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January 6, 2025
Best Practices for Medicaid Secret Shopper Survey Implementation
David Machledt and Michelle Yiu Issue Brief
Network adequacy has long been a challenge in Medicaid managed care. According to one 2023 survey, 1 in 3 Medicaid enrollees report that in the past year an in-network provider they needed to see did not have available appointments. To address these challenges, the 2024 Managed Care Access final…
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September 30, 2024
[Webinar] Implementing Medicaid Secret Shopper Surveys: Tips and Methods for Better Results
Walter Hsiang, MD, Sidney Watson, Leslie Hinyard, and David Machledt Webinar
Medicaid enrollees can face significant challenges trying to book a timely appointment. Provider directories from Medicaid managed care plans are often inaccurate and outdated, and network providers may stop accepting new Medicaid patients altogether. CMS recently took a big step to address these challenges by requiring annual independent secret…
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May 30, 2024
North Carolina Tailored Plan Network Adequacy: Acute Care Hospitals Update
Daniel Young Fact Sheet
North Carolina is launching Tailored Plans on July 1, 2024 to manage the behavioral health and physical health services for beneficiaries in need of enhanced services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD), or traumatic brain injury (TBI). A Tailored Plan’s provider network is critical…
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March 19, 2024
Managed Care Contract Provisions—Beefing Up EPSDT During Contract Renegotiations
Daniel Young
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is a mandatory and essential part of states’ Medicaid programs. As such, it needs to be thoroughly defined and detailed in state Medicaid managed care contracts. NHeLP maintains a bank of managed care contracts. NHeLP recently reviewed a select…
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November 27, 2023
Continuity of Care in Medi-Cal Managed Care (Updated 2023)
Abbi Coursolle Fact Sheet
Continuity of Care (“COC”) is critical to Medi-Cal beneficiaries in a variety of circumstances. There are a number of laws and policies that govern COC for Medi-Cal beneficiaries, depending on the situation. Some of these protections are specific to Medi-Cal while others are more broadly applicable to people enrolled…
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July 14, 2023
Comments on Proposed Medicaid Managed Care Access Rule
Sarah Somers Comments
CMS proposed a major administrative rule that would increase transparency in managed care; improve monitoring and assure adequacy of payments in managed care; increase accountability, transparency, and participant input into external quality review; and help states to make information about quality measures widely available. NHeLP filed comments in support…
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Best Practices for Medicaid Secret Shopper Survey Implementation

[Webinar] Implementing Medicaid Secret Shopper Surveys: Tips and Methods for Better Results

North Carolina Tailored Plan Network Adequacy: Acute Care Hospitals Update

Managed Care Contract Provisions—Beefing Up EPSDT During Contract Renegotiations

Continuity of Care in Medi-Cal Managed Care (Updated 2023)

Comments on Proposed Medicaid Managed Care Access Rule