Final Medicaid Managed Care Rule Updates Guidance to Improve Consumer Experience

By Carolyn McCoy

In May, the Centers for Medicare & Medicaid Services (CMS) released the final rule to guide Medicaid and the Children’s Health Insurance Program (CHIP) managed care delivery systems. This serves as an important update to rules that had not been revised since 2002, and responds to the many changes in how consumers access health insurance. The regulation seeks to align Medicaid rules with the rules that govern other major sources of insurance for consumers, including coverage offered through the marketplace, with one of the goals being to enhance the consumer experience. With more than 72 million people enrolled in Medicaid as of the most recent enrollment report, the impact of the rule is broad.

Enroll America provided recommendations to the Department of Health and Human Services (HHS) in July 2015, to support aspects of the rule that ensure managed care policies enable consumers to have an easy and straightforward Medicaid enrollment experience that best positions them to get covered and stay covered. This included things like access to enrollment materials in non-English languages, alignment of annual re-enrollment schedules for all enrollees in the same household, and requiring consumer support services to be coordinated with marketplace in-person assistance programs.

We were pleased to see that the final rule makes great progress in improving the consumer experience for Medicaid managed care enrollees in areas such as clearer guidelines for translation and oral interpretation requirements, requiring states to establish an independent beneficiary support system, and appeals rules that are better aligned with the marketplace and Medicare Advantage.

Enroll America will continue to work with thousands of partners across the country to reach consumers with information about how to get covered by Medicaid all year round, and these new rules will make it easier for consumers to make educated decisions about which Medicaid plan to enroll in and to get the support they need to stay covered.

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