CMS Continues Efforts to Reach Uninsured Children

CMS released an informational bulletin urging states to continue their push to reach the remaining 2.8 million uninsured children who are eligible for but not enrolled in Medicaid or CHIP (60% of all uninsured children). To support those efforts, CMS awarded $32 million, through the Outreach and Enrollment Program re-extended under MACRA, to 38 organizations in 27 states for community-based outreach and enrollment activities that target uninsured but eligible children. CMS also reiterated a number of strategies states should use to enroll and retain eligible but uninsured children in Medicaid and CHIP, including adopting hospital presumptive eligibility for CHIP and facilitating seamless coverage transitions for young adults. The uninsurance rate for children is at a record low and 91% of all Medicaid- or CHIP-eligible children are enrolled in the programs.

CMS Guidance Aims to Increase Access to Family Planning Services and Supplies for Medicaid Enrollees

CMS released guidance encouraging states to offer all FDA-approved contraceptive methods through Medicaid and proposing actions that would eliminate existing barriers to accessing same day long-acting retroactive contraception (LARC) methods. (This guidance supplements LARC utilization strategies highlighted in a recent informational bulletin.) CMS also clarified that family planning services and supplies are eligible for a 90% federal match regardless of the type of medical visit (such as an annual physical exam) if the purpose of those services is to prevent or delay pregnancy.

Medicaid Expansion Provides Enrollees With Greater Financial Protection Compared to Marketplace Coverage

Marketplace enrollees earning above 100% of FPL in non-expansion states are at risk of facing higher premiums and out-of-pocket costs than if they were able to enroll in Medicaid expansion, according to a new report by The Commonwealth Fund. The “most important difference” between Medicaid and Marketplace plans, according to the report, is that Medicaid out-of-pocket limits are applied on either a monthly or quarterly basis further protecting enrollees from large medical bills. The report notes that private plans do not adjust out-of-pocket limits based on income while Medicaid premiums and cost-sharing may not exceed 5% of income. While Medicaid and Marketplace plans both provide the 10 essential health benefits under the ACA, the report also highlighted that Medicaid enrollees have access to additional benefits.