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Medicaid Managed Care Final Ergs Take Effect

In late April, the Centers for Medicare and Medicaid Services (CMS) published the final rules for remaking Medicaid managed care, starting a huge reform process that will impact the majority of Medicaid recipients. The rules, proposed in fairly similar form a year ago, set new mandates for the states to develop rules for managed care plans serving Medicaid recipients.
As of 2013, 46 million — almost three-fourths — of Medicaid beneficiaries had all or part of their benefits in managed care, according to the CMS. The Government Accountability Office in December said that as of fiscal 2013, 39 states were using comprehensive, risk-based managed care in their Medicaid programs. Even Medicaid experts are still combing through the CMS’ 1,230 pages of explanations and responses to public comments and (at the end of the document) the almost 200 pages of actual rules. The regulations cover a large number of topics including what information should go to patients, how to ensure provider networks are adequate to take care of patients, and what enrollment protections should be available patients. “The rule is going to require more consumer information than we have ever had before,” says Kelly Whitener, associate professor at the Georgetown University Health Policy Institute Center for Children and Families, Washington, DC. That will be very important in helping consumers to understand their plans, she notes.
Source/more: Contemporary Pediatrics


David Wingate is an elder law attorney at the Elder Law Office of David Wingate, LLC. The elder law office services clients with powers of attorneys, living wills, Wills, Trusts, Medicaid and asset protection. The Elder Law office has locations in Frederick and Montgomery Counties, Maryland.

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