The Centers for Medicare and Medicaid Services (CMS) Low-Income Subsidy (LIS) Program (also known as Extra Help) provides premium and cost-sharing assistance for low-income Medicare beneficiaries enrolled in Medicare Part D. The way this program operates will change with the new year.

• Currently: Medicare beneficiaries with income up to 135% of the federal poverty level (FPL) receive full financial assistance. Those with an income between 135% and 150% of the FPL receive partial financial assistance.
• On and after January 1: The Inflation Reduction Act (IRA) expands the full financial assistance to Medicare beneficiaries with income up to 150% of the FPL. Medicare beneficiaries who are eligible and enroll in the Medicare Savings Programs (MSP) are automatically eligible for the full LIS subsidies. Other Medicare beneficiaries have to apply via the Social Security Administration to obtain the extra help subsidies.

Providers are encouraged to assist their Medicare patients in applying for MSP coverage. Enrollment in an MSP automatically makes them eligible for full Part D LIS subsidies and the payment of Medicare Parts A and B premiums and cost-sharing.

The Consolidated Appropriations Act requires all states to provide 12-month continuous eligibility to children under age 19 in Medicaid and the Children’s Health Insurance Program (CHIP) beginning Jan. 1, 2024. “Continuous eligibility” means that an enrollee can keep their coverage for 12 months after their eligibility determination (or redetermination) regardless of changes in household circumstances, like income fluctuations. Continuous eligibility helps improve health outcomes and is associated with improved coverage rates, reductions in gaps in coverage, a lower probability of being in fair or poor health, and an increase in the average length of enrollment. While half of states already provided 12-month continuous eligibility for children enrolled in Medicaid or CHIP prior to Jan. 1, 2024, this policy will help ensure that millions more children in Medicaid or CHIP receive the benefits of yearlong periods of uninterrupted coverage.

A database of available funding for Tribal governments, organizations, and individuals from across the federal government.

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Beginning January 1, 2024, the Centers for Medicare & Medicaid Services (CMS) will allow billing for two new provider types: Marriage and Family Therapists (MFT) and Mental Health Counselors (MHC).  To qualify, MFTs and MHCs must be licensed or certified by the state where they provide services, have performed at least two years of clinical supervised experience, and meet other requirements of the federal government. The coverage of MFT and MHC practitioners can help address behavioral health work shortages in rural areas; recent research found that nearly one-fifth (18.4 percent) of rural counties are without a counselor compared to other behavior health provider types.  Learn more from CMS about how to become a Medicare provider.

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This week, national experts in disease prevention issued draft recommendations for clinical treatment of children with a high body mass index (BMI).  The U.S. Preventive Services Task Force identifies children and teens who are Hispanic/Latino, Native American/Alaska Native, Non-Hispanic Black, and from lower income families as those with the highest rates of obesity, determined by a BMI at or above the 95^thpercentile for age and gender.  October 2023 research from the Centers for Disease Control and Prevention found that rural children and adolescents had higher odds of being overweight or obese than their urban counterparts.  The recommendation includes behavioral counseling interventions (pdf) from health professionals.

Comment by January 16.

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In January 2023, we first informed you of state-level changes to Medicaid and the Children’s Health Insurance Program (CHIP) brought by the end of the COVID-19 public health emergency (PHE). These programs play a critical role in rural areas, where people are more likely to be uninsured and face challenges accessing health care. In brief, states received extra federal funding to allow beneficiaries to keep their coverage – known as continuous enrollment – for as long as the PHE declaration remained in place.  As of August 2023, more than 13 million people had their enrollment in Medicaid/CHIP coverage renewed, but more than 7 million were disenrolled.  In this interim final rule, the Centers for Medicare & Medicaid Services (CMS) detail new reporting requirements for states as they “unwind” continuous enrollment – that is, return to reviewing the eligibility status of individuals and families.  The new requirements specify that reports for certain metrics, such as the number of individuals disenrolled and information about transitions to coverage through state Health Insurance Marketplaces, be completed and submitted in a timely manner.  New enforcement actions include suspended disenrollments, civil money penalties, and a reduction in federal funding known as the Federal Medical Assistance Percentage.

Comment by February 2.

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