Federal government issues new managed-care standards for Medicaid, CHIP

CMS logoThe U.S. Centers for Medicaid and Medicare Services (CMS) has set new standards for Medicaid private insurance plans, which apply to insurers operating as so-called Medicaid middlemen in 39 states and Washington, D.C., and the Children’s Health Insurance Program (CHIP).

Each state, including Kentucky, runs its own program, although the federal government pays most of the cost. Private insurers now provide coverage to about two-thirds of the more than 70 million Medicaid recipients, and the rules had not been updated for more than 10 years, according to an Associated Press article.

“A lot has happened to health insurance coverage through Medicaid over the past several years as millions more people have gained coverage because of the Affordable Care Act: The federal government and the states have sought to strengthen the program’s focus on the consumer, the delivery of high quality care, and providing greater access points, and on developing a modern set of rules,” wrote Andy Slavitt, acting administrator of CMS, with Vikki Wachino, director for the Center for Medicaid and CHIP Services at CMS, in a blog post  announcing the final rule.

“Today, we’re taking a next step in that work today by finalizing a long-anticipated rule that updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans. These improvements modernize the way these managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers,” they wrote.

The regulation is more than 1,400 pages long, and it will take time for states, consumer advocates, and insurers to assess all its implications.

According to an article in Morning Consult, “Wachino described it as having four parts: It will enhance delivery system reform, strengthen consumer experience and protections, strengthen the integrity of the program, and align the rules across different insurance programs.”

The changes start to take effect next Jan. 1, and will take years to fully put into place.