Monica Soni, Covered California’s chief medical officer, oversees an effort to hold health plans financially accountable for the quality of care they provide, including childhood vaccination rates, which have fallen in California and nationwide. She worries federal spending cuts could soon bring turbulence to the state’s Affordable Care Act marketplace.
This fall, the U.S. Government Accountability Office expects to release a report on how much it costs to run Georgia Pathways to Coverage — the country’s only active Medicaid work requirement program — as other states and Congress consider similar programs.
Carmen Aiken of Chicago thought their medical appointment would be covered because the Affordable Care Act requires insurers to pay for a long list of preventive services. But after the appointment, Aiken received a bill for more than $1,400.
Breakups between health providers and Advantage plans are increasingly common. The Centers for Medicare & Medicaid Services has allowed whole groups of patients to leave their plans.
Federal law requires states to offer health insurance to many people with low incomes or disabilities. But some states, including California, are far more generous than what’s required. Budget pressures may force lawmakers to cut benefits that have led to a historic low in the uninsured rate.
Montana’s powerful hospital lobby was instrumental in renewing the state’s Medicaid expansion program and has also fended off most legislation to increase state oversight of their business.
These fixers, officially known as caseworkers, unraveled complex and arcane health insurance rules to solve people’s coverage issues. They worked in a little-known federal department with which most consumers never interact — until they need help.
Although knee replacements are usually covered by health insurance, amputees face roadblocks to coverage and often must prove their prosthetics are medically necessary.
Republicans are pushing to implement requirements that Medicaid recipients work in order to obtain or retain coverage. Some states try to help enrollees find jobs. But states lack the data to show whether they’re effective.
Republicans are pushing to implement requirements that Medicaid recipients work in order to obtain or retain coverage. Some states try to help enrollees find jobs. But states lack the data to show whether they’re effective.
