September 27, 2022
Four managed-care insurance plans may lose contracts with California’s Medicaid program, which would force nearly 2 million low-income residents to switch their health plans—and possibly their doctors. The plans are fighting back.
September 20, 2022
Texas is at least the 12th state to settle with St. Louis-based Centene Corp. over allegations that it overcharged Medicaid prescription drug programs.
September 12, 2022
In an industry obsessed with consumer satisfaction national patient surveys still don’t get at an important question: Are hospitals delivering culturally competent care?
August 01, 2022
RISE summarizes recent regulatory-related news.
July 22, 2022
The Centers for Medicare & Medicaid Services (CMS) has released for the first time a voluntary quality measure set to promote consistent quality measurement within and across state Medicaid home-and community-based services (HCBS) programs.
June 10, 2022
The Biden administration is considering a requirement that the nation’s 15,500 nursing homes spend most of their payments from Medicaid on direct care for residents and limit the amount that is used for operations, maintenance, and capital improvements or diverted to profits.
May 31, 2022
In a grand state experiment to improve the health of some of its sickest and costliest patients, one health plan in California’s vast Inland Empire, where more than half of adults have diabetes or are at risk of developing diabetes, is delivering medically tailored meals to select patients in hopes it will develop healthier eating habits long after the shipments stop.
May 17, 2022
Do you have a clear picture of your data, and tools that allow you to easily identify the most impactful interventions to improve patient care?
May 10, 2022
Kaiser Family Foundation (KFF) researchers said the biggest losses will be among children, adults who became eligible for coverage under the Affordable Care Act’s (ACA) Medicaid expansion, and adults eligible for Medicaid other than due to a disability. These groups experienced the largest increase during the pandemic.
April 04, 2022
The pandemic crisis has overwhelmed understaffed state Medicaid agencies, already delaying access to the insurance program in Missouri. As the public health emergency ends, low-income people nationwide could find it even harder to have coverage
March 25, 2022
Sens. Robert Casey Jr. and Ron Wyden want a probe into what barriers are keeping Medicaid plans from reaching enrollees.
March 03, 2022
Our annual program returns April 26-27 as a virtual event and will explore the impact of COVID on vulnerable populations and the associated financial crisis related to Medicaid funding and enrollment, critical behavioral health challenges and the need for integrated care for members, and social determinants of health and associated funding issues.
February 28, 2022
Inoculation rates remain low despite massive outreach efforts and incentives from federal and state programs and Medicaid plan operators, leaving many low-income people vulnerable to the virus.
February 14, 2022
State Medicaid agencies for months have been preparing for the end of a federal mandate that has prevented states from removing people from the safety-net program during the pandemic.
February 10, 2022
The Biden administration is getting rid of several policies implemented by Trump-era appointees that restricted enrollment. Federal officials now say states can no longer charge premiums to low-income residents enrolled in Medicaid and have ruled out work requirements.
December 16, 2021
A new report from Together for Better Medicaid reveals states’ commitments to address social determinants of health (SDoH) and health equity through their partnerships with Managed Care Organizations (MCOs).
December 15, 2021
Starting in January, California will embark on an ambitious experiment to control asthma in its most vulnerable patients.
November 19, 2021
In a Health Affairs blog post, Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and Center for Medicaid & CHIP Services (CMCS) Director Dan Tsai described their policy agenda for Medicaid and Children’s Health Insurance Program (CHIP).
October 01, 2021
The attorneys general in Illinois and Arkansas on Thursday separately announced settlements with Centene Corporation, the largest Medicaid managed care organization in the United States, over inaccurate billing practices.
September 30, 2021
More than 2 million low-income adults are uninsured because their states have not accepted Medicaid expansion under the Affordable Care Act. Congressional Democrats want to offer them coverage in the massive spending bill being debated, but competition to get into that package is fierce.
September 15, 2021
The Census Bureau on Tuesday released its 2020 findings regarding Americans’ income, poverty, and health insurance coverage.
September 08, 2021
Although Medicaid traditionally doesn’t fund clinics to supply legal assistance, Colorado is one of several states that have been given permission to use some of their Medicaid money to help pay for such programs.
August 05, 2021
While federal Medicaid rules prohibit costs related to non-medical services, such as social determinants of health (SDoH), there are opportunities for state Medicaid programs to address enrollees’ social needs both within and outside of managed care, according to a new report by the Kaiser Family Foundation (KFF). In the brief, KFF discusses the options and federal Medicaid authorities that states can leverage to address enrollees’ SDoH, as well as examples of initiatives launched in response to the COVID-19 pandemic.
July 23, 2021
A recent brief from Kaiser Family Foundation (KFF) found that after years of progression in coverage across all racial/ethnic groups, uninsured rates have increased through 2019.
July 21, 2021
RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.
July 09, 2021
A coalition of more than 100 organizations have expressed their support for the reintroduction of the bipartisan bill.
July 08, 2021
Learn about the innovative strategies special needs plans (SNPs) can leverage to support individuals with significant, complex social needs while advancing health equity.
June 24, 2021
In a sharp shift from Trump-era policies, President Joe Biden looks at expanding Medicaid eligibility to new mothers, inmates, and undocumented immigrants and adding services such as food and housing.
June 24, 2021
RISE rounds up the latest news concerning COVID-19.
June 17, 2021
The Supreme Court on Thursday dismissed a challenge to kill the Affordable Care Act (ACA) and saved health care coverage for millions.
June 08, 2021
The latest data reveals 31 million Americans are enrolled in health coverage through the Health Insurance Marketplaces and Medicaid expansion under the Affordable Care Act (ACA).
May 25, 2021
The Senate voted 55-44 on Tuesday to confirm President Joe Biden’s nominee to oversee the Centers for Medicare & Medicaid Services (CMS).
February 10, 2021
The live-streaming virtual event will be a one-stop shop for state and federal legislators, health plans, providers, and community-based organizations (CBOs) to gain tactics to navigate a changing environment, move forward amid the pandemic, and further the drive for value-based care.
January 15, 2021
The Centers for Medicare & Medicaid Services (CMS) on Friday finalized the “CMS Interoperability and Prior Authorization” to improve the electronic exchange of health care data and streamline processes related to prior authorization.
January 12, 2021
RISE reviews the latest from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS).
December 18, 2020
RISE reviews the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
December 08, 2020
Xavier Becerra, President-elect Joe Biden’s choice to head the Department of Health and Human Services, is set to be a pandemic-era secretary with no public health experience. Whether that matters depends on whom you ask.
November 16, 2020
The Republican-led states are trying to prove they were harmed by the 2010 health law—and thus have “legal standing”—because their Medicaid costs increased, even though Congress eliminated the penalty for not having health coverage in 2019. At least one justice was skeptical.
November 13, 2020
The rule puts an end to overly prescriptive regulations that stakeholders have complained about since 2016, according to CMS Administrator Seema Verma.
November 10, 2020
The U.S. Supreme Court will hear arguments today in a case that could overturn the Affordable Care Act. California Attorney General Xavier Becerra, who is defending the law with the backing of more than 20 other states, told California Healthline that he predicts the justices will uphold it.
November 04, 2020
As the votes continue to be counted in the tight battle between President Donald Trump and former Vice President Joe Biden, the federal role in health care is at stake.
October 21, 2020
RISE reviews the latest headlines that impact Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act marketplace.
October 16, 2020
RISE looks at recent headlines in the news that impact the health care industry.
October 02, 2020
RISE looks at the latest headlines that impact Medicare and Medicaid.
September 25, 2020
RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
September 16, 2020
RISE looks at the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
August 13, 2020
John E. McDonough, DrPH, MPA, professor of public health practice, Harvard T.H. Chan School of Public Health, will be a featured speaker at RISE’s upcoming virtual event, RISE West 2020, Sept. 9-11.
August 07, 2020
RISE reviews the latest headlines involving Medicare, Medicaid, and the ACA marketplace.
July 28, 2020
For the first time since 2017, Medicaid enrollment has begun to increase, but not by as much as many analysts expected.
June 10, 2020
U.S. Department of Health and Human Services (HHS) announced Tuesday it would distribute relief funds to Medicaid providers following complaints from Congressional leaders about the payment delay.
May 18, 2020
Casa de Salud, a nonprofit clinic in Albuquerque, New Mexico, provides primary medical care, opioid addiction services and non-Western therapies, including acupuncture and reiki, to a largely low-income population. And, like so many other health care providers that serve as a safety net, its revenue—and its future—are threatened by the COVID-19 epidemic.
May 01, 2020
Community collaboration was a common theme throughout RISE’s two-day virtual event. Here are highlights from two case study sessions that offered an inside look at pilot programs that have proven partnership is key to addressing social determinants of health and improving population health outcomes.
April 09, 2020
The annual, two-day event will still feature the high-quality content that attendees are accustomed to but will now take place from the comfort of your home offices.
April 03, 2020
The coronavirus outbreak has forced millions out of work and the federal-state health program for low-income people could face unprecedented strains as many states don’t necessarily have the resources or systems in place to meet the demand.
March 25, 2020
RISE looks at the latest actions from the Centers for Medicare & Medicaid Services to help state Medicaid agencies respond to the coronavirus outbreak.
March 16, 2020
New Medicaid guidance reveals what states must do in response to the coronavirus outbreak.
February 24, 2020
The two-day conference will be a one-stop shop for Medicaid stakeholders to hear from leading experts as they share clinical best practices, first-hand experiences and insights, and how to prepare for the push toward value-based care.
April 01, 2019
Despite the Trump administration’s desire to force some Medicaid beneficiaries to work to maintain their benefits, a federal judge has thrown a monkey wrench into the plan by ruling against work requirements in Kentucky and Arkansas. The ruling comes in the wake of a Kaiser Family Foundation issue brief that found thousands of recipients in Arkansas have lost coverage because they failed to comply with the work requirements.
February 11, 2019
Thomas Duncan of Trusted Health Plan, John Lovelace of UPMC Health Plan, and Jim Milanowski of Genesee Health Plan will discuss the evolving landscape of Medicaid and ROI of social determinants of health as part of a panel to kick off the Medicaid Managed Care Leadership Summit in Chicago.