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Nevada Medicaid provides same-day transportation for testing and vaccines

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Nevada Medicaid is getting members to their vaccination appointments and also providing gas costs reimbursement for those with a ride already.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

File of the COVID-19 vaccine(KOLO)

RENO, Nev. (KOLO) – Nevada Medicaid is now offering same-day transportation on COVID-19 vaccines and tests for its recipients.

Kirsten Coulombe with Nevada Medicaid said with the pandemic, many people’s situations have changed, and more people are on Medicaid.

“We really wanted to make sure that our recipients who are on Nevada Medicaid would have the opportunity to go to those testing sites as well as receive the vaccine,” Coulombe said.

She explained one in four Nevadans are now recipients and it is important to make sure people are able to get to their tests and vaccination appointments.

Nevada Medicaid was already offering non-emergency transportation services, however Coulombe said they wanted to make services more versatile.

“What we have done differently is that we’re making it more flexible for COVID and response to COVID and the demand that may be there so those flexibilities include same-day service,” Coulombe said.

Nevada Medicaid will also provide gas reimbursement if you have a family member or friend that can take you, or a bank card to ride public transportation.

“If they do have some barriers with transportation, we did not want a Medicaid recipient to not receive a vaccine or test because they didn’t have the option for transportation,” Coulome said.

If you are a Medicaid recipient and are interested in the same-day transportation services, you can call 1-844-879-7341 and they will send one of their independent contractors, usually an Uber or Lyft, to come and bring you to your appointment.

 
 

Clipped from: https://www.kolotv.com/2021/02/05/nevada-medicaid-provides-same-day-transportation-for-testing-and-vaccines/

 
 

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CMS Failed to Flag Medicare Fee-for-Service Healthcare Fraud, Waste

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CMS did not use a method recommended by OIG for preventing payments to providers known to have high payment error rates.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

From 2014 to 2017, CMS had an improper payment rate of 60.7 percent, accounting for $3.5 million in healthcare fraud, waste, and abuse.

January 28, 2021 – The Centers for Medicare & Medicaid Services (CMS) and its contractors did not use Comprehensive Error Rate Testing (CERT) data to identify healthcare fraud or waste, according to a new Office of Inspector General (OIG) audit.

Data from the CERT program measures improper Medicare fee-for-service payments to providers. Previous OIG reports have recommended that CMS harness CERT data to determine error-prone providers and correct processes that contribute to these errors.

However, after reviewing CERT data from 2014 to 2017, the agency determined that CMS did not use the data to identify error-prone providers.

Of the $5.8 million reviewed by CERT, $3.5 million was an incorrect payment, making for an improper payment rate of 60.7 percent. OIG tracked these incorrect payments to 100 error-prone providers.

These providers had an error rate higher than 25 percent in each of the four CERT years analyzed and a total error amount of at least $2,500.

During the same time period, Medicare made $19.1 billion in FFS payments to those 100 error-prone providers.

In the audit, OIG recommended that CMS review this list of 100 error-prone providers and take action to reduce incorrect payments. This could include processes such as prior authorization, prepayment reviews, and postpayment reviews for these providers.

Like previous reports, OIG called on CMS to use annual CERT data to identify specific providers that have an increased risk of receiving improper payments. Additionally, OIG suggested CMS apply additional program integrity tools to monitor these providers.

CMS did not agree with OIG’s recommendations in written comments to the draft report.

“CMS disagreed with our methodology for identifying error-prone providers and suppliers. Additionally, CMS stated that it previously attempted to use CERT data to identify error-prone providers and suppliers but found that CERT data was ineffective for this purpose and discontinued the practice,” the agency said.

OIG reviewed CMS’s comments and maintained that its recommendations are valid in lowering improper payment rates.

“We maintain that CMS can improve its ability to detect these types of providers by using the provider-level CERT data along with its existing oversight efforts,” the OIG audit explained.

In recent years, aggressive corrective actions to reduce Medicare FFS improper payments in particular have led to less healthcare fraud, waste, and abuse. Data released in November of last year revealed that the Medicare FFS improper payment rate declined to 6.27 percent in fiscal year (FY) 2020 from 7.25 percent in FY 2019 leading to $15 billion in savings.

2020 was the fourth consecutive year that the Medicare FFS improper payment rate fell below 10 percent, CMS reported.

“President Trump made a clear commitment to protect Medicare for our seniors, and to do that we must ensure that fraud and abuse doesn’t rob the program of precious resources,” CMS Administrator Seema Verma said at the time of the data’s release.

“From the beginning this administration has doubled down on our commitment to protect taxpayer dollars and this year’s continued reduction in Medicare improper payments is a direct result of those actions,” Verma continued.

However, based on OIG’s CERT data review that revealed over $19 billion in improper Medicare FFS payments to error-prone providers, CMS has room for improvement in terms of reducing fraud, waste, and abuse in the healthcare industry.

Clipped from: https://revcycleintelligence.com/news/cms-failed-to-flag-medicare-fee-for-service-healthcare-fraud-waste

 
 

 
 

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18 states back Arkansas on Medicaid work rule

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More than 1/3rd of states have registered their support of their right to use work requirements to further the objectives of the Medicaid program as SCOTUS considers the case.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

WASHINGTON — Arkansas should be able to set work requirements for some of its Medicaid recipients, 18 states told the U.S. Supreme Court this week.

The granting of federal waivers, which allowed these “demonstration projects” to proceed, was not “arbitrary and capricious,” they said.

Seventeen states signed an amicus curiae — or friend of the court — brief arguing that a lower court’s ruling is “flatly inconsistent with historical and current practice” and could lead to “potentially disastrous consequences.”

The Supreme Court announced in December that it would hear appeals involving the Arkansas and New Hampshire work requirements; both had been struck down by lower courts.

Arkansas hopes to persuade the court to allow it to use the work requirement for the Arkansas Works program, which uses Medicaid dollars to buy private insurance for low-income people.

The 17 states, all of which have Republican attorneys general, are: Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Mississippi, Missouri, Montana, Ohio, Oklahoma, South Carolina, Texas, Utah and West Virginia.

An 18th state, Nebraska, filed a separate brief arguing that the lower courts’ rulings were flawed; its attorney general is Republican as well.

With then-President Donald Trump in the White House, the U.S. Department of Justice defended the waivers.

Now that President Joe Biden is in office, the department’s stance is unclear.

A department spokesman Wednesday declined to comment on the litigation.

Under federal law, the secretary of the Health and Human Services Department is authorized to approve “any experimental, pilot, or demonstration project which, in the judgment of the Secretary, is likely to assist in promoting the objectives” of Medicaid and other state-run programs.

In legal filings, Arkansas has argued that the Arkansas demonstration project’s aim was “to test the hypothesis that conditioning Medicaid expansion benefits on work, education, or volunteering would lead to healthier outcomes for its beneficiaries.”

Critics argued that Arkansas Works was not designed to promote the objectives of the Medicaid program, and they portrayed the works requirement as punitive.

The requirement, which applied to Arkansans ages 19-49 covered under Arkansas Works, resulted in more than 18,000 people losing their health coverage over a nine-month period.

In many instances, the recipients met the requirements to receive the assistance but had failed to properly fill out the documentation.

At least 10 states have adopted Medicaid work requirements, according to the Kaiser Family Foundation.

The work requirements vary from state to state. In Arkansas, a recipient could meet the requirement — unless he was exempt — by working or doing other approved activities, such as volunteering and going to school.

Under the leadership of then-Gov. Mike Beebe, a Democrat, Arkansas expanded its Medicaid program under the 2010 Patient Protection and Affordable Care Act to cover adults with incomes of up to 138% of the poverty level.

After his election in 2014, Gov. Asa Hutchinson, a Republican, urged the Legislature to keep the program in place, later adding work or job-training requirements.

The tighter requirements helped persuade the Republican-dominated state Legislature to continue the program.

The administration of President Barack Obama declined to grant the waivers. The changes were subsequently approved by the Trump administration in March 2018 pursuant to Section 1115 of the Social Security Act, which authorizes waivers from federal Medicaid law.

After Arkansas Medicaid recipients sued, an Obama judicial appointee, U.S. District Judge James Boasberg of Washington, D.C., struck down the restrictions.

In a March 27, 2019, ruling, Boasberg found that federal Health and Human Services Secretary Alex Azar exceeded his authority in approving the requirements by failing to consider how they would affect the Medicaid program’s goal of providing health coverage to needy people.

On Feb. 14, the U.S. Court of Appeals for the District of Columbia Circuit said federal approval of the plan had been “arbitrary and capricious.”

In a unanimous three-judge appellate ruling, written by Senior U.S. Circuit Judge David Sentelle, the court found that in approving the project without considering its effect on Medicaid coverage, the Department of Health and Human Services violated the Administrative Procedures Act.

Sentelle, appointed by President Ronald Reagan, was joined by Judges Harry Edwards, appointed by President Jimmy Carter, and Cornelia Pillard, appointed by Obama.

Arkansas subsequently appealed to the U.S. Supreme Court.

In July, Arkansas Attorney General Leslie Rutledge maintained that the requirements would give able-bodied Arkansans an incentive to enter the workforce, helping them establish “a stronger, more resilient connection with their communities.”

One of the attorneys representing the Arkansas Medicaid recipients, Legal Aid of Arkansas’ Kevin De Liban, had referred to the workforce requirements as “termination traps.”

The Biden administration hasn’t said whether it will defend the waivers or rescind them.

Asked Tuesday about the dispute over work requirements, White House press secretary Jen Psaki referred questions about the ongoing litigation to the Department of Justice.

“I will say that President Biden does not believe, as a principle, it should be difficult for people to gain access to health care,” she said. “He’s not been supportive in the past, and is not today, of putting additional restrictions in place. And he’s spoken about that publicly, too.”

A spokeswoman for Rutledge said Wednesday that the work on the appeal continues.

“The Attorney General’s office looks forward to defending Arkansas Works at the U.S. Supreme Court so Arkansas may enrich the lives of our fellow Arkansans through commonsense community-engagement requirements.”

Officials with the National Health Law Program, which is helping to challenge the waivers, could not be reached for comment Wednesday.

Arkansas lawmakers will consider changing the state’s version of Medicaid expansion, with the state planning to seek a new waiver from the federal government for the program because the current waiver expires at the end of this year. The program provides health care coverage for about 300,000 low-income Arkansans.

The Legislature also will consider the spending authority for the program for the next fiscal year, which requires a third-fourths vote in the House and Senate. That requires 27 votes in the 35-member state Senate and 75 votes in the 100-member House of Representatives.

“Regardless of what the Supreme Court says on the work requirement, and whether it is authorized or not, we have to get our waiver by the Biden administration, so we want to shape this in a way that we can get the waiver,” Hutchinson said.

The community engagement requirements continue to have the support of the governor.

“We believe that we want to move people from dependence into independence and a part of that is making sure they are adequately trained for work,” Hutchinson said.

Information for this article was contributed by Andy Davis of the Arkansas Democrat-Gazette.

 
 

Clipped from: https://www.arkansasonline.com/news/2021/jan/28/18-states-back-arkansas-on-medicaid-work-rule/

 
 

 
 

 
 

 
 

 
 

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Humana to Begin Serving Medicaid Managed Care and Dual Eligible Residents in South Carolina

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Humana will begin serving South Carolina Medicaid members July 1, 2021.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

The company’s entrance into the state’s Medicaid program supports its continuing commitment to improving the health of its communities and building stronger provider partnerships

The South Carolina Department of Health and Human Services (SCDHHS) has added Humana Inc. (NYSE: HUM) to its Healthy Connections Medicaid program and its Healthy Connections Prime program to serve children and adults across the state, including residents dually eligible for Medicaid and Medicare.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20210127005919/en/

– ADVERTISEMENT –

Humana will begin enrolling new Healthy Connections Medicaid members on July 1, 2021, followed by new Healthy Connections Prime members beginning January 1, 2022. Healthy Connections Prime is an expanded option for South Carolinians who have both Medicare and Medicaid, operating under a joint demonstration contract between the state and the federal government.

“We’re thrilled to partner with the South Carolina Department of Health and Human Services, and being selected to serve South Carolina Medicaid recipients means a great deal to all of us at Humana,” said Natalia Aresu, Humana’s South Carolina Medicaid Regional President. “As a company with a growing presence in the state, our commitment to serve our members and improve health across South Carolina is unyielding. We commend the state for adding new coverage options to better support people receiving coverage through the program.”

Humana has a strong and growing commitment to South Carolina, serving 425,000 members in the state. In addition to entering the state’s Healthy Connections Medicaid program, Humana currently provides coordinated medical, wellness and pharmacy benefits coverage to its Medicare Advantage and Prescription Drug Plan members in South Carolina, as well as members of the military, military retirees and their dependents, under Humana’s partnership with the TRICARE program.

“From our emerging service to Medicaid beneficiaries in South Carolina, to people with Medicare Advantage and military members with TRICARE benefits, we’re excited about all of the ways we are able to positively impact the health of people in this state,” said John Barger, National President of Humana’s Medicaid business, Humana Healthy Horizons. “It is truly our honor to serve the people of South Carolina, particularly when COVID-19 is disproportionally impacting people with Medicaid.”

About Humana

Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

  • Annual reports to stockholders
  • Securities and Exchange Commission filings
  • Most recent investor conference presentations
  • Quarterly earnings news releases and conference calls
  • Calendar of events
  • Corporate Governance information

View source version on businesswire.com: https://www.businesswire.com/news/home/20210127005919/en/

 
 

Clipped from: https://finance.yahoo.com/news/humana-begin-serving-medicaid-managed-210500088.html

 
 

 
 

 
 

 
 

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Florida Medicaid website hacked for 7 years, hundreds of thousands affected

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The website that hosts the application for multiple Florida Medicaid programs had a data vulnerability for 7 years that exposed personal identity and financial information.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Tallahassee-based children Medicaid health plan Florida Healthy Kids Corp. began notifying members Jan. 27 of a 7-year data breach that exposed the personal information of hundreds of thousands of  health plan applicants. 

The health plan was notified Dec. 9 of the security breach  and launched an investigation, which found there had been “significant vulnerabilities” since 2013 on its website and databases that support the online children health insurance application. The vulnerabilities lasted from November 2013 to December 2020, when the health plan temporarily shut down its website. 

The health plan said it discovered that several thousand applicants’ information was inappropriately accessed and tampered with as a result of the breach. Information of applicants and enrollees that was exposed included Social Security numbers, dates of birth, names, addresses and financial information. 

During the time of the breach, Jelly Bean Communications Design was maintaining the health plan’s website and databases. The health plan said it is  speeding efforts to move the website to a new vendor. The health plan incorporates four programs that offer health insurance for children from birth to age 18: Medicaid, MediKids, Florida Healthy Kids and the Children’s Medical Services program, according to local CBS affiliate WPEC

The health plan said it has not confirmed that  personal information was removed from the system as a result of the incident and recommended  that individuals who applied for or enrolled with the health plan between November 2013 and December 2020 set up fraud alerts or security freezes. 

 
 

Clipped from: https://www.beckershospitalreview.com/cybersecurity/florida-medicaid-website-hacked-7-years-hundreds-of-thousands-of-health-plan-applicants-enrollees-affected.html

 
 

 
 

 
 

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Executive Order on Strengthening Medicaid and the Affordable Care Act | The White House

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The new HHS administration has been instructed to open a special enrollment period for the exchanges and to review all policies and waivers approved in recent years to identify potential changes to nullify.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

     Section 1.  Policy.  In the 10 years since its enactment, the Affordable Care Act (ACA) has reduced the number of uninsured Americans by more than 20 million, extended critical consumer protections to more than 100 million people, and strengthened and improved the Nation’s healthcare system.  At the same time, millions of people who are potentially eligible for coverage under the ACA or other laws remain uninsured, and obtaining insurance benefits is more difficult than necessary.  For these reasons, it is the policy of my Administration to protect and strengthen Medicaid and the ACA and to make high-quality healthcare accessible and affordable for every American.

     Sec. 2.  Special Enrollment Period.  The coronavirus disease 2019 (COVID-19) pandemic has triggered a historic public health and economic crisis.  In January of 2020, as the COVID-19 pandemic was spreading, the Secretary of Health and Human Services declared a public health emergency.  In March of 2020, the President declared a national emergency.  Although almost a year has passed, the emergency continues — over 5 million Americans have contracted the disease in January 2021, and thousands are dying every week.  Over 30 million Americans remain uninsured, preventing many from obtaining necessary health services and treatment.  Black, Latino, and Native American persons are more likely to be uninsured, and communities of color have been especially hard hit by both the COVID-19 pandemic and the economic downturn.  In light of the exceptional circumstances caused by the ongoing COVID-19 pandemic, the Secretary of Health and Human Services shall consider establishing a Special Enrollment Period for uninsured and under-insured Americans to seek coverage through the Federally Facilitated Marketplace, pursuant to existing authorities, including sections 18031 and 18041 of title 42, United States Code, and section 155.420(d)(9) of title 45, Code of Federal Regulations, and consistent with applicable law.

     Sec. 3.  Immediate Review of Agency Actions.  (a)  The Secretary of the Treasury, the Secretary of Labor, the Secretary of Health and Human Services, and the heads of all other executive departments and agencies with authorities and responsibilities related to Medicaid and the ACA (collectively, heads of agencies) shall, as soon as practicable, review all existing regulations, orders, guidance documents, policies, and any other similar agency actions (collectively, agency actions) to determine whether such agency actions are inconsistent with the policy set forth in section 1 of this order.  As part of this review, the heads of agencies shall examine the following: 

(i)    policies or practices that may undermine protections for people with pre-existing conditions, including complications related to COVID-19, under the ACA;

(ii)   demonstrations and waivers, as well as demonstration and waiver policies, that may reduce coverage under or otherwise undermine Medicaid or the ACA;

(iii)  policies or practices that may undermine the Health Insurance Marketplace or the individual, small group, or large group markets for health insurance in the United States;

(iv)   policies or practices that may present unnecessary barriers to individuals and families attempting to access Medicaid or ACA coverage, including for mid-year enrollment; and

(v)    policies or practices that may reduce the affordability of coverage or financial assistance for coverage, including for dependents.

(b)  Heads of agencies shall, as soon as practicable and as appropriate and consistent with applicable law, consider whether to suspend, revise, or rescind — and, as applicable, publish for notice and comment proposed rules suspending, revising, or rescinding — those agency actions identified as inconsistent with the policy set forth in section 1 of this order.

(c)  Heads of agencies shall, as soon as practicable and as appropriate and consistent with applicable law, consider whether to take any additional agency actions to more fully enforce the policy set forth in section 1 of this order.

     Sec. 4.  Revocation of Certain Presidential Actions and Review of Associated Agency Actions.  (a)  Executive Order 13765 of January 20, 2017 (Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal), and Executive Order 13813 of October 12, 2017 (Promoting Healthcare Choice and Competition Across the United States), are revoked.

(b)  As part of the review required under section 3 of this order, heads of agencies shall identify existing agency actions related to or arising from Executive Orders 13765 and 13813.  Heads of agencies shall, as soon as practicable, consider whether to suspend, revise, or rescind –- and, as applicable, publish for notice and comment proposed rules suspending, revising, or rescinding — any such agency actions, as appropriate and consistent with applicable law and the policy set forth in section 1 of this order.

     Sec. 5.  General Provisions.  (a)  Nothing in this order shall be construed to impair or otherwise affect:

(i)   the authority granted by law to an executive department or agency, or the head thereof; or

(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

     (b)  This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

     (c)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

                             JOSEPH R. BIDEN JR.

THE WHITE HOUSE,

    January 28, 2021.

 
 

Clipped from: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/

 
 

 
 

 
 

 
 

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Analyzing Recent Trends in Medicaid/CHIP Applications: What We Do and Do Not Know

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KFF is unable to tell if the economy impact of COVID or the moratorium on eligibility terminations is driving the Medicaid enrollment increases.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

This data note discusses changes in the number of applications for Medicaid/CHIP coverage during the coronavirus pandemic. Application data include new applications for coverage that are received by state Medicaid/CHIP agencies and (if relevant) the State Based Marketplace; in many states, applications also include renewals and redeterminations. Data are from the Centers for Medicare and Medicaid Service (CMS) Performance Indicator Project, which is designed to track enrollment and an array of other measures to assess states’ Medicaid program performance. However, CMS has mostly focused on monthly enrollment totals, and other measures are either not publicly available or are not included in monthly summaries from CMS, though CMS recently highlighted changes in applications (see Methods box for more details about the data).

Enrollment in Medicaid/CHIP has increased steadily by more than 6 million individuals (9%) from February to September 2020, though it’s difficult to tease out the effects of the economic crisis with people losing their jobs from the requirement that states maintain coverage for people already enrolled in Medicaid during the public health emergency (PHE). The total number of Medicaid/CHIP applications has decreased by more than 150,000 (-6%) in the same time period, which might on the surface suggest that fewer people are applying for coverage even in the face of large job and income losses, but data limitations – in particular, the fact that application statistics do not distinguish between new signups and renewals – make it difficult to draw any clear conclusions.

For the median state, which is more stable than using the national total, the number of applications peaked in March 2020 (+12% from February) with a sharp decline in May 2020 (-22% from February), and applications only began increasing again in June and July 2020 (-16% and -13% from February) before leveling off in recent months (Figure 1). The decrease in applications is likely due to a number of factors and likely includes a reduction in renewals and redeterminations as well as the effects of lockdowns and closures due to the pandemic.

Figure 1: Medicaid/CHIP applications declined early in the pandemic, but data limitations make it difficult to interpret trends.

While the continuous coverage provisions of the FFCRA likely played a role in the decline of applications, it is difficult to parse out the impact based on the data available. In exchange for receiving an enhanced federal match rate on Medicaid spending, state Medicaid agencies must ensure continuous coverage for those enrolled as of March 2020. Initial guidance from CMS also specified that states could not move enrollees to a new eligibility category. As a result, most states likely stopped or slowed processing renewals. While states still could not disenroll people from Medicaid, some states may have started to process renewals over the summer contributing to an uptick in applications. States could start a new 12-month renewal period if all other eligibility criteria can be verified. These renewals could help stagger renewals at the end of the PHE. Available data do not identify new applications from renewals or redeterminations, and it is difficult to identify their role in declining application totals. In more recent guidance effective November 2, 2020, CMS reversed earlier guidance and specified that states are required to transition most enrollees determined ineligible for their current coverage to different coverage pathways for which they are eligible if such a transition is in the same tier of coverage (but cannot disenroll individuals). It is possible that this revised guidance could contribute to increases in application data in the upcoming months.

The declines in applications could also reflect challenges related to social distancing measures and office closures during the pandemic. Although all states provide online application options, the median state reported that 55% of Medicaid/CHIP applications completed online, suggesting that a large share of applicants rely on telephone, mail, or in-person applications. Office closures due to the pandemic could have limited some peoples’ options for filing Medicaid/CHIP applications, especially if they have limited access to the internet. It is also possible that prolonged changes in the economy and adaptations to provide better assistance and process new applications may have contributed to the increase in applications after the sharp decline in May. Timely information on the mode of applications is not currently available in national data sets, although it could help identify whether there have been changes in the modes that people apply for Medicaid/CHIP.

There is wide variation in application trends across states, with the majority of states seeing a decline from February 2020 (Figure 3). Variation in the number of applications is likely related to state-specific policies, economic conditions within states, and even seasonal patterns, such as open enrollment for federal and state-based health insurance marketplaces. Nebraska, for example, has seen a large increase in applications (67%) from February to September 2020, which the state attributed to early applications for the new Medicaid expansion program that began coverage in October 2020, according to a recent CMS Medicaid and CHIP Enrollment Trend Snapshot. Kentucky saw even larger growth, with a 224% increase in applications from February to September 2020, although the reason behind this increase is unclear. The majority of states (34 out of 49 with complete data) reported a decline in the number of Medicaid/CHIP applications since February 2020, with the lowest state (DC) seeing a 55% decline in applications in this time period (Figure 2).

Figure 2: Changes in the number of Medicaid/CHIP applications vary widely by state.

Methods

This analysis is based on KFF analysis of the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project Data. This data set is designed to track enrollment and an array of other measures to assess states’ Medicaid program performance. State Medicaid agencies submit data to CMS each month, and the data are typically used to track current enrollment in Medicaid and CHIP, usually with a 3- to 4-month lag when the data are made publicly available. Other measures aside from enrollment are either not made publicly available or not typically highlighted in monthly summaries, although CMS recently highlighted changes in states’ monthly Medicaid/CHIP applications.

Application data reflect all applications received by the state Medicaid and CHIP agency (or agencies) as well as the number of applications requesting financial assistance that have been received by the state-based marketplace (including Medicaid/CHIP applications, Advanced Premium Tax Credits, and Cost Sharing Reductions). Applications that are started on the federally facilitated marketplace are not included in the data. Additionally, 12 states use footnotes in the data between January 2020 and September 2020 to indicate that application counts include renewals and/or redeterminations (AK, DC, IA, MD, MO, NV, NY, OH, OK, PA, VT, VA), although inclusion of renewals/redeterminations or the number of renewals/redeterminations are not standardized measures in the publicly available data. For this analysis, we excluded two states (Kansas and Maine) that have missing data for one or more months between January 2020 and September 2020.

 
 

Clipped from: https://www.kff.org/coronavirus-covid-19/issue-brief/analyzing-recent-trends-in-medicaid-chip-applications-what-we-do-and-do-not-know/

 
 

 
 

 
 

 
 

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Oklahoma chooses vendors for $2 billion program partially privatizing Medicaid

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Winners include BCBS of Oklahoma, Humana, Centene and UnitedHealthcare.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The companies will usher in managed care and partially privatize Oklahoma’s Medicaid program, SoonerCare. That will include the portions under the recently passed Medicaid expansion.

  • Catherine Sweeney

This story was written in collaboration with The Frontier’s Kassie McClung.

State officials announced the winners of up to $2.1 billion in health care contracts on Friday, a major milestone in implementing Oklahoma’s hotly debated privatized Medicaid program.

Four private health insurance companies will handle much of Oklahoma’s Medicaid program starting in October: Blue Cross and Blue Shield of Oklahoma; Humana Healthy Horizons; Oklahoma Complete Health, which is a subsidiary of managed care giant Centene; and United Healthcare.

Gov. Kevin Stitt has made partially privatizing Medicaid one of his administration’s top priorities. Using a policy called the managed care model, Oklahoma will begin paying private health insurance companies to coordinate much of the state’s Medicaid program, known as SoonerCare. Up to 75 percent of the state’s Medicaid enrollees will work with the private companies. That includes the anticipated 200,000 working adults who will newly qualify for Medicaid after voters passed expansion last year.

Oklahoma has some of the worst health outcomes in the country, Stitt said during a news conference at the state Capitol on Friday. The state’s current approach to health isn’t working, he said, and it’s time to try something new.

“Business as usual will not make us a Top 10 state,” he said.

The program, which will be called SoonerSelect, has proven highly controversial.

Supporters, including officials within the Oklahoma Health Care Authority, argue that the policy protects the state from financial risk. For example, when demand for services increases because of a pandemic or a financial downturn, the onus would be on the private companies to adjust to new costs, removing the burden from state coffers. It would also place a new incentive on preventative care. That could improve the state’s health outcomes, which rank 46th nationally.

Opponents are concerned the program was designed hastily, that it will reduce health access for low-income Oklahomans instead of improving it, that it will drive down provider participation in Medicaid, that the $2.2 billion contracts faced no legislative oversight, and that Oklahoma’s past attempts to implement full managed care failed miserably. Most of the state’s medical trade associations and many top-ranking legislators have publicly criticized it.

The contracts will be valid for one year with the possibility of year-long extensions at the health care authority’s discretion. Enrollment into the programs will be effective Oct. 1. Seven companies went through the bidding process, which opened in mid-October and closed Dec. 15. The 400-page request for proposals for SoonerSelect asked companies to provide a substantial amount of information, including its experience working in Oklahoma, staffing and implementation plans.

Managed care changes how Medicaid funding works. Right now, the Oklahoma Health Care Authority manages SoonerCare and pays providers directly, using a fee-for-service model. That means the state pays doctors, hospitals, nursing homes and others a uniform rate for their services. For example, regardless of where they are in the state, physicians who accept SoonerCare will get paid the same amount to treat an ear infection.

Under managed care, the Oklahoma Health Care Authority will pay private companies to coordinate enrollees’ care, and those companies will be responsible for paying providers like doctors and hospitals. Instead of paying standard rates to providers, the state will pay the company a sum of money per enrollee. The company will determine the best way to use that funding for the enrollees’ health needs.

Several top officials spoke during the conference, including Stitt, long-time managed care proponent Sen. Kim David and Secretary of Health Kevin Corbett. Corbett also serves as the CEO of the Oklahoma Health Care Authority.

 
 

Gov. Kevin Stitt said during the Jan. 29 press conference that Oklahoma needs to improve its health outcomes, which now rank 46th in the nation. Photo by Ben Felder, The Frontier.

Several of Oklahoma’s top health care organizations have come out to oppose the managed care plan.

Three physicians groups — the Oklahoma State Medical Association, Oklahoma Osteopathic Association and the state’s chapter of the American Academy of Pediatrics — released a scathing joint statement on Friday afternoon, criticizing the move. Although there’s room to improve the state’s Medicaid program, handing over control to for-profit companies is ill-advised, the statement said.

“It is unfortunate that, rather than working with stakeholders and legislators on his managed care scheme, this administration has chosen to push through an ill-conceived plan that will have serious implications for our state’s most vulnerable and at-risk populations,” Stillwater
physician Woody Jenkins is quoted in the release. “Real leadership involves more than buzzwords and partisan talking points. It requires dialogue and compromise, two things that have been sorely lacking during this process.”

The Oklahoma Hospital Association criticized, among other things, the timing of the program.

“We are disappointed in the governor’s decision to award these contracts that will do nothing to
improve the health of Oklahomans and will increase costs to the state,” the statement reads in part. “The middle of a public health crisis is not the time to be sending Oklahoma health care dollars to insurance companies to manage the care of Oklahomans.”

The announcement of the contracts came just days before the state legislative session, which begins Monday. Although the Legislature appropriates funding to the Oklahoma Health Care Authority, it doesn’t get to control many specific funding decisions within the agency.

The proposal has drawn blowback from many Oklahoma lawmakers on both sides of the aisle. In December, dozens of House Republicans issued a joint press release, expressing fears that the program would “be a disaster,” and concern that the agency might “try to act before the legislative session begins Feb. 1.”

Sen. Rob Standridge, a former Senate Health and Human Services Committee chairman and vocal managed care opponent, criticized the Stitt administration for its lack of coordination with lawmakers.

“This may be the biggest contract ever contemplated by the state of Oklahoma, and we’re going to do that without legislative approval,” he said in an interview. “That defies all logic, in my opinion.”

During an Oklahoma Health Care Authority budget hearing before the Senate Health and Human Services committee on Jan. 25, chairman Greg McCortney raised concerns about bringing in costly private companies for work the agency could do in house.

“I think every one of us believes you could do this better,” he said.

Sen. Kim David, a longtime proponent of managed care, said she had no concerns that the Legislature and critics within it could block the program. She said the state question that placed Medicaid expansion in the constitution guaranteed it.

“Constitutionally, we have to fund the expansion population, so there is no doubt that we will absolutely fund this,” she said during Friday’s news conference.

She said that critics in the Legislature simply don’t understand the policy, or that they’re looking out for special interests that benefit under the status quo.

“I think a lot of a lot of members — some of those who have been outspoken about it — don’t understand exactly what the concept is,” she said. “They know what they’ve been told and they know they should be afraid. And then I have several who stand to gain by keeping the system the way it is.”

Asked whether introducing profit motives into Medicaid would hamper access or quality, Corbett said no.

“I think the reality is maybe the only organization in the health care system today that’s a not-for-profit, in the real sense of the word, is us (the Health Care Authority),” he said. “Most of our providers are in the business for profit or for surplus creation and things of that nature. What we’re looking for from our partners is the ability for them to make investments, bring innovation and really make a difference in what we need to be doing.”

At least 40 states have implemented some form of managed care, but many use it only for limited populations. Not all managed care programs use what is called fully capitated care, in which there is a hard cap on the amount of money per enrollee the state pre-pays the companies. SoonerSelect is fully capitated.

Oklahoma voters approved Medicaid expansion in June. That policy was created under the Affordable Care Act in 2009. When states choose to expand Medicaid, they change the program’s eligibility requirements to accept more working poor adults. Households with incomes at or below 138 percent of the federal poverty guideline will be eligible.

Like with traditional Medicaid, the state and the federal government share the cost. Unlike traditional Medicaid, the federal government pays for the bulk of expansion costs. For every dollar a state pitches into expanded Medicaid, the federal government pitches in nine. The option has been available for more than 10 years, but Oklahoma declined to expand until voters passed a state question mandating it in last summer’s election.

Medicaid expansion will make about 200,000 working Oklahomans eligible for the health program. State officials project Oklahoma’s share — one tenth of the total cost — to be about $160 million. Medicaid expansion goes into effect on July 1.

 
 

Secretary of Health Kevin Corbett also serves as the Oklahoma Health Care Authority CEO. He announced the four vendors during the press conference on Jan. 29. Photo by Ben Felder, The Frontier.

Corbett said the agency decided to go the managed care route after Medicaid expansion passed. That has meant creating this program from start to finish in about 7 months — a heavy load for the agency’s workers.

“They took the holidays and did all the work we needed to do,” he said.

This won’t be the state’s first foray into managed care. Oklahoma implemented a managed care program for urban residents in the late 1990s, which failed and was canceled in 2003.

The program, known as SoonerCare Plus, ran into several issues. The private companies contracting with the state demanded rate increases — one demanding an 18 percent increase year over year during a budget shortfall. When the state didn’t grant the increase, it dropped out of the program, like several others had in preceding years.

In 2002, Oklahoma Health Care Authority CEO Mike Forgary issued a letter to members, warning them that because of changes with their managed care organizations, they could soon see their care rationed or copays required.

“Our State is experiencing a revenue shortfall and OHCA must revise and balance its budget,” the letter reads in part. “As a result we have given the Health Plans greater leeway to control the cost of services that you receive.,. This will likely mean fewer services to you than you now receive… We very much regret that we have to take this action but the law requires it.”

The state canceled the program a year later, when too few companies were available to enrollees. A state-sponsored report on Medicaid policy later found that a different program that did not use fully capitated managed care, SoonerCare Choice, would be a better model.

“In 2003, OHCA developed an analysis that indicated OHCA could operate the Choice program in urban areas at approximately one-quarter of the administrative costs of the Plus program,” the report states in part.

OHCA chairman Stanley Hupfeld acknowledged the concern in an editorial published in late December.

“The concern now expressed by many providers is that we have been here before and that it was a disaster,” the editorial reads in part. “Indeed, this is very true…The justifiable outrage was intense.”

This go round will be different, he wrote.

“So, what is the difference now? In my opinion OHCA has gone to extraordinary lengths to ensure that the past is not repeated. There are a plethora of protections and safeguards built into the Request for Proposal (RFP) language that ensure the state’s providers will not be disadvantaged. For instance, the contractor will be held to a tight rein on how much they will be allowed for profit and overhead. So, too, the quality, patient and provider reactions will be closely monitored. As Chair of OHCA I am confident the mistakes of the past will not be repeated.”

 
 

Clipped from: https://stateimpact.npr.org/oklahoma/2021/01/29/oklahoma-chooses-vendors-for-2-billion-program-partially-privatizing-medicaid/

 
 

 
 

 
 

Posted on

Threat of Medicaid block grants could be axed under Biden

MM Curator summary

 
 

The new HHS administration has been ordered to review all policies and waivers that may restrict Medicaid “coverage.”

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Long-term care providers who opposed a federal proposal to turn the Medicaid program into a block grant system may get a solid stamp to their leanings under a new move by President Joe Biden. 

Biden on Thursday signed an executive order aimed at strengthening the Medicaid program and Affordable Care Act. Among its actions, the order tasks several agencies, including the  Department of Health and Human Services, to review all existing regulations, orders, guidance and policies related to Medicaid.

It also calls on them to examine “demonstrations and waivers, as well as demonstration and waiver policies, that may reduce coverage under or otherwise undermine Medicaid or the ACA.” 

Medicaid expert Joe Weissfeld noted that order could be the demise of block grants, which were pushed on a national scale by the Trump administration. He told Inside Health Policy the hope is that the order “marks the beginning of the end of work requirements, block grants, and attacks on reproductive health in the Medicaid program.”

A spokesman for the American Health Care Association once called block grants “an existential threat” to long-term care providers.

Last year, the Centers for Medicare & Medicaid Services announced its “Healthy Adult Opportunity” (HAO) program, which allowed participating states to receive a block grant for a specific population enrolled in Medicaid. That initiative was met with backlash from long-term care providers, among many others.CMS in mid-January approved an unprecedented demonstration for Tennessee to convert its Medicaid program into a block grant system.

 
 

Clipped from: https://www.mcknights.com/news/threat-of-medicaid-block-grants-could-be-axed-under-biden/

 
 

 
 

Posted on

DHHS approves Legal Aid of N.C. as Medicaid transformation ombudsman services

MM Curator summary

 
 

NC awards Legal Aid contract to help members navigate issues during the transition to managed care.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The N.C. Department of Health and Human Services said Wednesday that Legal Aid of N.C. will provide Medicaid Managed Care ombudsman services for Medicaid beneficiaries.

Legal Aid will partner with the Charlotte Center for Legal Advocacy and Pisgah Legal Services to educate and inform beneficiaries about the state’s move to Medicaid Managed Care through outreach events, a public website and a toll-free phone number.

The ombudsman will help resolve issues within the Medicaid Managed Care delivery system. The ombudsman services will begin in the spring.

The ombudsman will be available to address specific Medicaid-related questions from beneficiaries, make referrals to applicable resources and assist in resolving issues with managed care.

In addition, the ombudsman will help track crucial information regarding access to care for ongoing reporting and analysis. This will help identify trends across Medicaid Managed Care to ensure timely attention to potentially systemic issues.

The services provided by Legal Aid are not a replacement for the Grievance and Appeals processes required of each Prepaid Health Plan, nor do the services replace the right of a member to appeal through any State-administered appeals system.

These services are distinct from North Carolina’s existing Long-Term Care Ombudsman Program that assists residents of long-term care facilities.

 
 

 
 

Clipped from: https://journalnow.com/news/local/dhhs-approves-legal-aid-of-n-c-as-medicaid-transformation-ombudsman-services/article_33e62b20-5b3e-11eb-bd10-fff0a64a33fd.html