New CMS rule offers guidance on Medicaid access

Share this content:
U.S. Supreme Court
U.S. Supreme Court

The Centers for Medicare & Medicaid Services has issued a newly proposed rule to help Medicaid recipients maintain access to healthcare, even as states struggle to keep up with Medicaid budget shortfalls.

Under the rule, states must periodically conduct an analysis of their payment rates and enrollee needs to determine if recipients have adequate access to care. The results of each analysis will be made available to the public and CMS. This regulation is based on recommendations from the Medicaid and CHIP Payment and Access Commission. The commission's three-part framework offers guidance to states by focusing on enrollee needs, the availability of care and providers and the use of services.

Friday's issuance of the rule follows a Supreme Court announcement earlier this year that it would consider tackling the issue of Medicaid payments. The high court said that there have been several recent federal court rulings, many of which contradict each other, about whether states have the right to reduce Medicaid reimbursements to providers, in an effort to repair budget shortfalls. Medicaid is by far the largest single funder of long-term care in America.