Category Archives: Medicaid Eligibility

MACPAC Releases Updated MACStats

Our friends at MACPAC have released the December 2019 edition of MACStats:  the Medicaid and CHIP data book.  MACStats has data and statistics on virtually any aspect of Medicaid and CHIP that you’d care to learn about.  You can find the link to the document here.

The data book has five sections:  key statistics (including Medicaid and CHIP enrollment which, as we pointed out in a post last month,… More

MACPAC Releases Status Update on 2014 HCBS Final Rule

We’ve written previously about the the 2014 final regulation issued by the Obama administration making significant updates to the requirements for the qualities of settings eligible for reimbursement for Medicaid home-and-community-based services (HCBS) provided under sections 1915(c), 1915(i) and 1915(k) of the Medicaid statute. With the deadline for full compliance nearing (HCBS providers must comply with the new requirements by March 17, 2022,… More

Latest HHS Financial Report Highlights Medicaid Eligibility Errors – and Foreshadows Future Actions

On November 19, 2019, CMS announced key results from the 2019 HHS Agency Financial Report, which generally provides fiscal and high-level performance data for HHS for the reporting period of October 1, 2018 through September 30, 2019. While CMS leads off its press release with the good news — payment error rates in the Medicare fee-for-service program are at their lowest level since FY 2010 —… More

Why are Medicaid and CHIP enrollment numbers declining?

For much of the past two years, enrollment in the Medicaid and CHIP programs has been declining.  In May, 2017, enrollment in both programs was 74.6 million people.  As of May of this year, enrollment had declined by 2.5%, to 72.8 million.  This decline has applied across the board, in almost every state, for adults and for children.

Superficially, this might make sense;… More

As a Public Charge Rule is Finalized by DHS, Concern Over Upcoming DOJ Rule Grows

Last Fall, we wrote about a proposed regulation issued by the Department of Homeland Security that involved one of our favorite topics:  the intersection of immigration and health care law.  My colleague Christian Springer and I have been following this proposed regulation very closely, and last week, it was issued in final form.  Because it has generated enormous press attention and because it has significant implications for the Medicaid program,… More

CMS Updates “Settings that Isolate” Guidance for HCBS Waivers, Providing Relief to Farmstead and Lifesharing Communities

On March 22, 2019, CMS published a long-awaited letter to State Medicaid Directors and a new guidance document regarding the Home and Community-Based Services (HCBS) waiver program.  The letter  revises previous guidance that CMS had provided to states on “Settings that have the effect of isolating individuals receiving HCBS from the broader community” for purposes of receiving Federal funding for services provided under a HCBS waiver. … More

Medicaid Long-Term Care: A Background and look at the Eligibility Rules

One of the most common misperceptions of the American health care system is that if an elderly individual – maybe a parent or a grandparent – has to enter a nursing home, their stay will be fully covered by the Medicare program.  But that is not accurate.  Medicare does not cover long-term care.  It will pay for up to 100 days in a skilled nursing facility per spell of illness,… More