Adding Up the Costs: Utah’s Latest Waiver Requests Would Likely Result in Loss of Medicaid Coverage for Thousands of Low-Income People
Utah's waiver policies would likely result in the loss of Medicaid coverage for significant numbers of low-income Utahans who rely on the program for health care
Section 1115 of the Social Security Act allows the Secretary of Health and Human Services to waive certain Medicaid requirements and approve state proposals for experimental projects in programs. The waivers, intended to promote innovation, are not new. Historically, states have used them to cover new populations or implement delivery system reforms like providing services to people through managed care. But recently waivers have attracted attention—including from the mainstream media— as states have started using them in radically different ways. A prominent example involves states using waivers to obtain federal permission to condition receipt of Medicaid on work and work-alternative requirements. The issue is the subject of ongoing litigation.
The Medicare Diabetes Prevention Program helps older adults with prediabetes make the required lifestyle changes to prevent diabetes, but there are currently few providers available to meet the growing need for the program
Not Hitting the Pause Button: CMS Approves Utah’s Work and Work Alternative Requirements after Court Upends Similar Policies in Kentucky and Arkansas
In spite of the recent legal setbacks experienced by Kentucky and Arkansas, other states continue to seek federal approval of waivers that include work and work alternative requirements for Medicaid recipients
Diabetes among older adults is associated with significant health and cost burdens. Nearly a quarter of individuals age 65 and older have been diagnosed with diabetes, and one of every three Medicare dollars is spent on beneficiaries living with the condition. An estimated one-half of the Medicare population is prediabetic, meaning their blood sugar levels are high but not high enough to warrant a diabetes diagnosis.
The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative (the Initiative) to improve the quality of care received by low-income adults who are eligible for Medicare and Medicaid — known as dual eligibles. Many of these individuals have unmet behavioral health needs, ranging from mild depression to serious mental illness, like schizophrenia and bipolar disorder. A recent update on the Initiative presented to the Medicare Payment Advisory Commission highlighted four challenges to providing behavioral health services to this population. This blog describes the challenges and proposes strategies to overcome them.
The good news is that appropriate treatment can help most older adults with depression. What’s more, Medicare has recently improved its coverage for people with mental disorders. It now covers a free annual depression screening, and beneficiaries no longer have to pay more for outpatient treatment of mental illnesses than they do for physical illnesses. In addition, Medicare’s prescription drug benefit covers essentially all antidepressants used to treat people with depression.
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