The unwinding related section 1902(e)(14) strategies newly available to Medicaid and CHIP agencies can provide significant relief to states facing pending eligibility and enrollment actions and processing delays, workforce and systems limitations, and other operational challenges. Ensuring eligible individuals do not lose coverage for procedural or administrative reasons and supporting those who are ineligible for Medicaid/CHIP transition to Marketplace coverage will be paramount for all states as they begin to resume normal operations when the federal public health emergency (PHE) ends. This expert perspective outlines the time-limited targeted enrollment flexibilities that CMS has availed to states through section 1902(e)(14) waiver authority and discusses considerations beyond the strategies described in federal guidance and supplemental resources.
A Better Way to Manage Medicaid Costs
Anne Karl, Cindy Mann, and Patricia Boozang, Manatt Health
Many states are experiencing budget shortfalls due to the COVID-19 induced recession. Since Medicaid accounts for a significant portion of states’ budgets, states often look to the Medicaid program for savings. Since the Great Recession, states have invested in initiatives that can improve care and also lower costs—such as improving coordination of behavioral health and physical health services, making home and community-based options more available to those who might otherwise go into nursing homes, addressing social drivers of health, and lowering pharmacy costs. Not all of these initiatives can generate short-term savings, but they offer other actions that states facing budget shortfalls may take to achieve savings. This toolkit outlines state options to address Medicaid spending without harming enrollee health and provider stability and access to care.