Delivery System Reform Archive

Clear Filters

… results in Delivery System Reform.

June 18, 2026
NHeLP Comments on Interoperability Standards and Prior Authorization for Drugs Proposed Rule
Wayne Turner, Héctor Hernández-Delgado, David Machledt, Emma Parker-Newton, and Jasmine Young Comments
In these comments to HHS, NHeLP continues to raise concerns with the use of prior authorization as a barrier to access necessary care for low-income and underserved individuals. While supporting the application of prior authorization standards previously adopted for other services to drugs, NHeLP comments also urge HHS to…
Read more
June 15, 2026
NHeLP Comments on Proposed 2028 Medicaid Home and Community-Based Services Quality Measure Set
David Machledt Comments
These comments offer NHeLP's general support for the HCBS Quality Measure Set, but express some concerns related to a proposal to remove two mandatory measures related to measuring community inclusion and integration, the failure to require states to report certain measures stratified by race and ethnicity, and the divergence…
Read more
April 30, 2026
An Advocate’s Guide to Medi-Cal Services
Fabiola De Liban, Amy Chen, Abigail Coursolle, Alicia Emanuel, Héctor Hernández-Delgado, T. Nancy Lam, Kimberly Lewis, Carly Myers, Alexis Robles-Fradet, Skyler Rosellini, Jasmine Young, Elizabeth Zirker, and Jules Lutaba Guide
NHeLP’s Medi-Cal Services Guide provides an in-depth description of some of the most important services covered in the Medi-Cal program, including prescription drug services, mental health and substance use disorder services, reproductive and sexual health services, gender-affirming services, among others. The guide seeks to help legal aid attorneys, health…
Read more
March 31, 2026
The NC Medicaid Managed Care Ombudsman: A Robust and Effective Beneficiary Support System
Miriam Delaney Heard, Elizabeth Edwards, and David Machledt Issue Brief
The North Carolina Medicaid program implemented a model beneficiary support system when it transformed its Medicaid program to comprehensive managed care starting in 2021. This program, called the North Carolina Ombudsman Program, was operated by legal services organizations and had several key features that made an important asset for…
Read more
March 26, 2026
Lessons Learned from North Carolina’s MCPAR Reports
Daniel Young Issue Brief
States must submit Medicaid Managed Care Program Annual Reports (MCPARs) annually for each of their managed care programs. Examining the MCPARs for one state, North Carolina, reveals how the role and structure of MCPARs as oversight tools are helpful, but there are also ways to make them more useful…
Read more
January 2, 2026
Federal AI Policy Threatens Prior Authorization Reform
Brit Vanneman Automated Decision-Making, Uncategorized
Automated systems play increasingly important roles in shaping access to health care services. Frequently, insurers use algorithms and artificial intelligence (AI) to route requests and make coverage decisions, fill records and forms, and even make recommendations about medical necessity. While automation can improve speed, relying too heavily on AI…
Read more

Delivery System Reform Archive

Never miss a thing.

Subscribe today.

NHeLP Comments on Interoperability Standards and Prior Authorization for Drugs Proposed Rule

An Advocate’s Guide to Medi-Cal Services

The NC Medicaid Managed Care Ombudsman: A Robust and Effective Beneficiary Support System

Lessons Learned from North Carolina’s MCPAR Reports

Federal AI Policy Threatens Prior Authorization Reform

Delivery System Reform Archive

Never miss a thing.

Subscribe today.

NHeLP Comments on Interoperability Standards and Prior Authorization for Drugs Proposed Rule

NHeLP Comments on Proposed 2028 Medicaid Home and Community-Based Services Quality Measure Set

An Advocate’s Guide to Medi-Cal Services

The NC Medicaid Managed Care Ombudsman: A Robust and Effective Beneficiary Support System

Lessons Learned from North Carolina’s MCPAR Reports

Federal AI Policy Threatens Prior Authorization Reform