By Halima Ahmadi-Montecalvo PhD MPH – Improving health outcomes requires more than medical care alone—it demands a holistic approach that addresses Social Drivers of Health (SDOH), such as housing, food security, transportation and interpersonal safety. The evidence is clear: addressing these factors not only improves health but also…
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By Sue O’Connell – Mark Nay’s first client had lost the van she was living in and was struggling with substance use and medical conditions that had led to multiple emergency room visits. Nay helped her apply for Medicaid and food assistance and obtain copies of her birth certificate and other identification documents needed to apply for housing assistance.
By Lauren Barca, MHA, RN – The headlines for 2025 Medicare, Medicaid, and dual-eligible programs are rife with concerns about proposed changes. While those worries were certainly a topic of discussion at AHIP’s recent Medicare, Medicaid, Duals, and Commercial Markets Forum in Baltimore, Maryland, they weren’t the only story.
What do managed care organizations (MCOs) need to consider to successfully comply with the various requirements and achieve the goals the CMS final rule sets out to accomplish? This week’s Friday at Five, courtesy of Sellers Dorsey, provides five critical considerations for MCOs.
By Chris Emper – On April 22, CMS released an 895-page final regulation titled, “Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality.” At nearly 900-pages in length, this rule creates a list of new compliance obligations for managed care plans, including…
By Gerald A. Maccioli MD – To ensure the effective and efficient functioning of Medicaid, as well as to prevent fraud, waste, and abuse, Program Integrity Units should be established within the Medicaid system.
By Anup Panthaloor – As states disenroll millions of individuals from their Medicaid rolls, small and medium sized health plans with managed Medicaid plans face multiple risks. Their Medicaid members are losing access to care, many of them erroneously, with 72% of members being disenrolled for procedural reasons.
By Seth Ravine – As managed Medicaid and Medicare Advantage continue to grow—more participants and health plan expansion—the need to effectively address health related social needs increases proportionately.
By Liz Fowler JD PhD, Purva Rawal PhD, Sarah Fogler PhD, Brian Waldersen MD MPH, Meghan O’Connell MPH, & Jacob Quinton MD MSHS – In 2021, CMS established a goal to have 100 percent of Original Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030,,,