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National Health Law Program

23 stories

Managed Care·17d ago

National Health Law Program Calls for State Enforcement of Behavioral Health Network Adequacy Standards

The National Health Law Program is urging states to strengthen enforcement of network adequacy requirements for behavioral health services in Medicaid managed care plans. The organization highlights gaps in provider networks that leave enrollees unable to access timely mental health and substance use disorder treatment. States have existing authority under federal Medicaid managed care regulations to monitor network adequacy through time and distance standards, appointment wait times, and secret shopper surveys. The recommendation comes as states face ongoing challenges ensuring adequate behavioral health provider networks in managed care arrangements.

Federal Policy·24d ago

OBBBA Changes Medicaid Improper Payment Penalties, Increasing State Financial Liability

The Obligation-Based Budgeting and Accrual (OBBBA) legislation changes how improper payment penalties apply to state Medicaid programs under the Payment Error Rate Measurement (PERM) program. According to the National Health Law Program analysis, the changes expose states to significantly increased financial liability when their Medicaid error rates exceed federal thresholds. The modifications alter long-standing PERM rules that determine when CMS can impose financial penalties on states for payment inaccuracies. NHeLP provides recommendations for states to mitigate potential adverse effects from the new penalty structure.

State Policy·54d ago

NHeLP Intern Advocates for Medicaid Coverage of Climate-Informed Doula Services

A National Health Law Program intern argues that Medicaid should cover doula care tailored to climate-related pregnancy risks, including extreme heat, flooding, and natural disasters. The piece focuses on how environmental hazards affect maternal health outcomes and birth experiences. While doula coverage is expanding in many state Medicaid programs, the article addresses the intersection of climate impacts and maternal health services. The advocacy positions climate-conscious doula care as a health equity priority for pregnant Medicaid beneficiaries in vulnerable communities.

Legal·81d ago

National Health Law Program Examines Crisis Pregnancy Center Medicaid Billing Practices

The National Health Law Program has published analysis examining the relationship between crisis pregnancy centers and Medicaid reimbursement. CPCs, which typically do not provide abortion, contraception, or comprehensive reproductive health services, may seek Medicaid payment for limited services such as pregnancy tests and ultrasounds. The analysis raises questions about billing practices, scope of services, and regulatory oversight of these facilities within Medicaid programs. The issue affects managed care organizations that may receive claims from CPCs or face questions about network adequacy and covered services for reproductive health.

State Policy·CA·88d ago

California Launches Birthing Care Pathway to Improve Medicaid Maternity Outcomes

California's Department of Health Care Services has implemented a Birthing Care Pathway as part of a multi-pronged state initiative to improve maternity care delivery. The pathway is one of three current California programs targeting maternal health outcomes, alongside the Transforming Maternal Health Model and Rural Health Transformation Program. The initiative affects Medicaid managed care organizations operating in California and their contracted maternity care providers. This is part of California's broader strategy to address maternal mortality and morbidity through structured care delivery frameworks.

Managed Care·101d ago

National Health Law Program Calls for Expanded Menopause Coverage in Medicaid

The National Health Law Program identifies significant barriers to menopause care for Medicaid enrollees, including coverage gaps and access challenges. Approximately 6,000 people enter menopause daily in the U.S., experiencing symptoms like hot flashes, bone loss, sleep disturbances, and cognitive changes that can be disabling but treatable. The organization highlights that Medicaid beneficiaries, low-income individuals, and people of color face disproportionate obstacles in accessing menopause treatment. The article advocates for improved coverage policies to address these disparities.

State Policy·103d ago

Advocacy Group Recommends Using State Advisory Councils to Track Work Requirement Implementation

The National Health Law Program published guidance recommending that state advocates use Medicaid Advisory Committees and Beneficiary Advisory Councils to monitor implementation of work requirements mandated under recent federal legislation. The organization cites the rapid timeline states face to implement these changes as creating monitoring challenges. The guidance aims to help advocates track how states operationalize the new requirements through existing advisory body structures. While the article provides advocacy strategy recommendations, it does not detail specific work requirement provisions, state implementation timelines, or federal enforcement mechanisms.

State Policy·CA·107d ago

California DMHC Finds 70 Knox-Keene Violations in Commercial Plan Behavioral Health Audits

The California Department of Managed Health Care identified 70 Knox-Keene Act violations across three investigation rounds involving commercial health plans' delivery of behavioral health services for mental health and substance use disorder treatment. The violations indicate systemic failures in timely access to care. While these investigations targeted commercial plans regulated under Knox-Keene, the findings may signal enforcement priorities that could extend to Medi-Cal managed care plans, which are also subject to DMHC oversight and similar network adequacy standards for behavioral health.

Legal·108d ago

Legal Aid Groups Convene on Medicaid Cuts and Automated Eligibility Denials

Legal advocates gathered at the ABA/NLADA Equal Justice Conference in Charlotte to address threats to Medicaid from proposed federal budget cuts and automated eligibility systems. The National Health Law Program highlighted concerns about the One Big Beautiful Bill Act, which proposes significant Medicaid spending reductions, and automated systems that are denying coverage to eligible beneficiaries. The conference focused on legal strategies to protect Medicaid access and eligibility processes. No specific implementation dates or regulatory actions were announced.

Legal·108d ago

Olmstead Decision Marks 27 Years as Community Integration Faces Medicaid Budget Threats

The 27th anniversary of Olmstead v. L.C. arrives as the landmark Supreme Court decision establishing the right to community-based services faces new challenges from proposed Medicaid cuts. The 1999 ruling required states to provide services in the most integrated setting appropriate to individuals' needs, fundamentally reshaping long-term services and supports delivery through Medicaid managed care. Current budget proposals threaten funding for home and community-based services that emerged from Olmstead's community integration mandate, potentially reversing decades of progress in moving individuals out of institutional settings.

Federal Policy·109d ago

NHeLP Report Finds Electronic Asset Verification Creates Rural Medicaid Access Barriers

The National Health Law Program released a report examining how electronic asset verification systems in Medicaid create enrollment barriers for rural residents, particularly Black rural populations. The report identifies gaps in rural banking infrastructure and property transfer documentation that interfere with automated eligibility systems. The analysis focuses on how Medicaid agencies' reliance on electronic verification tools may disproportionately delay or deny coverage for applicants in areas with limited financial institution networks and informal property arrangements. The report provides recommendations for state Medicaid programs to address these verification challenges.

State Policy·CA·117d ago

National Health Law Program Publishes Updated Medi-Cal Advocacy Guide for California

The National Health Law Program has released an updated advocate's guide to Medi-Cal services in California. The guide is designed to help advocates, beneficiaries, and legal professionals navigate California's Medicaid program, which covers 15 million low-income residents. The resource addresses current challenges including federal and state budget pressures and potential cuts to the program. It serves as a reference tool for understanding Medi-Cal eligibility, covered services, and beneficiary rights in California's managed care environment.

State Policy·ID·128d ago

Idaho Seeks Waiver to Move Medicaid Enrollees to ACA Marketplace Coverage

Idaho has submitted a waiver application requesting federal approval to transition certain Medicaid enrollees to ACA Marketplace plans while maintaining Medicaid-specific requirements, including work requirements. If approved, affected enrollees would face higher out-of-pocket costs and reduced benefit protections compared to traditional Medicaid coverage. The proposal would impact thousands of Idaho residents currently enrolled in Medicaid. Managed care organizations operating in Idaho should monitor this waiver for potential impacts on enrollment, member cost-sharing, and program design if the administration approves the state's request.

State Policy·CA·129d ago

California to Cut Medi-Cal Dental Benefits for 2 Million Immigrants in July 2026

California will eliminate full-scope dental coverage for approximately 2 million adult immigrants enrolled in state-only funded Medi-Cal effective July 1, 2026, limiting them to emergency dental services only. Pregnant individuals retain full dental benefits during pregnancy and for 12 months postpartum. This policy reversal affects immigrants in state-funded Medi-Cal programs who previously gained comprehensive dental coverage. Managed care organizations administering Medi-Cal dental benefits will need to adjust benefit packages, care coordination protocols, and provider network contracts to reflect the reduced scope of services for this population beginning mid-2026.

State Policy·129d ago

NHeLP Brief Analyzes ADA Challenge to State Vaccine Mandate Prohibitions

The National Health Law Program released an issue brief examining potential Americans with Disabilities Act challenges to state laws that prohibit or weaken vaccine mandates. The brief addresses a growing trend of state legislation expanding vaccine exemptions, with Florida poised to become the first state to ban public vaccine requirements. The analysis is relevant to Medicaid managed care organizations that serve immunocompromised enrollees and children with disabilities who face heightened risks when community vaccination rates decline. MCOs may need to assess how state vaccine policy changes affect care management protocols and member safety.

Managed Care·129d ago

TV Drama Highlights Medicaid Redetermination Barriers Affecting Coverage Continuity

The Max series 'The Pitt' depicts a common Medicaid coverage loss scenario: a redetermination notice sent to an outdated address, followed by prolonged re-enrollment struggles due to documentation requirements. The storyline reflects real-world challenges MCOs face during the unwinding period, where administrative barriers—including unforwarded mail and burdensome income verification for gig workers—disrupt continuity of care. Health plans should note this mirrors ongoing member retention issues and the need for robust outreach systems to prevent procedural terminations.

Industry·129d ago

NHeLP Executive Director Marks Medicaid Awareness Month, Cites Program's Reach to 70 Million

The National Health Law Program's new Executive Director released a reflection for Medicaid Awareness Month in April, highlighting the program's role in serving over 70 million enrollees. The statement emphasizes Medicaid's impact on health outcomes and economic security. This marks leadership commentary during a period of heightened attention to Medicaid coverage and access issues. The piece appears to be an advocacy blog post rather than a policy or regulatory announcement.

State Policy·CA·129d ago

California Budget Proposes Cutting Community-Based Mobile Crisis Response Services

California's Administration has proposed cutting funding for community-based mobile crisis response services, which provide 24/7 in-person behavioral health crisis intervention in homes, schools, and community settings. These services involve specially trained crisis response teams with specific composition and timeliness requirements. The National Health Law Program argues the proposed cuts will harm beneficiaries without generating real savings. The timing and effective date of potential cuts remain unclear, but managed care organizations with behavioral health responsibilities should monitor this budget proposal as it could affect crisis service availability and network adequacy requirements.

State Policy·CA·129d ago

California Proposes Applying Federal Work Requirements to State-Funded Immigrant Medicaid Coverage

California is considering extending work requirements from the 2025 Reconciliation Act (H.R. 1/OBBBA) to immigrants covered through state-only Medi-Cal funding, despite the Governor's Office previously calling OBBBA "not cost-saving" and "cruel." State stakeholders project the requirements will cause coverage losses through administrative churn rather than generate savings. The proposal would affect immigrants ineligible for federally-funded Medicaid who currently receive state-funded benefits. This marks a significant policy shift as California would voluntarily apply federal work requirement provisions to populations the federal mandate does not reach.

State Policy·CA·129d ago

Federal Marketplace Rule and H.R.1 Target California Exchange Coverage

The Trump Administration's Marketplace Final Rule and pending H.R.1 legislation contain provisions that could significantly reduce enrollment and affordability in Covered California and other state-based marketplaces. The changes affect eligibility, premium subsidies, and plan requirements that have expanded coverage since the ACA's implementation. California Medicaid managed care organizations may see enrollment shifts as marketplace enrollees lose coverage or face higher costs. Implementation timelines depend on final regulatory effective dates and congressional passage of H.R.1.

Federal Policy·129d ago

NHeLP Outlines State Strategies to Mitigate OBBBA Administrative Burdens on Medicaid Eligibility

The National Health Law Program published guidance for states on mitigating administrative challenges created by the One Big Beautiful Bill Act (OBBBA). The legislation imposes more frequent renewals, work requirements, and additional eligibility checks that will increase strain on state Medicaid agencies and enrollees, particularly individuals with disabilities. NHeLP recommends states prepare operational "landing pads" to prevent coverage disruptions as these changes take effect. The guidance is critical for managed care organizations whose enrollment stability and member outreach will be directly affected by states' administrative capacity during implementation.

Industry·129d ago

Enhanced Premium Tax Credits Expire, Raising Marketplace Premiums for Low-Income Enrollees

Enhanced premium tax credits (ePTCs) for ACA Marketplace plans expired December 31, 2024, after Congress failed to extend the subsidy enhancement. Average monthly out-of-pocket premiums increased for millions of enrollees following the January 31 close of Open Enrollment. The expiration particularly affects low-income individuals who may have been previously eligible for both Marketplace subsidies and Medicaid, creating potential churn between coverage programs as affordability deteriorates.

Federal Policy·129d ago

NHeLP Launches Weekly Medicaid Work Requirements Implementation Tracker

The National Health Law Program has begun publishing a weekly series addressing Medicaid work requirements and implementation issues under the One Big Beautiful Bill Act. The resource aims to help advocates monitor federal and state agency actions as policy changes roll out. The series will provide practical guidance on emerging compliance and operational issues. This matters for MCOs because work requirements typically impose new eligibility verification, enrollment monitoring, and reporting obligations on plans under contract with states implementing these policies.

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