Nov 20, 2024 – By Verlon Johnson, Chief Government & Corporate Affairs Officer As always, Medicaid policy is shifting in ways that will profoundly impact state programs over the next few years. These mandates fall into four primary areas of focus: Justice-Involved Youth Services, Prior Authorization (PA) Modernization, Critical Incident Reporting, and Health Equity initiatives. Each mandate can significantly shape state Medicaid programs, and it is essential for Medicaid directors and state agencies to be vigilant and proactive in their preparations. Justice-Involved Youth Services and Reentry Care Federal mandates are placing new emphasis on ensuring care for justice-involved youth, particularly as they transition back into society. By January 2025, Medicaid programs must have processes in place for providing pre-release assessments, developing care management plans, and supporting the reentry process. State agencies should focus on creating robust assessment systems that prevent recidivism and ensure continuity of care. States should prioritize building systems that encompass both pre-carceral (before incarceration) and post-carceral (after incarceration) assessments and care plans. Oregon, for instance, is taking an active approach to implementing these services, focusing on reducing recidivism by maintaining continuous support. Prior Authorization (PA) Modernization The prior authorization process has long been a point of friction between healthcare providers and state Medicaid programs. The upcoming PA modernization mandate will focus on reducing provider abrasion and improving patient access to timely care. By January 2026, new business and technology standards will be required for the PA process, including the use of API integrations for provider access and peer-to-peer communications. State Medicaid agencies must invest in modernizing their IT systems to meet these regulatory requirements. CMS aims to streamline processes that previously caused delays, ensuring that ca

Oct 9, 2023 – By Verlon Johnson, Chief Government & Corporate Affairs Officer Key Takeaways from the National Association of Medicaid Directors (NAMD) 2023 Fall Conference The NAMD Fall 2023 Conference brought together state agencies, Centers for Medicare & Medicaid Services (CMS) representatives, and industry leaders for insightful discussions on the future of Medicaid. This year’s conference focused on four different themes: PHE unwinding, long-term care, maternal health, and youth health. Additional conference insights and main discussion topics from some of the NAMD sessions include the following: Member Outreach and Leveraging Data Insights The importance of multi-modal outreach to members was a key topic of discussion, as consumer literacy and response rates are lower than expected. States are increasingly leveraging data insights to develop targeted outreach strategies, with over 40 states having published dashboards to track population needs, engagement rates, and areas for improvement. Churn rate, or more simply known as the rate of members dropping out or not finishing the enrollment process, is a frequent focus of many states. CMS representatives stressed this focus with the need to “avoid the churn” in the process, citing that 25-30% of the population accepts the current churn going through the process. Supporting Youth Health and Well-being Young adults who grew up with Medicaid shared their stories, highlighting the need for additional improvements in outreach and support tactics. The group emphasized “meeting members where they are,” not just physically but also in terms of digital presence, advocating for more social media engagement and content in multiple languages. Additional care coordinators were also suggested as a potential resource to help members navigate the Medicaid system more effectively, serving as a point of contact for various circumstances and helping as children on Medicaid aged up in the system. Importance of Strengthening Partnerships S