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.
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 home and community based services (HCBS) programs. If finalized, these proposed changes would increase transparency and accountability and standardize data and monitoring, and would create opportunities for states to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care.
Comments on this proposed rule must be submitted by 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)”
Resources
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.
- Request for Information (2022) Questions (PDF, 304.31 KB)
Guidance
CMS-issued regulations and guidance to assist with implementation, monitoring and reporting.
- Proposed Rule: Access to Covered Medicaid Services—Rescission
- CIB: Comprehensive Strategy for Monitoring Access in Medicaid (PDF, 62.06 KB)
- Press Release: CMS Launches Comprehensive Effort to Strengthen Monitoring of Medicaid Beneficiary Access for Patients While Relieving Administrative Burden for States
- Methods for Assuring Access to Care: Exceptions for High Managed Care Penetration & Rate Reduction Threshold (CMS 2406-P)
- SMD: Medicaid Access to Care Implementation Guidance (PDF, 96.13 KB)
- Final Rule: Extension of Deadline for Access Monitoring Review Plan Submission
- FAQ: Access Rule Implementation March 16, 2016 (PDF, 175.49 KB)
- Final Rule with Comment: Methods for Assuring Access to Covered Medicaid Services
- Fact Sheet on Final Rule with Comment (PDF, 113.73 KB)
- Request for Information: Methods for Assuring Access
- Press Release on Final Rule with Comment
- Fact Sheet: Managed Care NPRM -- Improving the Beneficiary Experience (PDF, 776.03 KB)
- NPRM: Application of Mental Health and Substance Abuse Disorder Parity Requirements to Medicaid Managed Care, CHIP, and Benchmark Coverage
- SMD: New Service Delivery Opportunities for Individuals with a Substance Use Disorder (PDF, 205.64 KB)
- CIB: Coverage of Behavioral Health Services for Youth with Substance Use (PDF, 253.47 KB)
- CIB: Delivery Opportunities for Individuals with a Substance Use Disorder (PDF, 112.92 KB)
- FAQ: Medicaid & CHIP Services to Address Autism (PDF, 607.49 KB)
- CIB: Medication Assisted Treatment for Substance Use Disorders (PDF, 163.14 KB)
- CIB: Clarification of Medicaid Coverage and Services to Children with Autism (PDF, 143.2 KB)