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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.

 
 

 
 

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NC has launched an enrollment website for the new managed care program, and members can enroll from March to May of 2021.

 
 

 
 

Clipped from: https://www.wnct.com/news/north-carolina/nc-medicaid-launches-website-for-beneficiaries-to-learn-more-about-medicaid-managed-care/

 
 

RALEIGH, N.C. (WNCT) The North Carolina Department of Health and Human Services announced the launch of NC Medicaid’s managed care enrollment website in preparation for the launch of Medicaid Managed Care scheduled for July 1, 2021.

The purpose of the enrollment website is to help Medicaid beneficiaries learn more about Medicaid Managed Care.

In 2015, the NC General Assembly enacted legislation directing NCDHHS to transition Medicaid and NC Health Choice from a primarily fee-for-service delivery system to managed care.

Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services.

The enrollment website provides information about who will have to choose a health plan, who will stay in the traditional Medicaid program (NC Medicaid Direct), and who can choose between the two.

It will also share the basic medical and behavioral health benefits that are offered. There will be a list of frequently asked questions and answers to help beneficiaries understand the changes.

A small number of people will not need to choose a Medicaid Managed Care health plan because of the type of health services they need. They will stay enrolled in NC Medicaid Direct.

To learn more, beneficiaries can visit the NC Medicaid Direct services page on the enrollment website.

RALEIGH — The North Carolina Department of Health and Human Services today announced the launch of NC Medicaid’s managed care enrollment website, www.ncmedicaidplans.gov, in preparation for the launch of Medicaid Managed Care scheduled for July 1, 2021.
 
The purpose of the enrollment website is to help Medicaid beneficiaries learn more about Medicaid Managed Care. In 2015, the NC General Assembly enacted legislation directing NCDHHS to transition Medicaid and NC Health Choice from a primarily fee-for-service delivery system to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services.
 
The enrollment website provides information about who will have to choose a health plan, who will stay in the traditional Medicaid program (NC Medicaid Direct) and who can choose between the two. It will also share the basic medical and behavioral health benefits that are offered. There will be a list of frequently asked questions and answers to help beneficiaries understand the changes.

Most people currently receiving Medicaid benefits will need to enroll in Medicaid Managed Care. Open enrollment will begin March 15, 2021, and will continue through May 14, 2021. Medicaid beneficiaries will be able to choose from five health plans — WellCare, United HealthCare, Healthy Blue, AmeriHealth Caritas and Carolina Complete Health (serving regions 3, 4 and 5). Those who are federally recognized tribal members or qualify for Indian Health Services are exempt from managed care. Those who live in Cherokee, Graham, Haywood, Jackson or Swain counties or in a neighboring county may choose to enroll in the Eastern Band of Cherokee Indians (EBCI) Tribal Option.
 

Features that will be added to the Medicaid Managed Care enrollment website in January 2021 include:

• Medicaid and NC Health Choice Provider and Health Plan Lookup Tool members can use to find and select the best primary care provider for their families.
• Choice Guide members can use to view health plans and select those with the best features for their needs

To learn more about North Carolina’s transformation to Medicaid Managed Care, visit the Medicaid Transformation webpage.

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.

 
 

 
 

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The new OH MCO contract awards will focus on population health measures, and are expected to be announced January 2021.

 
 

Clipped from: https://www.limaohio.com/wire/state-wire/435620/why-ohio-is-overhauling-medicaid

The overhaul of Ohio’s Medicaid program has farther reaching consequences than CareSource.

The health insurance program for 3 million Ohioans with low incomes and disabilities is a major policy tool. It’s a key source of health care for the Dayton region, which is older and less affluent than the state as a whole, and also a source of funding for hospitals, doctors and other providers.

The change is designed to improve the care of the 2.7 million Ohioans who get their care get their Medicaid benefits through a system called Medicaid managed care where an insurance company that manages the plan and pays out the claims. Five insurance plans manage these policies in Ohio.

“We’re in a fairly unique group of states who have made a pretty near comprehensive commitment to manage care. So we want to keep pushing the envelope in terms of getting the best outcomes for people that we support,” State Medicaid Director Maureen Corcoran, in an interview after the procurement was publicly posted in October.

Some of the outcomes that the overhaul aims to improve have been documented in state and federal reports.

Loren Anthes, Medicaid researcher with Cleveland-based Center for Community Solutions, reported that the state had a “secret shopper” program that found trying to learn more about Medicaid member consumer experiences, the ability to schedule an appointment for routine care was less than 70%; the ability to schedule an appointment as a new patient was around 75%; on average, patients had to wait 27 days for an appointment; and only 7 in 10 contracted physicians accepted new patients.

When looking at the Healthcare Effectiveness Data and Information Set, which is a widely used set of performance measures in the Medicaid managed care industry, only 52% of Ohio children get their health checks completed, fewer than 2 in 3 children get regular vaccinations, and fewer than half of children have annual dental appointments.

Ohio is trying to create a new set of rules that gets better results. Gov. Mike DeWine’s office announced the request for proposals as part of a new vision for Ohio’s Medicaid program that focuses on people — not just the business of managed care.

“Since coming into office in January of 2019, my administration has been evaluating our Medicaid program to develop a vision of a better, healthier, and more productive state,” DeWine had said. “With input from Ohioans covered by Medicaid, physicians, hospitals, health care providers, and managed care plans, this will be the first major overhaul of Medicaid in 15 years.”

The overhaul has so far been a massive effort.

For the past 18 months, the DeWine administration has been doing the leg work leading up to this bid. This includes getting feedback from 1,100 different people and organizations.

Ohio Medicaid will let the winning bids know with award letters Jan. 25, 2021. The goal is for the newly rebid system to go live Jan. 5, 2022.

Some of the new conditions that Ohio Medicaid wants for insurance companies it contracts with include making the system easier to use, adding population health measures to keep people healthy, and the new conditions also add new accountability measures.

The method that will be used to score applicants like CareSource includes different points for different categories, with a total 1,000 points as the highest possible score.

The scoring method puts the highest emphasis on population health measures, where companies can earn up to 395 points. Qualifications and experience is the lowest weighted category, worth up to 85 points.

Some of the aspects of the bid includes that insurance companies are asked to describe how they will identify and address the need for reliable transportation to services, and they must submit a plan for how they will invest a portion of profits back into the community. The system also comes with a range of penalties for non-compliance, such as an insurance company getting an enrollment freeze until they fix the particular issue.

The new system is also supposed to make it easier for doctors and other providers to work with the system, such as having a single point for filing claims instead of the current system of working with up to five different plans.

“The thing I noticed in particular is there’s a big shift away from the interests of the managed care companies to the interests of patients and providers,” Anthes said.

 
 

https://www.limaohio.com/wp-content/uploads/sites/54/2020/11/web1_Ohio-15.jpg

By Kaitlin Schroeder

Dayton Daily News, Ohio (TNS)

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OH Medicaid will have MCOs offer companionship-focused calls to nursing home residents.

 
 

 
 

Clipped from: https://www.modernhealthcare.com/post-acute-care/ohio-medicaid-launches-program-curb-long-term-care-loneliness

The Ohio Department of Medicaid is introducing a “friendly caller” program to reduce loneliness among residents in long-term care facilities.

Through the holidays, Ohio Medicaid, Ohio’s five Medicaid managed care organizations and the state’s Area Agencies on Aging will work together to pair residents with volunteers for 30-minute informal calls twice a week.

The Area Agencies on Aging will train volunteers on how to provide companionship over the phone. Volunteers also will be trained on the UCLA Loneliness Scale to identify residents who made need more intervention. The program will be open to any nursing home or assisted living facility with at least 50 residents receiving services through Ohio Medicaid managed care programs.

“Research shows us that the holidays are an emotionally challenging time for those residing in shared living facilities, a reality exacerbated by months of social distancing and limited interaction with loved ones,” Ohio Medicaid Director Maureen Corcoran said in a prepared statement. “We also know that depression can accelerate physical deterioration. This initiative gets to the heart of the matter by offering consistent, caring and highly interpersonal connections that are needed now and throughout the holidays ahead.”

Heading into the holiday season, the isolation necessary to protect long-term care residents from community spread will make the pandemic more challenging, long-term care leaders said. Families won’t be able to visit residents, group meals among residents won’t happen and volunteers won’t be able to come in to celebrate, they said. Instead, staff will turn to virtual visits and, in some cases, outdoor visits, said Katie Smith Sloan, president and CEO of LeadingAge, a national association of aging services providers.

“Older adults are living at Ground Zero in the worst pandemic in a century,” Smith Sloan said. She and other long-term care leaders are calling on government officials and all Americans to help stop the spread of COVID-19.

Since April 15, about 21,000 residents in Ohio’s long-term care facilities have contracted COVID-19, about 3,100 of whom have died, according to Ohio’s COVID-19 dashboard. In Ohio, more than half of the deaths from the virus have been among long-term care residents. On Tuesday, Ohio saw its second highest daily number of total deaths – 98 – from COVID-19.

Nationwide, positive cases for nursing home residents rose 21% from the first week of November to the second, according to the American Health Care Association and National Center for Assisted Living, which represents nursing homes and assisted living communities. In the U.S., there were 12,429 resident cases the week of Nov. 8.

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.

 
 

 
 

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Medicaid members are using benefit and incentive cards for overall healthy activities during the pandemic.

 
 

 
 

Clipped from: https://apnews.com/press-release/pr-newswire/technology-georgia-government-and-politics-lung-disease-north-america-e1934baba96a2aeced83d6a45e9b7b73

ATLANTA, Nov. 23, 2020 /PRNewswire/ — InComm Payments, a leading global payments technology company, today released the results of its Medicaid subscribers research, which found that many Medicaid members are prioritizing healthy habits during the COVID-19 pandemic. The study was based on responses from 1,700 U.S. Medicaid subscribers during the month of October.

Medicaid enrollment is up this year, according to recent analysis completed by the Kaiser Family Foundation, a trend expected to continue as enrollment reflects changes to the economy. This trend was captured in the survey as 15% of respondents were new users who signed up for Medicaid within the past year. All respondents were asked about their health-related behaviors and attitudes regarding restricted-access network benefits and rewards/incentives cards.

“It’s no surprise that healthy habits and routine services are a top priority for many at this time,” said Brian Parlotto, Executive Vice President at InComm Payments. “It’s encouraging for health plans that members are paying attention to their long-term health and expressing an interest in plan incentives that may help maintain their healthy behaviors.”

Majority of Medicaid subscribers agreed that healthy habits are more important now than ever

• Nearly all respondents (96%) said healthy habits are on their daily priority list.
• However, 45% of respondents said healthy habits are difficult to maintain during the pandemic. The main factors impacting maintaining healthy habits were:

 
 

• Stress (49%)
• Expenses (24%)
• Reduced access to gyms or classes (10%)

• Over 40% of respondents said they were engaging in fewer in-person medical services.

 
 

• But 59% of subscribers are using telehealth appointments more now than in the past.

Medicaid subscribers report willingness to engage in preventive care if incentivized
We asked respondents what they’d be willing to do to earn rewards dollars through an incentives/rewards card program. The top five activities were:

• 68% said they’d complete annual wellness exams.
• 58% said they’d complete a yearly dental visit.
• 53% said they’d take annual vaccines, including the flu shot.
• 50% said they’d complete screenings and risk assessments, such as cholesterol tests, mammograms or prostate exams, etc.
• 42% said they’d participate in mental health coaching.

Subscribers express interest in restricted-spend/rewards card programs

Respondents who weren’t enrolled in restricted spend select product and incentives/rewards programs were asked about their interest in these plan benefits

• 82% of Medicaid subscribers who aren’t currently able to use a rewards/incentive card said they would have some level of interest in such a program.
• 83% agreed they’d be willing to complete some form of administrative activity (e.g., online logs, after-program tests, etc.) in order to join a rewards program.

Medicaid reward cards are overwhelmingly well-received by cardholders

• 90% believe this benefit helps them achieve their health and wellness goals.
• 90% rated their overall experience with the card as ‘4’ or ‘5’ out of five stars.
• 67% use their card at least monthly.
• 88% report using the card in-store is easy.

“We’re happy to see that health plans are able to make such a positive impact in Medicaid members’ overall health and satisfaction,” said Parlotto. “We’re excited keep growing our offerings at InComm Healthcare while assisting health plans in supporting the long-term health of their members; for example, our Healthy Foods Card can help plans distribute funds for healthy, nutritious foods, assisting members who may be struggling with food insecurity due to stress or cost.”
 

InComm Healthcare helps health plans to offer their members supplemental benefit and incentive dollars. InComm Healthcare currently serves more than 500 health and wellness programs for over 300 health plan partners, reaching over six million OTC Network cardholders. The cards in its product suite are accepted at more than 60,000 retail locations, including national retailers and independent pharmacies.
 

About InComm Payments
InComm Payments is a global leader in innovative payments technology. Leveraging dynamic technology and proven expertise, InComm Payments delivers enhanced end-to-end payment platforms and emerging financial technology solutions that help businesses grow across a wide range of industries including retail, healthcare, tolling & transit, incentives, mobile payments and financial services. By enabling omnichannel connections to an ever-expanding consumer base in an increasingly digital ecosystem, InComm Payments creates seamless and valuable commerce experiences across the globe. With more than 25 years of experience, over 500,000 points of distribution, 386 global patents and a presence in more than 30 countries, InComm Payments leads the payments industry from its headquarters in Atlanta, Ga. Learn more at www.InCommPayments.com.

Media Contacts:
 

Anthony Popiel
Dalton Agency
404-876-1309
apopiel@daltonagency.com

Nilce Piccinini
Sr. Communications Manager
InComm Payments
404-935-0377
npiccinini@incomm.com

View original content to download multimedia: http://www.prnewswire.com/news-releases/incomm-healthcare-explores-medicaid-subscribers-health-related-habits-cardholder-experiences-301178497.html

SOURCE InComm Payments

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.

 
 

 
 

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Increased Medicaid spending on early detection shows a 2% decline in deaths for breast, lung and colon cancer.

 
 

 
 

 
 

Clipped from: https://www.upi.com/Health_News/2020/11/05/Obamacare-cut-death-rate-for-3-major-cancers-study-shows/3531604599429/

Expanded Medicaid passed in some states as part of the Affordable Care Act has significantly reduced deaths from newly diagnosed breast, lung and colon cancers, a new study finds.

Death rates from these cancers are lower in states that opted for expanded Medicaid than in those that didn’t. The positive trend is largely due to earlier diagnosis, which increases the odds of survival, the researchers said.

Expanded Medicaid captures more low-income people by including those at or below 138% of the federal poverty level.

Earlier studies have shown that Medicaid is associated with increased cancer screening and earlier diagnosis.

RELATED Study: Obamacare repeal may leave young cancer patients in the lurch

For the study, the researchers used the U.S. National Cancer Database to track more than 523,000 patients who were newly diagnosed with breast, lung or colorectal cancer from 2012 through 2015.

“We found that Medicaid expansion was associated with a significant decrease in mortality compared to states without such expansion,” said researcher Dr. Miranda Lam, from Dana-Farber, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, in Boston.

Under expanded Medicaid, there was a 2% decline in death from the pre- to post-expansion period, the researchers found. No change was seen among states without expanded Medicaid.

RELATED Study: Obamacare cut out-of-pocket costs, but many still struggle

If the 2% reduction in deaths was seen in all states, then among the approximately 69,000 patients diagnosed with cancer in those states, 1,384 lives would be saved each year, the researchers calculated.

This suggests that the decline in deaths linked with Medicaid expansion is mostly due to diagnosing cancer at an earlier stage, the study authors said.

“Increased Medicaid coverage may remove barriers to accessing the health care system for screening and timely symptom evaluation, and that can translate into better outcomes for patients,” Lam said in a Dana-Farber news release.

RELATED Medicaid expansion increased earlier cancer detection by 15%, study finds

“We were reassured to find that patients living in areas of the lowest quartile of median household income showed a modest decrease in mortality after Medicaid expansion,” Lam said. “We also found that the mortality improvements occurred in both Black and white populations.”

The report was published online Nov. 5 in JAMA Network Open.

More information

For more on expanded Medicaid, head to HealthCare.gov.

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.

 
 

 
 

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Ohio Medicaid needs to make cuts, but stakeholders like hospitals are messaging they need a bailout.

 
 

 
 

Clipped from: https://www.dispatch.com/story/news/healthcare/2020/11/06/budget-shortfall-may-cause-cuts-ohios-tax-funded-medicaid-program-poor-disabled-because-covid/6165391002/

 
 

Medicaid caseloads have surged during the coronavirus pandemic, topping 3 million this year, up 9%, from last year.

But as needs intensify, declining state revenue and a projected budget shortfall will challenge the $23 billion health-care program for poor and disabled Ohioans, Medicaid Director Maureen Corcoran said during a virtual post-election conference Thursday.

“We are looking at several-billion-dollar shortfall in this current fiscal year,” Corcoran said.

More:Ohio reports 4,961 new COVID cases, again breaking record; new health officials appointed

Economic downturns tend to cause a spike in Medicaid demand.

“Medicaid is always counter-cyclical with the economy and it lags a little bit,” Corcoran said. “As we think about the recovery, that may take several years, that pressure will be on people who need their health-care services until they get back to a job.

“As tight as our state economy is going to be, it’s going to be important that we continue to support Ohioans, many who have not been out of a job or had the kind of economic experience that we see today.”

She projected that it will take years for Ohioans to recover, and in the meantime, “we do expect the budget to be very difficult … we’ve got some very difficult decisions ahead of us.”

During an hour-long discussion on health care and Medicaid during Impact Ohio’s post-election conference, Corcoran and representatives of the health-care industry said the coronavirus has strained the system, but also spurred improvements.

Mike Abrams, president and CEO of the Ohio Hospital Association, called COVID an “economic broadside for hospitals,” causing them to suspend elective procedures, straining supply chains and forcing staff furloughs as hospitals emptied.

“Ohio hospitals lost $4 billion and counting due to the stoppage of elective procedures,” Abrams said. “A portion of that has been recouped largely by federal aid … maybe 50-55%. For many hospitals it was a lifeline. They were faced with urgent economic circumstances, even making payroll.”

Abrams predicted Ohio will still see some hospital closures because of the economic hit.

But hospitals have been able to keep up with demand for treating victims of the pandemic. Currently, Abrams said Ohio hospitals are treating more than 2,000 COVID patients, about 73% of capacity, with ample supplies of much-needed ventilators and personal protection equipment.

Kelly O’Reilly, president and CEO of the Ohio Association of Health Plans, said insurance companies also have adjusted and tried to pitch in to help.

The plans expanded coverage for telehealth services, continued coverage for furloughed workers, delayed employer premium payments, waived COVID testing fees and expanded services to vulnerable populations including pregnant women and the elderly with food assistance and prescription delivery.

But the pandemic also has created uncertainty for the industry, which is making it difficult for insurers to set rates.

“We don’t know what the impact of that deferred care is going to do in terms of the impact on the system and cost of health care. We don’t know what the long-term impacts of COVID are in terms of the people who have recovered and what the medical impact on their ongoing health looks like.”

ccandisky@dispatch.com

@ccandisky