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MANAGED CARE – Magellan Health Appoints Dr. Caroline Carney as Chief Executive Officer

MANAGED CARE – Magellan Health Appoints Dr. Caroline Carney as Chief Executive Officer


Alternative Headline: Carney Named CEO of Magellan

[MM Curator Summary]: Dr. Caroline Carney has been appointed CEO of Magellan Health, bringing decades of behavioral and clinical leadership.

========================================


Magellan Health, Inc., a leader in behavioral health and related services, announced today that Caroline Carney, MD, MSc, FAPM, CPHQ, assumes the role of Chief Executive Officer of Magellan Health. Dr. Carney succeeds former CEO Derrick Duke.

Dr. Carney joined Magellan Health in 2016, holding various clinical leadership roles. She became chief medical officer of Magellan Health in 2020 and president of the company’s behavioral health business in 2022. As CEO, Dr. Carney will be responsible for Magellan’s strategic direction and operational execution of the Company’s business strategy.

“I am honored to have been chosen for this role leading a mission-driven organization that delivers innovative and integrated behavioral health solutions for the healthcare marketplace,” said Dr. Carney. “I look forward to working with the talented Magellan teams and engaging with our stakeholders as we continue our focus on a person-centered approach fueled by our clinical-first philosophy.”

Dr. Carney, a board-certified internist and a board-certified psychiatrist, has held key clinical leadership positions serving complex populations over the span of her career. Prior to joining Magellan Health, she served as the medical director for the Indiana Office of Medicaid Policy and Planning, helping to launch the Medicaid expansion product as well as the behavioral health transformation for the state’s community mental health services. Dr. Carney is a published author and co-author for over 100 peer and non-peer reviewed publications surrounding comorbid medical and behavioral health conditions.

She earned her medical degree and a master’s degree from the University of Iowa, where she also directed the Med-Psych residency program. She continues to provide clinical support to a behavioral health team at a federally qualified health center.

About Magellan Health: Magellan Health, Inc. supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan’s customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators. For more information, visit MagellanHealth.com.


https://southfloridahospitalnews.com/magellan-health-appoints-dr-caroline-carney-as-chief-executive-officer/



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MANAGED CARE – Fortuna Gets Funding to Expand Medicaid Enrollment Solution

MANAGED CARE – Fortuna Gets Funding to Expand Medicaid Enrollment Solution


Alternative Headline: Fortuna Boosts Medicaid Tech

[MM Curator Summary]: Fortuna Health raised $18M to expand its Medicaid enrollment tech as federal rule changes heighten coverage risks.

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A startup company that helps guide members through Medicaid enrollment has received additional funding to improve its platform and expand into new states. 

Fortuna Health partners with health systems and managed care plans to make Medicaid enrollment and recertification easier. It supports payers that collectively serve more than 25 million Medicaid lives, from regional health plans to Fortune 50 companies. It also serves as the Medicaid enrollment partner to patient payment and financial experience companies like Cedar.

The startup said its technology is purpose-built to address the fragmented nature of public benefits administration. Each of the 56 Medicaid programs across U.S. states and territories has its own eligibility rules, documentation standards, and renewal timelines. Fortuna claims to unify that variation into a single, personalized interface for consumers to manage eligibility, applications, recertifications, appeals, updates, and state-required actions with clarity and confidence. “Fortuna’s intelligent, multilingual platform integrates with trusted data verification sources and pairs with live navigators that support consumers every step of the way. Fortuna’s technology helps reduce churn by 15%, keeping more people consistently covered,” the company said. 

“Medicaid’s infrastructure is long overdue for modernization,” said Nikita Singareddy, CEO and co-founder of Fortuna Health, in a statement. “Access shouldn’t come at the expense of integrity or efficiency. We’re building the infrastructure to ensure the Medicaid coverage experience is reliable, efficient, and designed around the needs of today’s consumer.”

Singareddy had previously served as manager of population health for Oscar Health, a technology-driven health insurance startup, and as an investor at RRE Ventures. 

The company has raised $18 million in Series A funding. The round was led by returning investors Andreessen Horowitz with participation from Y Combinator and founders and executives from Abridge, DoorDash, Hex, One Medical, Oscar Health, Scale, and Vanta.

Fortuna added that recent federal legislation will make things even more complicated for patients and plan members because it introduces stricter eligibility rules including more frequent recertifications and 80-hour work requirements for certain adults. Around 11 million people are expected to face new procedural steps that put their coverage at risk.

“At MVP Health Care, we recognize that true access to care goes beyond coverage—it requires removing the systemic barriers that too often stand in the way,” said Richard Dal Col, M.D., M.P.H., president of MVP Health Care, in a statement. 

MVP offers Medicare Advantage, commercial and individual plans in Vermont and New York. 

“Fortuna’s platform brings both innovation and empathy to one of the most complex challenges in health care: Medicaid navigation,” Dal Col added. “We are proud to support Fortuna’s mission and technology, which reflect a deep understanding of the communities and customers we serve. Together, we are driving meaningful progress toward a more equitable, streamlined experience that helps individuals and families stay connected to the care they need.”

Another customer is Pennsylvania-based Highmark Health. “Through our Living Health model, Highmark Health is relentlessly focused on reimagining health and creating a system that is accessible, transparent, and affordable. As the complexities of Medicaid and Marketplace processes evolve, we seek solutions that streamline the Medicaid renewal process by removing administrative barriers and empower individuals to navigate their health journey with confidence,” said Jim Burgess, senior vice president, operations at Highmark Wholecare, in a statement. “Organizations that supply these solutions are vital in helping us deliver Living Health. They ensure that individuals seamlessly connect to the coverage and care they need to achieve lifelong health and well-being.”

With this latest round of funding, Fortuna said it will further invest in AI and automation, building features to respond to new federal policies such as work requirements. 

https://www.hcinnovationgroup.com/policy-value-based-care/medicare-medicaid/news/55304442/fortuna-gets-funding-to-expand-medicaid-enrollment-solution



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MANAGED CARE – Healthcare company Molina laying off hundreds of employees in Henrico

MANAGED CARE – Healthcare company Molina laying off hundreds of employees in Henrico


Alternative Headline: Molina Exits Virginia Medicaid

[MM Curator Summary]: Molina Healthcare will lay off 268 workers and close its Virginia office as it ends its Medicaid contract with the state.

====================================

As it prepares to wind down a contract with the state of Virginia, a California-based healthcare plan management firm is shutting down its local operations.

Molina Healthcare plans to permanently close its office at 3829 Gaskins Road and lay off 268 workers at the end of June, according to a notice that the company recently submitted to the state government.

Molina is a Fortune 500 company that manages government-sponsored healthcare programs in multiple states, including Virginia. But the company’s work with the Old Dominion is coming to an end.

The impending layoffs follow the company’s announcement in early May that it would soon end its contract with the Virginia Department of Medical Assistance Services. Molina is one of five companies that currently provide Medicaid coverage through the state’s Cardinal Care Managed Care program. Molina will no longer be a provider as of July 1, according to the DMAS website.

A Molina spokeswoman didn’t answer questions about the company’s layoffs, and instead shared a DMAS memo issued in late May about the implementation of contracts under the state’s Medicaid program.

Medicaid members who have a Molina plan will be transferred to a Humana Healthy Horizons plan unless they opt for different coverage. The other companies that participate in the state’s Medicaid program are Aetna, Anthem, Sentara and United Healthcare.

Molina’s Virginia office that’s slated to shutter is located in the Gaskins II office building, which is near the intersection of Broad Street and Gaskins Road in western Henrico. The company is terminating the employment of all its workers based at the office, which appears to be its only office in the region, and they include both hourly workers as well as directors and manager-level employees. Employees were notified about the layoffs in May.

https://richmondbizsense.com/2025/06/10/healthcare-company-molina-laying-off-hundreds-of-employees-in-henrico/


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MANAGED CARE – Sunflower Health Plan Champions Health Improvement Through Community Engagement in Kansas

MANAGED CARE – Sunflower Health Plan Champions Health Improvement Through Community Engagement in Kansas


Alternative Headline: Sunflower Boosts Care Access Statewide

[MM Curator Summary]: Sunflower Health Plan’s 2024 Community Impact report showcases how its Medicaid-driven programs — including programs focused on housing, food, education, etc. — improved health outcomes and member engagement across Kansas.

==============================


, /PRNewswire/ — Across Kansas, communities face healthcare challenges like mental health concerns, food insecurity and unequal access to care. The new Community Impact Report from Sunflower Health Plan, a wholly owned subsidiary of Centene Corporation, showcases how the company is addressing these issues head-on through innovative partnerships and programs.

"In every corner of Kansas, our partnerships are delivering real solutions to real problems," said Michael Stephens, Sunflower president and CEO. "We’re proud to stand with our community partners and remain committed to improving the health and well-being of every Kansan we serve."

Through service to members and collaboration with more than 300 organizations, Sunflower is advancing its mission: to transform the health of communities we serve, one person at a time.

Recognizing that health is shaped by more than medical care, Sunflower Health Plan invests in programs that address the broader social drivers of health—such as employment, housing, vaccinations, food access and education. These efforts are designed to empower individuals and strengthen communities.

2024 Highlights from the Community Impact Report:

  • Improved Health Metrics. Sunflower endeavors to help its members get essential care, like preventive care, screenings and prenatal care. Notably, the postpartum care rate for Sunflower members increased nearly 20% from 2019-2024.
  • Member Days at Farmers Markets. The Sunflower farmers-market benefit gives Medicaid members dollars to spend on fresh fruits and vegetables. These events also support local economies and are opportunities for Sunflower staff to learn from members and help them make the most of the services available to them.
  • High Member Satisfaction. For seven consecutive years, more than 95% of Sunflower members receiving long-term services and supports (LTSS) have reported being satisfied or very satisfied with the care management they receive.
  • Supporting Education. Sunflower supports members in earning their GEDs and offers youth-focused programs on mental health, employability and more. Furthermore, Sunflower promotes its health coaching to help members make informed decisions about their care.
  • Healthy Rewards. Sunflower rewards members when they complete specific activities to protect and advance their good health. My Health Pays® rewards can be used to pay for things like utilities and everyday essentials. Nearly 77% of members have active My Health Pays accounts.
  • Creative Health Outreach. Sunflower invested in several pilot programs in 2024 to engage members in their care. For example, Shoes for Shots awarded 162 pairs of shoes to adolescent members who completed their HPV vaccination series.

These initiatives reflect Sunflower’s deep commitment to building healthier, more resilient communities across Kansas.

"These connections have consistently served as the bedrock of Sunflower’s local health-centric approach and will remain the compass directing the company through 2025 and beyond," Stephens added.

To explore the full 2024 Community Impact Report and other ways Sunflower supports Kansans’ health and prosperity, visit www.sunflowerhealthplan.com/responsibility.html.

About Sunflower Health Plan
Sunflower Health Plan, a subsidiary of Centene Corporation, is a managed care organization established to deliver quality healthcare in the state of Kansas through local, regional and community-based resources. Sunflower is committed to improving the health of its beneficiaries through focused, compassionate and coordinated care in an approach based on the core belief that quality healthcare is best delivered locally. For more information, please visit www.sunflowerhealthplan.com.

https://www.prnewswire.com/news-releases/sunflower-health-plan-champions-health-improvement-through-community-engagement-in-kansas-302468947.html



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MANAGED CARE – CABS Health Network and CookUnity Launch Medicaid Meal Initiative to Tackle Food Insecurity in New York City

MANAGED CARE – CABS Health Network and CookUnity Launch Medicaid Meal Initiative to Tackle Food Insecurity in New York City


Alternative Headline: Chef Meals Now Medicaid-Covered

[MM Curator Summary]:  CABS Health Network and CookUnity have partnered to provide chef-crafted, Medicaid-covered meals to address food insecurity and improve health outcomes in New York — advocating for the importance of nutrition access for wellness. 

==============================


BROOKLYN, NY, UNITED STATES, /EINPresswire.com/ — CABS Health Network is proud to announce a groundbreaking partnership with CookUnity, the only premium 100% chef-crafted meal delivery service, to launch a new Medicaid-covered initiative that directly addresses food insecurity and healthy living through culturally tailored, chef-made meals.

This initiative, funded by Medicaid 1115-Waiver and being rolled out through the Social Care Network Program, empowers CABS to screen Medicaid recipients in the communities they serve and, for those who qualify, connect them with additional support services, such as food, non-medical transportation, and housing remediation. These services are beyond what’s traditionally covered, and CABS anticipates serving at least 500 Medicaid recipients with fresh meals by CookUnity over the next 12 months.

“This is more than a meal delivery service, it’s a path to better health and restored dignity,” said Sherly Demosthenes-Atkinson, CEO of CABS Health Network. “With rising grocery prices and limited access to nutritious meals, too many of our clients, especially seniors and individuals with chronic conditions, are left behind. Through this partnership, we’re saying: you matter, and your health matters.” CookUnity (https://www.cookunity.com/business ) is not your typical food program. With over 100 chefs and a rotating menu of more than 300 dishes, the platform offers restaurant-quality, fresh meals, crafted daily and delivered directly to the doors of eligible participants. From flavorful cultural recipes to globally inspired meals, every meal can be tailored to a personalized meal plan created in collaboration with a licensed CABS-registered dietitian or licensed nutritionist.

Unlike traditional meal programs offering one-size-fits-all options, this service is uniquely designed to meet each client’s needs, cultural background, and personal preferences. It redefines food access for Medicaid recipients by providing variety, dignity, and real nourishment in every meal.

Food is Medicine: The Heart of the Initiative

At the core of this partnership is the belief that food is medicine, a critical tool in managing one’s health. CABS expects to help address some of the prevalent chronic illnesses in NYC Medicaid communities–hypertension, diabetes, and heart disease. For many Medicaid recipients, this may be the first time they’ve had consistent access to meals that reflect their culture and directly support their health. By integrating nutrition with care planning and offering meals beyond the basics, CABS and CookUnity are delivering more than food; they’re providing a new standard of wellness.

“At CookUnity, we believe everyone deserves access to healthy, tasty, and culturally relevant food. Our partnership with CABS Health Network allows us to expand that access. We’ll be providing meals that are not only nourishing and chef-crafted but truly reflective of the communities we serve. Together, we’re raising the standard for what food access can and should look like in New York.” Bruno Didier, Head of CookUnity Business

CABS Health Network, long known for its trusted home care and care management services agency, is also integrating the program with its existing clients based on the program’s eligibility requirements.


How It Works:

To qualify for this program, individuals must:

· Be Medicaid eligible

· Be enrolled in a Medicaid Managed Care plan (e.g., MetroPlus)

· Be part of a designated enhanced population with qualifying chronic conditions or needs.

· Not receiving duplicate services.

· Undergo a community screening through CABS’ Social Care Network.


CABS will guide participants through the eligibility process, each receiving personalized coaching or support from CABS dietitians. Based on their needs, participants will gain access to up to six months of meal deliveries crafted to meet their specific health needs, all at no out-of-pocket cost. Certain populations, such as pregnant or postpartum individuals, may be eligible to receive meal services for an extended period.

In a time when fast food often seems like the only affordable option, this partnership aims to change that. CABS Health Network launched this initiative with a simple but powerful idea: food plays a key role in health. For Medicaid recipients, access to meals that are both nutritious and tailored to their needs can make a life-changing difference. This program isn’t just about delivering meals, it’s about providing better health, more choice, and a renewed sense of dignity.

This program removes financial and logistical barriers for Medicaid recipients, showing that high-quality food isn’t a luxury; it’s a necessity that everyone deserves access to.

CABS and CookUnity will also launch a community-facing awareness campaign with digital content, events, and open enrollment information to ensure this life-changing program reaches the people who need it most.

If your organization is interested in having CABS attend an event or host on-site Medicaid eligibility screenings, please visit https://cabshealthnetwork.org/nutrition-assistance/ to submit a request or learn more about bringing this program directly to your community.

About CABS Health Network:

CABS Health Network has been a trusted home- and community-based health service provider for over 45 years. Dedicated to health equity, CABS continues to lead with compassion, cultural sensitivity, and a commitment to improving lives one client, one service, one meal at a time.

About CookUnity:

CookUnity is a premium, chef-made meal delivery platform that connects top chefs with discerning consumers seeking nourishing meals delivered to their doorstep. With a mission to redefine convenience without compromising taste or quality, CookUnity offers a diverse menu curated by culinary professionals, using locally sourced ingredients whenever possible. Through innovative partnerships and a commitment to culinary excellence, CookUnity aims to reimagine the home dining experience, making chef-prepared meals accessible nationwide. Learn more at CookUnity.com.

To learn more about eligibility and how to enroll, visit www.cabshealthnetwork.org

For inquiries or corrections to Press Releases, please reach out to EIN Presswire.

https://www.wsav.com/business/press-releases/ein-presswire/817308435/cabs-health-network-and-cookunity-launch-medicaid-meal-initiative-to-tackle-food-insecurity-in-new-york-city/



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MANAGED CARE – Trividia Health, Inc. Announces Preferred Listing of the TRUE METRIX® Blood Glucose Meter and Test Strips for Pennsylvania’s Medicaid Recipients

MANAGED CARE – Trividia Health, Inc. Announces Preferred Listing of the TRUE METRIX® Blood Glucose Meter and Test Strips for Pennsylvania’s Medicaid Recipients


Alternative Headline: TRUE METRIX Gains Medicaid Nod

[MM Curator Summary]: Trividia Health’s TRUE METRIX® glucose monitoring products are now preferred on all Medicaid plans in Pennsylvania.

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Providing accurate and confident blood glucose testing for people in Pennsylvania

FT. LAUDERDALE, Fla.–(BUSINESS WIRE)–Trividia Health, Inc., announced today that its TRUE METRIX® Self-Monitoring Blood Glucose Systems are preferred on all Managed Medicaid Plans and Fee-for-Service Medicaid in Pennsylvania effective July 7th, 2025.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20250707696039/en/


The TRUE METRIX® portfolio provides a level of performance rooted in science, research and continuous technological advancements. TRUE METRIX Test Strips feature TRIPLE SENSE TECHNOLOGY®, which ensures clinically accuracy and confidence in results.

TRUE METRIX Test Strips are made in the United States, with manufacturing facilities in Fort Lauderdale, Florida. Trividia Health is the largest US manufacturer of pharmacy branded products for people with diabetes.

For over 40 years, Trividia Health has been unwavering in its commitment to advance diabetes care. Our team is driven to provide innovative and affordable solutions to help the millions of people living with diabetes manage their blood glucose levels.

“Alongside our pharmacy and distribution partners, Trividia Health’s priority is providing accessibility through national coverage with a local presence. Having the TRUE METRIX Self-Monitoring Blood Glucose Meters and Test Strips as preferred products within Pennsylvania allows patients the ability to test with confidence and manage their diabetes,” said Jonathan Chapman, President and CEO of Trividia Health.

The TRUE METRIX products are widely available throughout Pennsylvania and are sold under the TRUE METRIX brand name as well as the brand names of the nation’s premier retail drug stores, distributors, and independent pharmacies.

About Trividia Health

Trividia Health, Inc., is a global health and wellness company based in Fort Lauderdale, Florida and a leading developer, manufacturer and marketer of advanced performance and digital management products for people with diabetes. With products sold under TRUE and store brand labels, the company is the partner and supplier of affordable, high-quality blood glucose monitoring and health and wellness solutions for the world’s leading retail pharmacies, distributors and mail service providers. For more information, please visit: www.TrividiaHealth.com

View source version on businesswire.comhttps://www.businesswire.com/news/home/20250707696039/en/



Source: Trividia Health, Inc.

https://www.streetinsider.com/Business+Wire/Trividia+Health,+Inc.+Announces+Preferred+Listing+of+the+TRUE+METRIX%C2%AE+Blood+Glucose+Meter+and+Test+Strips+for+Pennsylvania%E2%80%99s+Medicaid+Recipients/25022203.html


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MANAGED CARE – FreedomCare Expands Home Care Services in Illinois Through the Medicaid Home Services Program

MANAGED CARE – FreedomCare Expands Home Care Services in Illinois Through the Medicaid Home Services Program


Alternative Headline: FreedomCare Expands in Illinois

[MM Curator Summary]: FreedomCare now offers Illinois Medicaid members in-home personal care through family or friends under the state’s Home Services Program.

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CHICAGO, IL, UNITED STATES, June 24, 2025 /EINPresswire.com/ — FreedomCare, a national leader in home-based care, is proud to announce the launch of its In-Home Care Services in Illinois through the Home Services Program (HSP). This expansion empowers eligible Medicaid members to receive essential personal care services from someone they trust—often a family member or friend.

The Illinois Home Services Program provides help with bathing, dressing, cooking, and mobility. FreedomCare simplifies the entire process by training caregivers, handling paperwork, and offering continuous support, ensuring high-quality home care services across the state.

“Every Medicaid member in Illinois deserves care that’s timely, compassionate, and reliable,” said Caitlin Griffin, Illinois Operation Director, at FreedomCare. “From downtown Chicago to Cook County and beyond, we’re honored to provide in-home care services that keep families together and promote independence at home.”

With over 72,000 families already served across the country, FreedomCare offers a trusted model for delivering care that values both the caregiver and the care recipient.

Who’s Eligible?

Medicaid members, family caregivers, and advocates throughout Illinois are encouraged to contact FreedomCare to see if they qualify for in-home personal care services under the Home Services Program.

To learn more about FreedomCare’s Home Care Services in Illinois, visit www.freedomcare.com/illinois or call 866-322-6041.

About FreedomCare

FreedomCare partners with the Illinois Department of Human Services to bring personalized in-home care through the Medicaid Home Services Program. As a trusted leader in home-based care, FreedomCare enables Medicaid members to choose their own caregiver—often a family member or friend—so they can remain independent at home. Serving over 72,000 families nationwide, FreedomCare is proud to support Illinois families with training, support, and fast caregiver pay.


Legal Disclaimer:

EIN Presswire provides this news content "as is" without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.

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For inquiries or corrections to Press Releases, please reach out to EIN Presswire.

https://www.wjtv.com/business/press-releases/ein-presswire/824075206/freedomcare-expands-home-care-services-in-illinois-through-the-medicaid-home-services-program/



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MANAGED CARE – TrueCare Appoints Key Executives to Lead Operations and Compliance

MANAGED CARE – TrueCare Appoints Key Executives to Lead Operations and Compliance


Alternative Headline: TrueCare Expands Executive Team

[MM Curator Summary]: TrueCare names two seasoned executives to guide its Medicaid and CHIP plan launch across Mississippi in July 2025.

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TrueCare, a nonprofit, provider-sponsored health plan, has announced the appointment of two new executives to its leadership team. Thomas “Kyle” Godfrey has been named chief operating officer, and Amanda Rogers has joined as chief compliance officer. 

Together, they bring decades of expertise in managed care operations, regulatory compliance and Medicaid program delivery — expertise that will be vital as TrueCare advances its mission to improve health outcomes for Mississippi’s most at-risk populations — from individuals with complex needs to mothers, infants, and children in the child welfare system.

“The addition of Kyle and Amanda brings exceptional operational and regulatory expertise to our team at a critical moment,” said Ashley Thompson, CEO of TrueCare. “Their leadership will help ensure we deliver on our commitment to high-quality, patient-centered care for Medicaid and CHIP members across Mississippi. We are building a team that understands the complex needs of our communities and is deeply committed to creating meaningful, measurable improvements in health outcomes.”

Godfrey brings more than 20 years of experience in health care delivery, regulatory policy and managed care operations. As chief operating officer, he leads day-to-day operations with a focus on performance, provider collaboration and strategic execution. His career spans executive roles across provider organizations, academic health systems and health plans.

He most recently served as chief operating officer for AmeriHealth Caritas of Louisiana, overseeing Medicaid plan operations. Previously, he was COO and vice president of network operations for Molina Healthcare of Mississippi, where he led provider network development and worked closely with the Mississippi Division of Medicaid to support MSCAN and CHIP program delivery. Godfrey also served as chief administrative officer and general counsel for a multi-state interventional spine surgery practice and as chief network officer for the Tulane University Medical Group. Earlier in his career, he contributed to health policy efforts at the Louisiana Department of Insurance.

Godfrey has led operations for national insurers including UnitedHealthcare, WellCare, AmeriHealth Caritas and Molina. His deep understanding of Mississippi’s Medicaid landscape positions him to strengthen TrueCare’s partnerships with members, providers and state agencies. He holds a bachelor’s degree in psychology and a Juris Doctor, both from Louisiana State University.

Amanda Rogers has been appointed chief compliance officer at TrueCare Mississippi, bringing over 15 years of experience in regulatory compliance, vendor management, and oversight of Medicaid and Medicare Advantage programs. She leads TrueCare’s compliance strategy and regulatory oversight, playing a key role in ensuring operational integrity and maintaining strong relationships with state partners.

Rogers most recently served as Mississippi compliance director for CareSource, where she supported TrueCare’s readiness review and market launch efforts. During her time at AmeriHealth Caritas, Rogers founded the vendor governance program for Medicare plans to improve oversight and ensure adherence with federal and state guidelines and developed and led the implementation efforts of the Inflation Reduction Act Medicare Prescription Payment Plan that went into effect for all Medicare beneficiaries in 2025. Previously, Rogers held leadership roles in vendor oversight and compliance within the Mississippi Medicaid program for UnitedHealthcare, and Molina Healthcare.

Throughout her career, she has led enterprise initiatives, managed large teams, and built a strong reputation for strategic and regulatory leadership. Rogers began her career in occupational therapy and successfully operated a multi-location therapy practice in central Mississippi. Her clinical background informs her commitment to strengthening collaboration between providers and payers to improve member care. She holds a bachelor’s degree in exercise science and a master’s degree in health services administration, both from Mississippi College. 

The Mississippi Division of Medicaid recently selected TrueCare to offer coverage statewide beginning in July 2025. TrueCare earned the highest score in the state’s competitive selection process, reflecting its commitment to improving health outcomes while effectively managing costs.

TrueCare, licensed in Mississippi as Mississippi True, is the state’s Medicaid health plan operated by Mississippi True, a nonprofit corporation and provider-sponsored health plan. Owned by nearly 60 Mississippi hospitals and health systems, TrueCare aims to transform the health and well-being of Mississippi communities. TrueCare’s innovative provider-payer alliance model gives providers a real voice in decision-making, prioritizes patient care, optimizes care coordination and provides members access to innovative solutions that address their needs beyond health care. TrueCare understands that improving the long-term health and well-being of Mississippians requires solutions that provide more than basic health care. 

https://www.onlinemadison.com/stories/truecare-appoints-key-executivesto-lead-operations-and-compliance,146259


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MANAGED CARE – Amid scrutiny, DeSantis says $10 million payment to his wife’s Hope Florida program is not illegal but a ‘cherry on top’

MANAGED CARE – Amid scrutiny, DeSantis says $10 million payment to his wife’s Hope Florida program is not illegal but a ‘cherry on top’


Alternative Headline: DeSantis Targets Accreditor ‘Cartel’

[MM Curator Summary]: 

Florida and other southern states plan to launch a new conservative-led university accreditor to bypass existing agencies they view as ideologically biased — so that they can mold them to be biased in the "right way." 

====================================


In conjunction with other southern states, Florida is developing a new university accrediting commission in response to existing agencies the governor says require schools to “bend the knee” to get accredited.

During a Thursday news conference at Florida Atlantic University in Boca Raton, Gov. Ron DeSantis announced, alongside State University System Chancellor Ray Rodrigues and university leaders from Texas and South Carolina, that the states are developing a Commission for Public Higher Education.

DeSantis has focused heavily on “woke” ideologies by pushing legislation to ban state spending on diversity, equity, and inclusion, and remaking state higher education institutions to be more conservative.

In the way of his higher education initiatives, he has said, are accrediting agencies that may require a commitment to those values or other expectations for a university to be recognized.

In order to “shape institutions in a positive way,” DeSantis said, “You gotta go two or three levels down sometimes. And we’ve identified this accreditation cartel as an issue for a long time.”

Florida is establishing the commission with the University System of Georgia, the University of North Carolina system, University of South Carolina, the University of Tennessee system, and the Texas A&M University system, which DeSantis said will “upend the monopoly of the woke accreditation cartels.”

The layers, for example, can be shown by a 2023 law, SB 266, which outlawed state spending on diversity, equity, and inclusion, but allowed for DEI initiatives to continue if required to maintain accreditation.

DeSantis, who used to own an LSAT prep company, said during the “woke era” “institutions really became corrupted by ideology, and they were putting ideology ahead of the pursuit of truth during COVID.”

Timeline

DeSantis did not lay out a timeline for when the commission would be up and running, acknowledging that it has to meet federal requirements before the U.S. Department of Education can approve it.

“We’re establishing it. You kind of got to go and actually do it for, you know, some period of time,” DeSantis said, adding, “I think U.S. DOE wants to be quick on this.”

DeSantis said he nudged Rodrigues shortly after Trump won the presidency.

“We didn’t really have the prospects of launching anything like this successfully during the Biden years, but it’s a new day, and I think this is going to make a big big difference,” DeSantis said, adding that if it gets established during the Trump presidency, “then it’s almost impossible for a future federal administration to try to upend the apple cart.”

As recently as 2020, the year after DeSantis took office, the State University System of Florida created a workgroup that, in its final report, concluded that the universities’ “Board of Governors is making a clear and steadfast commitment to prioritize and support diversity, racial and gender equity, and inclusion.”

In 2022, Florida lawmakers approved and DeSantis signed SB 7044 to provoke institutions to seek accreditation from accreditors approved by the State Board of Education or Board of Governors.

Expecting favorability

“I think almost all the states in our region are going to be favorable to this,” DeSantis said.

“All those states have done good stuff in higher ed anyways but, you know, it’s been more difficult when you have this accreditation cartel nipping at you all the time,” he said. “You know, now I think it’s going to be really, really smooth sailing.”

Florida’s and other southern state institutions are members of the Southern Association of Colleges and Schools Commission on Colleges. DeSantis and Rodrigues made jabs at SACSCOC, saying Florida institutions have problems with the accrediting organization and that its member schools’ performance has not been impressive.

“The Commission for Public Higher Education will offer an accreditation model that prioritizes academic excellence and student success while removing ideological bias and unnecessary financial burdens. These reforms will benefit our faculty, our students, and the hardworking taxpayers who fund our public systems,” Rodrigues said.

In an emailed statement to the Phoenix, SACSCOC said, “We welcome any new accreditor as they go through a rigorous approval process. Accreditation is central to quality education; thus accreditors are held to high standards and must themselves be reviewed.”

“As for SACSCOC, we know we currently accredit institutions that serve the largest number of students in the country (approximately 5M),” the organization said. “As such, we will work with our partnering institutions to ensure and strengthen a high standard of accreditation that reflects the needs of students, our institutions, and the workforce.”

DeSantis complained that Florida law schools “should not be captive to having to bend the knee to get accreditation from” the American Bar Association, which he said “mandates explicit DEI compliance as a condition of accreditation” and “has now become a far left activist group.” The association has suspended its DEI standard until at least 2026.

The commission “will create a first-of-its-kind accreditation model for public higher education institutions that will offer high-quality, efficient services prioritizing academic excellence, student outcomes, and achievement,” according to the State University System.

“​​Together, we are leaving behind the legacy systems and failed institutions of the past, while charting a new course in higher education, that puts student success at the forefront of everything that we do,” said Florida Atlantic University President Adam Hasner, who was recently named to that position following outcry from students who feared he would politicize the position.

Union backlash

The Florida Education Association and United Faculty of Florida released a joint statement following DeSantis’ announcement, saying they “strongly oppose” the move as “directly threatens the independence, integrity, and academic credibility of the state’s higher education system.”

“Accreditation matters because it’s the backbone of academic freedom, shared governance, and public trust in the quality of our institutions,” UFF President Teresa M. Hodge said in a news release.

“This proposed state accreditor appears designed to align more with political priorities rather than academic independence. It seems to be the state’s latest attempt to exert top-down control over what faculty can teach and what students are allowed to learn.”

Andrew Spar, president of the FEA, said he is concerned about how a new accreditor might affect teacher preparation programs.

“Students learn best when they’re free to learn and educators are free to teach — not when curriculum decisions are dictated by politics,” Spar said.

The commission’s announced core principles:

  • It is appropriate and necessary to introduce competition, aligned with state and institutional needs, into the existing marketplace of university accreditation.
  • It is in the best interests of all interested parties, including students, to launch an accrediting body comprised of true peer institutions focused on public colleges and universities and their governing university systems.
  • It is imperative to reduce bureaucracy through a more efficient and focused accreditation process, which will result in lower costs and significant time savings for member institutions, and which will translate into lower tuition prices for students and families.
  • It is critical to ensure that this new accrediting body is accountable to the states of the member institutions.
  • It is necessary for the new accrediting body to become and remain recognized by the U.S. Department of Education for the purposes of Title IV participation by its accredited institutions.


https://www.orlandoweekly.com/news/after-scrutiny-desantis-says-10-million-payment-to-hope-florida-program-is-not-illegal-but-a-cherry-on-top-39274575



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MANAGED CARE – Majority of Medicaid Managed Care Plans Cover Opioid Overdose Reversal Drug Naloxone

MANAGED CARE – Majority of Medicaid Managed Care Plans Cover Opioid Overdose Reversal Drug Naloxone


Alternative Headline: Most Medicaid Plans Cover Naloxone

[MM Curator Summary]: Most Medicaid Managed Care Plans cover naloxone, but restrictions and cost barriers still limit access for low-income populations most at risk of overdose.

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Majority of Medicaid Managed Care Plans Cover Opioid Overdose Reversal Drug Naloxone

A new study found that almost all plans in 40 states and Washington, DC covered at least one form of the opioid overdose reversal drug naloxone, although certain restrictions and quantity limits may still prevent people from accessing this life-saving drug.

In 2023, the US Food and Drug Administration approved the overdose reversal drug naloxone, commonly known as Narcan, for over-the counter (OTC) use. While hailed as a public health success for increasing access to this life-saving drug, this OTC option remains out of reach for people who cannot afford the $45 average price tag for a two-dose box.

Medicaid recipients are a low-income population that disproportionately experiences opioid overdoses, so access to low- or no-cost naloxone through insurance can help to save lives. A new study led by the School of Public Health investigated Medicaid managed care plan coverage of naloxone across the nation.

Published in JAMA Network Open, the study found that almost all Medicaid managed care plans (MCPs) cover at least one of the four formulations of naloxone. Eighty percent of Medicaid recipients, which include more than 70 million people, are enrolled in these plans. The study is the first to assess naloxone coverage within MCPs.

“These findings are important because over-the-counter naloxone can still be very expensive and insurance coverage can remove the cost barrier to accessing this drug,” says study lead and corresponding author Sage Feltus, research associate in the Department of Health Law, Policy & Management. “The overdose death rate among Medicaid beneficiaries is twice as high as the overdose rate among the general US population. Low-barrier and low-cost naloxone could help get this essential medication into the hands of people who are at high risk for overdose death.”

The study’s senior author is Maureen Stewart, research associate professor in HLPM at BUSPH, and coauthors include Jeffrey Bratberg, clinical professor at The University of Rhode Island College of Pharmacy, and Sophia Balkovski, a doctoral trainee at the Heller School for Social Policy and Management at Brandeis University.

After rising sharply during the COVID-19 pandemic, drug overdose deaths involving opioids declined to 83,140 in 2023, followed by a significant drop to 54,743 deaths in 2024, according to provisional data from the Centers for Disease Control and Prevention. Naloxone, which is considered the cornerstone of the harm-reduction approach to the nation’s opioid overdose emergency, can quickly reverse the effects of opioids such as heroin, oxycodone, and fentanyl. Experts have long sought to increase awareness of and access to this medication to safely and effectively reduce deaths from opioid use.

For the study, the researchers reviewed the preferred drug lists from 264 MCPs that covered 65.3 million Medicaid recipients in 40 states and Washington, DC. Insurance companies and states can use these preferred drug lists to negotiate rebates with drug manufacturers. The team examined MCP reported coverage and management of all available formulations of naloxone: brand and generic 4-mg nasal sprays; a generic injectable; and a newer, high-dose, brand nasal spray in 8 mg. They also reviewed publicly available data on state-level opioid overdose deaths.

The above figure illustrates the proportion of Medicaid managed care plans in states covering at least one generic injectable or generic or brand intranasal naloxone formulation without any restrictions. Crosshatch pattern indicates the state had an opioid overdose death rate per 100000 people in the 75th percentile or above (32.5%).

While quantity limits and other restrictions varied by plan, 94 percent of plans reported covering at least one generic injectable or 4-mg generic/brand versions of the nasal spray of naloxone, and 91 percent covered the 4-mg generic or brand nasal spray and injectable formulations. The generic versions of the drug were the most common forms listed on PDLs. Over half of plans (covering 42 million Medicaid recipients) had state-defined PDLs, and these plans were less likely to report covering the generic injectable naloxone.

Notably, three states with no MCPs covering at least one form of naloxone—Ohio, Kentucky, and Tennessee—had high opioid overdose rates, although the researchers caution that more data is needed to understand the causes of these high death rates. The findings did show that MCPs in states with low overdose rates were more likely to cover all forms of naloxone and less likely to impose quantity limits. Further research should identify how Medicaid coverage of naloxone contributes to recipients’ health, and MCPs should work to ease restrictions that make it difficult for people to actually receive this medication.

“Reporting coverage is a critical first step,” Feltus says. “Removing prior authorization requirements may ease administrative burden for providers prescribing naloxone. We don’t know as much about the impact of quantity limits on naloxone but this restriction could present a barrier for Medicaid recipients who may need more than the allowed amount per month or year.”

States can take action to increase access to naloxone, she adds. 

“States can require that MCPs cover all forms of naloxone by including all formulations on a uniform preferred drug list, or in contract requirements with MCPs.”


https://www.bu.edu/sph/news/articles/2025/majority-of-medicaid-managed-care-plans-cover-opioid-overdose-reversal-drug-naloxone/



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