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.
Webinar: Advancing Delivery and Payment Reform in Managed Care Provider Networks
Center for Health Care Strategies
States purchase health care benefits for more than a third of all Americans. State health care purchasers are increasingly interested in using this purchasing power to shift toward value-based purchasing (VBP) strategies that reward providers for value or outcomes as a means of improving care, improving health and reducing overall costs. Because managed care plans oversee health care services for most Medicaid beneficiaries, public employees, and those getting coverage through the marketplaces, health plans are key channels through which state purchasers can accelerate VBP at the provider level.
This webinar examines how states are currently advancing payment reform in their managed care provider networks by moving away from fee-for-service (FFS) and identifies key considerations for states interested in implementing VBP strategies in this environment. Representatives from Arizona and Tennessee share ground-level experiences in adopting VBP strategies in their Medicaid managed care programs. The webinar draws from a series of resources developed for SHVS by the Center for Health Care Strategies to help state purchasers design and implement VBP strategies within managed care.
Access a recording of the presentation here, or download the slides at the link below.