Prior Authorization Archive

Clear Filters

… results in Prior Authorization.

August 21, 2023
An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program (with 2023 Supplement)
Priscilla Huang, Madeline Morcelle, and Amy Chen Health Advocate, Guide
In 2019, NHeLP published the 2nd Edition of An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program (“Guide”). The Guide is designed to familiarize readers with the basics of the Medicaid program and highlight features that support reproductive and sexual health. Since the Guide was first…
Read more
June 28, 2023
California Abortion Coverage in Medi-Cal and Private Insurance
Jasmine Young, Amy Chen, and Fabiola De Liban Fact Sheet, Guide
*Co-written with Xochitl Lopez-Ayala (Policy Advocacy Coordinator at ACCESS REPRODUCTIVE JUSTICE) Access to comprehensive health care, which includes abortion care, is critical to every person’s health and well-being. Abortions are legal in California. Both Medi-Cal and private health insurance plans in California are required to cover all abortions. This…
Read more
March 13, 2023
NHeLP Comments on the HHS Prior Authorization Proposed Rule (2023)
Wayne Turner, David Machledt, and Sarah Somers Comments
In these comments on the Prior Authorization Proposed Rule, NHeLP urges HHS to go further to curb the abuse of prior authorization as a cost savings strategy that endangers patients’ health. NHeLP supports efforts to streamline prior authorization processing and bring greater transparency to denial rates and the clinical…
Read more
February 16, 2023
AMICUS:United Stated v. Walgreens Co., United States Court of Appeals for the Fourth Circuit
Litigation Team Cases
The U.S. and Virginia filed suit against Walgreens for the submission of false claims seeking reimbursement for Hepatitis C medications provided to Medicaid beneficiaries who did not meet Virginia's criteria for coverage. The district court dismissed the case, and the U.S. and Virginia appealed. The National Health Law Program…
Read more
November 19, 2019
Medicaid Abortion Coverage in Arizona
Fabiola De Liban Fact Sheet
After finding that several states violated federal policy requiring reporting waivers in cases of rape, NHeLP partnered with state advocates to institute those waivers when Medicaid enrollees seek abortion coverage. One such state is Arizona. The National Health Law Program is pleased to release its most recent fact sheet, Medicaid…
Read more
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…
Read more

Prior Authorization Archive

Never miss a thing.

Subscribe today.

An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program (with 2023 Supplement)

California Abortion Coverage in Medi-Cal and Private Insurance

NHeLP Comments on the HHS Prior Authorization Proposed Rule (2023)

AMICUS:United Stated v. Walgreens Co., United States Court of Appeals for the Fourth Circuit

Medicaid Abortion Coverage in Arizona

Ensuring that Assessment Tools are Available to Enrollees