Managed Care Plans as Critical Partners in Implementing New Medicaid Program Requirements
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What are the new Medicaid program requirements introduced by the One Big Beautiful Bill (OB3)?
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Well I want to welcome everyone. Um today we're uh gonna be uh speaking about an article uh managed care plans uh as critical partners impl in implementing. The new Medicaid program requirements. Uh it's an article that was uh co-authored by one of our guests, Kinda Sarafi of Manat Health, uh, along with her colleague, Ellen Monts. all managed or managing director at Manette Health. Um I'm Jamie Ostroff. Uh I am a vice chair of the Paris Plans and Managed Care uh practice group. Um again I like I said I'm joined by Kinda Sarafi. Uh Kinda is a partner in Manette Health, where she leverages her extensive experience in healthcare law and policy to advise a diverse array of clients, including states, foundations, managed care plans, providers, and technology companies.
Kind is recognized as a subject matter. authority on Medicaid and chip eligibility and enrollment and in designing and implementing innovative Medicaid initiatives and service delivery models. Welcome, Kinda.
Thank you.
We're also joined by Jared McNaughton. Jared is the Chief Executive Officer of Inland Empire Health Plan, also known as IEHP. Uh in his role, he works collaborative collaboratively with the IH IEHP governing board to set the strategic vision and provide executive leadership. For one of the five largest Medicaid health plants and the largest not-for-profit Medicaid Medicare public health plan in the US. He call he cultivates IEHP's strong partnership with providers, hospitals, and hundreds of community partners to deliver quality whole person care to more than one point four million members. Jared currently serves as board chair of Manifest Medics, the largest health information exchange in California.
He's also a board member of Local Health Plans of California. Welcome, Jared.
Thanks so much, Jamie. Great to be with you guys.
Uh so uh again as I mentioned, I'm Jamie Ostroff. Uh in addition to serving as a vice chair on the pair of plans and managed care practice group, I am the chief legal officer and general counsel for the California Medical Association. Um, I lead uh the CMA in defending the rights of physicians in courts, the legislature, and before regulatory agencies. And uh the topic of today's discussion is uh, as I mentioned earlier, managed care plans as critical partners in implementing the new Medicaid program requirements. that we find in the one big beautiful bill that we'll refer to uh throughout the podcast today is OB3. Um now, of course, OB3 is vast and and its breadth is well beyond the scope of of today's discussion.
So we're going to focus on four specific factors or or requirements, if you will, under OB3. Those are the uh work reporting requirements, the renewals and redeterminations, tracking, cost sharing. And providing uh provider oversight of fraud, waste, and abuse. So turning first to the uh work reporting requirements, um, Kinda, I'm gonna ask you if you could help us by briefly explaining how OB3 has changed the work and community engagement requirements for eligibility under Medicaid.
Sure. Happy too. So right now, um If someone is applying for Medicaid, there are a standard set of rules that every state has to apply to determine if someone is eligible for coverage. So they have to see if a person meets income requirements, if they're the resident of a state.
How do work‑reporting and community‑engagement requirements affect Medicaid eligibility?
if they meet the citizenship or immigration requirements and individuals provide this information in an application or a renewal form. And then the state does all this stuff in the back end to see if the person is eligible. And then the person gets health coverage. Um under OB three that Whole construct gets uh very subverted. So what happens, and this won't apply for everybody, this isn't gonna apply for Aged people who are over 65. This doesn't apply for children, doesn't apply to pregnant people. But for the vast majority of enrollees who are receiving Medicaid coverage, if they're 19 to 64, they're an adult, they are now not only going to have to provide information about their income, their citizenship immigration, their residency, but they're going to have to show that they are meeting work requirements.
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Chapters
8 chapters
1
What are the new Medicaid program requirements introduced by the One Big Beautiful Bill (OB3)?
0:05–3:50
2
How do work‑reporting and community‑engagement requirements affect Medicaid eligibility?
3:50–8:06
3
What challenges do Medicaid managed‑care plans face with six‑month renewals and redeterminations?
8:06–12:02
4
How are states and plans tracking cost‑sharing and copayment limits under OB3?
12:02–17:01
5
What role do managed‑care plans play in preventing fraud, waste, and abuse?
17:01–21:19
6
How is Inland Empire Health Plan preparing its data‑sharing infrastructure for OB3?
21:19–26:04
7
What impact could OB3’s administrative burdens have on enrollment and provider capacity?
26:04–29:05
8
What future expectations might states place on Medicaid managed‑care organizations after OB3?
29:05–33:41
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