Centers for Medicare & Medicaid Services

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This year, thousands of individuals in Southern California were impacted by the Palisades Fire and Eaton Fire. The fires were the second and fourth most destructive in the state’s history.[1] In 2024, millions of individuals in the southeastern United States were impacted by Hurricanes Helene and Milton. These hurricanes made landfall less than two weeks apart, establishing a new record for the shortest interval between two significant hurricanes in Florida.[2] The Southern California wildfires and Hurricanes Helene and Milton exemplify the pattern of increasingly severe and frequent natural disasters attributed to a changing climate. Such climate-related disasters have profound implications for healthcare systems, underscoring the necessity for coordinated efforts between federal and state governments to ensure the continuity of healthcare services and access to medical care. As a result of the Southern California wildfires, over 700 people were evacuated from nursing homes and other care facilities.[3] In Florida alone, over 350 healthcare facilities were evacuated as a preventative measure against Hurricane Milton.[4] Hundreds of other healthcare facilities throughout the region faced evacuations, closures, and damage as result of the hurricanes. Preparedness and swift response measures at all levels of government are essential to safeguard lives in the face of natural disasters.

Continue Reading The Role of Federal and State Governments in Maintaining Healthcare During Natural Disasters

On December 17, 2024, the House Task Force on Artificial Intelligence (Task Force) released a highly-anticipated report titled, “Bipartisan House Task Force Report on Artificial Intelligence,” (the Report) which establishes guiding principles and issues recommendations to guide U.S. innovation in artificial intelligence (AI), including in the healthcare sector. The Report is intended to serve as a blueprint for Members of Congress as they conduct oversight and introduce legislation to address advances in AI technologies, including the regulation of health-specific AI applications.

Continue Reading House Task Force on AI Issues Report and Proposes Healthcare Recommendations

In January 2024, the Centers for Medicare and Medicaid Services (CMS) announced a new innovation care delivery model that seeks to bridge the gap between behavioral and physical health. The Innovation in Behavioral Health (IBH) Model aims to improve the quality of care and behavioral and physical health outcomes for adults with moderate to severe mental health conditions and substance use disorders (SUDs). The IBH Model will service beneficiaries who are enrolled in Medicare and Medicaid, including those who are dual eligible.[1] These populations experience higher than average rates of mental health conditions or SUDs, or both, highlighting the importance of a model that integrates behavioral and physical healthcare as well as addressing health-related social needs (HRSN).[2]

Continue Reading CMS Notice of Funding Opportunity for the Innovation in Behavioral Health Model Open Until September 9, 2024

In December 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new model called the Transforming Maternal Health (TMaH) Model, the first of its kind to focus solely on improving maternal health care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. The model is intended to support state Medicaid agencies to address the physical health, mental health and social needs of mothers by developing whole-person approaches to pregnancy, childbirth, and postpartum care. The model’s overarching goal is to reduce disparities in access and treatment and to improve outcomes and experiences for mothers and their newborns. On June 26, 2024, CMS released the Notice of Funding Opportunity (NOFO) for states to apply. The NOFO will close for applications on September 20, 2024.

Continue Reading CMS opens Notice of Funding Opportunity (NOFO) for the Transforming Maternal Health (TMaH) Model

The end of the COVID-19 public health emergency (PHE) has pushed government benefit programs to reassess the use of their data that will ultimately improve access to health care benefits and streamline their processes to provide health and social services. With the end of pandemic-era policies like continuous enrollment, beneficiaries have been losing coverage while states face challenges reviewing Medicaid eligibility and may benefit from data sharing across government programs. Prior to the end of the PHE, KFF estimated that between 8 million and 24 million beneficiaries would be disenrolled. As of August 23, close to 5.4 million Medicaid beneficiaries have been disenrolled; and 74% of disenrollees have had their coverage terminated due to procedural reasons (e.g. changed addresses, did not receive a form, or did not have enough information about the renewal process).[i] This means that individuals are disenrolled because they did not complete the renewal process within a specific time frame or the state has outdated contact information.

Continue Reading Medicaid Redetermination Flexibilities and Data Sharing Under HIPAA

On July 10, 2023, the Center for Medicare & Medicaid Innovation (CMMI or “Innovation Center”) released a White Paper, Assessing Equity to Drive Health Care Improvements, outlining their analysis and assessment of health equity incorporation in model designs and evaluations. CMMI supports the development and testing of innovative health care payment and service delivery models. These innovation models are designed to improve quality of care and patient outcomes while reducing or maintaining program costs.[1]

Continue Reading CMS Innovation Center Reports Data Challenges in Assessing Health Equity

The Centers for Medicare & Medicaid Services (CMS) has recognized that addressing health care disparities and achieving health equity should drive our nation’s top health priorities.[1] According to the CMS Framework for Health Equity 2022-2023, health equity is defined as, “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes”. In order to eliminate health and health care disparities, there needs to be an effort to provide quality, equitable care to those in areas without access and availability to the services necessary to meet their health and social needs.

Continue Reading Examining the Use of the Area Deprivation Index in Value-Based Care Models

As we move into 2023, the impact of the pandemic on marginalized groups continue. The COVID 19-pandemic has exacerbated longstanding racial and ethnic disparities in health care. In terms of national healthcare spending, healthcare inequities make up about $230 billion in annual spending; and that amount could potentially reach $1 trillion by the year 2040 if inequities persist or worsen. In 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new strategic vision to guide the Centers’ model testing and priorities toward a vision of achieving equitable outcomes through high-quality, affordable, person-centered care. But it is important to also highlight what other federal agencies, states, and health plans are doing to address health inequity especially as our healthcare system, as a whole, is moving towards value-based care initiatives.

Continue Reading Health Sector Efforts to Address Health Equity and Affordability in 2023

Initiated in response to the COVID-19 pandemic, the Families First Coronavirus Response Act (FFCRA) requires Medicaid programs to keep beneficiaries continuously enrolled through the end of the public health emergency (PHE). The PHE is expected to end on May 11, 2023. Despite FFCRA’s initial timeline, the Consolidated Appropriations Act, 2023 (CAA 2023) established the end of the continuous enrollment provision to be March 31, 2023, in effort to reduce the enhanced federal Medicaid matching funds through December 2023. Accordingly, as of April 1, 2023, states can resume Medicaid disenrollment. The unwinding of the Medicaid continuous enrollment provision has raised concerns about the number of people who will lose coverage.

Continue Reading Medicaid Redetermination & Unwinding Updates