Recent Medicaid updates reflect seismic changes, from the sharp decline in improper payments reported by CMS to the rise in self-pay patients post Medicaid terminations. States grapple with Medicaid redeterminations, while Georgia reconsiders a full expansion. Tennessee’s contract extensions and discussions on weight loss drug coverage hint at evolving policies. Aetna Better Health of Kentucky’s CEO emphasizes disease management and community health. These developments underscore Medicaid’s ever-evolving nature and its crucial impact on millions relying on accessible healthcare.
The past months have witnessed notable shifts in Medicaid’s landscape, spotlighting critical changes reshaping healthcare access. From substantial decreases in improper payments to discussions on coverage expansions and management strategies, recent updates encapsulate Medicaid’s dynamic nature. These developments reflect not only policy alterations but also the program’s profound influence on individuals’ health journeys. Analyzing these shifts provides insights into the evolving challenges and opportunities within Medicaid.
In recent reports by Becker, Medicaid has taken the spotlight with various developments reshaping its landscape. Here are seven notable updates worth noting since November 14th:
1. Decrease in Improper Payments
CMS (Centers for Medicare & Medicaid Services) reported a substantial decline in the Medicaid improper payment rate from 2022 to 2023. The rate plummeted to 8.58%, equating to $50.3 billion in fiscal year 2023, a stark drop from 15.62% recorded in 2022.
2. Rise in Self-Pay Patients
A study conducted by Epic Research highlighted a surge in self-pay patients accessing emergency department, hospital, and primary care services beginning April 2023. This uptick coincided with states commencing terminations of Medicaid coverage, signifying a consequential trend.
3. States Falling Short in Medicaid Redeterminations
The NAACP’s assessment revealed that half of the states evaluated were deemed to be “failing” in the Medicaid redeterminations process. A total of 25 states received “F” ratings on the NAACP scorecard, indicating deficiencies in their handling of Medicaid-related procedures.
4. Georgia’s Potential Medicaid Expansion
After a decade, Georgia Republican lawmakers delved into discussions regarding a potential full-scale expansion of the state’s Medicaid program. Testimonies were heard, sparking a reevaluation of the program’s reach and accessibility.
5. Tennessee’s Managed Medicaid Contract Extensions
Tennessee prolonged three managed Medicaid contracts with UnitedHealthcare, BCBS, and Elevance’s Amerigroup for an additional year. This decision followed advocacy from some Republican legislators, including House Speaker Cameron Sexton, suggesting consideration for Centene after its previous failed bid in 2021.
6. Contemplating Weight Loss Drug Coverage
States like Illinois, Massachusetts, New Mexico, Utah, and Vermont are contemplating the inclusion of weight loss drugs within their Medicaid coverage. Insights from a KFF survey indicated the deliberation among Medicaid directors in these states regarding potential expansions in drug coverage for weight management.
7. Aetna Better Health of Kentucky’s Strategic Focus
Paige Mankovich, CEO of Aetna Better Health of Kentucky, outlined a targeted approach toward enhancing specific disease management and fostering community health. In an interview with Becker, she elaborated on the organization’s quality strategy and emphasized key priorities for 2024.
The evolving Medicaid updates underscore a transformative phase, evident in policy adjustments, contract extensions, and deliberations on coverage expansions. States navigating redeterminations face challenges, while discussions on weight loss drug coverage highlight evolving healthcare perspectives. The emphasis on disease management and community health represents a concerted effort towards holistic well-being. These recent developments underscore the significance of Medicaid’s adaptability in addressing the diverse healthcare needs of millions, illuminating a path toward a more inclusive and responsive healthcare system.