Medicare and Medicaid Program Design

Insights

Hawai’i Advances Medicaid Innovation with Proposed Section 1115 Demonstration

ATI sat down with Hawaii’s Medicaid Director, Judy Mohr Peterson, to discuss the ins and outs of their recently submitted Section 1115 Demonstration renewal application. Hawaiʻi is proposing a series of new initiatives, with a focus on addressing health-related social needs (HRSN), promoting access to and continuity of coverage, and supporting populations with complex care needs, including individuals involved in the justice system and those with substance use disorders (SUDs).
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Work

Opportunities to Advance Nursing Facility Quality of Care Through Medicare-Medicaid Integration 

This issue brief explores the attributes of a potential Medicare-Medicaid integrated model focused on ensuring high quality and high value care for dual eligible long-stay nursing facility residents. We identify policy opportunities for CMS and states to consider to facilitate a Medicare-Medicaid model in nursing facilities, including increasing payment transparency, promoting alignment between Medicare and Medicaid quality measures, and requiring that a percentage of plan payment go towards value-based contracts with nursing facilities. Taken together, these model elements could meaningfully improve experiences for dual eligible individuals living in nursing facilities, and for their families.
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Webinars

Value-Based Care in 2024: Anticipating Key Trends and Transformations

Brian Fuller, Managing Director of ATI Advisory’s Value-Based Care Design and Delivery practice, shared his observations on the evolution of value-based care during the webinar, “Value-based care in 2024: Anticipating Key Trends and Transformations.” 
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Webinars

Navigating the Decision to Apply to CMS’s GUIDE Model for Dementia Care Management

In the November 27, 2023, webinar, “Discovering Pathways of Support: Navigating the Decision to Apply to CMS’s GUIDE Model for Dementia Care Management,” Tyler Cromer and Tina Pickett discussed the GUIDE Program Request for Applications (RFA) and considerations for prospective applicants.
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Insights

CY2025 Medicare Advantage Proposed Rule

On November 6, 2023, CMS released its Contract Year 2025 Medicare Advantage and Part D Proposed Rule [CMS-4205-P]. ATI Advisory prepared a summary of key provisions and insights across D-SNP and dual eligible impacts, supplemental benefits, Part D formularies, network adequacy, agent and broker commissions, and equity-related provisions. The Rule has a heavy focus on beneficiary protections and program transparency.
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News

Medicare plans that help seniors afford groceries surge

Axios cites ATI Advisory analysis on Medicare Advantage supplemental benefits to support their article: "Next year, 1,475 plans – about a quarter of the market – will offer certain eligible enrollees financial assistance for food and produce, according to an analysis from consulting firm ATI Advisory."
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