Access to Care
Medicaid and the Children’s Health Insurance Program (CHIP) provide critical health coverage for millions of people. Through these programs, CMS supports access to care in several ways. First and foremost, providing health coverage allows individuals to access health care services that may not be affordable without Medicaid or CHIP. Additionally, some programs and benefits under Medicaid and CHIP include special protections to ensure services are accessible, such as provider network standards, payment methodologies, and other protections. CMS acknowledges the importance of using services, including preventative care, to help people stay healthy and avoid more costly care and has developed resources and materials to help Medicaid and CHIP beneficiaries understand the importance of these services and learn how to access them. To understand and ensure progress, CMS supports a variety of efforts to measure access and report the results. Learn more about topics related to access below.
CMS-issued regulations and guidance to assist with implementation, monitoring and reporting.
- Final Rule: Extension of Deadline for Access Monitoring Review Plan Submission
- FAQ: Access Rule Implementation March 16, 2016
- Final Rule with Comment: Methods for Assuring Access to Covered Medicaid Services
- Fact Sheet on Final Rule with Comment
- Request for Information: Methods for Assuring Access
- Press Release on Final Rule with Comment
- Fact Sheet: Managed Care NPRM -- Improving the Beneficiary Experience
- 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
- CIB: Coverage of Behavioral Health Services for Youth with Substance Use
- CIB: Delivery Opportunities for Individuals with a Substance Use Disorder
- FAQ: Medicaid & CHIP Services to Address Autism
- CIB: Medication Assisted Treatment for Substance Use Disorders
- CIB: Clarification of Medicaid Coverage and Services to Children with Autism
Reports and Evaluations that may contain sections of data specific to access.
Resources and programs to help states directly connect people to care.
- Innovation Accelerator Program (IAP)
- Helping Connect Enrollees to Care
- Living Well: Promoting Preventive Services
- Dental Benefits and the Children's Oral Health Initiative
- Self Directed Services as an Alternative to Traditional Models