MHPA Policy Positions and Issue Briefs
High-Cost Drugs in Medicaid (January 2025)
Recent breakthroughs introducing novel prescription drugs to the market have created both opportunities and challenges for the Medicaid program. In this issue brief, MHPA discusses recent drug spending trends, including for high-cost specialty drugs, and the role Medicaid Managed Care Organizations play in this ecosystem. MHPA highlights key policy positions on these topics, including the need for timely and appropriate access to new treatments and therapies, the importance of financial sustainability in drug spending, and the role of patient engagement on care delivery.
The Value of Medicaid Managed Care (July 2024)
The value of Medicaid managed care is demonstrated on a daily basis through the quality of care and services delivered to Medicaid enrollees across the United States and through support for the financial sustainability of the Medicaid program. Providing comprehensive medical benefits and services to almost 75% of Medicaid enrollees, Medicaid managed care organizations (MCOs) have the flexibility to deliver services and care coordination beyond what is available under a fee-for-service (FFS) model meeting the holistic needs of individuals through value-added services, such as medically tailored meals and transportation.
Connecting to Coverage Coalition - Medicaid: Looking Beyond the Unwinding (June 2024)
With millions at risk of losing coverage during the Medicaid unwinding process, the Connecting to Coverage Coalition (CCC) has published a new white paper outlining key recommendations for ensuring continuous coverage: extending ex parte renewal flexibilities, increasing data transparency, and reducing administrative burdens for smoother transitions between federal health programs.
Medicaid Managed Care: Comprehensive Compliance & Continuous Accountability (May 2024)
The Medicaid program is a joint federal and state partnership that provides free or low-cost health coverage to approximately 78 million Americans, including many low-income individuals, families and children, pregnant women, the elderly, and people with disabilities. Federal law sets overarching requirements for Medicaid programs, such as the coverage of certain benefits, but provides states substantial flexibility related to operational aspects of program implementation.
MHPA Technology, Education, and Action Workgroup (May 2024)
MHPA shares the following recommendations to support technological innovation and the adoption of technologies to improve the health care experience for Medicaid beneficiaries, caregivers, providers, and other stakeholders. Convening a special workgroup throughout 2023, MHPA brought together technology leaders from member health plans to find consensus on support for innovation-focused and technology-related policy proposals with the most significant impact on improving access for Medicaid enrollees.
Continuous Eligibility for LTSS (updated May 2024)
Given the evidence-based benefits of continuous eligibility (CE) for health outcomes, health equity, and overall costs, and the care needs of individuals qualifying for long-term services and supports (LTSS) under Medicaid, MHPA encourages the development, broad availability, and implementation of CE policies for Medicaid populations receiving LTSS. In our newest Issue Brief, the Association recommends that federal policymakers establish a statutory state option and encourage the implementation of section 1115 demonstration waivers.
Access to Behavioral Health (February 2024)
Federal law mandates Medicaid coverage of many behavioral health benefits with states having the flexibility to cover additional optional behavioral health benefits. However, behavioral health services are not a specifically defined category of Medicaid benefits. With the release of recent federal guidance and the launch of a new Biden-Harris Administration initiative, opportunities have increased for states and stakeholders to support SDOH in the Medicaid program. In this new resource, MHPA details how Medicaid managed care facilitates access to behavioral health care.
Social Determinants of Health (January 2024)
Unmet SDOH needs can contribute to decreased access to care and poorer health outcomes. MHPA strongly encourages and supports efforts to address SDOH and the HRSN of Medicaid enrollees. Working with their state partners, Medicaid MCOs have been effectively serving complex populations with person-centered care, including services that address SDOH and HRSN, within the parameters of the Medicaid program for many years; this experience has well-positioned Medicaid MCOs to understand how to best meet and coordinate the medical and non-clinical needs of Medicaid beneficiaries.
Policy Recommendations on Post-COVID-19 Redeterminations Period (November 2023)
During the unwinding of continuous coverage requirements tied to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has offered states numerous flexibilities aiming to minimize procedurally related coverage losses in Medicaid and CHIP. The adoption of these flexibilities has yielded valuable lessons learned which can be carried forward into the post COVID-19 era of Medicaid. As the resumption of eligibility determinations for Medicaid continues, MHPA offers these recommendations.
Health Equity in Medicaid (November 2023)
MHPA believes that Medicaid is a health equity program designed to support individuals who are underserved and face complex socioeconomic and clinical circumstances. In furtherance of health equity, MHPA supports efforts to identify and address barriers to care, promote social engagement through tailored outreach and communications, and collect and analyze data to inform and improve outreach and quality of care for traditionally underserved and vulnerable populations.
Prior Authorization (October 2023)
It's a phrase that's often used in media reports but is easily misunderstood outside the health care delivery system. Learn the objectives behind "prior authorization" and how it's used throughout the health care sector to enhance patient safety, increase evidence-based care, and reduce overutilization of medically unnecessary or low-value services.
Dual Eligibility for Medicare & Medicaid (June 2023)
MHPA supports meeting the health care and social service needs of dually eligible individuals through the delivery of care and services that are coordinated and integrated and that are aligned in the best interests of dually eligible individuals. We believe this approach facilitates the delivery of quality care, better outcomes, and increased value to the health care system through reduced spending and the elimination of silos that create care fragmentation.
Medicaid Managed Care (June 2023)
Medicaid MCOs deliver high quality health care to nearly three-quarters of America's 91 million Medicaid enrollees. As policymakers in Congress consider legislation to fund Medicaid, it's imperative that they understand the value of managed care and the impact it has on the lives of their constituents.
Rate Setting (May 2023)
MHPA supports adherence to two essential programmatic principles throughout the capitation rate-setting process to ensure the continued financial viability and stability of Medicaid MCOs and the sustainability of the Medicaid program: 1) actuarial soundness and 2) transparency.
Medicaid Expansion (May 2023)
Given the impact of Medicaid expansion on beneficiaries, healthcare system stakeholders, taxpayers, and policymakers, we believe states that choose to expand Medicaid are making a positive difference in the health and wellbeing of their state residents.
Pharmacy Carve-Outs (September 2022)
MHPA supports integrated care delivery for the Medicaid pharmacy benefit. Pharmacy benefit carve-in models delivered through comprehensive risk-based Medicaid managed care support integrated care for the whole person resulting in improved health outcomes and cost savings.
Managed Long-Term Services and Supports (December 2019)
MHPA's support for MLTSS is grounded in the belief that managed long-term services and supports are valued health care options for Medicaid beneficiaries that can make a meaningful difference in their lives, health outcomes, and quality of care.