Category: Curator

HHS Curator is our free research service published by our team. We read hundreds of Medicaid news items each week and highlight and summarize them for you to save you time.

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Amazon surpasses Walmart for most Nevada employees and dependents on Medicaid

MM Curator summary

 
 

7,892 Amazon employees are on Nevada Medicaid now, up from 4,040 last year.

 
 

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.

  
 

Amazon has surpassed Walmart to become the employer with the most employees and dependents on Medicaid in Nevada, according to a new report from the state. 

The number of Nevada Amazon employees and dependents on Medicaid nearly doubled year over year, increasing from 4,040 to 7,892, despite statements on the company’s website that they offer medical, prescription drug, dental, and vision coverage to all of their employees, regardless of their level or position. Amazon reports having more than 10,500 full and part time jobs in the state.

The massive jump in Amazon employees and dependents covered by Medicaid came alongside a significant jump for Integrity Staffing Solutions, a job placement company that has two of its three listed Nevada offices located at Amazon fulfillment centers.

Integrity Staffing Solutions was the fifth-largest Nevada employer of Medicaid-covered employees and dependents in the 2020 fiscal year, increasing from less than 500 in the previous year to 1,746.

Walmart, the leading employer of Nevada Medicaid recipients in the last three fiscal years, fell behind Amazon, but its number of Medicaid-covered employees and dependents also continued to rise, increasing about 11 percent from the previous year to 7,725 in the last fiscal year.

Nevada Medicaid Recipients Employed by Employers with 50 or More Employees
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Of the nearly 8,000 Nevada Walmart employees and dependents on Medicaid, 3,429 were company employees. The company reports having 14,548 employees in the state. Amazon would not indicate how many people it employs in the state.

Quentin Savwoir, the political director of Make It Work Nevada, a progressive non-profit and advocacy group, sees a problem with these increasing numbers. 

“If these corporations like Walmart, like an Amazon, invested in things like paying families quality, affordable childcare, or even just paying their employees equal pay, that would go a long way to making the lives of the women and families we work alongside a little bit better,” said Savwoir. “They wouldn’t have the need to rely on the social safety net.”

When asked for comment, Walmart’s communications department offered information about the pay and health care coverage provided to employees, including that the average total compensation and benefits for its hourly employees, both full- and part-time, is more than $18 an hour as of last January — and that eligible full- and part-time employees can receive medical coverage beginning at a cost of $30.50 per biweekly pay period. It also stated that the company’s goal is “moving people beyond entry-level jobs.”

An Amazon spokesperson said that the figures in the report are misleading because they include part-time workers and people who were only employed by Amazon for a short time, including seasonal employees.

“We have hundreds of full-time roles available, however, some prefer part-time for the flexibility or other personal reasons,” an Amazon spokesperson said.

In Nevada, households with annual incomes of up to 138 percent of the federal poverty level — $16,753 per year for an individual or $34,638 per year for a family of four — may qualify for Medicaid. A single adult with three children would have to earn almost $17 per hour while working 40 hours per week to no longer be eligible for Medicaid.

That means that even full-time employees working for companies like Amazon and Walmart could qualify. Amazon pays its employees a minimum wage of $15 per hour, and Walmart employees in Nevada earn an average wage of $14.84 per hour.

The report from the Department of Health and Human Services’ Office of Analytics, which was mandated by a bill the Legislature passed in 2017, comes on the heels of a nationwide report released last November by the Government Accountability Office (GAO) that showed some similar trends.

The GAO report found that across the 11 states studied, Walmart was consistently one of the top employers of Medicaid and SNAP recipients. The report also showed that Amazon was among the top employers of workers on Medicaid. 

Sen. Bernie Sanders of Vermont, who commissioned the GAO report, called the findings “morally obscene.”

“U.S. taxpayers should not be forced to subsidize some of the largest and most profitable corporations in America,” Sanders said in a press release.

The growth in Medicaid recipients from employers with 50 or more employees resulted in an increased cost to Nevada Medicaid of $2.8 million from the 2019 to 2020 fiscal year.

That increase was much less than the combined increase for Amazon and Walmart employees — which in 2020 was nearly $12 million more than the previous year. However, that was offset by the decrease in the number of employees and dependents covered by Nevada Medicaid at other companies, including Clark County School District, Smith’s Food and Drug and Wynn Resorts.

During the 2020 fiscal year, Amazon and Walmart employees and dependents’ cost to Nevada Medicaid was more than $43 million. In that same period, the cost to Nevada Medicaid from companies with 50 or more employees was approximately $737 million.
As of November, more than 761,000 Nevadans were enrolled in Medicaid, which was 120,000 more than the 2019 Legislature had predicted. To account for that growth, Nevada will spend an additional $153.5 million on Medicaid in fiscal year 2022, according to the latest state budget proposal.

 
 

Clipped from: https://thenevadaindependent.com/article/amazon-surpasses-walmart-for-most-nevada-employees-and-dependents-on-medicaid

 
 

 
 

 
 

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New Mexico leads nation in Medicaid health care enrollment

MM Curator summary

 
 

43% of all people in New Mexico are on Medicaid now.

 
 

 
 

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.

  
 

SANTA FE, N.M. (AP) — New Mexico has surpassed all other states in its reliance on Medicaid health care as the coronavirus wreaks economic havoc and shifts the way people receive health care, the state’s Medicaid director told a panel of lawmakers on Friday.

Residents have flocked to the federal- and state-subsidized health care program for people living in poverty or on the cusp, with 43% enrollment statewide as of November. States including Louisiana and Kentucky rely on heavily on Medicaid to insure about one-third of their populations.

Nicole Comeaux, director of the state Medicaid Assistance Division, says enrollment has grown by about 1.5% a month since the outset of the pandemic.

That has helped deliver a windfall of federal contributions to Medicaid spending in New Mexico. The federal government provides $4.76 for every dollar in state general funds spent on the program, up from $3.65 pre-pandemic.

That equation is providing the state with an additional $385 million, under the condition that it keep Medicaid patients enrolled even as they climb into jobs and out of poverty.

The recent expansion could be costly if bonus federal matching funds expire as scheduled in April. Comeaux said the state could see a $170 million shortfall for the coming fiscal year that starts July 1.

The Legislature convened this week to craft a spending plan for the coming fiscal year.

“Only half of that population is going to fall off” Medicaid insurance, she said. “Our base budget doesn’t account for those extra folks.”

States have begun lobbying the administration of President Joe Biden for a more gradual reduction in the Medicaid match, Comeaux said.

Highlighting New Mexico’s increasing reliance on Medicaid, Comeaux said that the program pays for three-quarters of births across the state. In rural Torrance and Sierra counties, more the three-quarters of the population is insured through Medicaid and the Children’s Health Insurance Program, for families that earn too much money to qualify for Medicaid but not enough to buy private insurance.

 
 

Clipped from: https://the-journal.com/articles/199839

 
 

 
 

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Feds boost Florida’s Medicaid coffers by extending COVID-19 public health emergency

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The public health emergency was extended to April, sending $130M more to FL alone.

 
 

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 — Florida lawmakers have gotten a well-timed budget break thanks to a decision by the federal government to extend the nation’s public-health emergency due to the COVID-19 pandemic.

U.S. Health and Human Services Secretary Alex Azar extended the public-health emergency last week.

Azar’s decision means the federal government will continue to allocate a 6.2 percentage-point increase in money for Medicaid, the joint federal-state health care program. Before the extension, the additional funding was slated to expire in March.

Justin Senior, chief executive officer of the Safety Net Hospital Alliance of Florida, estimated that each month the extension is in effect frees up about $130 million in state money that would otherwise be needed to fund Medicaid. Senior’s association represents 14 of the state’s public, teaching and children’s hospitals.

“That’s a huge boost to the budget, both this year and potentially next year, that can help lawmakers avoid cutting health care in the middle of a pandemic,” said Senior, a former secretary of the state Agency for Health Care Administration, which runs much of the Medicaid program.

The good budget news came as lawmakers return to Tallahassee this week for the first round of committee meetings before the March 2 start of the 2021 legislative session. With the pandemic reducing state tax revenues, finding a way to balance the budget will be a major issue during the session.

Recognizing the national economic problems caused by the pandemic, Congress initially agreed in March to boost the federal Medicaid match for all states by 6.2 percentage points.

The decision by Azar to extend the emergency means that Florida should continue to receive the increased federal funding through the June 30 end of the state’s 2020-2021 fiscal year.

Medicaid provides health coverage to poor, elderly and disabled people. Enrollment in the program is countercyclical, increasing in tough economic times when there is reduced state tax revenue to help pay for it. When the economy is thriving and money to fund the program is available, enrollment decreases.

Before the COVID-19 pandemic, enrollment in Florida’s Medicaid program had usually been below 3.9 million people. As of Nov. 30, 4.475 million Floridians were enrolled in the program, a nearly 19 percent increase from the 3.76 million who were enrolled in  March 2020, prior to the economic shutdown associated with the pandemic.

While enrollment in Medicaid programs is increasing nationwide, Florida, which did not expand Medicaid eligibility under the federal Affordable Care Act, has seen some of the largest increases, according to Tom Wallace, the state Agency for Health Care Administration’s assistant deputy secretary for Medicaid finance analytics.

The Medicaid program does not cover all low-income Floridians and has different eligibility criteria based on age, income and assets and medical conditions. But increases have been seen in nearly every eligibility category, from children to poor seniors, according to Amy Baker, coordinator of the Legislature’s Office of Economic & Demographic Research.

While the federal extension means additional funds for the state, it also means additional restrictions. During the pandemic, state Medicaid officials cannot alter the program to make enrollment more restrictive than what it was prior to January 2020.

Additionally, so long as the public health emergency continues, the state is largely precluded from disenrolling anyone who was enrolled in Medicaid on March 18 or who enrolled due to the pandemic, with some limited exceptions. For instance, states can disenroll people who have been incarcerated or people who were presumed to be eligible for Medicaid but were ultimately determined ineligible.

Clipped from: https://thecapitolist.com/feds-boost-floridas-medicaid-coffers-by-extending-covid-19-public-health-emergency/

 
 

 
 

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Ohio names one pharmacy benefit manager for Medicaid to save cash

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Gainwell will become the new PBM in Ohio, beating out 5 other bidders including Express Scripts and Magellan.

 
 

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.

 
 

Ohio’s grand quest to finally slay the dragon of overcharges by pharmacy benefit managers starts Monday with the rollout of a new $158 million contract by the state Medicaid agency.

The Buckeye State’s premise, a unique approach just approved by the federal government: It takes a PBM to beat a PBM.

Bearing the sword on behalf of the state is Gainwell Technologies, a single PBM newly hired to work on behalf of Ohio taxpayers. The company will replace the multibillion-dollar conglomerates such as CVS Caremark and Express Scripts that currently serve as middlemen in the prescription drug supply chain for 3 million poor or disabled Ohioans.

At last count, those privately run PBMs were making off with nearly a quarter billion dollars a year, charging up to six times the going industrial rate, a state consultant found.

Ohio Medicaid Director Maureen Corcoran said the switch to a single, state-controlled PBM alone will save roughly $150 million to $200 million per year. However, the new arrangement also would cost the state revenue, such as about $23 million from a tax on health insuring corporations that no longer could be collected. And additional staff must be hired to handle duties the agency is taking over from managed-care organizations.

The bottom line will be revealed when Gov. Mike DeWine unveils his budget on Feb. 1, she said.

How PBMs make money often has been called a “black box” because even outside experts cannot figure it out. The new setup is designed to “break open the black box and be better accountable for tax dollars,” Corcoran said.

Medicaid, funded jointly by the state and federal governments, covers about $3.5 billion worth of prescription drugs a year in Ohio. (It is separate from Medicare, a federal program that pays for health care of those 65 and older.) 

“We will have a very-good-quality, experienced manager of these medications that will save the state money and will allow transparency about the care and the expenditures for this program that did not exist in the past,” Corcoran said.

Big changes for children, recipients on the way

Hiring Gainwell as Medicaid’s single PBM is one part of a huge restructuring of the state’s biggest agency that won’t be completed for another year. Still to come is the hiring of a pharmacy operational support vendor, designed to monitor the performance of Gainwell.

Also on the agenda is the OhioRise plan to cover specialized behavioral services for children with complex health needs. Those crushing expenses often aren’t covered by parents’ insurance, causing many to make the heart-breaking decision to voluntarily give up custody to the government so their children can be treated outside of Ohio. Thousands of other children are forced to live in group settings to get the care they need.

Starting in 2022, a federal waiver will allow the state to set up a specialized managed care organization with expertise in providing services for the most complex “multi-system” youth. Corcoran said the goal is to serve 50,000 children by the end of next year.

“We don’t have to take away custody; we can keep them in their family,” she said.

And likely the biggest state contract in history is set to be awarded later this month to winners of an 11-way competition to handle Medicaid’s managed care operations starting next year. The current contract, shared by six outfits, totals about $20 billion.

When what Corcoran calls a “new generation of Medicaid” is finally put in place, both Medicaid recipients and health-care providers will notice the difference.

One simple change will occur when a person on Medicaid changes managed-care plans. Now, they must make sure that their preferred Pharmacy A is on the new plan, or whether they must change to Pharmacy B. But with the state using a new centralized credentialing setup to decide which pharmacies and which drugs are covered, there will be no difference when making the switch.

On the other end of the drug-supply chain, doctors and pharmacists — which currently must fill out as many as seven similar forms to make sure they can get Medicaid reimbursement, a process that can take months — will need to complete only one standardized state form.

Big PBM, lobbyist’s favorite lose out

The competition for the single PBM contract started out with six companies. But three — including Express Scripts, the second-biggest in the country — were eliminated along the way.

One of the final three considered was MagellanRx Management, which was represented by longtime lobbyist Neil Clark when then-House Speaker Larry Householder inserted the single PBM plan into the state budget in mid-2019. Both Clark and Householder are now under federal indictment for a what authorities say was a $60 million scheme culminating about the same time to build the Perry County Republican’s political power and pass a $1 billion bailout of Ohio’s two nuclear power plants via House Bill 6.

Corcoran noted that Householder’s original budget language was revised before the bill was passed, and that Gov. DeWine vetoed several specific mandates about the procurement process.

Deputy Medicaid Director Steven Voigt said the competition “was very fair, diligent, with plenty of safeguards. Every bidder had the same chance.”

Gainwell wound up with the highest score from the panel that evaluated the proposals, and the company also offered the lowest price.

Gainwell or its predecessor has received 16 Centers for Medicare and Medicaid Services certifications since 2010 — more than all other vendors within the same period, the Ohio Medicaid department said. It provides pharmacy services for 29 state Medicaid programs, and implemented 21 Medicaid system modules in eight states.

“They are not like CVS or Express Scripts or whatever; they are more of an entity that has specialized in IT, clinical support, not like traditional PBMs focus on drug market,” Corcoran said.

“They have all of the skills and tools and requirements that are needed. The combination of their pharmacy, various types of pharmacy experiences across 29 (states), means they have demonstrated boots on the ground experience in every element of this PBM design that we have selected.”

Gainwell would be paid $158.2 million if it remains for the entire 7.5 years of the state contract. The pact, which must be approved by the bipartisan state Controlling board, includes financial penalties and an “out” for the state if the new single PBM does not measure up to state standards, Corcoran said.

Gainwell, which says it has more than 7,500 employees, was created on Oct. 1 by the $5 billion sale of DXC Technology’s U.S. state and local health and human services business to Veritas Capital, a leading investor in Gainwell.

“As a construct of the words ‘gain’ and ‘well,’ the name reflects the company’s mission to empower its clients through technology in order to deliver health and human services programs that enable successful health outcomes for beneficiaries nationwide,” Veritas said in a Sept. 16 press release.

Clipped from: https://www.dispatch.com/story/news/healthcare/2021/01/11/pharmacy-benefit-managers-ohio-medicaid-saving-pbm/6556793002/

 
 

 
 

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Congress Delays Medicaid DSH Cuts, Makes Targeted Medicaid Policy Changes | Manatt, Phelps & Phillips, LLP – JDSupra

 
 

MM Curator summary

The latest COVID relief bill also delays DSH reductions another 4 years (they have been continuously delayed for more than 10 years now).

 
 

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.

 
 

In late December, following several weeks of dynamic negotiations, Congress passed the Consolidated Appropriations Act, 2021 (the Act).1 The massive legislative package includes appropriations through September 30, 2021, $900 billion in supplemental appropriations to address COVID-19, a ban on surprise billing, extensions of expiring health programs and an amalgam of odds-and-ends health policy provisions.

The Act contains several key Medicaid provisions, including a delay in Medicaid Disproportionate Share Hospital (DSH) allotment reductions, new Medicaid supplemental payment reporting requirements for states and codification of non-emergency medical transportation (NEMT) rules, described below.

But despite the vastness of the legislation, key Medicaid priorities were not included. States and other stakeholders have been lobbying Congress to increase the Medicaid enhanced matching rate that applies to medical expenditures for the duration of the public health emergency (PHE) and extend it beyond the duration of the PHE. This COVID-19 relief provision and other Medicaid proposals, such as a proposal to extend Medicaid coverage of postpartum women eligible for Medicaid on the basis of their pregnancy, will be high priorities for Democrats as they work with the incoming Biden administration to secure a fifth round of COVID-19 stimulus funding early this year.

DSH and Supplemental Payment Reporting Requirements

Delay in Medicaid DSH Allotment Reductions. The Act eliminates reductions in Medicaid DSH allotments—that is, the cap on federal match for state Medicaid DSH expenditures—in fiscal year (FY) 2021. It also delays the remaining four years of cuts until FY 2024, as shown in Figure 1 below.

Figure 1. Change in Medicaid DSH Allotment Reductions

  

FY 2021

FY 2022

FY 2023

FY 2024

FY 2025

FY 2026

FY 2027

Previous Reduction Amounts

$4 billion2

$8
billion

$8
billion

$8
billion

$8
billion

–

–

Modified Reduction Amounts

–

–

–

$8
billion

$8
billion

$8
billion

$8
billion

 
 

Changes to Calculation of Hospital-Specific DSH Limit. The Act also modifies the maximum amount of Medicaid DSH payments an individual hospital may receive, by redefining what costs are included when calculating hospital-specific DSH limits. States’ DSH payments to individual hospitals may not exceed a hospital’s uncompensated care costs for uninsured patients and Medicaid-enrolled patients. The second component—uncompensated care costs for Medicaid-enrolled patients—is the difference between the costs of services provided and payments received from Medicaid, and is referred to as the Medicaid shortfall.

Department of Health and Human Services (HHS) guidance and rulemaking regarding how hospitals calculate Medicaid shortfall for DSH purposes have been contentious and led to a litany of lawsuits. The issue at hand is how to account for Medicaid enrollees who have another source of coverage, such as Medicare or commercial insurance, when calculating Medicaid shortfall. Although HHS policy has been that states must account for all third-party payments when calculating hospital-specific DSH limits, some hospitals have argued that only Medicaid payments should count against the hospital-specific DSH limit.

Congress adopts an entirely different method for calculating Medicaid shortfall, as recommended by the Medicaid and CHIP Payment and Access Commission (MACPAC). Rather than focus on whether payments for individuals with third-party coverage should count in the hospital-specific DSH limit calculation, the Act simply omits from the calculation all costs for Medicaid-eligible patients with third-party sources of coverage where the third-party source of coverage is the primary payer. As a result, hospitals that treat high volumes of patients with Medicaid and third-party coverage (such as children’s hospitals that treat neonates, who commonly are covered by commercial insurance and Medicaid, or hospitals serving large numbers of dual eligibles) may report less Medicaid shortfall. And because many states use hospitals’ uncompensated care amounts to distribute DSH payments among hospitals, this change is likely to impact the distribution of Medicaid DSH payments among hospitals in certain states.

Supplemental Payment Reporting Requirements. The Act imposes new requirements on states to report any supplemental payments made through their Medicaid programs. By October 1, 2021, HHS must establish a system for states to submit reports on supplemental payment data as a requirement for a State Plan Amendment that would provide for a supplemental payment. In their reports, states will be required to explain, among other elements, (1) how supplemental payments are in keeping with the Social Security Act’s mandate that Medicaid payments be consistent with “efficiency, economy, quality of care, and access,” as well as with the purpose of the supplemental payment; (2) the criteria used to determine which providers qualify for a supplemental payment; (3) the methodology used to distribute the supplemental payments; and (4) the amount of supplemental payments made to each provider.3

Supplemental payments will continue to be a hot-button issue for many federal policymakers and increased transparency through required reporting may fuel future policy changes.

Other Medicaid Provisions

The Act includes several other Medicaid policies including:

  • Codification of NEMT Requirements. The Act requires states to provide NEMT to Medicaid beneficiaries who lack access to regular transportation (including those enrolled in benchmark and benchmark equivalent coverage). Previously, the requirement existed only in regulation, and the Trump administration had threatened to eliminate it. In making NEMT a mandatory benefit through statute, Congress also establishes some guardrails around the new benefit, namely by including NEMT provider requirements and by directing that the Medicaid state plan provide for methods and procedures to prevent unnecessary utilization and to ensure that payments are consistent with efficiency, economy, and quality of care and sufficient to promote access. The Act directs the Government Accountability Office to study NEMT services, with a particular focus on preventing and detecting fraud and abuse. The legislation also requires CMS to report Transformed Medicaid Statistical Information System data to Congress along with recommendations regarding coverage of NEMT to medically necessary services; to convene a series of stakeholder meetings to discuss best practices for improving Medicaid program integrity related to NEMT; and to review and update, as necessary, CMS guidance to states about designing and administering NEMT coverage. Finally, the legislation authorizes states that utilize NEMT brokerage programs, as permitted under Section 1902(a)(70), to consult stakeholders in establishing their programs.
  • Eligibility Restoration for Citizens of Freely Associated States. The Act eliminates the five-year bar on Medicaid eligibility for citizens of the freely associated states (i.e., Micronesia, Marshall Islands, and Palau) who are legally residing in the United States. The legislation restores access to Medicaid for this population after a drafting error in the 1996 Personal Responsibility and Work Opportunity Reconciliation Act excluded them from coverage.
  • Medicaid Extenders. The Act includes funding through FY 2023 for the Money Follows the Person Rebalancing Demonstration, which helps states rebalance utilization and spending toward home- and community-based services (HCBS) rather than institutional care; spousal impoverishment protections, which allow states to disregard individuals’ spousal income and assets when determining eligibility for Medicaid HCBS; and the community mental health services demonstration program, which provides eight states with enhanced funding to improve behavioral health services through Certified Community Behavioral Health Clinics.

1 P.L. 116-260.

2 Beginning in December 2020.

3 The Act indicates in what appears to be a drafting error that each state’s report must provide an assurance that the total payments made to an inpatient hospital provider (but excluding DSH payments) do not exceed the upper payment limit (UPL). However, there is no hospital-specific cap on supplemental payments subject to the UPL; rather, the UPL is assessed at an aggregate level for defined classes of providers (which is established in statute). Congress and/or the Centers for Medicare & Medicaid Services (CMS) may seek to clarify this provision.

 
 

Clipped from: https://www.jdsupra.com/legalnews/congress-delays-medicaid-dsh-cuts-makes-8125523/

 
 

 
 

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California proposes expanding Medicaid coverage of continuous glucose monitors

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California wants to add $12M in the next fiscal year’s budget to pay for CGM for adults with Type 1 diabetes.

 
 

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.

Dive Brief:

  • California Gov. Gavin Newsom proposed providing $12 million to expand coverage of continuous glucose monitors (CGMs).
  • The 2021-22 budget proposal is intended to increase access to CGMs among adults with Type 1 diabetes who are covered by California’s Medicaid program Medi-Cal. Abbott, Dexcom, Medtronic and Senseonics compete for the U.S. CGM market.
  • Trade group AdvaMed welcomed the proposal, arguing it will reduce overall healthcare costs, and called on other states to take similar steps to ensure access to CGMs.

Dive Insight:

Sales of CGMs such as Abbott’s FreeStyle Libre and the Dexcom G6 have grown quickly in recent years as Type 1 and Type 2 diabetics have identified the devices as ways to improve the management of their conditions. However, Medicaid coverage of CGMs is patchy with some states providing no coverage and others limiting access to the pediatric population.

California was one of the states with a Medicaid program that only provided CGMs to children who met certain criteria. Lawmakers sought to expand access in 2019, only for Newsom to veto the bill. Newsom said expanded access should be considered through the annual budget process.  

State lawmakers reminded the Democratic governor of his comments about the budget process late last year, adding that the COVID-19 pandemic has emphasized the need for improved access to CGMs. The lawmakers framed CGMs as a way to control spending on adult diabetes patients. 

The pressure has paid off. Newsom wants to include $12 million in funding to enable adults with Type 1 diabetes to access CGMs in California. The funding, which is set to kick in at the start of next year, is the start of an ongoing commitment to CGMs. Newsom’s office sees CGM funding as a way to boost health equity. Overall Medi-Cal funding is set to increase more than 10% in 2021-22.

The budget proposal comes shortly after an American Diabetes Association survey found 20% of people have foregone or delayed getting a CGM or other device due to financial constraints during the COVID-19 pandemic. Among people with a CGM or insulin pump, 15% have delayed sourcing consumable supplies for the devices, typically due to financial constraints.

AdvaMed praised the funding proposal, stating Newsom “is exactly right to push for expansion of Medi-Cal’s coverage of CGMs.” The trade group said providing the Medi-Cal population with CGMs is both the right thing to do and “a smart way” to reduce healthcare costs.

The California legislature will determine whether the budget request is enacted, and the proposal will take effect Jan. 1, 2022, if approved. 

 
 

Clipped from: https://www.medtechdive.com/news/california-proposes-expanding-medicaid-coverage-to-CGMs/593127/

 
 

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Bill to end Medicaid managed care advances in Illinois House

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Illinois lawmakers are ready to be done with MCOs.

 
 

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.

SPRINGFIELD – A House committee on Monday advanced a bill that would end the system of hiring private insurance companies to manage the state’s Medicaid program at the end of their current contracts and replace it with a standard fee-for-service payment system.

The bill also calls for a three-year moratorium on any hospital closures or downsizing.

However, it is expected that further amendments to the bill are being drafted, and it was unclear Monday whether a final version could be approved by both chambers of the General Assembly before the special lame duck session ends, either Tuesday or early Wednesday.

That proposal is part of a health care reform package being pushed by the Illinois Legislative Black Caucus, an agenda aimed at addressing racial and ethnic disparities in the state’s health care system.

Medicaid covers more than 3 million people in Illinois, according to the latest tally by the Department of Healthcare and Family Services, and the majority of them are enrolled in a managed care program. Nearly half of those enrollees, more than 1.4 million, are children in low-income families. Another 1.1 million are working-age adults, including more than 640,000 who became eligible with the federal expansion of Medicaid under the Affordable Care Act.

The idea behind managed care was to reduce costs and improve health outcomes by coordinating each person’s health care – making sure they get regular checkups and follow-up visits and coordinating services between primary care providers and specialists.

 
 

Clipped from: https://qctimes.com/news/state-and-regional/govt-and-politics/bill-to-end-medicaid-managed-care-advances-in-illinois-house/article_fe7c7e6e-4088-57b3-8da9-fe873e093502.html

 
 

 
 

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CMS won’t add new Medicaid accountability rule

MM Curator summary

Industry opposition has officially killed the last effort to reform entrenched Medicaid financing schemes.

 
 

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.

 
 

CMS has officially withdrawn its proposed Medicaid fiscal accountability rule.

CMS proposed the rule in November 2018. It aimed to promote transparency and fiscal integrity by establishing new reporting requirements for state supplemental payments to Medicaid providers.

But last August, some hospital associations called on CMS to withdraw the rule, arguing that it could exacerbate the challenges U.S. hospitals.

The hospital associations, including America’s Essential Hospitals and the American Health Care Association, argued that finalizing the rule would introduce “unprecedented restrictions on states’ ability to fund their share of the Medicaid program” at a time when hospitals are facing challenges and an uncertain future due to the COVID-19 pandemic. 

CMS Administrator Seema Verma tweeted last September that the agency would move to scrap the rule after listening to concerns from hospitals and other stakeholders.

The action taken by CMS officially withdraws the rule. The document officially withdrawing it is scheduled to be published in the Federal Register Jan. 19. 

“Today I took action to withdraw the proposed Medicaid fiscal accountability rule from the federal register,” Ms. Verma tweeted. “While we support its intent, further work is needed to ensure accountability for states while protecting critical safety-net care for vulnerable patients.” 

Clipped from: https://www.beckershospitalreview.com/finance/cms-won-t-add-new-medicaid-accountability-rule.html

 
 

 
 

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Medicaid transformation initiative remains on pace for July 1 launch (NC)

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North Carolina is set to roll out managed care for the first time this July.

 
 

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 ambitious Medicaid transformation initiative remains on track for a July 1 debut, state health officials told legislators Tuesday.

Dave Richard, the state’s deputy secretary for Medicaid, said that “we’re on target, we’re on schedule and our commitment to you is that we’re going to do everything possible” to go live with the managed care plans.

At stake with Medicaid transformation: three-year prepaid health plan contracts for four insurers that are projected to be worth $6 billion a year starting with the 2021-22 fiscal year which begins July 1.

With two optional one-year extensions, a contract could be worth a total of $30 billion — among the largest vendor contracts awarded in state history.

The state Department of Health and Human Services announced in February 2019 that the four PHPs are Centene (operating as WellCare of N.C.), AmeriHealth Caritas N.C., Blue Cross and Blue Shield of N.C. (operating as Healthy Blue) and UnitedHealth Group.

The next rollout steps are an online tool launching Jan. 25 that lists providers and the four PHPs, and insurers submitting their tailored plans by Feb. 2.

Statewide enrollment is projected to begin March 15 and end May 14. There is a 90-day “change period” that allows beneficiaries to switch PHPs. 

 
 

Clipped from: https://journalnow.com/news/local/medicaid-transformation-initiative-remains-on-pace-for-july-1-launch/article_0a710280-55ab-11eb-9824-5701b0d4908b.html

 
 

 
 

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Corrado Bill Raising Reimbursement Rates for Medicaid Private Duty Nurses Advances (NJ)

MM Curator summary

New Jersey legislation would raise home-based nursing care rates by about 50%.

 
 

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.

 
 

Bipartisan legislation sponsored by Senator Kristin Corrado that would boost minimum Medicaid reimbursement rates paid for private duty nursing services (PDN) was advanced by the Senate Health, Human Services and Senior Citizens Committee.

PDN services are individualized nursing tasks provided by licensed nurses on a continuous basis in the homes of certain qualifying patients.

“Skilled medical professionals are delivering high-quality, in-home care, but reimbursement rates have failed to keep up with the true cost of services,” said Corrado. “Thousands of residents rely on PDN nurses to improve their health and maintain their standard of living. To ensure a reliable roster of skilled nurses to meet the need, it makes sense to escalate reimbursement rates to a level that more reasonably reflects the work. Reimbursing more money to the providers will allow them to increase pay to the hard-working professionals caring for patients.”

The bill, S-2191, is also sponsored by Senator Loretta Weinberg. It would establish minimum Medicaid reimbursement rates for PDN services provided in the Medicaid fee-for-service delivery system or through a managed care delivery system. The minimum reimbursement for services rendered by a registered professional nurse would increase to not less than $60 per hour, and $48 per hour for a licensed practical nurse (LPN).

Under current State regulations, the maximum Medicaid reimbursement rate is not more than $40 per hour when a registered nurse provides the services, and not more than $28 for an LPN.

The bill will require all providers that receive reimbursement for PDN services under a Medicaid managed care contract to annually report to the State Division of Medical Assistance and Health Services (DMAHS) regarding the use of funds as reimbursement for the healthcare workers.

 

Clipped from: https://www.insidernj.com/press-release/corrado-bill-raising-reimbursement-rates-medicaid-private-duty-nurses-advances/