In May 2016, the Centers for Medicare & Medicaid Services (CMS) issued a comprehensive final rule governing managed care in Medicaid and the Children's Health Insurance Program (CHIP). Previous issues of the Update have identified various resources about the rule. Here are some additional resources:


  • From the Georgetown Center for Children and Families. The Georgetown Center for Children and Families (CCF) and the National Health Law Program have developed a series of briefs and webinars examining the impact of the managed care regulations on children. (See the "Webinars" section, above, for information about a June 23 webinar.) The briefs in this series identify areas where child and legal advocates can work with their states and managed care plans to make the rules stronger for consumers than the federal minimum standards require. The first brief, Looking at the New Medicaid/CHIP Regulations Through a Children's Lens, highlights the provisions of the rule of most importance to children - such as network adequacy, quality, and populations with special health care needs - including those provisions uniquely applicable to children, like EPSDT and CHIP.


HCBS Toolkit Updated

The Home and Community-Based Services (HCBS) Advocacy Coalition has developed multiple resources to help advocates understand the 2014 federal rule that requires settings receiving Medicaid home and community based services (HCBS) funding to have certain community attributes to ensure they are not institutional in nature. The Coalition's HCBS Settings Rule 3-Part Toolkit has been updated to reflect the new guidance by CMS addressing Planned Construction of Presumed Institutional Settings:

1.      What You Should Know

2.      Settings Presumed to be Institution & the Heightened Scrutiny Process

3.      How to Advocate for Truly Integrated Community Settings (Full Version)

a.      How to Advocate for Truly Integrated Community Settings (Abridged Version)