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Georgia officials seek to postpone limited Medicaid expansion

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Georgia HHS officials have asked for a minimum of a 1 month delay to implement their limited Medicaid expansion while they negotiate with a Biden administration hostile to its design.

 
 

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.

 
 

 
 

ATLANTA — State health officials are asking the federal government’s permission to delay the implementation date of a limited, Georgia-specific expansion of Medicaid for at least a month.

In a letter dated June 24, state Community Health Commissioner Frank Berry cited a decision during the early weeks of the Biden administration to withhold approval of a Georgia Medicaid waver application then-President Trump’s administration signed off on last year.

Biden’s Center for Medicare & Medicaid Services objected to provisions in the proposed Georgia Pathways program requiring Medicaid recipients to work, attend school or volunteer at least 80 hours a month. CMS officials argued recipients would have a particularly hard time complying with a work requirement during the pandemic.

Berry disagreed with the federal agency position’s in a letter he sent to CMS in March.

“Georgia Pathways provides a wide range of qualifying activities in which individuals can engage,” the commissioner wrote. “Moreover, there is also a temporary ‘good cause’ exception if, after enrolling in Medicaid through Georgia Pathways, an individual or immediate family member experiences a hospitalization or serious illness or needs to quarantine due to COVID exposure.

“If anything, the COVID-19 crisis makes the qualifying hours and activities — which include work, job training, education, or volunteering — more important, not less. CMS must allow this program to begin as planned and authorized.”

With the program set to take effect July 1, Berry’s letter asks for more time while discussions between the state and CMS continue.

Gov. Brian Kemp rolled out the limited Medicaid expansion plan early in 2019 as an alternative to the Affordable Care Act then-President Obama steered through a Democratic Congress in 2010. The General Assembly passed legislation later in 2019 authorizing the governor to submit two waiver applications to the feds.

Besides the Medicaid waiver, a second waiver would substitute a private-sector alternative to the federal government’s healthcare.gov insurance exchange.

CMS is also revisiting that second waiver, which the Trump administration approved last fall. Earlier this month, the agency ordered the state to revisit the data used to justify the new approach, taking into account changes in federal law and policy that have occurred since Biden took office.

 
 

 
 

Clipped from: https://www.news-daily.com/news/state/georgia-officials-seek-to-postpone-limited-medicaid-expansion/article_7d3b2daa-d5dc-515d-85e1-9ef86466ee24.html

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Ohio overhauling $20B Medicaid program, but budget could pump the brakes

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The Senate insistence on reinstating Paramount as an MCO no jeopardizes various improvements to the program.

 
 

 
 

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 DeWine administration’s overhaul of the more than $20 billion Ohio Medicaid program could halt under a budget amendment that would essentially restart the process.

Ohio Medicaid is already over two years into transforming its clunky bureaucracy and re-awarding billions of contracts with a new set of spending conditions, which should translate to better care for the 3 million Ohioans covered by the health insurance program for the poor and disabled.

 
 

The sweeping reforms range from stopping parents from having to give up custody when they can’t afford their child’s mental health care, slashing provider paperwork hassle and implementing long-demanded pharmacy reforms.

The new system is supposed to be in place early 2022.

But that could change because of the proposed state operations budget that just cleared the Ohio Senate. The budget now has an amendment that would prompt the state to give out Medicaid contracts under new rules — most notably requiring that the contracts awarded lean toward companies based in Ohio with Ohio-headquartered parent companies.

 
 

“A couple of the Ohio companies, who for many years have been providing this service, and of course their employees and everyone else are here in Ohio, those folks were concerned what the process was and how it went forward,” Senate President Matt Huffman, R-Lima, said when discussing the Senate’s budget version, according to the Columbus Dispatch.

 
 

This would impact Paramount Advantage, which was one of the bidders based and headquartered in Ohio that just lost out on its bid to keep doing business with Ohio Medicaid. Paramount is operated by Toledo-based ProMedica and is appealing the decision.

Dayton-headquartered CareSource is another bidder also based in Ohio, but it won its contract.

It’s not clear what the proposed Ohio budget would mean for the locally based company, whose primary business line is its Ohio Medicaid contract. A message was left with a company spokesman.

The amendment drew criticism and concern from some of the people banking on an urgent overhaul.

One of the hallmarks of the new system will be a specialty program called OhioRISE to coordinate care for children with complex needs. Those includes kids with significant mental health needs, who have sometimes spent time in foster care, in juvenile detention, or multiple other state systems.

Every year some Ohio parents choose to give up their child’s custody, sometimes returning an adopted child back to state care, because kids in state custody get all their expensive residential treatment covered. OhioRISE would help parents and children navigate these systems with experienced care coordinators and would cover residential treatment.

The Ohio Senate budget amendment does not call for a redo of the OhioRISE contract. But critics of the amendment noted the new overhauled system is full of interlinked programs that only work with the other parts in place, like how OhioRISE would be paid for with with savings from the other parts of the overhaul.

Lisa Norris, who has also been following the OhioRISE proposal, surrendered custody of her 12-year-old daughter on Tuesday in Franklin County because she had been unable to get the nearly $80,000 cash she would need up front to secure her daughter an open residential treatment spot. Norris said as an experienced special educator she knows the resources and there wasn’t another way to get her daughter care.

“I want no other family to ever have to sit in the court and make that decision yesterday because it’s devastating,” Norris said.

The DeWine administration’s overhaul is already underway. All the contracts awards have been announced and the administration did 18 months of pre-work before the bid, got feedback from 1,100 different people and organizations in the lead up to opening up bidding.

 
 

“The Department of Medicaid, from our perspective, spent a really incredible amount of time listening. They listened to providers they listened to consumers, they listened to families, they listened to stakeholders and advocates,” said Teresa Lampl, CEO with The Ohio Council of Behavioral Health & Family Services Providers, who is concerned the proposal could undo the work.

Pausing the overhaul would also pause the overhaul of Ohio Medicaid’s $3 billion pharmacy benefit system. The old system had been roiled in controversy over spending and transparency for years, and pharmacists had celebrated the incoming changes.

“The problem started in 2016, it didn’t see the light of day until the beginning of 2018. And here we are in 2021 with the ball on the tee to fix the problem, and this could throw a wrench into all of it,” said Antonio Ciaccia, pharmacy consultant with 3 Axis Advisors, who had lobbied for years for the changes with Ohio Pharmacists Association.

The new system is five contracts, which have already been awarded: one transparent pharmacy benefit manager instead of a handful of contractors; a central stop to get credentialed; a single clearinghouse for all provider claims and prior authorization requests; a new system to coordinate benefits for kids with complicated needs; and several large contracts for insurance companies to manage benefits and care.

The large contracts went to UnitedHealthcare, Human, Molina, AmeriHealth, Anthem and CareSource.

 
 

Clipped from: https://www.daytondailynews.com/blog/ohio-politics/ohios-overhauling-20b-medicaid-program-but-budget-could-pump-the-breaks/EBES6EYMDBBE5KHTKUQZNGMAX4/

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Senate Budget Derails Ohio’s Medicaid Managed Care Process

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The Senate insistence on reinstating Paramount as an MCO no jeopardizes various improvements to the program.

 
 

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.

 
 

COLUMBUS, Ohio — A plan to revamp Ohio’s Medicaid managed care system could be thrown off course.

After two years of input from key stakeholders, the state announced six managed care plans in April, but the Senate-passed budget calls for a re-do of the managed care procurement process, and stipulates managed care organizations based in Ohio be significantly considered.

LeeAnn Brooks, chemical dependency counselor for Health Recovery Services in Athens, is concerned about the impact on her patients.

“It’s going to make this whole managed care plan start all over,” Brooks contended. “And then that in turn is going to affect Southeast Ohio and Appalachia, and it’s going to take services away from people in the region as well as others in the state. That’s going to be a bigger setback, and it’s going to cost the state more money.”

It’s estimated more than $400 million in administrative costs would be wasted by stopping the procurement process.

Backers of the amendment claim there was not enough transparency in the bidding process for the $20 billion in contracts, and they argued Ohio companies should get special consideration.

This week, a budget conference committee will assemble. The final biennium budget is due June 30.

Brooks pointed out the Medicaid program is a crucial tool in helping those impacted by the opioid epidemic, many of whom don’t have any other type of insurance. She explained because addiction is a brain disease, it is important treatment not be interrupted.

“That’s planting a seed with people and getting them to understand that what they’re doing is really making their life unmanageable,” Brooks asserted. “With Medicaid, we can continue those treatment services in hopes of changing behaviors, in hopes of getting people into recovery.”

One of the current providers that did not make the list, Toledo-based Paramount Advantage, complained out-of-state companies were favored over those with headquarters in Ohio. The state countered the procurement process is competitive and included extensive public outreach.
 

Clipped from: https://www.clevescene.com/scene-and-heard/archives/2021/06/14/senate-budget-derails-ohios-medicaid-managed-care-process

 
 

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Florida asks for more time on potential Medicaid boost

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Florida is interested in the extra HCBS money, but needs more time to consider the implications.

 
 

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, Fla. – Gov. Ron DeSantis’ administration is asking the federal government for additional time “to consider the potential impacts” of drawing down hundreds of millions of dollars in additional federal Medicaid money for home- and community-based services.

In an email to the federal Centers for Medicare & Medicaid Services, Karen Williams of the state Medicaid office said Florida wants a 30-day extension, which would give the state until July 12 to submit a plan to the federal government.

“Please consider this email as the state of Florida’s formal request for the 30-day extension. This additional time will allow the state of Florida to continue coordinating with all impacted stakeholders to consider the potential impacts of this increase,” Williams wrote in the email late Friday afternoon.

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The American Rescue Plan Act, a stimulus package signed in March by President Joe Biden, included provisions that allow states to tap into additional federal Medicaid funding for a number of different groups and services, some of which Florida has taken advantage of, and others not.

For instance, the federal law provided incentives for 12 states, including Florida, to expand Medicaid to low-income childless adults. The law, at least in part, offers states a 5 percentage- point increase in their regular federal Medicaid matching rates for two years after expansion would take effect. But as they have done for years, Florida Republican leaders shunned the idea of expanding Medicaid during this spring’s legislative session.

The American Rescue Plan Act also allows states to tap into additional funds to extend by 10 months the length of time that postpartum women can qualify for Medicaid. Florida is taking advantage of that provision, with House Speaker Rep. Chris Sprowls, R-Palm Harbor, leading the charge.

The federal law also provided states with an opportunity to draw down a 10 percentage-point increase in federal Medicaid funds for home- and community-based services, such as services provided in Florida’s “iBudget” program for people with developmental and intellectual disabilities.

Tom Rice, a program manager with the state Agency for Persons with Disabilities, told members of the Florida Developmental Disabilities Council last month that the state was putting together plans to access the enhanced Medicaid funding. But advocates for people with disabilities grew worried that the state wouldn’t submit a plan to the federal government — or request an extension — by a Sunday deadline.

With the request for an extension filed Friday, Jim DeBeaugrine, a lobbyist and former director of the Agency for Persons with Disabilities, said he remains hopeful that Florida can tap into the additional federal money.

DeBeaugrine, also a former staff member of the House Appropriations Committee, estimated that Florida could tap into an additional $450 million in Medicaid funds for services provided through the iBudget program.

“I am cautiously optimistic that we can work with AHCA (the state Agency for Health Care Administration) and APD and hopefully come up with a good plan to use the dollars, at least associated with our population,” DeBeaugrine said.

While the 10 percentage-point increase has been a focus of providers that care for people with developmental and intellectual disabilities, the increased funding would be available for all home- and community-based services.

According to guidance issued by the Centers for Medicare & Medicaid Services, states could use the increased funds for a number of other services such as medical or remedial services recommended by physicians, including mental health and substance-use disorder services; private duty nursing services; and programs for all-inclusive care for the elderly, what is known as PACE.

“This is potentially a lot bigger than the population I am concerned with,” said DeBeaugrine, referring to people with disabilities.

Clipped from: https://www.clickorlando.com/news/2021/06/15/florida-asks-for-more-time-on-potential-medicaid-boost/

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VA- McAuliffe emphasizes health care with pitch for Medicaid buy-in plan

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A candidate for Governor in VA is using a Medicaid Public Option as part of his election campaign.

 
 

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.

 
 

RICHMOND — Former Gov. Terry McAuliffe wants to offer another health insurance option to Virginians who earn too much to qualify for Medicaid but can’t afford the out-of-pocket costs of coverage they can buy now in the marketplace.

McAuliffe pitched his Medicaid “buy-in” plan at appearances in Charlottesville and Harrisonburg on Tuesday as part of an opening policy salvo in his race for another term as Virginia governor against Republican nominee Glenn Youngkin, who has criticized the state’s decision to expand Medicaid under the Affordable Care Act.

McAuliffe proposes to offer a Medicaid insurance option for people to buy on the new state marketplace if they earn more than $17,775 a year individually or $30,305 for a family of three so they wouldn’t be eligible for Medicaid. He did not specify how much they could earn and still qualify to purchase the optional plan.

The former governor was unable to overcome Republican opposition to Medicaid expansion during his term, but the General Assembly took the step the year after he left office under a bipartisan deal that took effect Jan. 1, 2019, and now provides health insurance coverage for more than 555,000 Virginians.

“Terry was a brick wall against extreme Republican attacks on health care during his administration, and he will be ready on day one to fight for affordable health care as Virginia’s next governor,” his campaign stated in a news release that played off a vow by former House Speaker Bill Howell to wield his Republican majority in the House as “a firewall” against Medicaid expansion.

 
 

Clipped from: https://dailyprogress.com/news/state-and-regional/govt-and-politics/mcauliffe-emphasizes-health-care-with-pitch-for-medicaid-buy-in-plan/article_58754d62-1ad5-58bb-940c-a215569c9d14.html

 
 

 
 

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Missouri lawmakers expect special session next week to renew important Medicaid tax

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Republicans are fighting to prevent Medicaid paying for abortion drugs via withholding support for continuing a financing scheme that sends more money to large hospitals.

 
 

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.

 
 

JEFFERSON CITY, Mo. – Missouri lawmakers could be headed back to the capital city as soon as Monday to renew an important tax that funds the state’s Medicaid program after members could not reach a compromise before they adjourned from the legislature’s regular session.

Governor Mike Parson said he’s still planning to make budget cuts if there’s not a solution by July 1 to pass a new Federal Reimbursement Allowance (FRA) program.

“We’re going to have to move forward because I can’t delay it any longer,” Parson told reporters Tuesday. “July 1 there will be withholds, there is no other option for us.”

The FRA is a tax collected from medical providers like hospitals to support Medicaid. House Budget Committee Chairman Rep. Cody Smith (R-Carthage) said the tax brings in $1.6 billion a year.

“For about every FRA dollar we get, we get about two federal dollars for that and then we take all that money and we put it towards our Medicaid program,” Smith said.

The holdup for the General Assembly is if abortion providers and affiliates and certain contraceptives like Plan B should be covered for women who are already on Medicaid. What’s on the line is billions of dollars for the state’s program.

“The Republican party in the state of Missouri has shown no abandonment for women’s reproductive rights,” Senate Minority Floor Leader John Rizzo (D-Independence) said. “They’re trying to conflate abortion and birth control and the two things are not the same.”

Since lawmakers didn’t get it done before they adjourned, they have to come back for a special session since the FRA expires Sept. 30.

“I’m optimistic that we will be able to come to some compromise on a plan that enables us to go in legislate this fairly quickly and get it to the governor’s desk by the end of the month,” Smith said.

Lawmakers said the problem in finding a compromise is whether or not to allow Medicaid to cover contraceptives. During the last week of session, Sen. Paul Wieland (R-Imperial) attached an amendment to Senate Bill 1 that bans the use of FRA funds for contraceptives and abortions.

“You are literally putting $4 billion dollars in flux that is used to provide healthcare for Missourians over contraception, over birth control,” Rizzo said.

Republican Senators met with Parson Tuesday afternoon to try and find a compromise to renew the FRA. Part of the new language in the drafted legislation says:

Family planning as defined by federal rules and regulations; provided that such family planning services shall not include abortions or any abortifacient drug or device unless such abortions are certified in writing by a physician to the MO HealthNet agency that, in the physician’s professional judgment, the life of the mother would be endangered if the fetus were carried to term.

It goes on to say that an “abortifacient drug or device” include Plan B and intrauterine devices (IUD).

“We have a pro-life super majority on the Republican side and many of our members care about those issues,” Smith said.

Missouri has used the FRA for more than 20 years to fund the state’s Medicaid program. Parson said if it’s not renewed, it will more than a billion-dollar hole in the budget.

“If we can stay in the guidelines, if we can have language in there that doesn’t jeopardize the FRA and doesn’t jeopardize our CMS [Centers for Medicare and Medicaid Services], then we would be willing to take a look at something like that,” Parson said.

Rizzo said he hopes the governor “narrows” the call for the special session so lawmakers can pass a “clean FRA.”

“I think that there is still a lot of fence mending that needs to happen that hasn’t happened yet, I also think that we are adults, and we understand that this is something that could be catastrophe to the state of Missouri if we don’t get it done,” Rizzo said.

He believes lawmakers will be back at the Capitol starting Monday to start working on a plan to renew the FRA. Rizzo said the legislation will start in the Senate and then move over to the House.

Parson’s office has not confirmed when legislators will be back in Jefferson City.

Clipped from: https://fox2now.com/news/missouri/missouri-lawmakers-expect-special-session-next-week-to-renew-important-medicaid-tax/

 
 

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Medicaid Spending on Hemophilia Therapies in US Tripled in 2005-19

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Medicaid Spending on hemophilia drugs is now at $1.7B per year, driven by the use of extended half-life therapies started in 2015.

 
 

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.

 
 

 
 

 
 

Spending on treatments for hemophilia by Medicaid, a U.S. government health insurance program for select groups, more than tripled from 2005 to 2019, an analysis reported.

Its researchers expect this finding will help state agencies with decisions regarding treatment coverage based on their Medicaid budget, given that the program “provides insurance coverage for approximately half of all US patients with hemophilia,” they wrote.

Results from this analysis were described in the research letter “Trends in the Use of Conventional and New Pharmaceuticals for Hemophilia Treatments Among Medicaid Enrollees, 2005-2020,” published in the journal JAMA Network Open.

Hemophilia is caused by mutations that lead to the lack of functional blood clotting proteins — factor VIII (FVIII) in type A, and factor IX (FIX) in type B. One of its standard treatments is replacement therapy, which involves administering a version of the missing clotting protein to patients. Bypassing agents, which can circumvent the need for clotting factor treatment, are another common therapy.

In recent decades, there have been substantial advances in how hemophilia is treated. Starting in 2014, extended half-life products, which are replacement therapies modified to last longer and so require less frequent dosing, became available. Hemlibra (emicizumab), an antibody-based treatment for hemophilia A, was also approved in 2018.

While these therapies have improved hemophilia care, they come at a high cost. According to the U.S.-based research team that authored this study, hemophilia is now “one of the most expensive medical conditions to manage.”

These researchers performed an analysis of Medicaid spending on hemophilia products in the U.S. from 2005 to 2020. Medicaid provides free or low-cost health coverage to qualifying low-income individuals, families and children, pregnant women, the elderly, and people with certain disabilities.

Findings showed a steady increase in the use of standard half-life replacement therapies prior to 2015. Then, after extended half-life products became available, the use of these standard therapies dropped substantially — by 66% for FVIII and by 57% for FIX. The use of bypassing agents also decreased by 69% from 2017 to 2019.

In 2005, Medicaid spending on hemophilia treatments totaled $521 million. By 2019, spending had more than tripled, to $1.57 billion.

Between these years, spending on FVIII products more than doubled (from $330 million in 2005 to $779 million in 2019), and spending on FIX products more than quadrupled (from $52 million in 2005 to $238 million in 2019).

“The transition of factors VIII and IX from plasma-derived to recombinant pharmaceuticals, the transition from [standard to extended half-life] pharmaceuticals, and the use of bypassing agents and emicizumab have contributed to the transformation of hemophilia from a disease of significant morbidity to a condition that allows affected individuals to lead active lives,” the researchers wrote. “However, these advances have increased costs substantially.”

As of 2019, FVIII products accounted for 50% of all Medicaid spending on hemophilia treatments. FIX products accounted for 15%, bypassing agents for 17%, and Hemlibra for 19% of total spending.

Researchers noted these findings may be useful for states determining their Medicaid budgets. According to the investigators, these findings are particularly relevant since gene therapies for hemophilia are expected to become available in the near future, and state agencies will have to make coverage decisions.

Gene therapies work to deliver a non-mutated version of the defective gene to patients’ cells, thereby restoring the production of the functional clotting factor they are missing.

“These gene therapies, which will cost between $2 to $3 million per patient, have the potential to decrease requirements for factor replacement dramatically,” the researchers wrote.

Clipped from: https://hemophilianewstoday.com/2021/06/16/medicaid-spending-us-hemophilia-treatments-tripled-2005-2019-analysis/

 
 

 
 

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Gov. Abbott Signs Bill Extending Medicaid Coverage For New Texas Mothers

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TX added 6 months of post-birth care for mothers.

 
 

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 Texas Legislature passed a bill this session that increases coverage for new mothers on Medicaid from 60 days to six months.

Gov. Greg Abbott signed a bill this week that expands health care for new moms on Medicaid.

Women who’ve just given birth in Texas currently can receive health care services through Medicaid only for up to 60 days after they have the baby. Starting Sept. 1, new mothers will get a full six months of coverage before being removed from the program.

The Maternal Mortality and Morbidity Task Force and Department of State Health Services have been combing through maternal death data for years to come up with solutions on how to reduce deaths in Texas. Several years ago, they recommended Medicaid coverage be extended up to a year after a woman gives birth.

According to their report from July 2016, extending coverage for up to a year would “improve continuity of care, promote safe birth spacing, and reduce maternal morbidity,” which includes near-death experiences or serious health complications that arise during a pregnancy.

Members of the state health agency and task force also told lawmakers it could save the state money.

“Increasing access to care throughout the first postpartum year would improve interconception health while also reducing cost in the Medicaid program by decreasing the rate of unintended pregnancy,” the task force wrote, “and by preventing, detecting and managing chronic conditions and other risk factors, such as obesity, hypertension, smoking, and mental and behavioral health issues, that increase risk for maternal morbidity and mortality and lead to costly adverse pregnancy and birth outcomes including severe maternal morbidity, preterm birth, and low birth weight.”

After years of failed efforts to extend coverage, lawmakers did manage to pass a version of the task force’s recommendation this year. But House Bill 133 falls short of what was advised; instead of one year of postpartum coverage, lawmakers agreed to extend the coverage to only up to six months.

Adriana Kohler, a policy director at Texans Care for Children, said in a statement that HB 133 is a critical bill.

“Six months of health coverage after childbirth is an important step forward to support moms during this critical time for their health and their baby’s development, so we urge state and federal leaders to work together to quickly implement the legislation,” she said after Abbott signed it into law. “We also encourage state leaders to build on this effort and develop a plan to ensure that moms have health coverage before their pregnancy [and] after the six months of postpartum coverage expires.”
 

 
 

Clipped from: https://www.kut.org/health/2021-06-16/gov-abbott-signs-bill-extending-medicaid-coverage-for-new-texas-mothers