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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Comprehensive Home and Community-Based Services Waiver Amendment Approved By Centers for Medicare and Medicaid Services (CMS).

 
 

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An update to the NY IDD / HCBS waiver will allow for more services to be delivered via telehealth even after the pandemic.

 
 

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 Office for People With Developmental Disabilities (OPWDD) is pleased to announce that the 1915(c) Comprehensive Home and Community-Based Services (HCBS) Waiver Amendment, Amendment 06 has been approved by the federal Centers for Medicare and Medicaid Services (CMS).  This Waiver Amendment will be effective July 1, 2021 and will fund services for approximately 90,000 New Yorkers with intellectual and developmental disabilities.

The HCBS Waiver is the Medicaid program that provides opportunities for adults and children with intellectual and developmental disabilities to receive services in their own home or community.

The July 1, 2021 Amendment includes changes to permanently adopt telehealth and in-residence service delivery models that were temporarily adopted to address the COVID-19 public health emergency. These changes  include a revision to the service description for Community Habilitation to allow the delivery of Community Habilitation services within certified residences. In addition, the Amendment allows Day Habilitation, Prevocational Services, Respite, Pathway to Employment, Support Brokerage, Community Habilitation, and Supported Employment services to be delivered via telehealth modalities in accordance with State and Federal guidance. These service models will take effect following the end date of OPWDD’s Appendix K temporary authority, which was approved on an emergency basis by CMS in response to the COVID-19 public health emergency. The Appendix K authority will end six months following the end of the Public Health Emergency.

The amendment also includes a revision to the Intensive Respite service definition to allow individuals who live in certified settings to access Intensive Respite from a Crisis Services for Individuals with Intellectual and/or Developmental Disabilities (CSIDD) Resource Center.

Clipped from: https://news.hamlethub.com/brewster/politics/14964-comprehensive-home-and-community-based-services-waiver-amendment-approved-by-centers-for-medicare-and-medicaid-services-cms

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DHS: 2,868 people in Medicaid programs might have had information exposed

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A data breach in Wisconsin exposed personal health information for members.

 
 

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.

 
 

 
 

MADISON, Wis. (WBAY) – Wisconsin’s health department is notifying almost 3,000 people in Medicaid programs that their personal information might have been exposed, including names, birth dates, Social Security numbers, member ID numbers, and health information.

The Department of Health Services says it discovered a person who didn’t have authorization accessed an email account on February 19. Their access was disabled the same day.

The DHS isn’t aware of information being exposed, but an investigation determined there was that potential risk for people in Medicaid long-term care programs in Wisconsin, including Family Care, IRIS and Children’s Long-Term Support programs.

The state is sending notices to 2,868 people Friday to alert them to this possibility. The DHS says they’ll be offered free credit monitoring for one year and a dedicated call center to answer any questions.

 
 

Clipped from: https://www.weau.com/2021/06/04/dhs-2868-people-medicaid-programs-might-have-had-information-exposed/

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Biden’s Budget Gives States Another Big Reason Not To Expand Medicaid

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Biden’s proposed repeal the Hyde Amendment would force states to pay for abortions.

 
 

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.

 
 

 
 

 
 

If Congress enacts them into law, the legislative concepts outlined in President Biden’s first budget will have far-reaching effects on American debt, deficits, and taxation. One specific policy may have an effect even as a proposal. By suggesting a repeal of the Hyde Amendment, the president gave conservative states another reason not to expand Medicaid.

While coverage of the Biden budget has focused on its support of taxpayer funding for abortion, fewer articles have analyzed where that funding would occur. In practice, eliminating the Hyde Amendment would mean states that have embraced Medicaid expansion would find themselves on the vanguard of a major expansion of abortion coverage. The states that have yet to expand Medicaid—all of which have pro-life tendencies—should take note.

Additional Cash in COVID Spending Spree

Biden has offered new incentives for the 12 states who have yet to embrace Obamacare’s expansion of Medicaid to the able-bodied. Under the aegis of “COVID relief,” Section 9814 of Democrats’ economic legislation offers states that had not expanded as of its March date of enactment a two-year, 5 percent increase in the federal match for their existing Medicaid populations.

Democrats hope that the combination of a temporary increased federal match for current beneficiaries, coupled with a 90 percent enhanced federal match for the new populations covered by Obamacare, would entice the remaining states to take up expansion.

Cutting Hyde Means Forcing States to Cover Abortion

But the administration’s proposal to repeal the Hyde Amendment would have the opposite effect. First enacted in 1976 and named for the late pro-life Rep. Henry Hyde, R-Illinois, the amendment prohibits all federal funds, including Medicaid matching dollars, from being used for abortions, except in the cases of rape, incest, or to save the life of the mother.

Because the Hyde Amendment occurs as a rider to Congress’ annual appropriations bills, lawmakers must re-enact the measure every year. Biden’s budget proposed eliminating the rider for next year’s appropriations measure, in which case the pro-life protections would lapse.

If Congress follows the president’s lead and does not renew the Hyde Amendment, court precedents may require state Medicaid programs to cover abortions in most if not all cases. A 1994 district court ruling in Michigan, and earlier rulings from several federal courts of appeals, suggest that congressional authorization of comprehensive health benefits like those in Medicaid means such programs must cover all medically necessary treatments—including abortion—unless Congress explicitly states otherwise.

Some may argue that, even if the Hyde Amendment represents the only barrier from Medicaid programs being forced to fund abortions, concerns from pro-life Democrats and the Senate’s super-majority requirement for most legislation make it unlikely Congress would let the Hyde language lapse. Those individuals should remember that Biden supported the Hyde Amendment for decades—until quickly reversing himself soon after he announced his presidential campaign.

Another Good Reason to Pass Up Medicaid Expansion

The 12 states that have not adopted Medicaid expansion all have pro-life tendencies. While 16 state Medicaid programs cover abortion despite the Hyde prohibition on the use of federal funding by using state-only dollars, none of the states that have declined the Obamacare expansion do so.

States have many good reasons to eschew Medicaid expansion: The uncertainty of enhanced matching funds from Washington given more than $28 trillion in federal debt, and the need to preserve programs like Medicaid for the most vulnerable patients rather than expanding to able-bodied adults. But for pro-life lawmakers in conservative states, the president’s budget provides another tangible reason to avoid Medicaid expansion, as Biden wants to dragoon states that acquiesce into a massive expansion of abortion coverage.

Clipped from: https://thefederalist.com/2021/06/08/bidens-budget-gives-states-another-big-reason-not-to-expand-medicaid/

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MONTANA- Medicaid expansion enrollment hits record number in April

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MT Medicaid is at its highest ever peak due to not removing ineligible members from the rolls during the pandemic.

 
 

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.

 
 

 
 

MISSOULA, Mont. (AP) — A record number of Montanans are enrolled in the state’s Medicaid expansion program, which provides health insurance for low-income adults, according to the state health department.

Nearly 99,000 people were being served by the program in April, which is 18,300 more than the nearly 80,500 enrolled a year earlier, according to state data.

The state stopped disenrolling people from Medicaid programs during the COVID-19 pandemic, leading to the higher enrollment numbers, Chuck Council, a spokesperson for the Department of Public health and Human Services, told Montana Public Radio.

The department will resume taking people off the programs if they’re no longer eligible once Montana’s public health emergency ends, Council said.

Republican Rep. Ed Buttrey of Great Falls, who co-sponsored the Medicaid expansion legislation, said the program is working like it should.

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“When we get into hard times, people get into hard times, this is a safety net measure to make sure that folks are not neglecting their health care and that providers are getting paid for the services they provide,” Buttrey said.

The previous enrollment high was 96,656 people in August 2018.

Medicaid expansion in Montana is funded with 89% federal money and 11% state money. Montana’s Medicaid expansion program requires participants to pay premiums.

 
 

Clipped from: https://www.westport-news.com/news/article/Medicaid-expansion-enrollment-hits-record-number-16223162.php

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Louisiana Senate scuttles post-pregnancy Medicaid extension

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LA has now declined the extra maternity coverage in the COVID relief bills, citing concerns over the state-share of the increased costs.

 
 

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.

 
 

People would have been able to stay on Medicaid for 12 months postpartum

The Louisiana Senate Finance Committee killed legislation Thursday that would have allowed people who were pregnant to stay on Medicaid for a year postpartum. The federal government would have had to sign off on the approval before it went into effect. 

Currently, people who use Medicaid during their pregnancy lose their health care coverage two months after their pregnancy — unless they qualify for Medicaid in another way.

People who are pregnant can make more money than most Medicaid enrollees and still use the program. They may use Medicaid while pregnant, but make too much money to qualify for government-backed health insurance afterwards. State Rep. Mandie Landry, D-New Orleans, was attempting to fill that gap with this bill. 

The Louisiana House voted 95-0 for Landry’s legislation, House Bill 468, but the Senate Finance Committee said the bill was too expensive to approve. Expanding postpartum access would have cost Louisiana between $4.3 million and $4.6 million in state funding annually over the next five years.

The Senate Finance Committee scuttled several other bills — including legislation that would have eased criminal record expungement — because they were deemed too expensive. 


The committee did so even though Louisiana has more funding this year than it has since a financial windfall from recovery after hurricanes Katrina and Rita. The state has received billions of dollars from the federal government in recent months to help the state rebound from the COVID-19 pandemic.

After receiving the federal funding boost, lawmakers voted to spend over $70 million on local earmarks in their budget plan. Those projects  include a skate park, town hall renovations, lighting upgrades for certain cities, the installation of “cooling fans” in a neighborhood park and funding for a nonprofit entity created by a sitting senator. Lawmakers have also set aside $15 million next year for technology upgrades at the state Capitol. 

 
 

Clipped from: https://lailluminator.com/2021/06/03/louisiana-senate-scuttles-post-pregnancy-medicaid-extension/

 
 

 
 

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Illinois Selects CNSI to Support Ongoing Medicaid Modernization Efforts

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CNSI has won the IL MMIS contract.

 
 

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.

 
 

CNSI to Assist with Claims and Encounter Data Processing, Managed Care Coordination, and AWS Cloud Migration

MCLEAN, Va., June 8, 2021 /PRNewswire/ — CNSI, a leading provider of innovative, healthcare technology-driven products and solutions that improve health outcomes and reduce healthcare costs, announced today that Illinois has selected CNSI’s Medicaid Management Information System (MMIS) for core claims processing, encounter data processing, and MC-Track® managed care coordination platform. CNSI will also support Illinois’ MMIS migration to the Amazon Web Services (AWS) secure public cloud to power their infrastructure, become more agile, and lower costs. The Centers for Medicare & Medicaid Services (CMS) approved the four-year contract, which includes CNSI’s Fast Healthcare Interoperability Resources® (FHIR) based interoperability solution.

The Illinois Department of Healthcare and Family Services (HFS) is responsible for providing healthcare coverage for adults and children who qualify for Medicaid. Illinois’ medical assistance programs, consisting of Medicaid and numerous other associated health and human services programs, provide comprehensive health-care coverage to about 3.2 million Illinoisans.

“The state of Illinois is dedicated to creating a more efficient, accountable and integrated healthcare system, and providing better quality care and positive outcomes for our customers,” Illinois Department of Healthcare and Family Services Director Theresa Eagleson said. “CNSI’s partnership helps us avoid significant loss of time and inefficiencies as we work to modernize our 35-year old payment system and allows us to better focus our resources on connecting the Illinoisans we serve with quality care and services.”

Todd Stottlemyer, CEO of CNSI, added, “We have expanded the CNSI modular product suite to encompass claims and encounter data processing for care provided in a multitude of settings – each with their own data interoperability nuances. Illinois’ adoption of FHIR-based standardization will reduce the work required to implement, track, and report on health quality measures – all part of their long-term vision for growth and scalability.”

Central to the Illinois MMIS contract, CNSI received the top overall score in the 2020 NASPO ValuePoint™ multi-state evaluation of MMIS Claims Processing and Management Services.

 
 

Clipped from: https://www.prnewswire.com/news-releases/illinois-selects-cnsi-to-support-ongoing-medicaid-modernization-efforts-301307542.html

 
 

 
 

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OHIO- Senate Proposal To Change Medicaid Procurement Process Draws Criticism

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Ohio lawmakers are working to ensure local plans win government bids.

 
 

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 state has selected six managed care organizations to carry out Medicaid services, amounting to a $20 billion contract, but a provision in the Senate’s budget proposal would stop that procurement process and require the state to consider other measures.

The Senate plan would require the state to “significantly take into account” if the managed care organization applying for a contract is based in Ohio.

Other things to take into account, according to the bill language, is the number of jobs created or lost in this state by the award of the contracts; other economic impacts in this state resulting from the award of contracts; and whether the managed care organization has a proven track record of “providing quality services and customer satisfaction.”

Paramount Advantage, based in the Toledo area, was the only current provider not selected for a contract set to begin in 2022.

Critics of the procurement process say there was not enough transparency.

Loren Anthes, policy fellow with The Center for Community Solutions disagrees with that assessment.

“The idea that there’s a lack of transparency, after the dozens of hearings I’ve been to, the dozens of meetings I saw, the fact that the state has a website with all this material, is at least misleading, at most it’s manipulative,” Anthes says.

Anthes says the state used a thorough process to determine which companies provide the best coverage and the Senate’s amendment threatens to lower that bar.

 
 

Clipped from: https://www.statenews.org/post/senate-proposal-change-medicaid-procurement-process-draws-criticism

 
 

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OHIO- Gift cards offered as incentive for people on Medicaid to get COVID-19 vaccine

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MCOs now offer $50 gift cards to increase vax rates among Ohio Medicaid members.

 
 

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.

 
 

 
 

 
 

Some people visiting Butler County health clinics on Wednesday got a surprise: $50 gift cards for getting the COVID-19 vaccine.

“We’re willing to do whatever we can that’s legal and within reason to get people vaccinated so that this pandemic can be behind us,” said health commissioner Jenny Bailer of the Butler County General Health District.

The incentive is for patients on Medicaid, and it’s part of an effort to get more people vaccinated. According to Ohio’s five managed-care providers, people on Medicaid are vaccinated at lower rates than the rest of the population. Bailer said that this type of benefit isn’t easy to offer, so she was glad that the program was able to get off the ground.

“We’ve kicked around the incentive program in a lot of different ways,” Bailer said “There are a lot of barriers to implementing incentives, so we felt really happy that this one came through for us and we were able to do this with Medicaid.”

Another major motivation for getting the gift card reward to vaccine recipients was the slowdown in people showing up at vaccine clinics. Bailer said earlier this year Butler County was up to 33 different drive-through clinics; when they put out a call on Facebook, about 2,000 cars would show up. Things are much different now.

“Most of the people who really wanted to get vaccinated have gotten vaccinated,” Bailer said. “So now we’re reaching out to those who are a little bit harder to reach, maybe don’t have transportation, maybe they’re a little hesitant and they want to do a little education and think about it first.”

Emily King, a cashier at Dollar Tree, heard about the payout and was happy to have the convenience of a walk-in clinic Wednesday to get her first dose of the vaccine.

“I’ve been needing to get it for quite some time,” King said. “I thought, ‘Well, this is really close to where I live. I might as well get it done.'”

Fifteen-year-old Morgan Sloan was waiting to get the vaccine until she became eligible. She’s said she’s been living with extra caution and still masking and socially distancing herself from others.

“I kind of woke up and my mom said, ‘You’re getting your vaccine today,’ and I said, ‘OK, great, let’s go,'” she said. “I just feel safer being out in public, being around people.”

Kathy Eatmon of CareSource, one of Ohio’s managed care organizations, said in addition to the $50 gift card incentive, people are being assisted in registering for Ohio’s Vax-a-Million drawing. And for added motivation, the $50 gift card isn’t just for the first dose — it can be given for both doses of COVID-19 vaccine. Eatmon said she hopes that word of mouth will help drive more people to show up for the clinics.

“I always tell them to tell a friend,” she said. “If you know a friend who hasn’t received that vaccine, go ahead and tell them to come on out today.”

 
 

Clipped from: https://www.wcpo.com/news/coronavirus/covid-vaccine/gift-cards-offered-as-incentive-for-people-on-medicaid-to-get-covid-19-vaccine

 
 

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Parson says budget cuts are coming next month if deal on Medicaid tax renewal is not reached

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The Governor notifies the legislature that there will be program cuts if the provider-tax funding device is not able to be passed.

 
 

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 Jeanne Kuang | The Kansas City Star (TNS)

JEFFERSON CITY — Medicaid budget cuts are coming next month unless lawmakers strike a deal to renew a critical medical provider tax that underwrites a major portion of the state’s health coverage program for low-income residents, Missouri Gov. Mike Parson warns.

Lawmakers did not renew the tax, which expires Sept. 30, before they ended their session May 14. At issue was a fight led by Republican Sens. Paul Wieland, of Imperial, and Bob Onder, of Lake St. Louis, to insert language banning Medicaid coverage of certain birth control methods.

The tax collected from hospitals, nursing homes and pharmacies generates roughly $1.6 billion a year. That allows the state to bring in $3 billion in federal funds that is returned to the facilities for treating low-income elderly and disabled residents enrolled in the state’s $12 billion Medicaid program.

“The clock’s ticking on us,” Parson told reporters Monday. “If there’s not some sort of agreement where we have a solution, and it doesn’t happen before July 1, there’s not going to be choices. We’re going to have to start withholding [from the budget] July 1.”

 
 

Gov. Mike Parson signs prescription drug monitoring program bill on Monday, June 8, 2021. (Handout photo/governor’s office)

The $35 billion state budget sitting on Parson’s desk for the fiscal year that starts July 1 includes increased funding for homes for the developmentally disabled, higher Medicaid payments to nursing homes and expanded mental health services.

 
 

Clipped from: https://www.stltoday.com/news/local/govt-and-politics/parson-says-budget-cuts-are-coming-next-month-if-deal-on-medicaid-tax-renewal-is/article_9dbd8dc2-0cda-557c-8953-57dc73fd4319.html

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Missouri deems Medicaid expansion lawsuit an ‘attempt to circumvent’ constitutional requirements

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MO AG offers arguments in the press ahead of the hearing.

 
 

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.

 
 

 
 

KANSAS CITY, Mo. — In response to a lawsuit regarding Missouri’s backtracking on Medicaid expansion, the state’s attorney general alleged that the suit’s interpretation of state law is “an impermissible attempt to circumvent bedrock constitutional requirements.”

Filed June 4, Eric Schmitt argued that the lawsuit, filed by three women who qualify for Medicaid coverage, is “premised on an incorrect statutory interpretation of HB 11 and other appropriations statutes enacted in the 2021 session of the General Assembly.”

Missouri voters initially approved in August a constitutional amendment for the expansion, but Gov. Mike Parson announced in May that the state would not move forward, citing a lack of funding.

The court documents, filed in Cole County, stated that the House bill’s plain text confirms that the funds were not appropriated through HB 11, which covers the Department of Social Services, or any other bill for Medicaid expansion.

“Under Article III, Section 51 of the Constitution, the constitutional amendment purportedly authorizing Medicaid Expansion could not and did not mandate an appropriation,” court documents state. “Rather, the General Assembly retained authority to appropriate, or not appropriate, funds for Medicaid Expansion. Because the General Assembly did not do so, Defendants lack authority to implement Medicaid Expansion and they lack appropriations authority to disburse taxpayer funds for that purpose.”

The voter-approved expansion included language stating that the federal government would reimburse the state for a majority of the expansion costs.

But the state argued that using federal funds to offset some costs associated with Medicaid expansion “does not make up for the lack of appropriations authority under state law to expend any funds, whether state or federal, for the purpose of implementing Medicaid expansion.”

Additionally, the state said that granting the plaintiff’s relief request would “violate the separation of powers provision of the Missouri Constitution.”

Stephanie Doyle, Melinda Hille and Autumn Stultz filed the suit against the Missouri Department of Social Services and its acting director, Jennifer Tidball; MO HealthNet Division and its acting director, Kirk Mathews; and the state’s Family Support Division and its director, Kim Evans.

 
 

Clipped from: https://www.kshb.com/news/local-news/missouri-deems-medicaid-expansion-lawsuit-an-attempt-to-circumvent-constitutional-requirements