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Medicaid and Other Payers

Medicaid interacts with other payers when Medicaid beneficiaries have other sources that are legally liable for payment of their medical costs. These may include private insurance, Medicare, other public programs such as the Ryan White program, workers’ compensation, and amounts received for injuries in liability cases. The program also interacts with CHIP when states provide Medicaid coverage to beneficiaries using CHIP funds.

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Featured Publications

Medicaid Coverage Based on Medicare National Coverage Determination: Moving Towards Recommendations

January 23, 2023

Under Medicare Part B, the Centers for Medicare & Medicaid (CMS) Services has the authority to make a national coverage determination (NCD) on whether a service or prescription drug is reasonable and necessary. Under certain circumstances, CMS can link coverage of an item or service to participation in an approved clinical study or to the […]

Transitions in Coverage Between Medicaid and Other Insurance Affordability Programs

December 8, 2022

This session examined policy issues that affect the ability of beneficiaries who are losing Medicaid eligibility to smoothly transition to other insurance affordability programs, including the State Children’s Health Insurance Program, the Basic Health Program, and subsidized exchange coverage. This work follows up on MACPAC’s previous work examining transitions between coverage sources before the COVID-19 […]

Financial Alignment Initiative for Beneficiaries Dually Eligible for Medicaid and Medicare

May 19, 2022

Medicaid and Medicare together provide health coverage for approximately 12.2 million low-income seniors and people with disabilities who are dually eligible for both programs. The Centers for Medicare & Medicaid Services’ Medicare-Medicaid Coordination Office has implemented the Financial Alignment Initiative to improve care and reduce program costs for these beneficiaries, as well as improve coordination […]