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November 24, 2015
Health Advocate: Reproductive Health Data and Accountability Project
dfitzgerald Issue Brief
This month's Health Advocate details our Reproductive Health Data and Accountability Project, which, in collaboration with the Advancing New Standards in Reproductive Health program at the University of California, San Francisco, establishes systems to collect, analyze, and utilize data on access barriers to family planning and abortion services in…
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October 20, 2015
Health Advocate: Autism Spectrum Disorders
Abbi Coursolle Issue Brief
This month's Health Advocate reviews the advocacy history that led up to guidance from the Centers for Medicare & Medicaid Services (CMS) to ensure that state EPSDT programs keep up with the evolving standard of care for children. In July 2014, CMS issued a Clarification of Medicaid Coverage of…
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September 23, 2015
Health Advocate: Nondiscrimination and the ACA
Mara Youdelman Issue Brief
In this month's Health Advocate, NHeLP provides an overview of the proposed regulation implementing Section 1557 of the ACA. Section 1557 updates nondiscrimination provisions to include prohibiting sex, gender identity, and sex stereotyping discrimination, as well as clarifying standards regarding discrimination based on language, disability, and other protected groups.…
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September 10, 2015
Ensuring that Assessment Tools are Available to Enrollees
Jane Perkins Issue Brief
The amount of Medicaid services for enrollees, particularly home and community based services, is increasingly being determined through prior authorization processes that use assessment tools and clinical coverage criteria. These assessment documents may not be made available to the enrollee. However, Medicaid law and due process call for disclosure…
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August 31, 2015
Step Guide to Reviewing Your State’s 2017 Essential Health Benefits Benchmark
Michelle Lilienfeld Issue Brief
Introduced by the Affordable Care Act, Essential Health Benefits (EHB) are a set of ten health care service categories that certain health plans must cover. The EHBs are defined through a benchmark approach where states either select or get assigned a benchmark plan which serves as a reference plan…
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August 14, 2015
Managed Care in California Series, Issue 4: Internal Grievances and External Review
Abbi Coursolle Issue Brief
Federal and state law and the state and federal constitutions require that beneficiaries in Medi-Cal managed care plans receive notice, and grievance and appeal rights when they are denied access to medically necessary services. Frequently, however, enrollees fail to receive the required notice, get an inadequate notice, or do…
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