Issue Briefs | Mar 12, 2013

Purchasing Coverage for Medicaid Beneficiaries in the Exchange: A Review of Premium Assistance Options

Manatt Health Solutions – Deborah Bachrach and Patricia Boozang

This brief prepared by Manatt Health Solutions examines some of the legal, policy and operational issues states should contemplate while considering the possibility of using “premium assistance” to purchase coverage for Medicaid-eligible adults in the Exchange. It overviews the benefits of premium assistance along with the logistical challenges of its implementation.  States have authority under Section 1906 of the Social Security Act to use Medicaid premium assistance to wrap around employer coverage for an employed individual who is also eligible for Medicaid. In January 22, 2013 draft regulations, the Centers for Medicare and Medicaid Services (CMS) proposed to allow states to use Medicaid/CHIP funding to purchase coverage for Medicaid/CHIP eligible beneficiaries in the individual market, including coverage through Qualified Health Plans (QHPs) in Exchanges.

 

 


Expert Perspectives

December 1, 2023

The Proposed 2025 Notice of Benefit and Payment Parameters: Implications for States

On November 15, 2023, the Centers for Medicare & Medicaid Services released its proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective focuses on aspects of the proposed rule likely to be of interest to state officials, including requirements for State-Based Marketplaces to align with the standards of the Federally Facilitated Marketplace, proposals for states to update essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.

CMS Releases Information Bulletin on Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid

This expert perspective summarizes CMS’ new Informational Bulletin and accompanying framework which together detail Medicaid coverage options for services that address the health-related social needs (HRSN) of Medicaid enrollees. The new guidance reiterates the importance of addressing HRSNs to improve access to care and health outcomes, and summarizes (and in some cases updates) multiple previous sources of CMS guidance on how HRSN services may be covered in Medicaid, including guidance on in lieu of services authority and on HRSN coverage in section 1115 waivers.