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Medicaid plans to offer transit | News, Sports, Jobs – Tribune Chronicle

Curator, Ohio, Managed Care, News Roundtable

 
 

 
 

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.

 
 

 
 

Curator summary

All MCOs in Ohio will provide free transportation for members to food banks.

 
 

 
 

Clipped from: https://www.tribtoday.com/news/local-news/2020/11/medicaid-plans-to-offer-transit/

WARREN — In an effort to “ensure our most vulnerable citizens maintain reliable access to food resources,” Ohio’s five Medicaid Managed Care Plans will offer free transportation services to and from food banks, food pantries, food clinics and grocery stores as part of the benefit plan.

People with Medicaid plans through Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage and United Heathcare Community Plan can access the benefit.

“This transportation service is essential to many of our members,” states an informational email. “By undertaking this united effort on behalf of every Ohio member, we can help get food on the table for Ohioans in need during this unprecedented health crisis.

Members of the plans can find more information by calling the Ohio Department of Medicaid Member Hotline at 1-800-324-8680.

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Molina Healthcare of California and Inland Empire Health Plan Join Forces to Provide Support for Job and Health Coverage Losses

Curator, News Roundtable, MCOs, California

 
 

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.

 
 

 
 

Curator summary

 
 

2 California MCOs are teaming up to let potential enrollees know about Medicaid and exchange coverage options after seeing a surge in unemployment in their area.

 
 

 
 

Clipped from: https://www.prnewswire.com/news-releases/molina-healthcare-of-california-and-inland-empire-health-plan-join-forces-to-provide-support-for-job-and-health-coverage-losses-301144251.html

SAN BERNARDINO, Calif., Oct. 1, 2020 /PRNewswire/ — Molina Healthcare of California (“Molina”), and Inland Empire Health Plan (IEHP) are joining forces to lead a new healthcare initiative called “Together4IE.” This collaboration will raise awareness about available coverage through Medi-Cal and the health insurance marketplace (Covered California) to support Californians affected by income or employment changes during the COVID-19 pandemic. The health plans launched a website and are offering a toll-free number (1-866-U2Apply) to learn more about securing affordable health insurance.

The California Employment Development Department reported that as of July 2020, more than 275,000 residents in the Inland Empire region were unemployed. The unemployment rates in Riverside and San Bernardino counties are both over 13%, having increased by approximately 4.7% and 4.4%, respectively, compared to the unemployment rates from 2019, which has led many to consequently lose health insurance coverage for themselves and their families.

“As many families face increased uncertainty during this time, Molina and IEHP are here to help them navigate the health care system,” said John Kotal, president of Molina Healthcare of California. “As a company with roots in this region for decades, Molina continues to advocate for quality access to health care for IE residents who need it most.”

Working together to support this population, the “Together4IE” initiative connects qualified residents to resources and works to reduce any stigma around government-sponsored health care. In addition to the resources made available, partnering organizations are actively engaging with individuals and families, as well as communities, to ensure that those interested in affordable health care are fully aware of the available options. 

Community agencies engaged in support of the initiative include: Covered California, Arrowhead Regional Medical Center, Riverside Department of Public Social Services, Riverside University Health System, San Bernardino County Transitional Assistance Department, Southern California Edison, Southern California Gas Company, and hundreds of local community organizations.

“This is about doing the right thing for the community we know and love,” said Jarrod McNaughton, IEHP chief executive officer. “Through collaboration and partnerships with agencies in the Inland Empire, we can rally around our neighbors to fill in the gaps in care, coverage and information. The health and wellness of our communities is our largest priority, and we will do all we can to ensure residents have access to the care and resources they need.”

For more information or to enroll, visit https://www.together4ie.com/ or call 1-866-U2Apply (866-822-7759).

About Molina Healthcare of California
Molina Healthcare of California has been providing government-funded care for low-income individuals for 40 years. Molina’s mission has always been to provide quality health care to people receiving government assistance. As of June 30, 2020, the company serves approximately 572,000 members through Medi-Cal, Medicare, Medicare-Medicaid (Duals) and Covered California (Marketplace). Molina’s service areas include Sacramento, Los Angeles, San Bernardino, Riverside, San Diego, Orange, and Imperial counties. For more information, visit MolinaHealthcare.com and connect with us on Facebook, Twitter, Instagram and YouTube.

About IEHP
IEHP, Inland Empire Health Plan, is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. With a network of more than 6,400 Providers and more than 2,000 employees, IEHP serves more than 1.3 million residents in Riverside and San Bernardino counties who are enrolled in Medicaid or Cal MediConnect Plan (Medicare-Medicaid Plan). Through a dynamic partnership with Providers and Community, award-winning service and innovative products, IEHP is fully committed to advocating for our Members and providing them with quality, accessible and wellness-based health care services. For more information, https://iehp.org/

SOURCE Inland Empire Health Plan (IEHP)

 
 

Related Links

http://www.iehp.org
 

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How the Biden Administration Can Make a Public Option Work

Curator, Managed care, News Roundtable Show

 
 

 
 

Clipped from: https://hbr.org/2020/11/how-the-biden-administration-can-make-a-public-option-work

 
 

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.

 
 

 
 

Curator summary

A coupla researchers at HBR think Medicaid can be “easily folded in” to national, standardized Public Option (whose main feature is prepaid managed care).

 
 

The incoming Biden administration is expected to expand access to health care insurance coverage in the United States by adding “a public option.” In this article, the authors argue that it should be based on Medicare Advantage plans, which would accelerate the movement away from fee-for-service care to capitated payment tied to the quality of outcomes and patient satisfaction.

Under a plan proposed by President-elect Joe Biden’s camp, Obamacare would be expanded to include a “public option” health plan. Anyone without insurance could be automatically enrolled. In addition, people younger than 65 could obtain affordable coverage. Employers that decide not to offer employer-sponsored health plans could enroll their employees in the public option plan for a significantly smaller percentage of their employee salary cost (somewhere around 20%).

Rather than creating a new vehicle, we suggest a public-private option that we call the Better Care Plan (BCP), which would use as a model existing Medicare Advantage plans that provide Medicare benefits, including inpatient and outpatient coverage through a private sector health insurer. More than one-third of Medicare enrollees choose these plans today, and their satisfaction is very high.

The advantages of this approach are many, but one of the most important is to relieve the health care delivery industry of its addiction to fee for service — a payment system that encourages more visits, procedures, and services than are necessary, resulting in poor quality and high cost: in other words, low-value care. We propose a “capitated payment,” which, like Medicare Advantage plans, would prepay providers a fixed, risk-adjusted payment to care for all patients enrolled in it. This change in incentive would stop the pay-for-volume system and replace it with care for health outcomes. Under the present system, full hospitals mean higher revenue. If pay were tied to keeping people healthy, hospitals would become cost centers and the focus would be on avoiding hospitalization by better managing chronic disease.

In addition, upfront payment would encourage the development of new care models such as “hospital at home” operations like Atrius’s Care in Place and the independent Medically Home. This model allows for as many as 30% of patients who would have been hospitalized to be managed at home, reducing the cost of care by as much as 30%.

In a prepayment world, any care model that improves quality and reduces cost would be embraced much more quickly than has been the case with fee for service. Take telemedicine: clinicians seeing patients via video links. This technology has been available for more than a decade, but until insurers began to pay for virtual visits due to Covid-19, its use languished.

A third major advantage of BCP is it would provide a predictable revenue stream for providers. During the pandemic, hospitals and physician organizations across the United States have lost billions of dollars for two reasons: The amount they have been paid for their care of critically ill Covid-19  patients hasn’t covered its costs, and the postponement of elective surgeries has drastically reduced their revenues. In contrast, those provider organizations operating with upfront negotiated budgets have largely maintained their financial viability. What is more, they have been able to redeploy resources to focus on early detection and treatment of Covid-19 patients, helping them to manage the surges.

The following evidence suggests that the Better Care Plan would be better from a cost and quality standpoint than fee-for-service approaches:

  • Despite having a higher proportion of clinical and social risk factors, Medicare Advantage beneficiaries with chronic conditions experienced lower utilization of high-cost services, comparable average costs, and better outcomes.
  • Medicare Advantage enrollees with chronic conditions who were eligible for Medicare and Medicaid had better patient outcomes and lower costs compared to traditional fee-for-service Medicare members.
  • Humana recently reported that the medical cost of caring for seniors enrolled in its Medicare Advantage plans that have value-based payment contracts with physicians were 19% lower than those in traditional fee-for-service Medicare. Overall, the patients in its Medicare Advantage plans spent 211,000 fewer days in the hospital per year and had 10.3% fewer emergency department visits per year than Humana Medicare Advantage members receiving care from physicians in the traditional models.
  • Critics of Medicare Advantage plans claim that their better performance is the result of their cherry-picking the healthiest patients, but evidence suggests this is not the case.
  • Overall, the costs per patient in Medicare Advantage plans are about 40% less than fee-for-service Medicare. As a result, Medicare Advantage plan premiums are expected to decline about 11% in 2021.

We suggest the following six steps for implementing the BCP:

1. Develop standardized benefits packages. They could be similar to the Affordable Care Act’s (ACA’s) tiered set of benefit plans (bronze, silver, gold, and platinum), which would offer a range of premium and out-of-pocket-expense options. For example, the uninsured would qualify and be automatically enrolled in the equivalent of the ACA’s silver plan with low premiums and deductibles. Any out-of-pocket expense would be based on income and could be zero at certain income levels. Subsidies would be provided to limit out-of-pocket spending to 8.5% of a person’s income, which is much less than many Americans on Medicare pay today. The plans could be offered through the various existing federal or state exchanges established by the ACA or by employers through newly created private exchanges.

2. Fold Medicaid into the BCP. Many Medicaid programs today have contracts with insurers that offer Medicare Advantage plans. These plans could be easily converted to the BCP and designed to meet the needs of current Medicaid enrollees. Uniform base-eligibility rules for Medicaid enrollees could be established at some percentage (e.g., 150%) of the federal poverty level. States could increase this threshold if they deemed that necessary and could decide which BCPs to offer to Medicaid enrollees.

3. Negotiate the prepaid health budgets. One of the most difficult problems will be establishing the baseline monthly per-member payment rates to health systems. There have been several ideas floated on how to do this, but the experience in states that are offering a public option suggests that initial payments to hospitals may need to be 1.5 to 2 times the current Medicare rates or higher.

The negotiated budgets would need to consider the wide national differences in current payments to providers by Medicare, Medicaid, and commercial insurers. With a consistent and predictable cash flow not dependent on volume of care, hospitals and physician organizations would have strong incentives to redesign care to provide better value. There would be incentives to utilize staff at the highest level of their license, which would result in major productivity improvements in care delivery. The focus would be on delivering the highest quality, lowest cost care — as opposed to filling hospital beds or doing unnecessary procedures.

4. Give employers an opportunity to provide a BCP option. Employers that decide to participate would pay into a risk pool, which would cover their entire employee population. We believe that the fee would be approximately 20% of employee salary cost, which is lower than the 25% to 35% that most employers pay today. This would allow employers to access multiple competing BCPs. They still would have control over which plans were offered to their employees through the public or private exchanges of their choice. The difference is they wouldn’t be negotiating the rates with insurers every year; these rates would be established by a commission of government and private sector representatives.

5. Focus on disparities. The BCP would enroll many of the uninsured in the African American, Hispanic, Native American, and other underrepresented communities. Payments between insurers and health systems would be risk-adjusted by age, sex, and selected clinical indicators, reflecting a person’s health status. But risk adjustment should also include social determinants of health, which could be represented by the deprivation index. This would provide health systems with incentives to redesign their care model, which might include better outreach utilizing pharmacists and home care agencies to proactively address chronic diseases in the underserved population. There would be a reason to develop better integration of primary care with existing public health and mental health services and community resources such as food pantries and religious institutions. Finally, we would think about access differently, utilizing care navigators, nontraditional avenues for education — for example, hairdressers have been shown to be trusted to give advice about breast cancer screening.

6. Promote competition to improve quality and lowers cost. Insurers who chose to offer BCPs would be required to annually provide transparent and uniform cost, utilization, quality, and patient experience data to the public. The BCPs would compete on the basis of this performance information. The existing Medicare Advantage NCQA star ratings, which measure the quality of the various plans, would be expanded, utilizing more health outcomes measures such as complications from chronic disease or from elective procedures such as heart surgery.

Medicare Advantage plans have more narrow or “selective” networks of providers than traditional fee-for-service Medicare. Providers are chosen based on cost and quality, which critics argue means less consumer choice. But as discussed above, the quality of the health care obtained via Medicare Advantage is better and the costs much lower, and Medicare members are highly satisfied with plans. However, in rural areas, where providers are scarce, BCP plans may need to share providers or allow patients to travel outside of network without penalty. As virtual medical delivery continues to change, expanding broadband service to rural areas where providers are scarce will be important.

Ultimately, the United States must improve the quality and lower the cost of care delivery. The Better Care Plan’s competitive approach may be the best way to create agreement among the many disparate stakeholders in the health care system and address many of the coverage and access problems that exist today. The track record of Medicare Advantage plans proves it could work.

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Kentucky Medicaid court case heads to mediation with several hurdles – Louisville Business First

Curator, KY, Managed Care, Roundtable Show

 
 

Clipped from: https://www.bizjournals.com/louisville/news/2020/11/18/medicaid-mediation-starts-at-loggerheads-over-memb.html

 
 

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.

 
 

 
 

Curator summary

KY MCO lawsuits continue, but with a focus on mediation by early December.

Court documents show that there are hurdles just to get mediation in the case over how the state awarded its Medicaid contracts started.

 

Mediation among the eight organizations at the heart of the controversy surrounding the state’s Medicaid program has started off with conflicting visions for the process.

Court documents filed on Friday show differing views on matters such as timing, how to handle a pending motion in Franklin Circuit Court and disputes over a proposed precondition to the outcome of mediation.

On Nov. 12, Franklin Circuit Court Judge Phillip Shepherd ordered that the two government agencies and six Medicaid companies in the suit try to resolve the matter through mediation and to set a date to do so before Dec. 12.

Under dispute

The two government agencies — the Kentucky Cabinet for Health and Family Services and the Finance and Administration Cabinet — filed a joint status report with Medicaid companies: Aetna Better Health of Kentucky Insurance Co., Anthem Kentucky Managed Care Plan Inc. and Molina Healthcare of Kentucky Inc. in which they proposed a mediator: John Van Winkle of Indianapolis-based Van Winkle Baten Dispute Resolution.

They also hope to set a mediation date of no sooner than the week of Nov. 30 and no later than the court-mandated Dec. 12, the report reads. But UnitedHealthcare of Kentucky Ltd. and Humana Health Plan Inc. want to see mediation no later than or on Nov. 26, Thanksgiving, according to a joint status report that also included WellCare Health Insurance Company of Kentucky.

UnitedHealthcare brings one of the most specific demands to the table before the mediation takes place.

“[P]rior to the mediation and included with each party’s mediation statement, each [Medicaid company] must acknowledge a willingness to permit reassignment of its membership,” UnitedHealthcare states.

WellCare and Humana reject the precondition of the Medicaid companies forfeiting members, which is a major sticking point for the lawsuit that preceded the order for mediation. The two government agencies and Aetna, Molina and Anthem reject any preconditions to the mediation talks.

How we got to this point

On Oct. 23, Judge Phillip Shepherd ordered that the state must allow Anthem to remain in the Medicaid program, expanding the number of participant companies from five to six, despite Anthem’s inability to win a contract in two RFP process in the last year.

In court, UnitedHealthcare filed a motion calling for Shepherd to amend his order to release the state from providing a contract to Anthem and to eliminate Molina Healthcare from the program and assign the members of the two companies to United.

With Anthem remaining in the Medicaid program and Molina taking over Passport’s members, UnitedHealthcare contends that there won’t be enough members in the program to make it viable or enough members for the state to meet its contractual obligation to provide enough members to help new Medicaid companies get started.

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Annual Milliman Analysis of Medicaid Managed Care Financial Results

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Curator summary

COVID has led to a 9% decrease in MLR for Medicaid health plans.

Original Report:

https://www.milliman.com/-/media/milliman/pdfs/2020-articles/articles/3159hdp_medicaid-managed-care-financial-results-for-q2-2020.ashx

3159HDP_Medicaid-managed-care-financial-results-for-Q2-2020Download
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State Revenues Decline for First Time Since the Great Recession, With the Worst Still to Come

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.

 
 

Curator summary

State revenues were projected to increase in the previous survey- but now they have taken significant hits due to COVID. General fund revenues are now at 6% below where they were projected to be. Gaming revenues have taken the largest hit, with 17.5% YOY decline.

 
 

 
 

 
 

Clipped from: http://budgetblog.nasbo.org/budgetblogs/blogs/shelby-kerns1/2020/09/08/state-revenues-decline-for-first-time-since-the-gr

State Revenues Decline for First Time Since the Great Recession, With the Worst Still to Come

The majority of states have closed out fiscal 2020 and, as expected, most states experienced a decline in general fund revenues, both compared to prior-year (fiscal 2019) collections and to pre-COVID revenue projections. This large swing in tax collections led to a roughly 6 percent shortfall for states for fiscal 2020 in just a few months’ time.  This initial decline is only the beginning of what is projected to be a multi-year revenue challenge facing states with the potential to dampen the economic recovery. As states continue to experience high unemployment rates and lower consumption levels, the trends seen in the fourth quarter of fiscal 2020 are expected to further depress state revenues in fiscal 2021 and beyond.

  • Despite three quarters of strong growth through March 2020, fiscal 2020 revenue collections could not overcome the impact of the COVID-19 pandemic in the fourth quarter (April-June), as the vast majority of states operate on a July 1 to June 30 fiscal year. States saw general fund revenues decline 3.0 percent compared to fiscal year 2019 collections, whereas prior to the COVID-19 crisis, collections were expected to grow 3.0 percent based on states’ latest pre-COVID revenue estimates reported to NASBO in the spring, creating a roughly 6 percent shortfall. States, required by law to balance their budgets, have responded to these revenue shortfalls with spending cuts, in addition to using reserves and other one-time measures. New York, which operates on an April 1 fiscal year start, experienced a 10 percent decline in General Fund revenues in the April-June 2020 quarter compared to the prior year, after adjusting for the tax filing extension and liquidity financing to offset the delay.

 
 

  • Facing more severe revenue losses ahead, many governors and their administrations have directed agencies to develop budget reduction plans of as much as 15 percent or 20 percent for fiscal 2021 and/or fiscal 2022. Declines in state tax collections (and state spending) tend to lag the economic cycle, and can take a long time to recover. After steep declines during the Great Recession, state general fund revenues took a decade to return to fiscal 2008 levels, after adjusting for inflation. Additionally, state general fund spending did not return to the inflation-adjusted pre-recession fiscal 2008 level until fiscal 2019, only to be hit with the current fiscal crisis the following year. Rising public health costs, as well as increased caseloads from citizens needing assistance during the economic crisis further increase state budget gaps.

 
 

  • These declines do not include those to non-general fund revenues such as gas taxes and program fees that have also been hit hard by this fiscal crisis.

 
 

Update on Fiscal 2020 Revenue Collections Compared to FY 2019

Based on a survey of states and territories, general fund revenues are showing year-over-year declines for fiscal 2020 compared to fiscal 2019, as shown in the chart below.

Note: Some states reported estimates for fiscal 2020, as preliminary actual data were not yet available.

* The figures reported above only include states that operate on a July to June fiscal year, as these states all experienced a similar period of COVID-19 impact on their fiscal 2020 revenues. The states that do not operate on this cycle include New York (fiscal year starts on April 1), Texas (September 1), Alabama and Michigan (October 1), and New Jersey (only for fiscal 2021, October 1).

  • Sales tax collections, which states had estimated to increase 5.0 percent, instead declined by 0.5 percent, representing a roughly 5.5 percent revenue loss compared to pre-COVID projections. This decline comes despite the strong start to the fiscal year and the impact of temporary federal stimulus measures on spending levels. Figures from the Federal Tax Administrators (FTA) show a median drop in sales tax collections of 10 percent in the fourth quarter, an ominous predictor of what is in store for states dependent on sales tax as economic activity remains constrained by the pandemic and recession. Enhanced Unemployment Insurance and direct payments to individuals kept personal consumption levels from falling further than they would have otherwise. Most states have also been able to collect taxes on online sales activity, which helped soften the blow to collections.

 
 

  • Personal income tax collections, which states had expected to increase 2.7 percent, declined by 3.7 percent compared to fiscal 2019, resulting in a 6.4 percent revenue loss compared to projections. This category of revenue is expected to show a much steeper decline in fiscal 2021, since personal income tax returns collected in fiscal 2020 for most states reflected 2019 economic activity and income levels. In states that withhold taxes from unemployment benefits, withholding collections were buoyed by temporary stimulus provided by the federal government, namely the Enhanced Unemployment Insurance benefits. Additionally, the Paycheck Protection Program loans kept individuals employed and paying income taxes.

 
 

  • Corporate income tax collections, which states had predicted to see a modest annual increase of 1 percent, took a large hit, declining by 9.5 percent compared to fiscal 2019 – a 10.5 percent revenue loss from projections. This drop reflects a decline in corporate profits, even as stimulus measures such as the Paycheck Protection Program sought to keep companies operating.

 
 

  • Gaming/lottery revenues declined 17.5 percent from fiscal 2019, due to the closure of casinos and other gaming establishments during the pandemic, and continued negative impacts on this revenue source can be expected as consumers change their behavior. The scale of this reduction speaks to the magnitude of the pandemic’s impact on this revenue source, given that this represents a sharp year-over-year decline while casinos and other gaming were only shuttered for a few months of fiscal 2020. Before COVID-19, gaming/lottery revenues were projected to decline 3.6 percent (due primarily to one state’s elimination of this revenue stream as a general fund source), so the net revenue loss compared to projections is 13.9 percent.

 
 

  • All other general fund revenue declines include large hits to severance taxes in oil producing states. Collapsing oil prices and a sharp decline in demand will continue to depress this source of revenue. All other general fund revenue, which may also include fund transfers for some states, declined by 1.6 percent compared to fiscal 2019 overall. This broad category of revenues was expected to grow 0.7 percent, so this decline represents a 2.3 percent revenue loss compared to projections.

 
 

Impact of Delayed Tax Filing Deadline

An unusual circumstance impacting fiscal 2020 was the delay of the federal tax filing deadline. Most states extended their tax filing deadlines to conform with the federal government, which resulted in 19 states counting revenue in fiscal 2021 rather than fiscal 2020. Among those 19 states, 17 states were able to report preliminary or estimated amounts for those deferrals. If we account for those filings in fiscal 2020, the revenue comparisons improve slightly but continue to show the same troubling trends, especially when one remembers that the COVID-19 crisis only affected revenues for the last few months of the fiscal year. After adjusting fiscal 2020 revenues to include these deferred amounts, total general fund revenues declined 1.6 percent compared to fiscal 2019, with personal income taxes declining 1.1 percent and corporate income taxes declining 6.8 percent.

 

Fiscal 2020 Revenue Collections Compared to Pre-COVID Projections

As reported in NASBO’s Spring 2020 Fiscal Survey of States, before the COVID-19 crisis, states were estimating general fund revenue growth of 3.0 percent. Instead, this preliminary data shows revenue declines for fiscal 2020 of 3.0 percent, resulting in a roughly 6 percent general fund revenue gap for states, on average. States budgeted based upon forecasted tax collections, so these revenue losses left a sizeable budget gap for states to close, requiring them to take actions including spending cuts to core services such as education. Even some states that ended fiscal 2020 with general fund revenues up slightly year-over-year had to make budget cuts or turn to reserves, since they still fell short of projected tax collections. Deeper cuts will be necessary in fiscal 2021 and 2022 as budget gaps grow wider due to an expected continued decline in revenues and rising expenditure pressures from the public health crisis, economic downturn, inflation and population growth.


State Revenue Outlook Expected to Worsen

States are expected to see the impact of COVID-19 on their revenues for years to come. While most states saw revenue decreases in fiscal 2020, state revenues are expected to see more severe declines in fiscal 2021 than they experienced in fiscal 2020 for several reasons:

  • For the vast majority of states, only the last quarter of fiscal 2020 revenue collections were impacted by the economic fallout of COVID-19. Coming into this crisis, most states were seeing revenues coming in at or ahead of projections. This provided some immediate cushion for states to soften the blow of the precipitous declines experienced in the fourth quarter. As economic activity remains significantly depressed and unemployment remains high, this crisis will affect the full fiscal year of state revenue collections for fiscal 2021.

 
 

  • Federal stimulus measures, including checks to individuals, enhanced unemployment compensation, the Paycheck Protection Program, and other measures, have been propping up the economy, and therefore state tax revenues, but those have largely ended.

 
 

  • State tax returns for fiscal 2020 reflected the strong economic activity of 2019, while returns for fiscal 2021 will reflect the much weaker economy in 2020.

 
 

  • The decline in state tax collections typically lags the start of national economic downturns. For example, state revenues grew 4.2 percent in fiscal 2008 even though the Great Recession began in December 2007 (the middle of fiscal 2008 for most states), while tax collections declined 10.0 percent in fiscal 2009.

 
 

Forecasted Revenue Declines and Budget Impacts for Fiscal 2021 and Fiscal 2022

For the reasons outlined above, state revenue forecasts for fiscal 2021 (and fiscal 2022 for those states that have released estimates) are projecting more significant losses, especially without additional federal aid. Overall, state revenue losses resulting from the COVID-19 recession are expected to exceed the 11.6 percent drop states experienced over two years during and following the Great Recession, with some states anticipating revenue declines of 20 percent or more. Moody’s Analytics released an analysis on stress testing state budgets based on its latest economic forecasts, which estimates budget shortfalls through fiscal 2022. According to that analysis, state budgets could experience a fiscal shock (revenue declines plus increased Medicaid expenditures) of $498 billion due to a prolonged economic recovery and continuation of COVID-19 cases in the fall. This analysis assumes flat spending by states with no increases to combat the epidemic or address other needs.

 

States have already begun making budget cuts in response to these forecasted revenue declines, and more adjustments are expected. Numerous states that enacted budgets for fiscal 2021 based on pre-COVID revenue forecasts have called special sessions to revise those budgets, eliminating pay increases and making cuts to baseline spending and personnel. Meanwhile, states that passed budgets after the onset of the COVID-19 crisis similarly cancelled planned investments, implemented furloughs and other actions, and cut base spending. Many governors and their administrations have directed agencies to develop contingency plans to reduce their budgets, for fiscal year 2021 and/or fiscal year 2022, by as much as 15 or 20 percent.

 

Looking Beyond General Fund Revenue Impacts

This analysis is limited to general fund revenue impacts only, and therefore does not show the full magnitude of revenue loss facing states. States are also seeing significant losses and ripple effects in other critical revenue streams, such as gas taxes and various program user fees, due to the public health crisis. These revenue sources are typically less vulnerable to the economic cycle, but the COVID-19 pandemic is not a typical recession.

 

Strained State Budgets and the National Economy

State and local governments are major economic drivers. Their spending totaled $3.1 trillion in 2019, representing 14.7% of gross domestic product. As states continue to experience high unemployment rates, the trends seen in the fourth quarter of fiscal 2020 are expected to further depress state revenues in fiscal 2021 and beyond. Without additional federal aid to mitigate these revenue losses, states will be forced to make deeper cuts to services and spending, as well as turn to tax increases, creating a drag on economic growth at a time when the nation’s economy is attempting to recover.

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Medicaid managed care companies take protest to court | NC Health News

Curator, Managed Care, North Carolina

 
 

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.

 
 

 
 

Curator summary

NC managed care now is required to move forward by the legislature by July 2021, though protests/ lawsuits are still pending.

 
 

Clipped from: https://www.northcarolinahealthnews.org/2020/09/29/medicaid-managed-care-companies-take-protest-to-court-again/

 
 

In the middle of a coronavirus pandemic that has tossed up challenge after challenge, the state Department of Health and Human Services also must tend to another enormous project.

Over the next 10 months, the department has been told by the legislature to complete the transformation of its cumbersome Medicaid system.

In the current system, the state pays for each office visit, test and hospitalization for the seniors and children enrolled in Medicaid. By July 1, North Carolina is expected to launch a managed-care system in which private insurance companies get lump-sum payments from the state to pay providers for their overall care of most of the state’s 2.3 million beneficiaries.

North Carolina lags behind the rest of the country in making this switch and the changeover has been touted by Republican legislators as a potential cost-saver for the state.

As DHHS staff tend to the details of the massive switch of how some 1.6 million Medicaid patients will get health care, companies that lost out on bids for a share of the more than $30 billion the state will dole out over the next five years are stepping up their challenges in court.

In late August, an administrative law judge ruled against Aetna, Optima and My Health By Health Providers, companies that argued DHHS unfairly awarded Blue Cross Blue Shield of North Carolina a contract.

My Health By Health Providers, a consortium of major hospital systems in North Carolina, petitioned a Wake County Superior Court judge this week to reverse that decision.

In the court document filed on Sept. 23, the provider-led entity, or PLE,  argued that the contract awarding process gave a weighted bias to traditional insurance companies over the 12 health systems that have joined together as My Health By Health Providers.

They argue that their owners, which already serve more than 1 million Medicaid beneficiaries each year, are in a better position to provide the managed care, in part, because they are in North Carolina and familiar with the health needs already.

They are troubled that the judge issued a ruling in summary judgment, a step that precluded them from presenting their entire body of evidence in a hearing.

Was the process rigged against PLEs?

Lisa Farrell, executive director of My Health By Health Providers, said her organization was only before the administrative law judge for two hours of arguments.

On Monday, she ticked off a few reasons why she thought the DHHS process was rigged against PLEs from the start. She also explained why My Health By Health Providers is continuing its challenge in Wake County Superior Court instead of trying again when the procurement process opens again.

It’s best to be in on the ground-level, she said.

“One of the considerations as you go forward is members will establish themselves,” Farrell said.

Though My Health By Health Providers was the highest PLE scorer in the bidding process, the state argues that it was looking for a regional plan and the conglomeration of health care systems had pitched a statewide plan. The 2015 law mandating the Medicaid switchover stipulates that PLEs can bid for business in a region, or two contiguous regions, but doesn’t say anything about PLEs bidding for all of the state’s regions.

Farrell argues that My Health By Health Providers’ bid also offered regional options.

While explaining why she thinks PLEs are needed in North Carolina to complement and challenge  the managed care that traditional insurance companies provide, Farrell gave an example of a pediatrician in rural North Carolina treating a child with a complex illness.

The health care systems comprising My Health By Health Providers include Atrium Health, Cape Fear Valley Health, CaroMont Health, Cone Health, Duke Health, Mission Health, New Hanover Regional Medical Center, Novant Health, UNC Health, Vidant Health, Wake Forest Baptist Health, and WakeMed Health and Hospitals, some of which are connected to academic research centers.

With that connection, the rural provider could get the patient quickly linked to a health care facility that could provide the more complex care, Farrell argued.

“Providers, because they are providing the care, are really closer to their beneficiaries,” Farrell said.

Conflict of interest contentions

The state’s selections for the coveted managed-care contracts were announced in February 2019. The awards went to four well-established insurance companies: AmeriHealth Caritas, Blue Cross and Blue Shield of North Carolina, UnitedHealthcare and WellCare. Carolina Complete Health, a provider-led group that will be run by Centene, a managed care giant, was the sole provider-led entity selected. The N.C. Medical Society backed that plan.

In challenges that started last year in the state Office of Administrative Hearings, My Health By Health Providers, Aetna and Optima Health, another provider-led group linked to Virginia’s Sentara Healthcare, argued that DHHS employees involved in the contract awarding process had conflicts of interest that caused them to favor BCBSNC over their bids.

The state and BCBSNC have disputed those claims, and on Aug. 25, Tenisha Jacobs, an administrative law judge, sided with them, ruling that the contract had been properly awarded.

DHHS issued a statement several days after the decision.

“The NC Department of Health and Human Services (NCDHHS) is pleased to announce that once again court rulings affirm the integrity and fairness of the Departments’ managed care procurement process,” according to the statement.

Jacobs heralded the possibility of such an outcome in a June 2019 ruling before the companies had presented all their evidence. They had asked her to halt the Medicaid system transformation while their court cases remained unresolved.

Though Jacobs ruled against the request, saying the companies seemed unlikely to succeed on the merits of their claims, the transformation was instead put on hold in late 2019 because of a budget standoff between Gov. Roy Cooper and Republicans leading both General Assembly chambers.

July 2021 launch date

The transformation had been scheduled to begin in February of this year, but the General Assembly closed its 2019 session without a budget that dedicated funding to the project.

This summer, the General Assembly set a new deadline. Lawmakers considered penalizing DHHS if the transformation did not occur by July 1, raising the possibility that the department could be charged millions of dollars for each month after that date that the launch did not occur.

Eventually, the bill that passed did not include penalties.

“North Carolina’s approach to managed care has received national recognition and focuses on improving the health of North Carolinians through an innovative, whole-person centered and well-coordinated system of care that addresses both the medical and non-medical drivers of health,” according to the DHHS statement issued in August after the ruling.

Aetna immediately appealed the August ruling in Wake County Superior Court.

“For the past 18 months, Aetna Better Health has dutifully followed the Office of Administrative Hearings’ (OAH) protest process in our protesting the North Carolina Department of Health and Human Services’ (DHHS) awarding of contracts for prepaid health services regarding the state’s Medicaid program on several grounds, including, but not limited to, conflicts of interest between DHHS and certain awarded carriers, changes in the scoring process by DHHS to benefit certain awarded carriers, and DHHS’ attempt to conceal how scores were changed to benefit particular awarded carriers,” Aetna said in a company statement at the time. “After a year and half of protest with little progress, we are left no viable choice procedurally but to pursue our Medicaid protests against DHHS in Superior Court.”

Depositions and 230,000 pages of documents

Dave Richard, deputy DHHS secretary for NC Medicaid, said in an interview last week that while he’s confident in the process used to award the contracts, legal challenges were not unusual.

“I think we’re seeing that across the country that that happens,” Richard said. “No one wants to go through this process. It takes time from people, but we were always prepared that this is a possibility.”

As part of the legal defense, the department produced some 230,000 pages of documents and staff members had to sit through weeks and weeks of depositions.

“The judge ruled in our favor,” Richard said. “We believed she ruled correctly, and we have no reason to believe that there’ll be anything different that happens in the appeal.”

The challengers hope for a different outcome, arguing that they did not get to present all their evidence to the administrative judge.

Could too many lawsuits crash plans?

Matt Salo, executive director of the National Association of Medicaid Directors, said the challenges in North Carolina are not unique, but all that litigation eventually might lead states to reconsider managed care systems.

“I appreciate that this is really important stuff, that this is big business, these are contracts that are very, very meaningful,” Salo said in a telephone interview last week. “But having said that, if we keep going on this trajectory, where everybody who doesn’t like the outcome, just resorts to the courts, and sues and has a bid protest, we’re going to end up in a world where states are just going to throw their hands up and say, ‘You know what, it’s easier if we just go back to fee for service.'”

Salo did not speak specifically about the North Carolina cases, but acknowledged that some companies that lose out on contracts might have legitimate concerns that should be litigated.

In Louisiana, contracts worth billions of dollars were thrown out in January after the state’s chief procurement officer determined the health department had mishandled the bidding process.

Two losing bidders helped reveal the problems in challenges filed by Louisiana Healthcare Connections and Aetna Better Health, which banded together to complain of conflicts of interest, a skewed process and improprieties.

“There can be a role for a protest, you know, if something serious has gone wrong, if there was a serious mistake that was made, and sometimes that happens,” Salo said. “You know, it’s important to have an outlet. …There are legitimate protests. And if that’s the case, you should do it.

“What I’m worried about is the trend where it’s just, it’s just a knee jerk reaction of ‘I didn’t like the option. So, I’m escalating to the next step.'”

 
 

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Medicaid Who’s Who Interview: Jodi Patton

Jodi Patton is the Head of Payer Operations at Hazel Health  

Check out her LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I am currently working in the healthcare delivery segment, providing direct pediatric physical health services via telehealth in both school and at home. My primary focus is on the collaboration with Medicaid payers to support Medicaid eligible populations in accessing care where they feel safe and supported and to close gaps in care. We work to provide a seamless integration between children, the healthcare system and education by adapting and working to find solutions.

How many years have you been in the Medicaid industry?

I have been working both directly and indirectly in the Medicaid industry for the past 6years. My initial experience with the Medicaid was as a case manager for both the geriatric population and for children with Autism Spectrum Disorder. I was able to experience first-hand the complexity of delivering care within these populations and eventually worked at Nevada Medicaid. I started my tenure at the State as a policy and program specialist within medical programs and eventually served as Chief. During my tenure, I was able to successfully work with CMS to change our State Plan for free care reversal and tribal FQHCs. This work was incredibly rewarding and working with Hazel has allowed me to have the opportunity to work on the implementation side of the school-based policies.

What is your focus/passion? (Industry related or not)

I am passionate about bringing equity in healthcare and education to children. I am so fortunate that my career is aligned with my passion. I grew up in an impoverished area in Las Vegas and I have witnessed first had the impact that this can have. As leaders in the industry, we must truly keep a keen eye on how to make the lives of our future generation better.

What is the top item on your “bucket list?”

Post pandemic, my bucket list will be filled with travel and new experiences. Since that is not feasible at the moment, I have been focused on traversing as many trails as possible around Lake Tahoe where I reside.  There are a lot of incredible hikes, lakes and wildflowers to see in the area and I don’t want to look back with regret that I didn’t make the most of them. I think right now there is so much value in finding pleasure in the moment and slowing down just a bit.

What do you enjoy doing most with your personal time?

Most of all, I enjoy my family. I have four incredible daughters and a granddaughter. They bring so much joy and insight into my life. Time spent with them is invaluable. I also really enjoy being active and I read all the time. I like my personal time to be a place of growth and exploration.

Who is your favorite historical figure and why?

That’s a tie between Maya Angelou and Rosa Parks. I admire Maya’s clarity of thought and inspiration that she brings to the world. Rosa had so much courage in the face of adversity and made such an impact during the civil rights movement. Both women came up through adversity and made changes to the world. They are both heroes.

What is your favorite junk food?

Ice cream. Hands down. I love all of the unique flavors and artisanal approaches. Growing up in an Italian family, spumoni would be my all-time favorite. I loved going to Thrifty as a kid and getting the cool cylindrical shaped scoops of butter pecan. We didn’t have much money growing up, but we could always scrape out the15 cents for a scoop. These are such strong, happy memories from my childhood. I just always remember laughing and life feeling perfect in these moments.

Of what accomplishment are you most proud?

I am incredibly proud of my four daughters. They provide more meaning and value in my life than anything. I continually try to carve a path so that they will have amazing futures. I just finished my second master’s degree in six years, both with a 4.0 and honors and working full time. I have to admit I am proud of that accomplish as well. Education and knowledge are so incredibly valuable and a gift not to be taken lightly.

For what one thing do you wish you could get a mulligan?

Honestly, I don’t want any mulligans. I have learned more from my mistakes even when they are painful and I wish there was a do-over. It’s the ability to be scrappy, pull it together and move forward that builds your character and resistance. It’s all about progress. I gave up trying to be perfect a long time ago.

What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

The importance of Medicaid is more critical and even more complex than ever right now. We are going to see a surge in enrollments amidst budget cuts and changing methods of healthcare delivery. We are going to have to be thoughtful in our approaches and work together in truly addressing the needs of our communities. This is not a time of self-serving interests, but to be givers and not takers. We will need to be mindful in our approaches of supporting healthcare business practices while ensuring that recipients are able to receive the care they need. We will need to move and change quickly but with intelligence and think outside of the standard ways of delivering Medicaid services. 

Know someone in the space who’s doing great work and is an all around interesting person?

Send a note to clay@mostlymedicaid.com to nominate them for the next round of Medicaid Industry Who’s Who Interviews.