Expert Perspectives

Jul 27, 2020 

Ensuring Medicaid MCO Enrollees Receive Necessary Care During COVID-19

COVID-19 has significantly reduced health care utilization in the United States. Of great concern to states is that Medicaid beneficiaries safely access medically needed services. There are already worrisome indications that many beneficiaries are not receiving such care and it is incumbent on states to take steps with their Medicaid plans to make sure needed services are delivered during the course of the pandemic. This expert perspective recommends three categories of state Medicaid program activities to facilitate the delivery of needed services.

Jun 25, 2020 

Update on Federal Mandates to Cover COVID-19 Testing Services: New Guidance for States, Plans, and Insurers

The Departments of Health & Human Services, Labor, and Treasury (collectively, the “tri-agencies”) published guidance on April 11 in attempt to clarify some of the testing coverage requirements under FFCRA and the CARES Act. However, as calls have increased for more widespread and frequent testing, particularly of at-risk populations such as health care workers, residents and staff of long-term care facilities, and people potentially exposed at protests or rallies, insurers have questioned their responsibility to cover all testing in all circumstances.On June 23, the tri-agencies published new guidance that attempts to answer implementation questions from states, plans, and insurers, including the definition of “medically necessary”, surveillance or workplace related testing, coverage of hospital “facility fees”, and protections against provider balance billing.

Jun 23, 2020 

Addressing Equity through COVID-19 Response: Communications Approaches in States

This expert perspective highlights examples employed by DC Health Link, the Oregon Health Authority, and beWellnm and the community-centered outreach they are using to actively enroll and connect consumers to care.  The expert perspective also includes best practices surfaced for marketplaces and agencies to adapt their COVID-19 communications and outreach—and beyond—to ensure those with inequitable access to health coverage are prioritized and supported.