CMS Issues Guidance on Family Planning Coverage Under Medicaid

CMS sent a letter to all State Medicaid directors reiterating that providers may not be excluded from participating in Medicaid for reasons other than being unable to perform covered medical services or being unable to bill for those services. The letter further reminds States that any provider exclusion must be supported by evidence of the provider's failure to meet the State's "reasonable" standards. States also may not target providers for reasons unrelated to their ability to perform covered services or the adequacy of their billing practices. The letter notes that providing a full range of women's health services does not disqualify a provider from participating in Medicaid. Ten states have recently taken action or passed legislation to cut off Medicaid funding to Planned Parenthood. This is the first time CMS has issued a collective warning to all 50 State Medicaid agencies, according to the Washington Post.

Parties in ACA Contraceptive Case Propose Accommodations

The petitioners and government in Zubik v. Burwell submitted briefs describing how contraceptive coverage may be provided to employees without violating the employer's preference to exclude contraceptive coverage from their sponsored plans. The petitioners suggested a process whereby insurers would provide contraceptive coverage to individuals at no cost if the individual actively enrolled in a separate program, with different enrollment processes, insurance cards and contracts. The government argued that the existing accommodation process for employers already meets standards articulated by the Court.

Minorities and Low-Income Individuals See Sharpest Coverage Gains Under the ACA

Minorities accounted for two-thirds of the national increase in insured adults in 2014 and 70% of the increase in private insurance coverage, according to analysis of census data by the New York Times. Immigrants, including 1.2 million documented non-citizen residents, had the sharpest rise in coverage rates, and low-wage workers saw "historic increases." Native Americans and Hispanics, who had the lowest coverage rates in 2013, had the highest gains in 2014 among the racial groups: 6.1 and 7.2 percentage points, respectively. The analysis also found that people with high school degrees gained coverage at double the rate as college graduates and adults living in households headed by a sibling or a cousin—often a marker of economic distress—gained coverage at double the rate of those in "traditional" households. The analysis described coverage gains for low-income blacks as "muted," citing states' failure to expand Medicaid. The coverage rate increased three times as fast for low-income blacks in expansion states (by 6 percentage points) compared to those in non-expansion states (2 percentage points). The report's authors write that the coverage gains were enough to halt "the decades-long expansion of the gap between the haves and the have-nots in the American health insurance system." They also note that nearly 14% of those who gained coverage in 2014 are ineligible to vote because of their citizen status.

Uninsurance Rate Among Children Reduced by Two-Thirds, New Reports Find

The number of uninsured children (age 18 and under) declined by 66% between 1997 and 2015 (to 4.8%), and the number of "young children" (under age 5) declined by 75% (to 3.2%), according to two new reports from the Urban Institute. Those declines coincided with major eligibility expansions through CHIP, increased participation among children in Medicaid and CHIP, and the enactment of the ACA's coverage provisions. The reports also found that the uninsurance rate among children continued to fall during the Great Recession (December 2007 through June 2009), despite uninsurance rates for nonelderly adults increasing during that time. Medicaid and CHIP are cited in the report as offsetting the loss of private coverage for children as the economy worsened.