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- September 18, 2023
EPSDT’s Legal Landscape & Implementation History
Amanda Avery and Jane Perkins Court Document, Health Advocate, Regulations and Laws, Fact Sheet, Case ExplainerRead moreThis Fact Sheet provides essential information to help advocates become EPSDT experts. After giving an overview to EPSDT, we focus on: (1) legislative milestones; (2) notable federal agency guidance; and (3) precedent-setting cases from the judiciary. Next, we provide a snapshot of states’ performance implementing EPSDT, using government reports…
- July 14, 2023
Comments on Proposed Medicaid Managed Care Access Rule
Read moreCMS 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…
- July 13, 2023
Comments on Proposed Medicaid Access Rule
Jennifer Lav, Wayne Turner, David Machledt, Abigail Coursolle, Dania Douglas, Charly Gilfoil, Jasmine Young, and Madeline Morcelle CommentsRead moreCMS proposed changes and additions to regulations enforcing the "equal access" provision of Medicaid. These changes would strengthen opportunities for enrollees' input and oversight of state Medciaid programs, would help promote access to Medicaid services, would improve quality of care, and promoting transparency and adequate payment for fee-for-service Medicaid.…
- May 10, 2023
EPSDT Litigation Trends and Annotated Docket
Read moreThe Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions are among the most specific in the Medicaid Act. Over the years, however, states have not adhered to their responsibilities, and litigation has resulted. This Fact Sheet summarizes the federal requirements for EPSDT and provides an annotated case docket.…
- April 20, 2023
AMICUS: J.R. v. Horizon NJ Health, New Jersey Superior Court, Appellate Division
Litigation Team CasesRead moreJ.R. is a young child who requires nursing services and appealed a significant reduction in her Medicaid nursing services that was based on the results of a secret scoring tool and care guidelines. The notice provided to J.R. reducing their services only provided the end result of the tool…
- April 17, 2023
What Makes Medicaid, Medicaid? Services
Wayne Turner, Catherine McKee, Amy Chen, Abigail Coursolle, Jasmine Young, and Héctor Hernández-Delgado Issue BriefRead moreMedicaid offers myriad optional services and benefits that states can cover, as well as a minimum baseline of services that must be covered. This paper details the optional and mandatory services and how they are tailored to meet the health care needs of low-income people and underserved communities. The…
