Category: Amazing Free Content

Posted on by

Former state Medicaid director hired by University of Vermont Health Network

MM Curator summary

 
 

The quick hiring of the VT Medicaid director by a hospital system has raised a few eyebrows.

 
 

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.

 
 

For the past four years, Cory Gustafson oversaw the state’s Medicaid program, which provides funding to doctors and health care facilities. Now, he’s taken a job at Vermont’s largest health care organization. 

Gustafson, whose last day as commissioner of the Department of Vermont Health Access was May 28, started June 1 at the University of Vermont Health Network as network director of strategic and business planning. In his new role, he will develop “long term capital plans and strategies” for the organization, which serves about half of the state’s patients, according to spokesperson Neal Goswami. 

Gustafson said the move from state government to an entity that relies on state funding doesn’t represent a conflict of interest because he will focus on “internal-facing” issues such as business planning, capital planning and increasing efficiency within the six network hospitals in Vermont and New York. The role allows him to abide by ethics rules that prohibit lobbying for a year after leaving state government, he said. 

“This being an internal-facing position, I don’t see that being a problem,” he said of potential ethical conflicts. Upon deciding to leave state government, he said, he looked only for jobs “that would not run afoul of” the rules.

Goswami said Gustafson’s responsibilities “will not involve representing the Network before the state of Vermont, or any public and regulatory bodies.” The network spokesperson highlighted Gustafson’s “deep experience and knowledge in health care” and said that the new employee was “committed to following all state policies.”

It’s not the first time the hospital has recruited former state officials from the Agency of Human Services. In 2019, the Health Network hired Al Gobeille, former chief health care regulator of the Green Mountain Care Board and former secretary of human services, as its executive vice president for operations.

Prior to joining state government, Gustafson represented the health care industry before the legislative and executive branches. From 2011 to 2013, he worked as a lobbyist for the Vermont Association of Hospitals and Health Systems. After that, he lobbied on behalf of Blue Cross Blue Shield of Vermont. 

Gov. Phil Scott appointed him commissioner in January 2017. 

As head of the Department of Vermont Health Access, he was responsible for running the state Medicaid program, which provides health insurance for low-income Vermonters — and pays hospitals for those services. The department also manages the state’s health insurance exchange.

Most of the department’s day-to-day interactions with UVM Health Network were conducted by his subordinates, Gustafson said. However, he worked with the network on its role in the all-payer model, the state’s effort to change the way health care is financed. Vermont’s Medicaid program is a participant.

When it came to speaking with his future employer, “I had health care reform conversations, but that’s about the extent of it,” Gustafson said. He recused himself from those conversations after applying for the job, he said. 

A large hospital’s interest in hiring a well-connected state official makes sense — and often pays off, according to Mike Fisher, Vermont’s chief health care advocate. Fisher said he was speaking generally and not specifically about Gustafson’s or Gobeille’s employment.

“Even if you have to wait a year, you have a person who really knows the ropes and has the relationships,” Fisher said. 

Still, he said, “there’s a problem” with “the general flow from state government into an entity that’s regulated by state government.” 

“There’s a concern about the integrity of the position,” Fisher said. 

As a cabinet member, Gustafson said, he signed the executive code of ethics that bars officials from lobbying for one year after leaving their posts. He said he had no plans to move into a lobbying role even after the requisite time has expired. 

But, he added, “Who knows what the future brings?”

 
 

Clipped from: https://vtdigger.org/2021/06/02/former-state-medicaid-director-hired-by-university-of-vermont-health-network/

Posted on by

Ohio Senate wants a redo of Medicaid managed care contracts

MM Curator summary

 
 

Local, losing bidders (Paramount/Promedica) in the OH MCO awards have successfully enlisted legislators to undo the recent awards.

 
 

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.

 
 

 
 

After a more-than-two-year effort to overhaul Ohio‘s Medicaid managed care system, state senators are asking for what could amount to a redo of the whole thing.

The state in April had finally chosen six companies to handle the governmental health insurance for more than 3 million low-income or disabled residents. But it’s run into hiccups, with at least two of the companies who lost out on contracts filing complaints against the Ohio Department of Medicaid.

Those complaints have turned into legislative action.

Senate Republicans on Tuesday inserted language into the state budget bill requiring the state to complete a new procurement process with a few new rules. The move comes just months after those $20 billion awardees were determined, potentially the largest contract in state government history.

“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,” said Senate President Matt Huffman, R-Lima. 

Pete LuPiba, spokesperson for the Ohio Office of Budget and Management, defended the administration’s handling of procurement, saying it has had extensive public outreach and has been transparent.

“We will continue to work with the General Assembly on Medicaid as part of the budget process,” he said. “It would be unfortunate to lose the momentum that we have to transform Ohio’s Medicaid at this late stage in the process.”

Preference for Ohio-based companies

The budget language stipulates that contracts with Medicaid managed care organizations have to include those based in Ohio, and so do parent companies. 

The proposed requirement echoes a complaint filed by Paramount Advantage, owned by Toledo-based ProMedica, the only current Medicaid managed-care contractor that lost out on a contract. A question as to whether it played a role in requesting the legislation was ignored.

“Out-of-state, for-profit, multi-billion-dollar Fortune 500 companies appear to have been favored over mission-driven, not-for-profit managed care organizations headquartered in Ohio,” the company said in a statement to the USA TODAY Network Ohio Bureau. “We are encouraged that it appears our state lawmakers understand the importance of the issue and the need to protect Ohio jobs from being lost.”

ProMedica called the bidding process “systemically flawed and unfair” and said it was grateful that lawmakers were trying to ensure a fairer method.

The one other major Ohio company, Dayton-based CareSource, said through a spokesperson it did not request that preference language. CareSource was able to get a contract.  

If that component stays in the budget and becomes law, the consequences would be “disastrous,” said Loren Anthes, who chairs the Center for Community Solutions‘ Center for Medicaid Policy.     

For one, he isn’t a fan of requiring the procurement process be geared toward Ohio-based companies, as it flies in the face of using free-market, competitive principles to get the most efficient health care outcomes.  

“We… are creating a provision that would guarantee direct economic benefit to existing businesses with taxpayer money,” he said. “I’m not saying that if you’re domiciled in Ohio, that you are underperforming, but all I’m saying is that it means that you don’t have as much of an incentive to do better with my money.”

Furthermore, forcing a redo could put in jeopardy other parts of the budget that rely on the current procurement process, such as the entire Medicaid budget, as well as around $416 million in savings from current and previous procurements.   

“If you take a segment out, you pull a piece out of the wrong part of the Jenga stack, it all is going to come tumbling down,” said Anthes. 

Awardees might not be too happy as well to see the promised contracts yanked away, which could result in litigation.

Frustration with the DeWine administration

The motive behind putting this in the budget, however, seems to come more out of frustration with Gov. Mike DeWine’s administration. Lawmakers haven’t been able to get information on why certain parts of the bidding process played out the way it did, said Huffman.

For example, there was one Ohio company that received “0” points on their oral presentation during the bidding process.  

“They gave a presentation, but I’m not sure how you can receive zero. I suppose that happens somewhere,” he said. “Things like that are mystifying when you ask the question, ‘How did someone get a zero? How badly did they do to get a zero?’ And the answer is, ‘We can’t tell you anything, we’re in litigation.’ That’s concerning.”

That’s likely in reference to ongoing lawsuits the state has against at least three of the applicants for Medicaid contracts. The main one against health care company Centene was cited as a reason for putting its bid on hold.     

Huffman said he agreed with arguments that companies shouldn’t get the contracts simply because they’re from Ohio.

“But certainly there should be special preference, as we do in many other situations,” he said. “These are Ohio jobs.”

Nothing is final until after the Ohio House and Senate work out their differences in the budget bill. For now, the Senate is plunging forward on this issue.

“We have to do something. We can’t simply accept that we’re not going to get any information,” said Huffman. “Until this is resolved… until this information is forthcoming… this is what we’re going to do.”

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

 
 

Clipped from: https://www.dispatch.com/story/news/healthcare/2021/06/03/ohio-senate-wants-redo-who-gets-states-medicaid-money-mike-dewine-budget-paramount-advantage-lawsuit/7504416002/

 
 

Posted on by

State officials drop plans for 2-tier Medicaid system

MM Curator summary

 
 

Medicaid beneficiaries in the new Nebraska expansion group will get dental, vision and OTC drug coverage without having to meet any volunteer or wellness requirements.

 
 

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.

 
 

 
 

LINCOLN, Neb. — State officials are dropping plans for a two-tier system to cover voter-approved Medicaid expansion in Nebraska.

The Nebraska Department of Health and Human Services (DHHS) announced Tuesday that all Nebraskans covered by the expansion will get a full range of benefits starting Oct. 1, the Omaha World-Herald reported. The announcement is a change from the earlier plans of Gov. Pete Ricketts’ administration to offer a two-tier system that would include a “basic” plan covering physical and behavioral health care services and a “prime” plan that would also cover dental, vision and over-the-counter drugs.

The two-tiered system would not have applied to those who receive benefits through the traditional Medicaid program, only those who qualify for the expanded coverage.

To qualify for prime coverage, recipients would have been required to meet work or volunteer benchmarks or participate in educational or job-training programs. They also would have had to meet with a health care provider for a wellness assessment.

Tuesday’s announcement means the state will provide the full range of benefits without the additional requirements.

The Trump administration approved Ricketts’ two-tier plan last year, prompting a lawsuit by advocacy group Nebraska Appleseed. But President Joe Biden’s administration made clear early this year that it would not approve the system.

It’s unclear how Tuesday’s announcement will affect Nebraska Appleseed’s lawsuit, but a hearing in the lawsuit was set for Monday.

Voters expanded Medicaid through a 2018 ballot measure, but the state Health and Human Services Department stalled implementation of it for nearly two years — the longest delay in the nation among states that have expanded the program. Activists placed the measure on the ballot after years of failed attempts to expand Medicaid in the Republican-dominated Legislature and strong opposition from the state’s GOP governors.

The expansion extends coverage to able-bodied, working-age adults who earn too much to qualify for regular Medicaid but too little to be eligible for tax credits to help them buy health insurance under the Affordable Care Act.

 
 

Clipped from: https://nebraska.tv/news/local/state-officials-drop-plans-for-2-tier-medicaid-system

 
 

Posted on by

Gov. Stitt’s plan to privatize Medicaid lacks required legislative authorization, Oklahoma Supreme Court says

MM Curator summary

 
 

A court ruling means the state will now expand Medicaid but under a fee for service model, making this the first example of this combination.

 
 

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.

 
 

OKLAHOMA CITY (KFOR) – The Oklahoma Supreme Court delivered a blow to Gov. Kevin Stitt’s plan to privatize the state’s Medicaid program, ruling in favor of medical associations that challenged the constitutionality of his plan.

Governor Stitt and Oklahoma Health Care Authority announce managed care organizations to assist with Oklahoma Medicaid, despite pushback from lawmakers

The Oklahoma State Medical Association, Oklahoma Dental Association, the Oklahoma Osteopathic Association, the Oklahoma Society of Anesthesiologists, Inc., and Oklahoma Chapter of American Academy of Pediatrics, Inc., challenged the Oklahoma Health Care Authority (OHCA) and the State of Oklahoma’s effort to outsource management of the state’s Medicaid program to for-profit companies, awarding those companies $2.2 billion in contracts.

The Supreme Court ruled in a 6-3 decision that the State and OHCA went beyond their authority by implementing an entirely new capitated managed care program, SoonerSelect, following the passage of State Question 802.

Oklahoma State Medical Association to seek motion for injunction against Gov. Stitt’s Medicaid managed care plan

“In effect, the OHCA moved ahead without the required legislative authorization,” the Supreme Court’s conclusion states.

 
 

Oklahoma Supreme Court

The website OKPolicy.org describes SQ 802 as “an initiative petition that gave Oklahoma voters the chance to expand Medicaid to cover low-income adults in Oklahoma beginning no later than July 1, 2021.” SQ 802 was passed on June 30, 2020.

Oklahoma’s top physician & health groups file motion for injunction against Gov. Stitt’s Medicaid managed care plan

The court determined that SQ 802 does not allow the governor and the OHCA to outsource Oklahoma’s Medicaid program to private insurance companies.

The Supreme Court’s full conclusion is as follows:

“The provisions of SQ 802 in no way authorize this course of action. The OHCA, through an RFP [Request for Proposal] process and competitive bidding, awarded contracts to MCOs [Managed Care Organizations] without legislative authorization or required rules in place. In effect, the OHCA moved ahead without the required legislative authorization. This Court assumes original jurisdiction and grants declaratory relief to the Petitioners. We find the actions of the OHCA are invalid under Oklahoma law. Having determined the Respondents did not have legislative authority to implement the SoonerSelect program, there is no need to issue a writ of Mandamus for OHCA to promulgate any rules. A writ of prohibition is also not appropriate in this matter. In addition, having determined declaratory judgement in favor of the Petitioners, we need not address whether the provisions proposed in the RFPs and model contracts are unconstitutional in and of themselves.”

OKLAHOMA SUPREME COURT

Gov. Stitt criticizes House Public Health Committee’s challenge to his Medicaid privatization effort

 
 

Gov. Kevin Stitt

Stitt announced SoonerSelect, his plan to revamp the state’s Medicaid program, on Jan. 29.

Selected Managed Care Organizations include Blue Cross Blue Shield of Oklahoma, Oklahoma Complete Health, Humana Health Horizons and UnitedHealthcare – each established in the state and serving Oklahomans. Stitt’s office estimates 1,500 new jobs will be created.

Stitt said the new program will improve health care outcomes for Oklahomans.

Oklahoma governor battles with members of own party over Medicaid privatization plan

Physicians across the state and several lawmakers, both Democratic and Republican, opposed privatizing Medicaid, wanting to keep the Medicaid expansion brought on by SQ 802 in the hands of the state.

“The Supreme Court today agreed that the Managed Care contracts were awarded without legislative input and contrary to the plan approved by the voters through State Question 802,” said Lynn Means, executive director, Oklahoma Dental Association. “Medicaid expansion will provide coverage for more than 200,000 of Oklahoma’s most vulnerable citizens. The managed care plan would’ve jeopardized health care for all Oklahomans by driving out providers of general health care, as well as dentists and specialists across the state. This lawsuit was one part of a physician-led effort to ward off privatization to insurance companies and keep Oklahomans in charge of health care in Oklahoma.”

Oklahoma lawmakers seek to put ‘guardrails’ on privatized Medicaid expansion

Stitt was on the cusp of succeeding in privatizing Medicaid, as legislators who opposed the privatization effort instead began focusing last month on putting guardrails on privatization to prevent problems experienced by 42 other states that enacted some form of managed care.

Sen. Greg McCortney, R-Ada, spoke with KFOR on May 19 about rewriting Senate Bill 131 to insert guardrails that would ensure Managed Care Organizations keep up their end of the deal.

Supreme Court Managed Care Decision by KFOR on Scribd

Gov. Stitt released the following statement:

“The Supreme Court’s ruling will unnecessarily delay Oklahoma’s efforts to improve health outcomes through managed care, which the Legislature confirmed is the right path forward for our state through Senate Bill 131. I will continue to work with the Oklahoma Health Care Authority to determine the next steps in the process.”

The Oklahoma Health Care Authority released the following statement:

“Improving health outcomes in Oklahoma will continue to be a top priority for the Oklahoma Health Care Authority. While we are disappointed in the Supreme Court ruling, we respect their decision and continue to focus on providing quality care to the more than one million Oklahomans we serve through SoonerCare. We are excited to welcome our newest population of Oklahomans now eligible for benefits through Medicaid expansion. This will allow us to serve an estimated 200,000 more people who deserve health care benefits.”

 
 

Clipped from: https://kfor.com/news/oklahoma-legislature/gov-stitts-plan-to-privatize-medicaid-lacks-required-legislative-authorization-oklahoma-supreme-court-says/

Posted on by

Senate confirms Chiquita Brooks-LaSure as head of CMS

MM Curator summary

 
 

CMS now has an administrator.

 
 

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.

 
 

 
 

Phil Roeder, Flickr

Dive Brief:

  • The Senate has confirmed health policy veteran Chiquita Brooks-LaSure as the Biden administration’s head of CMS, following a drawn-out approval process. As CMS administrator, Brooks-LaSure will have extensive oversight over the massive Medicare and Medicaid insurance programs and the exchanges set up by the Affordable Care Act.
  • The body voted 55-44 to confirm the nominee Tuesday morning. A majority of the Senate on Monday voted to limit debate on her nomination, queuing up Tuesday’s final vote. Brooks-LaSure’s nomination was earlier held up by Senate Republicans over an unrelated Biden administration policy move to rescind a Texas Medicaid waiver.
  • Industry groups including the Federation of American Hospitals and the Surgical Care Coalition cheered her confirmation, saying Brooks-LaSure’s policy know-how and experience managing insurance programs should help increase equitable access to affordable care in the U.S.

Dive Insight:

Brooks-LaSure has a long career in public policy, working in the Office of Management and Budget as a Medicaid analyst before moving on to serve as deputy director for policy at the Center for Consumer Information and Insurance Oversight during the Obama administration. She was also a director of coverage policy at HHS before transitioning to the private sector, working as a Medicare and Medicaid policy consultant for Manatt Health.

With Tuesdays vote, Brooks-LaSure becomes the first Black woman to lead CMS.

Despite general support for the health policy veteran in Congress and a lack of any partisan fireworks during her hearings, Brooks-LaSure’s confirmation process has been slow.

In April, Republicans in the Senate Finance Committee held up the process not due to Brooks-LaSure’s record or experience, but due to HHS’ withdrawal of a Medicaid waiver to Texas that had previously been approved by the Trump administration. The waiver would have given the state more than $100 billion over a decade in federal funding and allowed more flexibility in how it structures the safety-net insurance scheme.

Its withdrawal caused Sen. John Cornyn, R-Texas, to say he would delay the confirmation. Cornyn said losing the waiver would threaten vulnerable Texans’ access to care by winnowing hospital funding, though progressives generally view the waivers as a stop-gap measure that doesn’t address fundamental issues with medical access and curbing downstream costs.

Eventually, the committee voted 14-14 along party lines to move the nomination to the full Senate floor, without a recommendation for confirmation.

And on May 12, the full Senate once again advanced Brooks-LaSure’s nomination, in a 51-48 procedural vote. Senate Democrats were joined by two Republican legislators in backing a discharge petition to bring her nomination to a floor vote after it was held up by the finance committee and GOP opposition to her confirmation.

Hospital and payer groups, progressive think tanks and patient advocates were pleased with the confirmation on Tuesday.

Many noted that Brooks-LaSure’s experience in health policy, especially with the ACA and Medicaid, should help expand access to low-cost care as medical prices continue to rise in the U.S.

“We congratulate Ms. Brooks-LaSure on her historic confirmation,” FAH President and CEO Chip Kahn said in a statement. “While the fight against COVID is not over, as the pandemic winds down we need to move forward on the broader health care agenda and I am confident our new Administrator is exceptionally equipped to provide the leadership that is crucial for CMS at this time and beyond.”

Brooks-LaSure is the last major health policy appointment from the Biden administration. Previously, HHS Secretary Xavier Becerra faced grilling from Republicans over his abortion views, but was approved by a single-vote margin; while HHS deputy secretary Andrea Palm was confirmed in a 61-37 vote earlier this month.

But, four months into his administration, President Joe Biden still has not nominated anyone to fill the top spot at the Food and Drug Administration, a crucial post with oversight over drugs and vaccines, but also major public health issues like food safety and tobacco.

 
 

Clipped from: https://www.healthcaredive.com/news/senate-confirms-chiquita-brooks-lasure-as-head-of-cms/600302/

 
 

 
 

Posted on by

Oklahoma Senate want framework for Stitt’s Medicaid managed care

MM Curator summary

 
 

OK lawmakers have moved forward with efforts to make to violations of MCO contracts a violation of state law.

 
 

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 Oklahoma Senate on Wednesday overwhelmingly approved a bill to add legislative oversight and legal guardrails to Gov. Kevin Stitt’s plan to outsource care for most Medicaid recipients.  

The passage of an updated version of Senate Bill 131 gives opponents of third-party managed care a victory, but perhaps not the victory they wanted.

The latest version of the bill did not include House-approved language that sought to undo Stitt’s plan entirely by requiring the Oklahoma Health Care Authority to better manage Medicaid care in-house, as opposed to relying on four health insurance giants. 

Senate Pro Tem Greg Treat, R-Oklahoma City, called the latest version of SB 131, crafted by Sen. Greg McCortney, R-Ada, a good compromise that left people on both sides of the managed care debate dissatisfied. 

Treat, who voted in favor of SB 131, characterized the decision as a choice between letting the governor’s plan for privatized managed care move forward as is or putting into law some checks on the program, including the possibility for legislative involvement at a later point. 

House version would have created ‘massive bureaucracy,’ senate leader says

The version passed by the House that would have required the Health Care Authority to do in-house managed care, at a cost of $263 million annually, was a nonstarter, he said. 

“When Senate Bill 131 came across the rotunda, it was going to eviscerate the current model that the governor and the Health Care Authority put into place and create a massive bureaucracy at the Health Care Authority,” Treat said.

The most recent version of SB 131 puts into state law much of what the four health insurance companies agreed to through contracts with the Health Care Authority, which oversees the state’s Medicaid program.

The bill would also require the agency to seek legislative approval before expanding the contracts to include more Medicaid recipients. Initially, care for the aged, blind and disabled Medicaid population will remain with the Health Care Authority due to the high costs of care for that group of Medicaid recipients.

A framework is better than nothing, said Rep. Marcus McEntire, who sought to derail the governor’s Medicaid plan, dubbed SoonerSelect. 

Now under SB 131, if a managed care company breaks its contractual obligation to the state, the company will be breaking state law as well, said McEntire, R-Duncan. 

“It’s very disappointing, but it is what it is,” he said. “Sometimes, the chess board is set up before you even get to play.

“We worked too hard this year not to at least get some type of regulatory framework around (third-party managed care).” 

Some opposition from supporters of governor’s plan

Senate Majority Floor Kim David, R-Porter, opposed SB 131. A longtime supporter of privatized managed care, David stood beside the governor as he announced his SoonerSelect plan earlier this year. 

On the Senate floor Wednesday, David argued private companies can provide better care management than the government. 

Calling McCortney’s version of SB 131 “the best of the worst” managed care proposals she’d seen, David insinuated opponents of privatized Medicaid were more concerned about making sure health care providers get paid than improving care for patients. 

“I’ve always believed it’s our job to protect the people that we serve, not protect the people who are paid to put the programs out there on the government dollar,” she said. 

McCortney said he’s optimistic some Medicaid recipients, namely pregnant mothers and children, will see better care coordination and improved health outcomes under privatized managed care. 

But SB 131 allows the legislature to keep a close watch on the program and expand SoonerSelect if outcomes improve or slow down changes if Medicaid deteriorates, he said. 

“Managed care is not this horrible, evil, awful, thing, but it is this really big thing that, in many instances, has been done poorly,” McCortney said. 

With a veto-proof margin, the Senate passed SB 131 on a vote of 39-8. The bill now returns to the House.

Clipped from: https://www.oklahoman.com/story/news/2021/05/20/oklahoma-senate-want-framework-stitts-medicaid-managed-care/5162921001/

Stitt’s office did not respond to a request for comment on the bill. 

Posted on by

Tennessee moves to defend Medicaid waiver from legal challenge

MM Curator summary

The Volunteer State is fighting to keep its approved contract with CMS to reform its 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.

 
 

 
 

A COVID-19 patient connected to a ventilator tube in the Intensive Care Unit (ICU) at the Centre Cardiologique du Nord private hospital in Saint-Denis, near Paris, amid the coronavirus disease pandemic in France, May 4, 2021. REUTERS/Benoit Tessier

Tennessee is seeking to intervene in a lawsuit that aims to undo the Trump administration’s approval of a waiver allowing the state’s Medicaid program to restrict prescription drug coverage and capping its expenditures.

In a motion filed Thursday in Washington, D.C., federal court, Tennessee, represented by Scott Keller of Lehotsky Keller, said it had a “unique sovereign interest in defending its state Medicaid program,” called TennCare, which it said promoted cost savings and efficiency.

The lawsuit was filed against the U.S. Department of Health and Human Services in April on behalf of TennCare enrollees by lawyers at Tennessee Justice Center and the National Health Law Program, along with Joel McElvain and others at King & Spalding.

Tennessee Justice Center Executive Director Michele Johnson said she was not surprised by Tennessee’s intervention.

“They had an ideological perspective that they share with the Trump administration, and they are pursuing that ideological perspective even though it would harm Tennesseeans,” she said.

Tennessee said in its motion that the plaintiffs did not oppose its intervention, and that it had not had a chance to confer with HHS. The agency did not immediately respond to a request for comment.

“The corporate plaintiffs behind this lawsuit, who consistently sue the state, are trying to stop a significant and beneficial policy reform for our state with a federal lawsuit filed in D.C.,” Tennessee Attorney General Herbert Slatery said in a statement. “Our office is intervening to make sure Tennessee’s unique healthcare infrastructure is appropriately defended.”

Medicaid, which covers low-income and disabled people, is run jointly by HHS and state governments. The Medicaid law allows HHS to grant states waivers from the program’s usual requirements for “experimental, pilot or demonstration projects” that it finds likely to promote the objectives of the Medicaid program.

TennCare has been operating under a waiver since the mid-1990s, allowing it to require beneficiaries to enroll in managed care plans and to forego the usual three months of retroactive coverage.

In January 2021, shortly before President Donald Trump left office, HHS approved a new 10-year waiver for TennCare. This new waiver includes a cap on funding tied to enrollment, and allows the state to use up to 55% of any unspent federal funds below that cap for other state health programs.

It also allows TennCare to place new limits on coverage of prescription drugs.

In their lawsuit, the plaintiffs said that the Trump administration had approved the waiver without a public notice and comment period, violating the Administrative Procedure Act. They also said that the waiver went beyond the authority granted by the Medicaid statute.

The plaintiffs further alleged that the waiver of three months’ retroactive coverage, which has been in place since 1994, no longer qualifies as an experimental program.

The lawsuit is one of several pending legal battles over Medicaid waivers granted to states in the last days of the Trump administration.

The case is McCutchen et al v. Becerra et al, U.S. District Court, District of Columbia, No. 21-cv-01112.

For plaintiffs: Gordon Bonnyman of Tennessee Justice Center, Joel McElvain of King & Spalding, Jane Perkins of National Health Law Program and others

For HHS: Not immediately available

For Tennessee: Scott Keller of Lehotsky Keller

Clipped from: https://www.reuters.com/business/legal/tennessee-moves-defend-medicaid-waiver-legal-challenge-2021-05-21/

 
 

 
 

Posted on by

Illinois Medicaid companies made record-breaking profits during pandemic, investigation finds

MM Curator summary

 
 

Early numbers are out for how much MCOs might have to pay back in the IL market due to pandemic-related underutilization.

 
 

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.

 
 

An analysis of quarterly and year-end financial statements of five Illinois Medicaid companies by the Better Government Association revealed an unprecedented increase in profits from April through December of 2020.

Meridian Health Plan of Illinois, IlliniCare Health Plan and Molina Healthcare of Illinois experienced a $282 million increase in profits from the same nine-month period in 2019. 

Blue Cross and Blue Shield of Illinois and Aetna Better Health of Illinois reported large profits on a national scale, though exact numbers from the state level have yet to be determined, according to the Better Government Association’s May 24 report. 

While the number of Illinois Medicaid members increased due to job loss during the pandemic, most members deferred elective treatment, a scenario that occurred across the country and resulted in larger profits for payers.

A spokesperson for the Illinois Department of Healthcare and Family Services told the Better Government Association earlier this month that “initial incomplete figures indicate HFS would recoup over $120 million” from the insurance firms for the 2020 calendar year. 

“We will recoup more from the health plans than we otherwise would,” she said.

 
 

Clipped from: https://www.beckershospitalreview.com/payer-issues/illinois-medicaid-companies-made-record-breaking-profits-during-pandemic-investigation-finds.html