Medicaid and the Children’s Health Insurance Program (CHIP) provide critical health coverage for millions of people. Through these programs, the Centers for Medicare and Medicaid Services (CMS) supports access to care in many ways. Most importantly, people gain access to health care services that may not be affordable without Medicaid or CHIP. Additionally, some programs and benefits include special protections—such as provider network and payment methods—that help ensure services are accessible.
Preventive care and other services help people stay healthy and avoid more costly care. CMS offers materials, toolkits, and other resources for states to help Medicaid and CHIP beneficiaries learn about these services and how to access them. CMS also supports many efforts to measure access, share the results, and promote progress.
Final Rule
CMS published the final rule, “Ensuring Access to Medicaid Services (CMS-2442-F)” on April 22, 2024. This final rule takes a comprehensive approach to improving access to care, quality, and health outcomes, and better addressing health equity issues in the Medicaid program across fee for service (FFS), managed care delivery systems, and in home and community-based services (HCBS) programs. These improvements increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care.
Additional information on the rule can be found in the Fact Sheet: Ensuring Access to Medicaid Services and the dates of applicability summary.
Proposed Rule
CMS published a Notice of Proposed Rulemaking (NPRM) titled, “Ensuring Access to Medicaid Services (CMS 2442-P)” on April 27, 2023. The proposed rule takes a comprehensive approach to improving access to care and quality and health outcomes, and seeks to better address health equity issues in the Medicaid program across fee for service and managed care delivery systems, including in HCBS programs. These changes were proposed to increase transparency and accountability and standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care.
The deadline to submit comments on the proposed rule was July 3, 2023. Additional Information:
- Fact Sheet: Ensuring Access to Medicaid Services (CMS 2442-P) and Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality (CMS-2439-P)
- Fact Sheet: Summary of Medicaid and CHIP Payment-Related Provisions
- Fact Sheet: Summary of Key Home and Community Based Services (HCBS) Provisions
- Fact Sheet: Summary of the Medical Care Advisory Committee and Beneficiary Advisory Group Provisions
- Information on the related NPRM, also published on April 27, 2023 titled “Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality (CMS-2439-P)”
Ressourcen
Request for Information (2022)
The Request for Information (RFI): Access to Coverage and Care in Medicaid & CHIP was open for a 60 day public comment period from February 17, 2022 through April 18, 2022. The RFI is now closed. CMS requested feedback from all interested stakeholders on topics related to health care access in Medicaid and CHIP including: enrollment in coverage; maintaining coverage; and access to services and supports.
Guidance
CMS-issued regulations and guidance to assist with implementation, monitoring and reporting.
- Ensuring Access to Medicaid Services – A Guide for States to the Fee-For-Service Provisions of the Final Rule
- Access: Rate Reduction/Restructuring Template (Note: As of July 9, this template is pending PRA approval by OMB, and states are not required to use it to meet the requirements of 42 CFR 447.203(c) until it has been approved. The 60-day notice published in the Federal Register on May 21, 2024 (89 FR 44685)).