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Clay’s Weekly Medicaid RoundUp: Week of September 16th, 2019

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2MaW5ia

For optimist readers- http://bit.ly/2M8fsbh

IN CASE YOU HAVEN’T HEARD, THERE’S A DELAY IN NC- Well all you naysayers telling me you heard whispers of a delay back in August were right. It’s official, we have our first delay in the NC move to managed care. The Good Guvn’r Cooper is throwing a hissy-fit over this everyone-agrees-its-the-answer-to-all-our-problems-Medicaid-expansion thing, and he took his toys and went home when those “other” reps (voted in by some very deplorable people in a Russian-rigged election, I’m sure) were not so excited about a possible increase to the already murderous Medicaid cost trends [insert foolish, but confident economic theory here about “losing out on free federal money”]. Translation: Cooper fouled up the funding for managed care startup costs because he couldn’t get his way and score political points on Medicaid expansion. What was to be Phase 1 in November, will now be Phase 1 and 2 simultaneously in February. The Medicaid agency team is doing a great job of managing the chaos – but there’s only so much Cooper a successful transition can handle. He may end up being placated anyway- as of yesterday the house passed a gravy-train (Medicaid expansion) bill. That bill would expand under the pretense that work requirements and related premiums will be implemented. And we all know how that will turn out (just ask NH in case you have any questions).

MICHIGAN MCO MERGERS- Priority Health will gobble up Total Health Care. The gobbler has about $4B in revenue over 830k covered bennies; the gobble-ee has about $365M over 53k covered Medicaid members (96k total). To help grease the regulatory skids, Priority will be dropping $25M into a foundation to “fund a variety of non-profit initiatives” in Detroit.

FOSTER CARE IN ILLINOIS- IL DFCS is working to move 74,000 foster kids into managed care and some reps are raising concerns. The gist of the concerns are related to a rocky experience with MCOs in general. Here’s an idea you IL knuckleheads- actually pay the MCOs and it might turn out better (see previous reporting on how IL gets sued every 6 months or so and is forced to pay MCOs BILLIONS of dollars it reneged on). Here’s another idea- do a real audit of the quality of care for those foster kids now to see how well you are doing in the absence of managed care.

AL LAUNCHES ALABAMA COORDINATED HEALTH NETWORK (ACHN)- The state launches an expanded care coordination program October 1. About 750k bennies will begin to receive services designed to better manage their care. Childhood obesity, infant mortality rates and substance abuse are the top 3 targets of the new program.

AFTER THREE DECADES OF OPERATION, FEDS DECIDE TO TRY AND CONFIRM LIFELINE SUBSIDY ELIGIBILITY FOR REALS- If you are not familiar with Lifeline, it’s a $10/month subsidy for low income folks to get a cell phone. For 34 years you have been able to get one if you are eligible for Medicaid. Actually you have been able to get one if the phone carrier (who makes money if you are deemed eligible) says you are Medicaid-eligible. So now the feds decided to start verifying that with an independent system. An OIG audit found that 36% of bennies could not be verified as eligible back in 2017. Keep smiling while you pay for all this fraud, dear taxpayer.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award.  Felicia Blount of Gary, IN got 12 months in the slammer for stealing $195k Medicaid bucks. Her and her momma both falsified bills to Medicaid for transporting Medicaid patients to appointments. Dang, Felicia! Head on up (over?) to Columbus, OH where James McFadden was convicted of stealing $258,000 from Medicaid by faking PTSD and pretending he could not talk. His charade also required him to wear diapers. His co-conspirator got paid as his personal care aide to help with his bogus condition. Go west and we find 34 people in CA, AZ and OR nabbed in a $257M Medicare and Medicaid fraud scheme. The fraudsters used various means involving medically unnecessary tests and prescriptions.  And finally (there are at least a dozen more on my desk I could write about this week, I just need to land this plane)- let’s fly back to the heartland to check in on Craig Barnett of Nebraska. Barnett is a former Medicaid auditor now serving jail time for stealing $277k using his father’s power of attorney. He used that power to take SSI monies, raid mutual funds and falsely obtain nursing home coverage (which is where the Medicaid part comes in) for his father. He was head of the NE Medicaid Audit and Financial Support Division the whole time. Mr. Barnett, I hope you can come to some sense of right and wrong as you stare at those prison bars. But in the meantime, you win this week’s award!

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (assuming you don’t find yourself suddenly living in a parched desert like I do) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

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Medicaid Who’s Who Interview: Robert Garnett

Robert Garnett, MBA, CHIE, is President, Amerigroup Tennessee at Anthem, Inc

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

Amerigroup Tennessee is a Medicaid Managed Care Health Plan and is part of the Medicaid Central Region and Government Business Division at Anthem, Inc. We are privileged to serve approximately 400,000 Tennesseans in the TennCare program across TANF, SSI, LTSS, and IDD (ECF) products. TennCare is regarded by most as one of the most advanced and innovative Medicaid programs in the country, so it is both exciting and daunting to be on the forefront of the industry. We have a terrific team of experienced and passionate leaders at Amerigroup Tennessee and it is my absolute honor to lead them and deliver on our promise to not only meet the needs of our members, our providers, and the State of Tennessee, but do so with a keen eye towards the future.

How many years have you been in the Medicaid industry?

I’ll be honest and admit that I didn’t know the difference between Medicaid and Medicare when I first joined Amerigroup in 2007. I have been privileged to stay involved in Medicaid ever since, serving in a variety of Corporate and health plan roles over 12 years. I was selected into Amerigroup’s Leadership Development Program (LDP) early on in my career and it was nothing short of a life changing experience to get exposure to our Executive Leadership Team and spend time in Business Development, Government Relations, Product Development, and Quality during a time of so much growth and industry maturation. Since 2011, I have spent the majority of my time in the Southeast serving on the health plan Operations side and in leadership roles in Georgia, Kentucky, Louisiana, and now in Tennessee since 2014.

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

I am passionate about collaborating and engaging with our providers, community-based organizations, and the State of Tennessee to achieve excellence in providing care and solutions to the Medicaid population through innovative, engagement-focused approaches. Amerigroup’s focus on addressing our members’ barriers to health has potential to revolutionize how we think about our healthcare system. It’s exciting to be in a role and at a company with the ability to impact these social determinants of health. Leveraging technology and engaging our members where they are presents significant opportunity to identify and combat some of the large social barriers to care that are at the heart of the challenge we face every day as a Medicaid Managed Care organization in improving the health of our members.  

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

Professionally, I would love to be regarded as a leader in the movement to address social barriers to care when all is said and done. Improving the fundamental way care is delivered would be a monumental change in the health care system, but a change in my opinion with huge return for all. Personally, I would love to make it to Australia with my wife. We had the pleasure of going to New Zealand before we had our children and it was a truly fantastic part of the world unlike any other place I have ever been.

What do you enjoy doing most with your personal time?

Nothing helps get my energy level up and my day off to a great start than getting a workout in, particularly when the activity is out on the trails in the Tennessee woods near my house. I am someone that truly enjoys nature and the outdoors and whether it’s on a trail in Tennessee or climbing a mountain in Colorado, it’s always enjoyable and helps me put everything into perspective. It also happens to be where I do my best innovative thinking and problem solving.  

Who is your favorite historical figure and why?

Without George Washington’s leadership, many other great leaders in our country’s history- Abraham Lincoln, Martin Luther King, Jr, Franklin Roosevelt, etc. wouldn’t have had the opportunity to have had the impact they did if not for Washington’s tenacity, steadfastness, and his ability to make decisions during difficult times and as our country’s first President.  I’d particularly recommend “Washington,” by James Thomas Flexner, which provides a very interesting and different look into his life.

What is your favorite junk food?

My wife threw a candy themed party for my 30th birthday and so that pretty much speaks for itself. I am a huge movie buff and a trip to the theatre isn’t complete without a box of Junior Mints to enjoy.

Of what accomplishment are you most proud?

I was extremely fortunate to be the project leader for Amerigroup Georgia’s RFP submission for Foster Care when the population first moved into managed care and we were selected to be the first managed care organization to lead it. The process and solution development exemplified everything about teamwork and buckling down against tight timelines and a challenging environment that I enjoy most in this industry. The opportunity to create innovative solutions and best practices that improve the care for such a vulnerable population was extremely rewarding both professionally and personally.

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

Missing my twins’ 2nd birthday for a business trip. It was an important lesson in proper work life balance. What that taught me is that more often than not, there is someone else that is more than ready to jump in and it affords them experience that they otherwise might not get and ensures you remain focused on the most important things in life. It also demonstrates and supports your leadership philosophy to live by the words you preach.

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

Health care reform, specifically work requirements, block grants, and other waiver requests clearly pose the greatest area of change, opportunity, and disruption in Medicaid Managed Care.

———————

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

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Clay’s Weekly Medicaid RoundUp: Week of July 15th, 2019

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2Y8ReSk

For optimist readers- http://bit.ly/2Y93BOl

AND SO IT BEGINS (MCO ENROLLMENT IN NC)- Open enrollment for the first ever Medicaid managed care plans in the Tarheel State began this week. 540,000 members in 27 counties can pick their insurance cards until September (if they don’t pick, one will be picked for them). There could be a monkey wrench though- the MCO rollout costs about $200M in start-up money. And that money is tied up in fights over the current state budget. The Good Guvn’r Cooper is trying to use this fight to force expansion on the state and vetoed the latest Republican compromise bill. Stay tuned.

IOWA RATES FINALLY FINALIZED 2 WEEKS INTO FISCAL YEAR– Which is better than last year which went 2 months past the contract start dates. MCO rates got bumped another 8.6%- but that’s all going right back out to providers (facilities, mostly) and Big Pharma (hep c coverage). There is also new funding included for more MCO “oversight.”

FL COUNTIES RAISING ALARM OVER TRUE COSTS OF MEDICAID EXPANSION DREAMS– See, all that “free” Medicaid money comes from somewhere, even at the state level. And in many states, a ton of that state money comes from counties, who must fund it with property taxes. So, one neighbor’s millage is another’s Medicaid. Whether the funding neighbor likes it or not (or even knows it). Well in FL (where they Expansion Lobby incessantly tells everyone they must expand, just like in every other non-expansion state), some small counties are trying to build awareness. It doesn’t hurt that Florida has a law that requires actual economists (which are different from NYT columnists promoting junk science, by the way) to assess the financial impact to Florida’s “fiscally restrained” counties.

MANY STATES TALK ABOUT CONTROLLING OUT OF CONTROL MEDICAID SPENDING DEATH SPIRAL; ALASKA IS ACTUALLY DOING IT- AK Governor Dunleavy is not playing the normal game of “appear hard on Medicaid spending but eventually cave” and just do what the Medicaid lifers (and industry lobbyists) tell you to do. The Good Guvn’r just vetoed $58M in state monies for Medicaid (including jettisoning the adult preventive dental benefit). The immediate, across-the-board provider rate cuts triggered a lawsuit from the Alaska Hospital and Nursing Home Association (the groups who get the lion’s share of the Medicaid biscuit). Yeah, I just replaced pie with biscuit- and you love it. Hold on tight, Guvn’r.

ID SUBMITTED A 1332 WAIVER TO ALLOW MEDICAID EXPANSION MEMBERS TO NOT ACTUALLY HAVE TO BE ON MEDICAID- Idaho is expanding Jan 1, 2020. Right now there are about 18,000 Idahoans on the exchange who will have to drop their commercial policies because they would qualify for Medicaid. The state has asked CMS for permission to instead subsidize their exchange premiums instead of moving them onto Medicaid. Analysts currently expect CMS approval, since it is similar to a request approved for Utah earlier this year.

 

I SEE WHAT YOU DID THERE (EMPIRE STATE SHENANIGANS MEANT TO COVER UP FAILURE TO CONTROL MEDICAID OVERSPENDING)- This one is delicious. The good Guvn’r Cuomo quietly slid $1.7B in Medicaid spending by delaying a payment 3 days. Why does that matter? Because it was at the very end of a fiscal year, and it allowed the state to look like it was compliant with state law that keeps Medicaid spending increases capped at 3%. If the transaction were made when it was supposed to (and more reflective of actual costs and spending, which is of course more in keeping with both the letter and spirit of the law), then the state’s fiscal failure would be obvious. Its looking like the state is on track to overspend again this fiscal year. Don’t worry, they will just slide the payment again next year!

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker- no fraud follies this week, friends. Just not enough time in the day or space in the column. Let’s all just pretend its not happening this week (makes me feel better, anyway).

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (pressure wash your driveway, its miraculous!) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

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Clay’s Weekly Medicaid RoundUp: Week of July 8th, 2019

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2XR8wTL

For optimist readers- http://bit.ly/2XQzwD0

CA MAKING IT EASIER TO TEXT- While it pains me to realize that 1991 is now 28 years ago (1991 is when the law blocking spam texts was passed; its also when this album came out and changed all of music), it does seem like maybe our SMS policy needs a touch up. See, when healthcare companies can’t use the communication method that 50% of Americans say is their primary day to day method, we have a problem. Why can’t an MCO text Clay the Medicaid bennie? Because laws. And stuff. The California health agency is working to remedy that by laying out some basic ground rules to make it easier for MCOs. Summary of the rules: submit a form to the state to text to members, make it free, give them an opt-out option and let us know your game plan re: privacy protections (hint- don’t let Amazon or Facebook access the info so they can market them new products via their discounted Medicaid/EBT Prime accounts).

GARDEN STATE WELCOMES NEW DIRECTOR TO THE HELM- Jennifer Jacobs will be the next New Jersey Medicaid Director by late July. Jennifer- We’re glad you’re here!

INDIANA WORK REQUIREMENT BEGAN LAST MONDAY- By Tuesday morning, there were 17 lawsuits filed, 4 HuffPo articles explaining how Evil this is, 2 protests in the streets and 4 new Democratic Presidential Candidates. Ok that last one was unrelated to the work requirements program beginning. Members subject to the requirements (as in all the of the states trying to roll out this feature, almost all members are exempt) will have to work 20 hours a month in year 1 (which boils down to 5 hours a week, or 1 hour a day, M-F).  So 240 hours of total work to obtain a benefit valued around $6,000 comes out to being paid $25/hour if you have to work for your health insurance.

OREGON MCO AWARDS ARE OUT- CCO 2.0 (Coordinated Care Organizations, for those that missed the first memo 5 years ago about how this was the next great idea that was going to save Medicaid from a financial death-spiral) is now live after the MCO awards were announced this week. All incumbents won except for 1 (Primary Health), with 4 newbies given 1-year contracts as a type of probation.  Congrats to our friends and clients in the winning orgs. Here’s to five more years!

EMPIRE STATE TAKING LTC RESIDENTS BACK OUT OF MANAGED CARE- Under new NY policy, skilled nursing facility residents will be back in fee for service if they are in a facility more than 90 days (assuming the carve-out is approved with the CMS waiver in play). The thinking behind the change is that there’s not a lot of cost management achievable for long term institutional residents (NY thinks they will save $158M savings in the first fiscal year)- so why pay an MCO basically an additional administrative fee. I personally am skeptical that there is no room for efficiencies in nursing facility management, but we shall see.

NEED A JOB IN ILLINOIS? There are 300 new job openings to help deal with the pile of Medicaid applications that are backlogged (more than 100,000 currently, which are older than 45 days – which is non-compliant with federal rules).

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award. Not a lot to cover this week, but let’s at least scratch the itch… Vasso Godiali of Bay City, MI got popped for his role in a $60M healthcare fraud (not sure how much was Care vs Caid). Seems he had a penchant (been a while since I used that word) for bogus stent claims. What started out as a Medicaid fraud case got bumped up to include Medicare when the state folks realized they were just the tip of the iceberg. Qaiser Gondal of Watervliet, NY plead out in Albany this week. He was part of the dozen or so thugs using Ti Taxi to steal multiple Medicaid millions. And finally, Nikkitta Chesney of Bridgeport, CT joined her partner in crime (Toshirea Jackson) at the sentencing hearing for their Medicaid fraud. Their crime? They stole Medicaid bennie IDs (about 150 of them) and then used them to steal $3.9M using fake claims for psychotherapy services. The lovely ladies Nikkitta and Toshirea are our winners this week, albeit on a technicality (since we don’t know the Care/Caid loot mix for Mr. Godiali). Congrats, fraudsters! You get a Mostly Medicaid Fraud All-Stars T-Shirt. It comes in orange and also in orange.

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (if you bag the grass when you cut it, it does really help with weeds after a few years. Every think about how many seeds are in the soil in your yard? Scientific notation is surely required) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

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Clay’s Weekly Medicaid RoundUp: Week of July 1st, 2019

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2JjSCxc

For optimist readers- http://bit.ly/2JjuTNU

HAPPY BIRTHDAY TO YOU- Happy birthday to you. Happy birthday, dear America- Happy birthday to you!

RATES? WE DON’T NEED NO STINKIN’ RATES- On July 1, MCOs in Iowa began another fiscal year without official capitation rates (the same thing happened last year- it was 2 months before rates got locked down then). Last time this happened it didn’t turn out too bad for MCOs, though: They got an 8.4% bump.

CMS FUNDING NEW OPIOID TREATMENT GRANTS- CMS announced new $50M grants available for states to improve substance abuse treatment and recovery efforts. The feds are looking for proposals that would fund 18-month pilots. Applications due August 9th.

PRAIRIE STATE OWES FEDS LOTS OF DOUGH- Seems Iowa did not collect rebates on about $7M worth of Medicaid drugs. Federal HHS IG sent a letter looking to collect on the $4M federal share of those rebates. HHS has been reviewing state rebate collections, with Illinois being the 36th state to have its tires kicked. NJ has been asked to pay back $8M.

SOONER STATE DOES, TOO- Oklahoma had some recent success suing Purdue Pharma. By success, I mean they got a settlement of $270M awarded (all related to Purdue’s OxyContin marketing practices, I think). Well someone at CMS saw the news and sent a letter to OK Medicaid making sure they knew the feds were entitled to some of that money. The Good Guvnr Stitt is currently saying no dice, federalis.

NH TWEAKING WORK REQUIREMENTS- Dem state reps have been trying to undo the deal they made to keep expansion going. Looks like a compromise is being struck- the requirements stay, but there are now no penalties for non-compliance.

AK TIGHTENING THE BELT- The Good Guvnr Dunleavy is cutting $444M from the overall state budget, with $50M of it coming from Medicaid. Here is a quote that will strike terror in the heart of Medicaid-industry lifers: “Cost-saving measures can be achieved in the Medicaid program through creativity, program reform, and focusing on fraud.” What the heck does he mean cost savings through creativity? Reform? Focusing on fraud? How dare he?! Has no one told him yet the way Medicaid actually works? Someone talk to this man!

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award. Brenda Copeland of Warner Robbins, GA stole near bouts $500k using her counseling business. She was charged this week with filing false claims (and I think it may have been to an MCO, but not sure. If you are, please weigh in). Move on up and over to Pulaski County, Arkansas where we meet Charline Brandon. She has to pay back $289k to AR Medicaid for tricking patients into thinking they were dying so they would sign up for hospice (that’s a particularly special kind of cruel). One victim spent 3 years in hospice. For another entry in the despicable department, head back east to Greensboro, NC. Here we meet the good people at United Care Youth Services. According to allegations made by patients, this outfit is requiring people to stay hooked on drugs so they can stay in their housing program. Plaintiffs say they were provided free or reduced housing as long as they did not have 3 clean, consecutive drug tests. The organization also provided classes and substance abuse treatment, then billed it to Medicaid. As of the time of writing all allegations were being denied but state investigators are looking into this and other similar schemes. Ann Eldridge and Angela Keith of Sumter, SC are wrapping up their court adventure over their pilfering of $13M from Medicaid. How did they do it, you ask? Using their organization (Early Autism Project) to bill false claims over a 9-year period. The two ladies ended up getting 6 months in prison… Ok enough southern-fried fraud- lets move this party up North. Crispin Abarientos of Middletown, CT plead guilty to getting $894k worth of Remicade (an injectable used for rheumatoid arthritis) using false claims to Medicaid. He then turned around and used that Remicade on commercial or Medicare members and got paid by those payers. So get some “free” Remicade (paid for by Medicaid-funding citizens), then sell it to Medicare and commercial plans. Total taxpayer tab (grin and bear it, you suckers!) for this paragraph: $14.7M. Our illustrious ladies from South Carolina (Mrs Eldridge and Mrs Keith), you win this week’s award.

 

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (stare long and hard at those almost-ready tomatoes) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

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Medicaid Who’s Who Interview: Mark Shaffer

Mark Shaffer is Vice President of Medicaid Operations at BlueCross BlueShield of South Carolina

Check out his LinkedIn profile HERE.

Which segment of the industry are you currently involved?

I work in BCBSSC’s Celerian Group, where I am responsible for the Medicaid Operations Division. The Celerian Group is a collection of companies that primarily provide services to Government Programs. My team currently delivers Medicaid related services including Claims Processing, Provider Enrollment, Provider Call Center services, Eligibility application processing, and Third Party Liability functions.

How many years have you been in the Medicaid industry?

I started in Medicaid back in 1988, I like to think those of us with this length of service have a genetic predisposition rather than a defect, but only history will decide that. I have been fortunate to work in a wide variety of market segments over my career and the breadth of this experience has certainly kept things interesting over the years.

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

Meeting new people and helping them if I can. My father, a retired Marine, recently recounted that when I was in Kindergarten living in Korea when they met new people, they would say “oh, you are Mark’s parents”.  Growing up I lived in 11 houses before the age of 13 and my wife of 30 years and I have just completed our 11th move to our 6th State! No matter the different backgrounds and perspectives over the years it is amazing how much we are alike and share the same needs. By the way, everyone also thinks their traffic is terrible!

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

My wife and I have discussed creating a behavioral health charity to help working families that are struggling with children with behavioral health needs. Unfortunately for working parents, the current system does not provide the support necessary to help children when needed.

What do you enjoy doing most with your personal time?

I love motorcycles and the camaraderie of riding with friends. It really doesn’t matter where we go it is about getting away from the day to day and enjoying the ride and the shared experience.

Who is your favorite historical figure and why?

If you asked which historic figure I would want to meet, it would be Jesus. Just too many answers that could be cleared up in a single meeting! But since that isn’t the question, my favorite other historic figure is Peter the Great. While he is known for conquering additional territory and expanding his empire he also lead a cultural renaissance to modernize his country based on his experiences with Western Europe leaving a lasting legacy on the world.

What is your favorite junk food?

Bacon. Although bacon should never be referred to as junk food.

Of what accomplishment are you most proud?

Helping to raise my three adult children and having them all out of my house!

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

In the early 90’s when I was with Electronic Data Systems (EDS), we implemented the FLORIDA system (integrated eligibility). The system served Florida well for decades (all systems end up being legacy systems at some point), unfortunately EDS and the State ended up in a protracted legal dispute. The dispute negatively affected the company, reduced competition in the market, and disrupted service to the citizens. I think I would have made different recommendations to my leadership if we had a mulligan.

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

Expanded use of social determinants of health

Disruption from early adopters using AI and related technologies in the health insurance space

The impacts continuing industry consolidation

———————

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