Access to Care
Medicaid and the Children’s Health Insurance Program (CHIP) provide critical health coverage for millions of people. Through these programs, the Centers for Medicare and Medicaid Services (CMS) supports access to care in many ways. Most importantly, people gain access to health care services that may not be affordable without Medicaid or CHIP. Additionally, some programs and benefits include special protections—such as provider network and payment methods—that help ensure services are accessible.
Preventive care and other services help people stay healthy and avoid more costly care. CMS offers materials, toolkits, and other resources for states to help Medicaid and CHIP beneficiaries learn about these services and how to access them. CMS also supports many efforts to measure access, share the results, and promote progress. Learn more through the following guidance, reports, and initiatives.
Guidance
CMS-issued regulations and guidance to assist with implementation, monitoring and reporting.
- Methods for Assuring Access to Care: Exceptions for High Managed Care Penetration & Rate Reduction Threshold (CMS 2406-P)
- SMD: Medicaid Access to Care Implementation Guidance
- Final Rule: Extension of Deadline for Access Monitoring Review Plan Submission
- FAQ: Access Rule Implementation March 16, 2016
- Final Rule with Comment: Methods for Assuring Access to Covered Medicaid Services
- Fact Sheet on Final Rule with Comment
- Request for Information: Methods for Assuring Access
- Press Release on Final Rule with Comment
- Fact Sheet: Managed Care NPRM -- Improving the Beneficiary Experience
- NPRM: Application of Mental Health and Substance Abuse Disorder Parity Requirements to Medicaid Managed Care, CHIP, and Benchmark Coverage
- SMD: New Service Delivery Opportunities for Individuals with a Substance Use Disorder
- CIB: Coverage of Behavioral Health Services for Youth with Substance Use
- CIB: Delivery Opportunities for Individuals with a Substance Use Disorder
- FAQ: Medicaid & CHIP Services to Address Autism
- CIB: Medication Assisted Treatment for Substance Use Disorders
- CIB: Clarification of Medicaid Coverage and Services to Children with Autism
Reports
Reports and Evaluations that may contain sections of data specific to access.
- Access Monitoring Review Plans
- Section 1115 Demonstration Evaluations
- Medicaid and CHIP Enrollment Data
- Quality of Care: Performance Measurement, Reports, and Initiatives
Initiatives
Resources and programs to help states directly connect people to care.