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Governor drops proposal for Medicaid budget cut

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Governor Little dropped a planned $30M cut to Medicaid because he says the enhanced federal funds under the Public Health Emergency (PHE) funding will cover the revenue gap this year.

 
 

 
 

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

 
 

C. Scott Grow
 

BOISE — There was big news at Thursday’s Medicaid budget hearing at the state Legislature: Gov. Brad Little has withdrawn a recommendation in his budget proposal for next year to find $30.2 million in state general fund savings in the Medicaid budget, which would come to a cut of $118.4 million in total funds including federal matching funds, because the state has been informed it’ll get much more than that in Medicaid funding from the federal government due to the COVID-19 pandemic.

The Biden administration notified the state two weeks ago that it will continue a significantly higher federal matching rate for Medicaid throughout calendar year 2021, according to state Health & Welfare Director Dave Jeppesen and Alex Adams, Little’s budget director.

The “cost containment” proposal had aroused big controversy, at a time when Idaho’s health system is struggling with the COVID-19 pandemic.

Idaho also is seeing increased numbers of its residents take advantage of its Medicaid expansion program, which voters authorized in November of 2018 and which started covering Idahoans who earn up to 138% of the federal poverty level just over a year ago, on Jan. 1, 2020. The federal government picks up 90% of the cost of that program.

Joint Finance-Appropriations Committee members expressed concerns over future Medicaid costs. Sen. Jeff Agenbroad, R-Nampa, said although the increased federal funding can “fill in some of the holes,” it’s a temporary fix. “We have to look beyond this year,” he said. “This is an anomaly.”

Once the pandemic is over, he noted, Idaho could see its federal matching rate for traditional Medicaid drop because of the state’s strong economy; that’s part of the federal calculation for the non-expansion portion of Medicaid in normal times.

Agenbroad said long-term reforms, including moving Idaho’s Medicaid program to a value-based, rather than fee-for-service, payment system, are “probably the longer-term solution.”

Jeppesen agreed. He noted that the Legislature last year enacted significant cost-containment moves for Medicaid that are underway, including shifting more and more of Medicaid onto value-based, rather than fee-for-service, payment models, in which payment is based on good health outcomes rather than number of services provided. Contracts with major hospital systems and nursing homes to accomplish that change are set to be signed by July 1, he said.

“We will continue to look at other cost containment efforts and will be back next session,” Jeppesen said, possibly proposing other cost-containment legislation.

Earlier in this year’s legislative session, the department proposed legislation to allow it to cut reimbursements to providers at its discretion to achieve savings; lawmakers rejected it.

Jeppesen said the administration is recommending that rather than cut $30 million in in state funds from Medicaid next year to achieve cost savings, the Legislature tap the additional federal matching funds to cover that amount, and funnel additional savings from the boost in federal funding into a “stabilization account” to hedge against future Medicaid cost increases.

Because of the COVID-19 pandemic, the federal government has temporarily increased the amount of Idaho’s regular Medicaid costs it covers from about 70 percent to about 76%, through an increase in the Federal Medical Assistance Percentage, or FMAP. Now, that increase will last through the end of the year. Jeppesen said that means $28.7 million more in Medicaid funds for Idaho this year, “and additional savings of $56 million in fiscal year ’22 that was not otherwise built into the governor’s budget recommendation.”

In addition to the direct impact of the pandemic on Idaho’s health care system, Idaho has been seeing significantly increased costs in Medicaid in part because of pent-up demand for medical care among new enrollees in Medicaid expansion, and in part because the federal government has cut off disenrollment of those who no longer qualify during the pandemic. That’s led to roughly 32,000 Idahoans currently staying on the Medicaid rolls who otherwise wouldn’t be eligible, including more than 13,000 in Medicaid expansion.

Legislative budget analyst Jared Tatro told lawmakers, “As of Jan. 27, it was 32,914 individuals, and of those, 13,217 were related to Medicaid expansion. … When the public health emergency ends, the department knows who they are, and they’re ready to start the process of disenrolling effective immediately.”

JFAC members had lots of questions about how much Medicaid expansion has actually cost the state and how much the state has saved in offsets in existing programs that now are 90% federally funded, rather than 100% state-funded as they were previously. Tatro said, “There are cost offsets.” For the first year, the net cost to the state was zero, he said, due to about $32 million in cost offsets in Corrections, courts, Health & Welfare and the Catastrophic Health Care program. Since then, Tatro said, estimates forecast by Milliman, an actuarial consulting firm, now appear to be off and costs are expected to be higher than anticipated, “basically almost double.” But there still are offsets, he said, “And we know there are more offsets coming.”

Initial Milliman projections put the state’s cost for the first full year of Medicaid expansion, this current year, at around $41 million, which is where it was budgeted; all of those costs were offset through a combination of savings in existing state programs and an allocation of $12.6 million from the Millennium Fund, a state fund that holds tobacco settlement proceeds. But now Milliman has issued a revised report projecting costs this year will be nearly 66% higher than it originally projected, based on higher medical and pharmacy costs, COVID-19 impacts and economic conditions. That would mean another $22.8 million in state costs this year.

Tatro said the new report bases its projections on just a few months of Idaho experience during a pandemic, while the original forecasts were based on experiences of other states, so there are still plenty of unknowns.

“With hospitals shut down, it’s going to be hard to realize what is the cost of these individuals,” he said, “so we won’t know the net impact this session.” Longer term, additional savings from Medicaid expansion are expected in the state’s Catastrophic Health Care fund, mental health services and psychiatric hospitals, child welfare and public health, he said.

“We’re just going to have to be a little patient before we fully realize the actual net. But right now about half is being offset,” he said.

Rep. Ron Nate, R-Rexburg, called the increased Milliman projections “a disturbing increase,” and said, “These costs are outrageous, and I wonder if the voters who voted for Medicaid expansion really knew what it was going to cost us and all the trouble it’s causing with budgeting, (if they) would have voted for it.”

Idaho voters approved Medicaid expansion by a more than 60% margin in 2018, after the Legislature discussed it but didn’t act for six straight years. The expansion covers Idahoans who previously fell into an insurance gap: They made too much to qualify for Medicaid, but not enough to qualify for subsidized health insurance through the Your Health Idaho insurance exchange.

Sen. C. Scott Grow, R-Eagle, noted the way Medicaid expansion costs doubled from the first year of enactment to the second, and asked whether that’s likely to continue. Tatro responded, “If we double again I’ll take you to lunch. … We don’t anticipate doubling year after year after year. That is six months compared to one year.” That’s because expansion started halfway through Idaho’s state fiscal year, which runs from July 1 to June 30.

Jeppesen told lawmakers, “I just wanted to close by reminding the committee that the department exists to serve the people of Idaho and specifically to promote their health safety and independence. I remain committed to working as I have been for the last three years in a collaborative, transparent way, and I only know of one way to solve problems, and that’s to talk through them.”

JFAC is scheduled to start setting agency budgets Feb. 19.

Clipped from: https://www.idahopress.com/news/local/governor-drops-proposal-for-medicaid-budget-cut/article_d464ebf8-999b-5369-bb26-ea7661757912.html

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Indiana Lawmakers Propose Using Cigarette Tax For Medicaid

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The state is considering a new $1 tax to cigarettes and redirect 40% of the existing tax to Medicaid providers.

 
 

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 proposal, now headed to the House Ways and Means Committee, would add $1 to the state’s current 99.5 cents per pack cigarette tax.

 
 

INDIANAPOLIS (AP) — A House committee made significant changes Thursday to the way Indiana would spend proceeds from a proposal to hike the state’s cigarette tax for the first time in more than a decade and impose a new state tax on vaping liquids.

House legislators revised the measure in committee to direct 40 percent of Indiana’s cigarette tax revenue toward Medicaid reimbursements for health care providers. That’s a change from the original proposal, which would have deposited a majority of the new revenue generated by the tax hike — estimated to be nearly $290 million a year — into the state’s general fund and pension programs.

The proposal, now headed to the House Ways and Means Committee, would add $1 to the state’s current 99.5 cents per pack cigarette tax. It also would charge a 39 percent tax on the liquids used in e-cigarettes, which bill sponsor Rep. Julie Olthoff, a Crown Point Republican, said would be roughly equivalent to the cigarette tax.

Olthoff said Thursday she welcomed the change, noting Medicaid covers the health care expenses of eligible smokers. The lawmaker has maintained that the legislation is aimed at reducing Indiana smoking rates. The state’s 21.1 percent smoking rate among adults was the fourth-highest in the country for 2018, according to the federal Centers for Disease Control and Prevention.

A separate amendment seeking to allocate more of the tax revenue toward public health initiatives was voted down by committee members. The proposal, authored by Democratic Rep. Robin Shackleford, would create a health improvement fund to help the State Department of Health treat and prevent tobacco addiction, drug addiction, diabetes, mental illness, obesity and other health disparities.

Republicans on the committee said they prefer the proposal be reconsidered in Ways and Means, and after more progress has been made on the state budget.

Casey Smith is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

 
 

Clipped from: https://www.wfyi.org/news/articles/indiana-lawmakers-propose-using-cigarette-tax-for-medicaid

 
 

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Medicaid expansion cost-share deal would stay put in Warnock, Ossoff bill

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A Georgia Senator has introduced a bill to expand Medicaid at 100% federal costs for states who did not take the money under ACA.

 
 

 
 

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.

 
 

 
 

Newly seated U.S. Sen. Raphael Warnock of Georgia unveiled legislation Friday, Feb. 5, to give states that skipped out on early Medicaid expansion equal federal cost-sharing coverage if they join later.

The bill, called the “States Achieve Medicaid Expansion (SAME)” Act, aims to quell concerns over possible future changes to the federal-state payment arrangement for Medicaid under the Affordable Care Act (ACA), which has been a stumbling block for many states opposed to full coverage expansion.

Its leader sponsors are Warnock and U.S. Sen. Mark Warner of Virginia. Georgia’s U.S. Sen. Jon Ossoff, who teamed with Warnock in the 2020 elections to flip both of the state’s Senate seats, is also joined on the bill.

Currently, the federal government pays 100% of the costs for the first three years for states that provide Medicaid to residents with incomes up to 138% of the federal poverty level, the definition of full coverage. Georgia is set to partially expand coverage this year but remains among about a dozen states that have declined full expansion.

Warnock, a Democrat who is Georgia’s first Black senator and remains senior pastor of Atlanta’s Ebenezer Baptist Church, campaigned on a platform to expand Medicaid, institute a national $15-an-hour minimum wage and bolster voting rights. He called his bill a push to blanket all Americans with health-insurance coverage.

“Health care is a human right, and for too long, too many Georgians have been denied access to affordable health care through Medicaid,” he said. “I’ve long believed that expanding Medicaid in Georgia is an important step toward making affordable health care for all a reality.”

Medicaid enrollment has spiked during the COVID-19 pandemic that began last March. In Georgia, Medicaid rolls increased by 338,000 between March and December 2020, raising the total number of children, adult and family recipients to roughly 2,104,000, according to state Department of Community Health (DCH) data.

Opponents have warned covering thousands more people could bust Georgia’s budget for Medicaid, even with the extra federal spending. Currently, the federal government pays about two-thirds of the more-than $10 billion Georgia spends on Medicaid each year.

Critics also worry policy changes now could saddle Georgia with costly terms for jumping on the full-expansion train late in the ballgame, years after other states joined the Obama-era health-care program.

“I don’t know if the federal government will ever return to a period of budget austerity,” Chris Denson, policy and research director for the nonprofit Georgia Public Policy Foundation (GPPF), said last week (week of Jan. 24). “But there’s always a chance that the feds will drop that matching rate.”

Medicaid coverage is now available for Georgia adults with incomes about 35% below the federal poverty line, as well as children in households making up to 138% above the poverty line and low-income senior, blind and disabled adults.

Gov. Brian Kemp, a Republican, gained federal approval last October from the Trump administration for a partial Medicaid expansion, covering adults earning up to 100% of the poverty level. That would cover about 50,000 Georgians, according to state estimates.

Kemp’s plan also requires Georgia Medicaid recipients to work, attend school or volunteer at least 80 hours each month – a controversial provision critics argue strips deserving low-income Georgians and families of a safety net.

Warnock’s bill leveling Medicaid cost-sharing percentages stands a good chance to win approval in Congress, thanks to his and Democratic co-campaigner Ossoff’s wins in last month’s runoff elections.

Warnock and Ossoff defeated Georgia’s two incumbent Republican senators, shifting control of both chambers in Congress to Democrats at the same time President Joe Biden – a Democrat – took office.

Ossoff, who is Georgia’s first Jewish senator and currently the chamber’s youngest member, called his colleague’s bill both a moral document and good incentive for states like Georgia that have not expanded Medicaid.

“This bill would ensure Georgia gets the same funding as other states that expanded Medicaid years ago – and create even more incentive for our state government to do what should have been done a decade ago and expand Medicaid for Georgia families,” Ossoff said.

Both of Georgia’s new senators have been busy since taking office on Jan. 20. They have called for showering Georgians with more dollars for COVID-19 pandemic relief, as well as bolstering voting rights even as Republican state lawmakers move to put new restrictions on absentee voting.

 
 

Clipped from: https://www.northwestgeorgianews.com/catoosa_walker_news/medicaid-expansion-cost-share-deal-would-stay-put-in-warnock-ossoff-bill/article_a24b316e-67e1-11eb-8fb5-b7a65dab9e59.html

 
 

 
 

 
 

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Some Illinois Medicaid patients in Chicago have limited pharmacy access

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The Aetna decision to block CVS competitor Walgreens from Medicaid payments has left members with less options for filling prescriptions near their home.

 
 

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.

 
 

CHICAGO (WLS) — A recent change to the Illinois Medicaid prescription plan is making it difficult for many to get medications, especially on Chicago’s South and West sides.

It is a potential dilemma for millions in Illinois. Two months ago, Medicaid clients were told they could no longer use Walgreens unless they wanted to pay full price for their prescriptions.
 


New legislation is calling for Medicaid recipients to be able to use any pharmacy. But in the meantime, some patients are struggling to access what could be life-saving drugs.

Aetna provides coverage for Illinois Medicaid patients. In December, Aetna changed the prescription plan, dropping Walgreens as a provider. Walgreens makes up 30% of all Chicago’s drugstores. Because Aetna is owned by CVS, Medicaid patients now have to get their medications at CVS and other in-network pharmacies.

“These patients already have a restricted network of pharmacies where they can get their medications, and we’re already in a pharmacy desert, and unfortunately this is being restricted even more,” said Dr. Thomas Huggett, Lawndale Christian Health Center.

There are more than 11,000 Medicaid patients who live on the West Side of Chicago, according to health equity experts. Most West Side neighborhoods do not have a CVS.

“We really need a corporation like CVS/Aetna to really look at its own practices and policies or we’re never going to get to an equitable society,” said Dr. David Ansell, Rush University Medical Center.

State Representative La Shawn Ford sponsored a bill that would allow Medicaid patients access to the pharmacy of their choice, discussing it at news conference on Thursday.
 

“We have to pass legislation, put pressure on HFS and Aetna to reverse that administrative rule, but right now Aetna and CVS believe that they’re right. They believe that there are enough pharmacies in the boundaries of their clients, and they don’t see a problem with their new rule,” said State Representative Ford.

In a statement to the I-Team, Aetna said:

Aetna Better Health of Illinois is committed to helping Medicaid recipients obtain access to affordable prescription drugs when they need them. Criticism about the access to pharmacy services we provide in our Medicaid network are not accurate and seem to be based on incomplete information.

Across Illinois, nearly 2,000 pharmacies participate in our Medicaid network. In Chicago, our members live – on average – just six blocks or a half-mile from one of 271 in-network Chicago pharmacies, including CVS Pharmacy, Jewel-Osco, HY-VEE, Kroger/Mariano’s, Meijer, Walmart, Target, and importantly – many independently-owned community drugstores. None of the pharmacy chains in our network is designated a preferred pharmacy, and the fact is that many of our members choose to support locally-owned independent pharmacies in their neighborhood. Support of these small businesses is an important long-term solution to addressing pharmacy deserts and stimulating local economies.

We regularly review our network and geographic access points to ensure we are meeting the needs of our members and maintaining network adequacy. We continue to meet or exceed all of the state’s access requirements for managed care organizations. Our strategy to address greater access for members living near pharmacy deserts includes free delivery from many chain and independent pharmacies and 90-day prescriptions shipped directly to members’ homes. We continue to invest in partnerships to drive innovation and community-based solutions to address this issue.

 
 

Clipped from: https://abc7chicago.com/illinois-medicaid-pharmacy-plan-walgreens/10315664/

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Nevada Medicaid provides same-day transportation for testing and vaccines

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

 
 

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

 
 

 
 

File of the COVID-19 vaccine(KOLO)

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

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

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

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

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

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

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

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

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

 
 

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

 
 

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Medicaid Concepts: Modularity

This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.

What do we mean by Modularity?

States spend billions of dollars each year on claims payment and related technology systems. These payments have traditionally gone to a handful of vendors able to build such large scale solutions.

It has proven difficult to flexibly evolve Medicaid technology systems when most functions reside in one solution. Over the past 20 years, CMS (which pays for the majority of the costs of these systems) has attempted to create positive disruption with an emphasis on modularity. In lay person’s terms, this means using a set of smaller modules that can work together to accomplish objectives instead of one monolithic system.

An entire industry has grown up around the concept of modularity, including both technology and consulting vendors.

To understand modularity, there are two related key terms:

MMIS– Medicaid Management Information Systems is the term used to talk about the technology systems needed to pay provider claims, conduct certain federally required functions (like fraud detection) and interface with other systems such as eligibility and enrollment. This term is defined in section 1903 of the Social Security Act. At the most simple level, states must have payment systems approved by CMS since CMS is paying so much of the costs of healthcare services.

MITA – The Medicaid Information Technology Architecture (MITA) initiative is sponsored by CMS and is designed to improve systems used in Medicaid programs. It has various goals and standards, and states have to report on their use of related principles in their system design.

One of the common concerns is perceived lack of precision in the definitions provided by CMS. Many stakeholders have called for CMS to identify a list of acceptable modules.

“A module is a packaged, functional business process or set of processes implemented through software, data, and interoperable interfaces that are enabled through design principles in which functions of a complex system are partitioned into discrete, scalable, reusable components. An MMIS module is a discrete piece (component) of software that can be used to implement an MMIS business area as defined in the Medicaid Enterprise Certification Toolkit (MECT)” – CMS State Medicaid Director Letter, August 16, 2016

What role does Medicaid play?

While CMS pays most of the costs of these systems, states procure them. As states update their MMIS systems, they have an opportunity to do a modular procurement. So far, states have typically sought to procure modules for claims payment, eligibility, drug management and electronic visit verification. In addition to modules, states also procure Systems Integrator (SI) contracts. SI vendors provide the overarching system needed to integrate modules together.

Explore further

https://www.medicaid.gov/medicaid/data-systems/medicaid-management-information-system/index.html

https://www.medicaid.gov/medicaid/data-systems/medicaid-information-technology-architecture/index.html

https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MedicaidInfoTechArch/Downloads/mitaoverview.pdf

https://mmcp.health.maryland.gov/Documents/MMAC/2019/05_May/2019%20MMAC%20Summit_MMIS%20Transformation.pdf

https://doit.maryland.gov/contracts/Documents/catsPlus_torfp_status/M00B0600019-MHT-MMT-RFP.pdf

https://www.cns-inc.com/wp-content/uploads/2018/06/CNSI-Modularity-White-Paper-FINAL_0.pdf

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/contracting/pre-solicitation-announcement.pdf

https://www.medicaid.gov/medicaid/data-systems/downloads/rfi-modular.pdf

https://www.medicaid.gov/medicaid/data-systems/medicaid-enterprise-certification-toolkit/index.html

https://downloads.conduent.com/content/usa/en/white-paper/defining-mmis-modularity.pdf

https://www.optum.com/content/dam/optum3/optum/en/resources/PDFs/optum-modularity-approach-for-hhs-medicaid.pdf

https://www.medicaid.gov/federal-policy-guidance/downloads/smd16010.pdf

https://www2.deloitte.com/us/en/pages/public-sector/solutions/medicaid-management-information-system-modernization.html

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

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

 
 

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

 
 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
 

 
 

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18 states back Arkansas on Medicaid work rule

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

 
 

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

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

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

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

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

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

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

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

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

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

A department spokesman Wednesday declined to comment on the litigation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
 

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

 
 

 
 

 
 

 
 

 
 

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

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

 
 

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

 
 

 
 

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

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

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

– ADVERTISEMENT –

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

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

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

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

About Humana

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

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

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

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

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

 
 

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

 
 

 
 

 
 

 
 

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

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

 
 

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

 
 

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

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

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

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

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

 
 

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