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REFORM; STATE NEWS- Why One State Is Pushing Back Against Medicaid’s IMD Exclusion

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: NY is looking to get a double waiver approach approved to transform how it uses IMDs to impact SUD and SMI outcomes.


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New York state hopes to strengthen and remake state-managed behavioral health care by getting around the so-called IMD exclusion.

It’s doing so by securing federal Medicaid funds typically forbidden from covering facility-based behavioral health through its latest 1115 waiver amendment.

On Jan. 5, the Centers for Medicare & Medicaid Services (CMS) announced New York applied for a waiver to Medicaid’s now-antiquated institution for mental disease (IMD) exclusion. New York has asked for federal matching funds for Medicaid to be allowed to cover IMD services to address serious mental illness (SMI), substance use disorder (SUD) and serious emotional disturbance (SED) for adults and children.


New York specifically is seeking matching funds to reimburse short-term inpatient, residential and other services for SMI and SUD by IMDs. The state is also applying for matching funds to help transition patients in state psychiatric facilities back to the community up to 30 days before their discharge.

“The objective of the demonstration is to transform the role of some state psychiatric inpatient facilities and [SUD] residential treatment facilities, improve care transitions and access to community-based treatment and support services, and improve health and behavioral health outcomes in individuals with chronic and/or [SMIs] by transforming selected (pilot site) state-run psychiatric hospitals, facilities, and campuses from long-term care institutions to community-based enhanced service delivery systems,” the 1115 waiver amendment proposal states.

Since the beginning of Medicaid in 1965, the Social Security Act forbade federal funds for Medicaid from covering treatment provided by facilities where 16 or more beds are dedicated to treating behavioral health issues of people aged 21 to 64.


This move was intended to prevent states from offloading state psychiatric hospital costs on the federal government through the jointly funded and managed Medicaid program. It was also part of a political and regulatory retreat from treating behavioral health issues in large hospital-like settings, with champions of that movement including President John F. Kennedy.

The movement is sometimes referred to as deinstitutionalization.

However, some see the start of the deinstitutionalization movement as the start of the present psychiatric bed shortage, even within the federal government.

“There’s been an understanding in the past several years that this lack of federal funding contributes to high levels of unmet need,” Madeline Guth, senior policy analyst for Kaiser Family Foundation (KFF), told Behavioral Health Business. “The federal government has been providing some new mechanisms in the past few years for states to get an exception to this exclusion and get some federal financing for IMD services for non-elderly adults.”

The mechanisms, including the Medicaid 1115 waiver, allow states to secure some federal funding for certain IMD-related services.

Medicaid 1115 waivers, if approved by the federal government, allow states to experiment with different ways of implementing the Medicaid program.

There are three specific 1115 waiver benefit expansions that are related to behavioral health.

KFF, which tracks these waivers, found that 34 states have received approvals for an IMD exclusion payment exemption for SUDs. Additionally, 10 states have an exemption for mental health treatment, with 23 states having other exemptions for community-based health and behavioral health. 

Recent presidential administrations have enabled ways around the IMD exclusion through the 1115 waiver.

In July 2015, the Obama administration allowed for 1115 waivers to “develop a full continuum of care for individuals with SUD, including coverage for short-term residential treatment services not otherwise covered by Medicaid,” which included the IMD exclusion. 

The Trump administration announced in November 2019 that it approved the first-ever 1115 waiver related to IMD exclusion for SMIs and SEDs for adults and children.

Addressing the IMD exclusion did come up during the legislative work in 2022 that culminated in a sweeping behavioral health bill included in the omnibus funding bill passed just before Christmas. However, it was not included in the final bill that was signed into law on Dec. 29

While New York’s latest 1115 waiver application is not unprecedented, it does reflect a two-for-one application for two IMD exclusion exemptions — including both SMI and SUD funding.

Further, the New York waiver and the other waivers tracked by KFF show that states of all political leanings seek to address mental health via innovations to Medicaid.

Medicaid is the single largest payer of mental health services in the U.S. 

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REFORM- RI Legislators Want to Use Medicaid Waiver Funds to Provide Homeless With Housing

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: The state house is hearing all about designs to pilot a new program to use Medicaid funding to impact homelessness, a la HI, AZ and NY.



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The proposal comes after a recent multi-week protest about RI’s homelessness policies at the State House. PHOTO: Sionni

Rhode Island legislators on Tuesday introduced a proposal to create a pilot program testing the effectiveness of using Medicaid waiver funds to provide the chronically homeless with housing.

Rhode Island State Representative David Bennett and State Senator Josh Miller’s proposal (2023 H-5098), modeled after legislation in Hawaii, directs the Executive Office of Health and Human Services (EOHHS) to commission Medicaid waiver funds for a pilot program covering supportive housing services to people suffering from chronic homelessness. 

The program would provide individuals with behavioral health services, case management, personal care and assistance services, home and community-based services and housing support services. Arizona and New York have similar programs, housing thousands of chronically ill individuals and saving taxpayers in both states.


“As an RN case manager, I’ve worked with a lot of these folks. When they don’t have a roof over their heads, it’s very hard to make sure they’re taking their medications regularly, make sure they’re going to the doctor,” said Bennett (D-Dist. 20, Warwick) who is a registered nurse who has seen the impact of housing first hand. But once they have housing, they can recover and stand on their own two feet again.”


Modeling Other States

According to the National Alliance to End Homelessness, roughly 20% of homeless individuals are defined as chronically homeless, meaning they have been homeless for at least a year and suffer from chronic and complex health conditions including mental illnesses, substance use disorders, and medical conditions. Without stable housing, they cycle in and out of emergency departments, inpatient hospital stays, psychiatric centers, detoxification programs, and jails, costing taxpayers roughly $35,000 per year as of 2017.

“The acute correlation between homelessness and adverse health conditions is a heinous reality. Unfortunately, issues tend to be aggravated since the tragedy of homelessness brings more attention to shelter than to treatment options,” said Miller (D-Dist. 28, Cranston, Providence). “Getting people into housing removes the burden of finding shelter and allows for the freedom to get connected with programs and employment opportunities, while directly engaging in the most effective preventative care mechanism we have, a roof.”

One of the biggest health costs related to homelessness is emergency room visits, said Miller, who co-chaired a 2013 Senate commission that studied ways to reduce ER visits. Homeless individuals show up to emergency rooms for many reasons. 

According to the legislators’ release, homeless individuals “often struggle to get preventive care, so regular problems may not get treatment until they become critical. Emergency rooms cannot, by law, turn anyone away for inability to pay, so homeless individuals can use them to address more mundane health issues. Sometimes, shelters are full and families just need somewhere warm to sleep.”


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STATE NEWs- Governor, Ohio Medicaid launch maternal care program

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: A new maternal care program will distribute funds to OB practices focused on bending troubling maternal mortality trends.



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A new Comprehensive Maternal Care program has launched in Ohio and is expected to improve health outcomes for mothers, infants and their families by addressing food instability, housing options and more.

“Giving all Ohioans the best possible start at life truly begins before a child is even born and that means ensuring the child’s family has access to the resources they need,” said Ohio Gov. Mike DeWine, who collaborated on the program with Ohio Department of Medicaid Director Maureen Corcoran. “Personalized access to those supports from trusted community partners and high-quality, responsive care that focuses on patients lead to better, healthier outcomes for mothers, babies, and their families,” he said.

‘This is a baseline year’

Ohio Medicaid estimates investing $5 million in the program by the end of its first year, reaching more than 14,000 pregnant and postpartum patients and enrolling 77 medical practices currently caring for pregnant and postpartum patients.

“This is a baseline year,” said Marisa Weisel, Ohio Medicaid’s deputy director of strategic initiatives. The program provides quarterly payments to practices based on the number of Medicaid patients those practices typically serve, according to Weisel.

ExploreOhio Medicaid extends postpartum coverage for new mothers

The Comprehensive Maternal Care program creates a framework for providers and community partners to develop individualized plans to support women and families who’ve historically lacked ready access to high-quality, responsive care before and after pregnancy, according to the governor’s office.

“Ohio Medicaid and our vision for the ‘Next Generation’ of care commits to delivering a personal care experience to every Ohioan served,” Corcoran said, referencing Ohio Medicaid’s Next Generation managed care program. The next stage of implementation will launch on Feb. 1, which will include managed care plans.

“The (Comprehensive Maternal Care program) model builds on that commitment by encouraging providers and communities to partner on building a trustworthy and comprehensive system of care for members,” Corcoran said.

What that care looks like

The practices involved in the program may use the funds to help their patients achieve better health outcomes, as Ohio Medicaid will be monitoring them through measurements to allow those practices to track how they are doing.

We could have a practice that decides they want to hire a community health worker with their extra resources,” Weisel said. The health worker could help patients sign up for benefits such as WIC, help them work on finding stable housing or help get women connected with the behavioral health system to deal with post-partum depression.

Weisel said post-partum depression can play a big role in the parent’s ability to care for their child. It also points to how mental health impacts maternal mortality rates. In an analysis on pregnancy-related deaths between 2017 and 2019, the Centers for Disease Control found four out of five pregnancy-related deaths could have been avoided, with 23% of those deaths being associated with mental health conditions, including deaths to suicide and overdose/poisoning related to substance use disorder.

The health practices involved in the program also must consider and link patients to resources that address broader factors of health, such as housing, food instability and transportation.

“We know that health care is not the only thing that matters,” Weisel said. “There are often other barriers to them accessing care.”

Additional support

Gina McFarlane-El, CEO of Five Rivers Health Centers, said the Comprehensive Maternal Care program will help them continue to care for their pregnant patients. Five Rivers Health Centers is the 10th largest federally-qualified health center in Ohio, seeing more than 27,000 patients a year. Of their pregnant patients, approximately 22% of them are uninsured.

In addition to health visits, McFarlane-El said Five Rivers Health Centers also supports their pregnant patients through programs like their diaper and bra banks, as well as with group visits for pregnant individuals.

Diapers are one of those things that are not supported through any of the various funds that our women receive, so we created Montgomery County’s first diaper bank within this area through our Healthy Start program,” McFarlane-El said. “We use those resources to help women not worry about diapers.”

Cost figures vary for diapers, but the National Diaper Bank Network estimates the average monthly supply of diapers costs approximately $80 in Ohio, costing parents approximately $960 a year.

Five Rivers Health Centers also offers group prenatal care visits through the program Centering Pregnancy. Toni Tipton, a certified nurse midwife at Five Rivers Health Centers, said pregnant women can take part in group prenatal visits to allow for them to learn more and connect with other individuals whose delivery dates are similar to theirs.

“We really highly recommend it for first time moms, and it also provides social support,” Tipton said. The program is also aimed at decreasing infant mortality, while also increasing breastfeeding and immunization rates.

McFarlane-El said they will use some of the funds they receive through Ohio Medicaid’s Comprehensive Maternal Care program to support those programs and expand other efforts.

Requirements for providers

Participation in the Comprehensive Maternal Care program requires obstetrical practices to receive feedback from patients and families, such as through advisory councils or other means, which can then be used to improve patient experiences and reduce disparities.

“One thing we’ve heard, sometimes (patients) don’t feel like they’re able to communicate effectively with their provider,” said Weisel. This program then encourages those practices to get regular feedback from patients.

ExploreLocal hospitals recognized as ‘high performing’ in maternity care, per new report

Additionally, Weisel said practices must use the pregnancy risk assessment to identify women in need of a first prenatal appointment and ensure timely access to appointments and services. This assessment also helps Ohio Medicaid track pregnant individuals’ needs and maintain their Medicaid coverage while they’re pregnant and also after their pregnancy. In April of last year, Ohio Medicaid extended its coverage of benefits for new mothers from 60 days to 12 months after the birth of their child.

Additional criteria for participation includes engaging community supports, evaluating the mother’s and family’s experiences throughout the treatment, ensuring patient involvement and care continuity with their providers and assessing the practices’ operations to make sure they are achieving healthier outcomes.

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PROVIDERS- Hospitals Face Significant Medicaid DSH Cuts This Year

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: This year’s installment of Medicaid hospital payment Kabuki theater.


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Congress will need to address a significant Medicaid disproportionate share hospital (DSH) cut this year. Under current law, $8 billion in DSH cuts are scheduled to begin October 1, 2023, and continue annually through Federal fiscal year 2027. These cuts would be catastrophic for safety net hospitals and could force many of them to reduce services or even permanently close.

Congress must delay the DSH cuts for at least two more years so that financially struggling hospitals can continue caring for vulnerable communities and low-income individuals.

In addition, the Federal government caps the amount of DSH funding that individual hospitals can receive at their “DSH cap”—their losses from treating Medicaid patients and the uninsured. The current DSH cap calculation excludes Medicaid shortfalls from services provided to Medicaid-eligible beneficiaries who are dually eligible for Medicare or other coverage. This policy will result in significant cuts to safety net hospitals and will reduce New York hospitals’ Medicaid DSH caps by an estimated 25%. GNYHA urges Congress to allow hospitals to include in their DSH cap calculation Medicaid shortfalls from Medicare dual-eligible patients and individuals dually covered by an “applicable plan.”

GNYHA has begun an aggressive Federal advocacy campaign to delay the DSH cuts and resolve issues with the current policy. GNYHA also will establish a working group focused on DSH issues and advocacy.

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EXPANSION- Georgia won’t take up full Medicaid expansion anytime soon, lawmakers say

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Talk to the hand, expansioners (says GA rep).


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Georgia will not consider a full expansion of Medicaid in the near future, The Atlanta Journal-Constitution reported Jan. 19. 

Georgia House Speaker Jon Burns said the state instead needs to focus on Georgia Governor Brian Kemp’s proposal to expand the program, which would require adults to work at least 80 hours a month to qualify for Medicaid coverage. 

The more limited expansion is slated to begin this summer. State officials estimate it will insure around 50,000 adults. If the state fully expanded Medicaid, it would insure around 400,000 adults, The Atlanta Journal-Constitution reported. 

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NMI’s 83 pct. federal match rate for Medicaid is now permanent

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: One of the territories now has 87% of its Medicaid costs paid for by federal taxpayers. 4-Eva.


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Esther Muña

Thanks to the CNMI’s health partners as well as the efforts of Delegate Gregorio Kilili C. Sablan (D-MP), the federal match rate for the CNMI’s Medicaid program will now permanently remain at the current 83%.

Commonwealth Healthcare Corp. CEO Esther Muña shared the good news during a news briefing yesterday that Sablan recently informed CHCC that the Biden administration has decided to permanently keep the federal match rate for the CNMI’s Medicaid at 83%, meaning the CNMI would only shoulder 17% of Medicaid-related costs.

“I did get a call from Congressman Sablan…that we’re getting the 83% and it’s permanent. That’s obviously great news. It’s been something that we’ve been fighting for—equitable funding financing for the territories,” she said.

Essentially, Muña said, the CNMI government would now only have to shoulder 17% of medical costs accrued by the Medicaid program. Previously, the CNMI was shouldering 50% before it was lowered to 45% and the CNMI still could not afford it.

CHCC hopes that the 17% match will prove more affordable for the CNMI as it would come from the Commonwealth’s general fund.

“The 83% is going to come from the federal [government] and the 17% is going to come from the local funds appropriated for CHCC. The reason why we opted to do this is because, in the past, we’ve always struggled to find the funds to cover our match. It used to be 50%, then our match was lowered to 45% and that obviously was still very difficult. We are hoping that now, the CNMI can afford 17%,” she said.

Muña said this is a great opportunity for CHCC to look at how it can better address health care access with the extra funding it would save with the federal government shouldering 83% of Medicaid costs.

“This is a great opportunity for us to plan better and also to really address the health issues of the CNMI and even for public health,” she said.

According to Saipan Tribune archives, the Marianas’ current 83% federal match rate, technically called the Federal Medical Assistance Percentage, or FMAP, is higher than it is for any state.

The FMAP was set in U.S. Public Law 116-94 in 2019, extended in U.S. Public Law 117-103, in a previous continuing resolution in early 2022, and again in another fiscal 2023 continuing resolution which was passed on Dec. 20, 2022.

The continuing resolution provided appropriators more time to draft an omnibus spending bill to cover the entire fiscal year which has since been passed, permanently keeping the FMAP for the CNMI at 83%.

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Op-Ed- California should accept the federal government’s invitation to trim Medi-Cal rolls

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: In which the op-ed writer suggests the un-thinkable.


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California should accept the federal government’s invitation to trim Medi-Cal rolls

Despite tougher fiscal conditions, Governor Newsom’s January budget proposal for California misses an opportunity to take advantage of a large cost-saving opportunity other states will be leveraging in the coming months.

Since 2020, the federal government has prevented states from removing no-longer-eligible Medicaid beneficiaries from the program’s rolls. Now that this pandemic emergency measure was eliminated by the omnibus budget bill Congress passed last month. California should join other states in enforcing eligibility requirements for those receiving healthcare benefits.

Of the $297 billion in state revenues Newsom expects to spend in 2023-2024, the largest share – $102 billion – is devoted to Health and Human Services. Most of the spending in this category will take the form of provider reimbursements by the state’s Medicaid program, known as Medi-Cal.

Normally, the federal government covers 50% of Medi-Cal reimbursements for most beneficiaries. But during the COVID-19 pandemic, Congress increased the federal percentage to 56.2%, as long as the state maintained continuous coverage for everyone using the program as of early 2020 or added to the program thereafter. Now, the federal share will gradually fall back to 50% in early 2024, and the continuous coverage mandate will be removed.

According to federal data, California’s population of Medicaid beneficiaries grew from 10.3 million at the beginning of the pandemic to 12.6 million in September 2022 (the last month that data was available). An additional, 1.3 million young people are enrolled in the Children’s Health Insurance Plan, meaning that over one third of the state’s population is now covered by federal/state health programs that do not require participant contributions.

Many states plan to respond to the federal policy change by systematically reviewing all Medicaid beneficiaries to see whether they still qualify for benefits. For example, Texas has identified a cohort of 1.4 million beneficiaries that are most likely to be deemed ineligible because they have reached the age of 65 (and should instead use Medicare) or no longer have an eligible dependent child in their household. Once the state is allowed to begin disenrollments in April 2023, it plans to run electronic data matching algorithms on this cohort to determine who should be removed from the program.

California appears to have no such plan. The governor’s budget summary projects a large increase in General Fund Medi-Cal spending due to the “loss of increased federal funding consistent with the end of the federal Public Health Emergency while costs for caseload persist through the year.”

This is unfortunate because the state expects to have a $22.5 billion budget shortfall in the next fiscal year and further deficits thereafter. Rather than make meaningful cuts to balance the budget, many of Newsom’s budget balancing measures involve taking on more long term debt and shifting resources between funds.

In California, where political leaders have emphasized the need for universal health coverage, the idea of disenrolling Medi-Cal beneficiaries may seem anathema. But it is necessary to minimize wasteful and fraudulent spending. Right now, Medi-Cal is covering highly skilled workers who, after being temporarily unemployed, got high paying jobs as the economy bounced back. These individuals can afford to pay for their company’s insurance coverage. Other beneficiaries may have moved out of state or stopped participating in the program for other reasons. Unless their names are removed from the rolls, unscrupulous providers could file claims under their names.

Medi-Cal beneficiaries who are now self-employed or who hold jobs at employers that do not provide healthcare benefits are eligible to buy policies on Covered California, often with large federal insurance subsidies. So, rather than contribute nothing to the cost of their care, they might expect to pay a relatively small amount for healthcare coverage.

While enforcing eligibility rules may seem cruel, it is necessary to ensure that state resources are available for the truly needy without bankrupting taxpayers or driving them out of the state. The previous Democratic-controlled Congress has invited all states to trim their Medicaid rolls; this is an invitation that California should accept.

Marc Joffe is a federalism and state policy analyst at the Cato Institute.

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Abortion- Montana DPHHS proposes new regulations on Medicaid-reimbursed abortions

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[MM Curator Summary]: The state is looking to ensure its existing rules around payment for abortion are actually followed.


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HELENA — This week, state regulators will hold a hearing on a proposed rule change that would add more requirements in order for an abortion to be covered by Medicaid.

The Montana Department of Public Health and Human Services announced the proposal, which would require prior authorization before Medicaid pays for abortion services. DPHHS leaders said additional documentation is needed to ensure that the state Medicaid program is only covering abortions that are medically necessary. However, some advocates say the change would be an unnecessary barrier to accessing an abortion.

The federal government’s Hyde Amendment prohibits Medicaid funding for abortions, except in cases of rape and incest and when the mother’s life is endangered. Montana, though, has a different standard. After a 1995 court ruling, the state has used its own general funds to cover abortions that have been determined to be “medically necessary,” even if the mother’s life isn’t endangered.

DPHHS leaders say, after a contractor reviewed Medicaid-reimbursed abortions, they concluded most claims lacked sufficient documentation to confirm medical necessity.

The consistent lack of documentation, coupled with the conditions routinely provided on the MA-037 forms as the basis for medical necessity, lead the department to reasonably believe that the Medicaid program is paying for abortions that are not actually medically necessary, but are, in fact, elective, nontherapeutic abortions,” the rule proposal said.

The proposal would require a claim for Medicaid reimbursement to include a number of supporting documents, including a medical history, the results of a physical exam, and confirmation of a medical professional’s diagnosis. It would also say Medicaid reimbursement can only be made when a physician performs an abortion — not a physician assistant or advanced practice registered nurse.

In a statement to MTN, DPHHS director Charlie Brereton again argued the change was necessary.

“DPHHS must ensure that abortions paid for by Montana taxpayers under Medicaid are truly medically necessary, in accordance with the law,” he said. “We welcome comment on the proposed rule and look forward to further protecting the integrity of our Medicaid program through its finalization and implementation.”

But opponents of the change are expressing concerns about the impact it would have on those seeking an abortion.

“It’s functionally an abortion ban for low-income families,” said Aileen Gleizer, a communications consultant with Blue Mountain Clinic. “If individuals have private health insurance, they don’t have to go through these hoops.”

Gleizer says about half of the clinic’s abortion patients are covered by Medicaid, and that other clinics have seen similar numbers.

“Abortions are a time-sensitive service, so the mandatory prior authorization is particularly harmful,” she said. “It would delay abortions later in pregnancy, it would make them more expensive, more invasive, require a longer recovery.”

Gleizer also serves as a board member for the Susan Wicklund Fund, which provides financial support for people seeking an abortion. She said, since the vast majority of Montana counties do not have abortion providers, many of the patients they work with are traveling hundreds of miles. She said the additional requirements – especially the need for a physical exam, which she said could prevent approval by telemedicine – would hit those patients especially hard.

“Adding additional preauthorization, additional appointments, would delay,” said Gleizer. “And we don’t know what that process looks like, and what rejection looks like.”

DPHHS will hold a public hearing on this rule change Thursday, Jan. 12, at 1 p.m., via remote conferencing. The department will accept public comment through Jan. 20.

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Reform- Georgia establishes its own health insurance portal, Georgia Access

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Georgia even had to fight to do its healthcare marketplace website the way it wants to- and now their new one won’t really point people to “free” (subsidized) plan options.



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The homepage for the new Georgia Access website, set to go live in January, was built by the state government in fall 2022.

Credit: Screenshot

ATLANTA — After failing to win federal approval to exit the federal insurance marketplace earlier this year, Georgia has established its own health insurance portal directing people to private insurers and brokers to buy health insurance. 

The new website, called Georgia Access, includes links to 10 health insurance companies — including big players such as United, Kaiser Permanente, and Aetna — as well as seven online brokers, organizations that help people shop for and enroll in health insurance.  

The dueling state and federal websites each offer a different route to the same destination: signing up for health insurance.  

Georgians can use the links on to explore the insurance companies’ and brokers’ offerings, which include but are not limited to the same marketplace plans offered on the federal website.  

The new Georgia Access site also includes links to companies and brokers that offer dental and vision plans, basic information about Medicaid and PeachCare for Kids, and links to state health care agencies that assist with mental health.  

But notably absent from the state’s new portal is a link to the federal, a one-stop shop for buying health insurance coverage through the Affordable Care Act. The website provides comparisons of the different companies’ health plans.

The state decided to set up the portal with the resources it had initially devoted to its plan to exit the federal marketplace, said Gregg Conley, executive counsel for the Georgia Department of Insurance.  

Republican Gov. Brian Kemp first sought permission to exit the federal health insurance marketplace back in 2020. But the Biden administration rejected the Georgia plan earlier this year after analyses showed it would cover fewer, not more, Georgians than the federal marketplace.  

According to Georgia Access, 1.3 million Georgians lack health insurance.

“I would encourage people to sign up for health [insurance],” Conley said. “What we don’t want is people not to have health care.”

But many advocates argue that online brokers and private insurers are not the best custodians of consumers’ interests.  

Insurance companies and brokers, most of which are for-profit entities, may push people to enroll in “substandard” plans that don’t cover all services, Joan Alker, a research professor at Georgetown University, wrote earlier this year.  

Brokers may fail to help people enroll in Medicaid or other state health insurance plans for people with low incomes and they may not adequately cater to the needs of racial and ethnic minorities and people who are not proficient in English, Alker wrote. 

In Georgia, legislative Democrats have called for expanding Medicaid to address the state’s large population of uninsured people.  

“Georgia should expand Medicaid,” House Minority Leader James Beverly, D-Macon, said Wednesday. “I am calling on the governor and the Georgia legislature to make it priority No. 1 to ensure every Georgian has access to quality health care benefits.”

Open enrollment for marketplace plans ends on Jan. 15, 2023. That gives Georgians just two more weeks to select their plans for next year, whether through the links provided on or the federal 

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.

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PHE/Elig: Budget Act Includes Items on Medicaid Eligibility, Telehealth, Mental Health

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Technically what the new law does is it allows states to start redeterminations back. It doesn’t actually declare the PHE funding over. And you better believe people are looking for ways to keep that $40B+ annual bump alive.


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After a nearly three-year pause, states may resume eligibility redeterminations for Medicaid beneficiaries beginning in April. This is one of several health-related provisions included in the Consolidated Appropriations Act of 2023, the federal budget bill signed into law Dec. 23.

During the COVID-19 public health emergency, state Medicaid programs received enhanced federal Medicaid funding, and in exchange, state officials were not permitted to terminate coverage for most Medicaid enrollees. That limitation ends in April under the federal budget act.

Notably, Arkansas law requires Medicaid officials to complete the redetermination process within six months.

In separate but related provisions, the act will also require state Medicaid programs to keep children continuously enrolled for 12 months after they are deemed eligible. The law also makes permanent the option for states to continue coverage for pregnant women 12 months postpartum. The American Rescue Plan previously offered states the option to extend coverage for up to five years postpartum.

Many federal health agencies will receive boosts in funding under the budget act. The U.S. Department of Health and Human Services will receive approximately $10 billion more in funding compared to last year ($120.7 billion in total). The Centers for Disease Control and Prevention will receive an increase of $760 million ($9.2 billion in total) to enhance public health infrastructure and surveillance efforts.

Medicare telehealth flexibilities permitted during the public health emergency will now be continued through the end of calendar year 2024. A few examples of these flexibilities include allowing telehealth care delivery at any site at which a patient is present (including their home), continuing to allow federally qualified health centers and rural health clinics to provide telehealth services, and extending coverage of audio-only telehealth services. Medicare physician reimbursement rates, which were set to decrease by 4.5% in 2023, will instead be reduced by 2% in 2023 and by about 3% in 2024.

The budget act also includes provisions designed to protect pregnant and breastfeeding workers. It requires employers to provide reasonable accommodations for medical conditions related to pregnancy and prohibits employers from refusing employment to workers needing such accommodations. The act also requires employers to provide time and space for breastfeeding mothers to pump breastmilk, further clarifying that the space provided must be private and cannot be a bathroom.

The act also includes enhanced funding opportunities for programs aimed at improving mental health, substance use disorder, and crisis intervention services. Examples include funding for mobile health sites for mental health services, Medicare coverage for family and marriage counseling services, and a requirement that Medicaid programs offer searchable directories of mental health service providers.

Finally, the act includes efforts to bolster the physician workforce. In 2026, an additional 200 Medicare-funded graduate medical education positions will be established, with half of the positions dedicated to psychiatry and psychiatry subspecialty residencies. Ten percent of these positions will be dedicated to rural hospitals, hospitals that serve in health professional shortage areas, and hospitals in states with new medical schools.