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.
Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care
Bailit Health Purchasing—Megan Burns, Mary Beth Dyer, and Michael Bailit
Overuse and misuse of health care services are problems that affect both quality and cost of care. Experts estimate that perhaps one-third of all U.S. health care spending produces no benefit to the patient–and some of it actually results in harm. This issue brief focuses specifically on the key purchasing strategies that state Medicaid agencies and state employee health benefit purchasers can implement in order to reduce the overuse and misuse of health care services, and improve the quality and reduce the cost of care. This brief primarily focuses on actions state purchasers can take with contracted plans, providers, and other engaged purchasers to reduce overused and misused services.
Based on the issue brief, the webinar presentation focuses on actions state purchasers can take with contracted plans, providers, and other engaged purchasers to reduce misuse and overuse of health care services. Neal Kohatsu MD, MPH offers insight on overuse and misuse from his perspective as Medical Director for the California Department of Health Care Services.