On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance announcing a new policy that, for the first time, will allow states to make participation in a work or “community engagement” program a condition for Medicaid enrollment. The next day, CMS approved a Medicaid waiver in Kentucky that will allow the state to test this new policy.

Over the past few months, the Medicare Rights Center has been actively engaged in considering and commenting on proposals from the Centers for Medicare & Medicaid Services (CMS) that could have significant effects on people who are enrolled in Medicare Advantage (MA) and Part D plans. Last week, CMS released both the Contract Year 2019 Final Rules for Medicare Advantage and Part D (Final Rules) and the 2019 Call Letter. CMS also released fact sheets for the Final Rule and the Call Letter. As we continue to analyze the Final Rules and Call Letter, as well as the impact of the recent two-year budget deal, here is a preview of the issue areas we intend to spotlight, which focus on regulatory trends, anticipated implementations, and practical changes that will impact people with Medicare and those who help them navigate coverage decisions.

The recently-passed Bipartisan Budget Act of 2018 (BBA of 2018) makes a number of changes to Medicare, including permanently authorizing Dual Special Needs plans (D-SNPs), which are Medicare Advantage (MA) plans for people who are dually eligible for Medicare and Medicaid.

To help inform implementation of these changes, earlier this month the Centers for Medicare & Medicaid Services (CMS) issued a request for stakeholder input on (1) The design of an integrated Medicare-Medicaid appeals approach for D-SNPs; and (2) The establishment of minimum state contract requirements for D-SNPs.

This week, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Advantage and Part D 2019 Rate Announcement and Call Letter. This is the finalized annual update to Medicare Advantage and Part D programs, which includes payment updates and policy changes for payment in calendar year (CY) 2019.

The Kaiser Family Foundation recently published a list of frequently asked questions about the Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare & Medicaid Services (CMS).

Also known as the “Innovation Center” CMMI was created by the Affordable Care Act to test new ways to improve care and lower costs within Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

The Commonwealth Fund recently released a report analyzing different proposals by states to impose a work requirement for Medicaid benefits and how those proposals would impact older adults and people with disabilities. To date, 12 states have proposed conducting demonstrations that add work requirements to Medicaid, and the Centers for Medicare & Medicaid Services (CMS) has so far approved proposals from Kentucky, Indiana, and Arkansas. Among other policy changes, these demonstrations would tie Medicaid benefits to a minimum work requirement.

Last week, Congress passed and the President signed legislation to fund the federal government for the remaining six months of fiscal year 2018 (FY18). The spending package, known as an omnibus, addresses several of Medicare Rights top priorities:

Health care in the United States is very expensive, and many experts believe one thing contributing to that expense is the abundance of unnecessary or “low-value” health care services provided to patients. Policymakers typically believe that patients receive this unnecessary care because they expect or demand it. However, this month, the University of Michigan revealed new polling data that turns that assumption upside down.

Last night, lawmakers unveiled draft legislation to fund the federal government for the remaining six months of fiscal year 2018 (FY18). Congress is expected to finalize the package this week in order to prevent a government shutdown when current federal funding expires at midnight Friday.

The report, Medicare Trends and Recommendations: An Analysis of 2016 Call Data from the Medicare Rights Center’s National Helpline, re-examines the top three issues heard on Medicare Rights’ helpline in prior years. Each issue is demonstrated through clients’ stories heard on the helpline, which the Centers for Medicare & Medicaid Services (CMS), state agencies, insurers, elected officials, and other stakeholders can use as a basis to strengthen the Medicare program for the more than 58 million people it serves.