On January 27, 2023, the Centers for Medicare & Medicaid Services released a State Health Official (SHO) letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023.” The SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible. This expert perspective reviews the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter.
Leveraging Multi-Payer Claims Databases for Value
Erin Taylor and Michael Bailit, Bailit Health
All payer claims databases (APCDs) and other multi-payer claims databases are a source of information that, when used effectively, can provide insight into how states’ health care systems are functioning and facilitate data-driven decision-making. This issue brief looks at the progress states and community organizations have made in using their APCDs or other multi-payer claims databases for various strategic purposes, and offers considerations for states that are seeking to optimize their own claims databases to achieve health care system performance improvement goals. It identifies three broad data use categories and provides a high-level description of the approaches taken by select states and one community organization, with attention to practices that may not be as widely used across states, or in areas that states and community organizations are just beginning to pursue.
The State Health Policy Highlight, Achieving Transparency and Value Using Multi-Payer Claims Databases, provides an overview of how states are leveraging their claims databases and reviews the lessons experienced states and community organizations have to offer other states seeking to optimize their own databases.
State Health and Value Strategies, in partnership with the Peterson Center on Healthcare, hosted a webinar on March 27 during which presenters from the state of Vermont and Rhode Island, as well as the Washington Health Alliance, discussed how they are employing claims databases to enhance the value of care and shared lessons learned for those seeking to optimize their own databases