What Do We Know About People with HIV Who Are Not Engaged In Regular HIV Care? June 22, 2023 Issue Brief This analysis uses nationally representative data to assess the characteristics and experiences of people with HIV who are out of regular HIV care. Reaching and engaging people with HIV who are not in care involves addressing the complex and systemic barriers they face, which impede both their health and wellbeing and also the HIV response in the U.S. more broadly.
Medicaid Managed Care Network Adequacy & Access: Current Standards and Proposed Changes June 15, 2023 Issue Brief This brief describes current network adequacy and availability standards for Medicaid managed care plans, presents related findings from KFF’s 22nd annual Medicaid budget survey, and summarizes proposed changes to network adequacy and access rules in the Managed Care NPRM.
Standardized Plans in the Health Care Marketplace: Changing Requirements May 8, 2023 Issue Brief This brief examines the evolving requirements for insurers on HealthCare.gov to offer standardized plans that follow set cost sharing rules for covered benefits in addition to other plans they might offer. It also reviews how some state-run marketplaces have used standardized plans to limit cost sharing for insulin, mental health care, and other services.
Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans May 1, 2023 Blog Recently released data show that Medicare Advantage, the private plan alternative to traditional Medicare, now covers half of eligible Medicare beneficiaries. As the role of Medicare Advantage grows, so will interest in understanding how well the program serves the increasingly diverse group of enrollees who receive their Medicare coverage from private insurers.
Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans April 28, 2023 Issue Brief This brief describes the scope of mental health and substance use disorder benefits in Medicare Advantage plans, including extra benefits, cost sharing, and prior authorization and referral requirements, based on an analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage plan benefit and enrollment files for 2022.
Medicaid Financing: The Basics April 13, 2023 Issue Brief Medicaid represents $1 out of every $6 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.
Medicare and People with HIV March 27, 2023 Issue Brief This data note provides an overview of the role of the Medicare program for people with and at risk for HIV.
Medicaid and People with HIV March 27, 2023 Issue Brief This data note provides an overview of the role of the Medicaid program for people with and at risk for HIV.
Unwinding the Continuous Enrollment Provision: Perspectives from Current Medicaid Enrollees March 9, 2023 Issue Brief This brief describes 10 key points about the unwinding of the Medicaid continuous enrollment requirement, highlighting data and analyses that can inform the unwinding process as well as recent legislation and guidance issued by the Centers for Medicare and Medicaid Services (CMS) to help states prepare for the end of the continuous enrollment provision.
Claims Denials and Appeals in ACA Marketplace Plans in 2021 February 9, 2023 Issue Brief This analysis of HealthCare.gov Marketplace insurers’ transparency data finds that 17% of in-network claims were denied in 2021, with denial rates varying widely across insurers. Consumers appealed less than two-tenths of 1% of denied in-network claims.