The Commonwealth Fund’s Post

The U.S. maternal mortality rate continues to far exceed those of other high-income nations, despite a decline since the end of the COVID-19 pandemic.

🔓 Unlocking Better Care Quality and Access in Medicaid and CHIP Two highly anticipated rules from the Centers for Medicare & Medicaid Services (CMS) could improve access to care for millions of people covered by #Medicaid and the Children’s Health Insurance Program (CHIP).   On To the Point, Manatt Health’s Cindy Mann, @Julian Polaris, and Nina Punukollu explain how the rules align with key CMS goals, including data transparency, new opportunities for consumer input, greater health equity, and standardization across federally funded health programs. The provisions include requirements that:  📑 states publish comparisons of provider payment rates for certain outpatient services and home and community-based services ⏰ Medicaid and CHIP-managed care plans don’t exceed maximum wait times for routine appointments 🗳️ people enrolled in the programs, along with their family members and caregivers, have opportunities to recommend improvements.

🧾 New Rules for Paying Medicaid Managed Care Plans Likely to Improve Access and Equity Medicaid could become a more competitive health care payer under new federal rules that have major implications for access and equity. Writing on To the Point, Manatt Health’s Avi Herring, Cindy Mann, and Anne Karl report that the recently finalized rules allow states to direct Medicaid managed care plans to pay providers at rates up to those of commercial plans, which historically have far exceeded Medicaid payment rates. Researchers have previously documented the relationship between higher payment rates and improved access to care. The authors note that higher payment rates could also increase the pool of providers that serve Medicaid patients while also providing critical support to the health care safety net for people with low income. “Allowing Medicaid to pay rates more akin to Medicare or commercial levels is also a matter of equity.”

⚕️ How “Dual-Eligible” Beneficiaries Fare in Traditional Medicare vs. Medicare Advantage Nearly 13 million Americans are enrolled in both Medicare and #Medicaid for health coverage. In addition to having low income and few resources, “dual-eligible” beneficiaries typically have more complex health care needs than the average Medicare enrollee. A new resource from The Commonwealth Fund offers insights into how the health care experiences of dual-eligible beneficiaries enrolled in the traditional #Medicare program compare with those in #MedicareAdvantage, which provides Medicare benefits through private insurance plans. In nine charts, we show: 📈 How the proportion of dual-eligible beneficiaries enrolled in Medicare Advantage plans has grown. 📊 How the demographic profiles of dual-eligible beneficiaries in Medicare Advantage and traditional Medicare compare. ⭐️ Differences in satisfaction ratings, cost-related delays in care, access to dental, vision, and hearing services, and more.

🚧 Understanding the Challenges of Medicare Enrollment for Low-Income Beneficiaries Navigating the Medicare system can be daunting, especially for low-income individuals who qualify for both Medicare and Medicaid. Choosing the wrong plan can significantly impact their out-of-pocket costs and access to necessary healthcare services. The State Health Insurance Assistance Program (SHIP) plays a vital role in providing counseling on Medicare coverage options. However, interviews with SHIP counselors and coordinators, conducted by Melissa Garrido, David Biko, Allison Dorneo, Paul Shafer, Austin Frakt, highlight several areas where improvements are needed To better serve low-income #Medicare beneficiaries and ensure they receive the best possible advice on their health care options, the authors suggest investing in both the expansion of the pool of counselors and the enhancement of their training. Full report at the link below:

✍️ Easy-Enrollment Programs Help States Sign People Up for Affordable Coverage ☂ An increasing number of states are experimenting with simple, low-cost ways to connect uninsured people with comprehensive, affordable coverage options. On To the Point, Georgetown University’s Rachel Swindle, Rachel Schwab, and Justin Giovannelli describe how these easy-enrollment programs combine tax or unemployment filing forms with targeted outreach to find people who may be eligible for subsidized marketplace plans or Medicaid. The results have been promising. Maryland, the first state to enact such a program, has enrolled more than 13,500 people since 2020. Additional states have followed, and others are considering adopting what the authors call “an efficient and relatively low-cost mechanism” to get their uninsured residents covered.