Rules for Private Medicaid Plans

  • ‘Milestone’ rules would limit profits, score quality for Medicaid plans, By Jay Hancock, May 27, 2015, St. Louis Post-Dispatch: “Sweeping proposals disclosed Tuesday would create profit guidelines for private Medicaid plans as well as new standards for the plans’ doctor and hospital networks and rules to coordinate Medicaid insurance more closely with other coverage.  ‘We are taking steps to align how these programs work,’ said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, which proposed the rules.  Privatized Medicaid has grown rapidly as budget-pinched states have responded to commercial insurers’ promise to deliver care for a fixed price. Most beneficiaries of Medicaid — state programs for the poor run partly with federal dollars — now get care through contracted insurers…”
  • Pennsylvania moves to keep pace with increase in Medicaid, By Bill Toland, May 29, 2015, Pittsburgh Post-Gazette: “With Medicaid enrollment growing nationally and in Pennsylvania, the federal government is proposing new oversight of privately administered Medicaid plans, tightening profit guidelines for insurers and keeping a closer eye on doctor availability for patients.  Participation in Medicaid, the state-run health insurance plan for the poor and disabled, has grown by about 10 million in the U.S. over the last 18 months, an increase driven by federal subsidies and the broad income-based eligibility expansion included in the 2010 Affordable Care Act…”

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