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.
Reference Pricing: An Overview and Suggested Policy Considerations
Kayla Connor and David Cusano, Georgetown Health Policy Institute, Center on Health Insurance Reforms
Reference pricing is intended to reduce medical costs both for insurers and for purchasers of health care services, encouraging enrollees to obtain services from lower-cost providers and motivating higher cost providers to lower their reimbursement rates for those same services. This issue brief, prepared by the Georgetown Health Policy Institute’s Center of Health Insurance Reforms, provides an overview of this pricing method and federal guidance that has been issued to date. There are a number of factors that state and federal regulators should consider when reviewing plans that apply the pricing method, which are summarized in the issue brief, along with other policy considerations.