GAO Releases Multiple Reports Assessing Medicaid and Marketplace Eligibility and Enrollment

One of three Government Accountability Office (GAO) reports recently released on eligibility and enrollment in Medicaid and the Marketplaces found that CMS policies and procedures do not adequately minimize the potential for gaps in coverage when people churn between these sources of coverage nor sufficiently prevent consumers from being inappropriately enrolled in both sources of coverage. A second GAO report found that CMS is not reviewing the accuracy of Medicaid eligibility determinations in states that have delegated this authority to the federal government, creating a gap in the agency’s efforts to ensure only eligible individuals are enrolled and that state expenditures are correctly matched by the federal government. CMS agreed with GAO’s recommendations across both of these reports to address the findings. Finally, GAO released preliminary results from “undercover testing” of Federal and selected State-based Marketplaces, which indicated that fictitious applicants were able to enroll in Marketplace coverage; a final report is forthcoming.

Three States File Affordable Care Act Lawsuit

Texas, Kansas, and Louisiana have filed a lawsuit against the Department of Health and Human Services and the Internal Revenue Service challenging the constitutionality of requiring for-profit Medicaid and CHIP managed care organizations to pay the ACA’s Health Insurance Provider Fee. The plaintiffs claim that the fee is passed on to states that are coerced into payment because failure to do so would result in a loss of federal Medicaid funding. The lawsuit cites NFIB v. Sebelius, the 2012 Supreme Court decision that ruled the federal government could not coerce states to expand Medicaid.

HHS Announces $23 Million in Planning Grants for Behavioral Health Clinics

The Department of Health and Human Services awarded $22.9 million in grants to help states develop a prospective payment system (PPS) for behavioral health services that emphasizes high quality and evidence based practices. Specifically, the grants provide funding for states to certify community behavioral health clinics, establish the PPS for Medicaid reimbursable services, prepare an application to participate in the second phase of the grant, and engage with stakeholders. When the planning grant ends in October 2016, awardees will have the opportunity to apply for a two-year demonstration that will begin January 2017 to test the PPS by receiving federal matching funds. Under the demonstration program, no more than eight states with certified behavioral health clinics will be paid using an approved prospective payment system.