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.
Value-based Purchasing for Managed Care Procurements: A Toolkit for State Medicaid Agencies
Mary Beth Dyer and Beth Waldman, Bailit Health
Value-based Purchasing for Managed Care Procurement: A Toolkit for State Medicaid Agencies is designed to assist states interested in implementing value-based purchasing (VBP) approaches with their Medicaid managed care organizations (MCOs). Using a VBP approach can mean significant and ongoing changes for a state Medicaid agency and its MCOs. The Toolkit is designed to guide Medicaid agencies through key action steps and considerations in four phases of the managed care procurement cycle – 1) strategic procurement planning, 2) solicitation development, 3) bidder selection, and 4) contract management.
If you are interested in an overview of the Toolkit and its contents, we have a summary, Purchasing Value in Medicaid Managed Care, that provides a road map for the Toolkit and is an introduction for those interested in learning more about value-based purchasing for managed care.