New Medicaid Regs Seeks to Enhance MCO Accountability, Advance Health Equity

A comprehensive pair of rules introducing new “access standards” in Medicaid and the Children’s Health Insurance Program (CHIP) propose new requirements touching on multiple aspects of managed Medicaid, from medical loss ratio (MLR) reporting and state directed payments (SDPs) to provider payments and quality ratings. Industry experts tell AIS Health, a division of MMIT, that such changes are intended to ensure that Medicaid dollars are being used appropriately in managed care, support the Biden administration’s efforts to advance health equity and align Medicaid and CHIP with other government programs such as Medicare Advantage and the Affordable Care Act exchanges. But experts say not all provisions will be easy to implement, and the rules should be viewed as directing incremental steps toward moving the needle on health equity.

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Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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