By: Jennifer Lav and David Machledt
Executive Summary
The Medicaid Act requires that state payments for Medicaid are sufficient to provide at least equivalent access to care for Medicaid beneficiaries as the general population in any given geographic area. Over the years, CMS has tried to enforce payment adequacy via increased monitoring and other requirements, but these efforts have not resolved ongoing problems with insufficient Medicaid provider rates. In April 2024, CMS finalized regulations aimed at enhancing rate transparency and improving access to quality care across Medicaid managed care and fee-for-service programs. If faithfully implemented, this Access Rule will increase HCBS provider availability for people with disabilities. This brief summarizes key substantive changes finalized in the rule and the timeline for implementation.
