Karin Hoelzer’s Post

🚨 The Families First Coronavirus Response Act required Medicaid to provide continuous coverage for beneficiaries throughout the COVID-19 pandemic. With disenrollments paused, Medicaid and the Children’s Health Insurance Program (CHIP) enrollment grew by over 23 million beneficiaries. The continuous coverage policy ended with the public health emergency, and states could begin coverage redeterminations on April 1, 2023. HHS had projected that 15 million beneficiaries would lose Medicaid coverage. However, as of March 20, 2024, more than 18 million people have been disenrolled. What’s more, 35 million beneficiaries’ eligibility redeterminations have either still not been completed or have not been reported. Disenrollment numbers and processes have varied across states. Starting from April 2023, states have up to twelve months to initiate redeterminations. Some states began disenrollments in April, while others waited until May, June, or July. 🌟 #Medicaid #HealthcareCoverage #Disenrollment #HealthEquity #HealthcareAccess #HealthcareSystem #SocialJustice #PublicPolicy #HealthcareAwareness #HealthcareRights #SupportMedicaid #HealthcareIsEssential

A survey done by KFF reveals that 6 in 10 insured adults face issues when using their health insurance, with prior authorization problems standing out as a key pain point. These issues have widespread effects, from delayed treatments to higher out-of-pocket costs. Key Findings: 🔒 Who’s Affected? Medicaid enrollees: 22% face prior authorization issues. Frequent healthcare users: 31% of those with 10+ physician visits in the past year. Chronic conditions: 26% for mental health care, 23% for diabetes. 💔 Consequences Health Decline: 26% report worsened health due to delays or denials. Denied Care: 34% couldn't receive necessary treatment. Higher Costs: 37% paid more out-of-pocket for care. 🏥 The Bottom Line Prior authorization is intended to manage costs but often leads to delays, financial strain, and worse health outcomes for patients. For those navigating the system, it’s more than just paperwork—it's life or death decisions. #HealthInsurance #PriorAuthorization #Medicaid #HealthcareAccess #InsuranceIssues #MentalHealthCare #DiabetesCare #HealthPolicy

CMS Releases Transforming Maternal Health Model Notice of Funding Opportunity! The Centers for Medicare & Medicaid Services' new Transforming Maternal Health (TMaH) model focuses on improving #MaternalHealth care for people enrolled in #Medicaid and Children's Health Insurance Program (#CHIP). It aims to reduce #disparities in access and treatment and improve outcomes for mothers and newborns. Learn more and apply by Sept. 20: https://hubs.li/Q02DD4_h0

Increasing Medicare Savings Program Enrollment—Improving Affordability of Care Sixty-five million older adults and people with disabilities have health insurance through the US Medicare program. However, high out-of-pocket costs, including premiums and cost sharing, make it difficult for many Medicare beneficiaries to afford care. One in 4 Medicare beneficiaries had an income of less than $21 000 per person in 2023 and 36% reported forgoing or delaying care due to cost concerns.1 Beneficiaries from racial and ethnic minority groups and those with multiple chronic conditions or disabilities frequently report cost barriers, raising concerns that high costs may keep essential care out of reach for vulnerable individuals.1 [JAMA Network] More>https://lnkd.in/gYy5Nt7V #medicalcosts #healthcare #medicine #dental #publichealth #medicare #communityhealth #populationhealth

This new Centers for Medicare & Medicaid Services #CMS final rule (CMS-2439-F), which was published this week , will strengthen managed care delivery in #Medicaid and #CHIP, the Children's Health Insurance Program. As many as 70% of #Medicaid and #CHIP beneficiaries receive care through managed care plans. Ensuring these plans provide timely access to high-quality care and appropriately reimburse participating healthcare providers is key to making high-quality health care accessible and affordable for every American. Among other things, the final rule establishes maximum appointment wait times, strengthens requirements for program monitoring and oversight, streamlines key parts of the provider payment and reimbursement process, enhances program transparency, increases public engagement, and enhances key program flexibilities. This final rule is certainly a step in the right direction and marks important progress for #raredisease patients and families. Read a comprehensive summary of the rule here: https://lnkd.in/gGXUkSJi

(FISCAL TIMES) - "Nearly 1 in 4 of Those Removed From Medicaid Now Uninsured." Millions of Americans have been removed from state-level Medicaid programs over the last year, following the official end of the Covid-19 pandemic and the return to pre-pandemic rules governing access to the system. Request A Health Or DENTAL Insurance Quote On The Plans Being Offered Within Your State When You Go To: HI4E.Org 1(800) 793-0471 #MedicaidCoverage #AffordableHealthInsurance #HI4E.Org #ObamacareTaxSubsidies #AffordableCareAct #HealthInsurance4Everyone #MedicaidTaxes #FilingTaxes #2023TaxReturnPenalties #TaxPenalties #HealthAndLifeSolutionsLLC #MissedOpenEnrollment #OpenEnrollmentEnded #ObamacareTaxSubsidyPenalties #ObamacareSubsidies #ObamacareTaxes #TaxReturnPenalties #MedicaidEnding #MedicaidCuts #FiscalTimes #MedicaidFundingCutbacks #MedicaidEnrollment #MedicaidEligibility #CovidFundingEnded #CovidFundsClawedBack #MedicaidRecipients https://lnkd.in/gAPfn64V

Do the New CMS Rules on Prior Authorization Go Far Enough? — No, say some physicians and advocacy groups The new CMS regulations on prior authorization have been heralded as a big step forward in reducing administrative burdens on physicians, but some people think it doesn't go far enough. Here is the disappointment- the regulation is limited to Medicare Advantage (MA) plans, Medicaid HMOs, and some plans on the Affordable Care Act's insurance exchanges, though it also includes plans in the Children's Health Insurance Program. In addition, the prior authorization requirements only apply to requests from physicians who are in the MA plan's network. There is solid support in the medical community for encompassing regulations that rein in the hatchet approach by payers to rein in payments and potentially put patient's care in jeopardy waiting for authorization or even worse refusing to pay for medically necessary care the patient is paying for in ever-increasing premiums. #priorauthorization, #denyingmedicallynecessarycare, #pittingpatientcareinjeopardy https://lnkd.in/eSc3x7GS

Uninsured Rate Rises To 8.2% Healthcare Dive (8/7, Pifer) reports, “The percentage of Americans without health insurance grew to 8.2% in the first quarter of this year as states culling their Medicaid rolls reversed a once-record low uninsurance rate, according to new Centers for Disease Control and Prevention data.” Specifically, “an additional 1.6 million people lost coverage from January through March, bringing total Americans without insurance to 27.1 million, the CDC said.” Many Americans who are losing coverage “have turned to the Affordable Care Act exchanges for insurance, causing enrollment in the plans to swell to historic highs this year.” The rate of uninsured Americans “could hit 8.9% over the next decade because of Medicaid unwinding and the loss of the subsidies, according to recent projections from the Congressional Budget Office.” #cdc #uninsured #medicaid

Health insurance plans on the Affordable Care Act #ACA #marketplace provide countless #raredisease #patients and families with affordable, high-quality #healthinsurance. Unfortunately, the sheer number of plan choices can make it challenging to compare plan options and find the right coverage - and fraudulent actors undermine consumer trust. It is reassuring to see the Centers for Medicare & Medicaid Services #CMS take decisive action on unauthorized plan switches and unauthorized enrollments performed by agents and brokers in the Marketplaces that use the HealthCare.gov platform. According to recent data, CMS received approximately 40,000 complaints of unauthorized plan switches in the first three months of 2024, and 50,000 complaints of unauthorized enrollments. Luckily for consumers, 90% or more of these complaints have been resolved, with an average resolution time of less than a month - and the handling time is decreasing. Right now, most unauthorized plan switches are resolved in fewer than 11 business days. Given the significant out-of-pocket costs and disruptions to care that can be associated with unplanned plan switches, these shortening resolution times are good news for #raredisease patients and families, although ever day is a day too long. Read the full statement here: https://lnkd.in/egZeKw_D

Recent discussions about Rep. Alexandria Ocasio-Cortez and her comments on denied insurance claims being an "act of violence" have sparked intense debate about health care access in America. Her recent statements about insurance denials and their impact on American families have drawn attention to her position on health care policy. 🔎 Let's look at her voting record on recent health care legislation. The 118th congressional record shows AOC's support for two significant health care bills. She voted in favor of the Protecting Health Care for All Patients Act of 2023 (📜 House Bill No. 485). ✅ This legislation aims to prevent federal health programs from using quality-adjusted life years to determine care value, meaning insurance companies can't discount coverage based on disability, age, or terminal illness - a significant protection for vulnerable patients facing insurance denials. ✅ She also supported the Lower Costs, More Transparency Act (📜 House Bill No. 5378), demonstrating her commitment to making health care costs more transparent for Americans. This bill requires health care providers and insurers to be upfront about costs and establishes requirements for certain payment methodologies under Medicare and Medicaid. Both bills align with her recent statements about improving health care access and preventing financial hardship from medical costs. 🔗 Learn more about Rep. Alexandria Ocasio-Cortez's voting record and these bills at: https://lnkd.in/g8QEcgVg #AOC, #HealthcareReform, #MedicareForAll, #HealthcareAccess, #InsuranceReform, #PublicHealth, #Congress, #HealthPolicy, #Healthcare, #PatientRights, #MedicalBills, #HealthInsurance