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MANAGED CARE – State’s Medicaid managed care plan compliance improving

MANAGED CARE – State’s Medicaid managed care plan compliance improving


Alternative Headline: NY Medicaid Mental Health Gains

[MM Curator Summary]: New York Medicaid plans show improved compliance with mental health coverage rules, contrasting with federal regulatory rollbacks.

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ALBANY | Gov. Hochul has announced that all Medicaid managed care plans operating in New York State have improved compliance with rules for fair access to mental health and substance use disorder services, even as the Trump Administration rolls back enforcement of these critical protections. Among the plans reviewed by the New York State Office of Mental Health (OMH), the Capital District Physicians’ Health Plan, Inc., and Excellus BlueCross BlueShield were found to be 100 percent compliant with all regulations.

“While the Trump Administration sleeps on regulations aimed at ensuring access to critical behavioral health services, New York State has achieved landmark reforms and is holding insurance companies accountable so that all New Yorkers can get coverage for this critical care,” Gov. Hochul said. “The gains in compliance we’re seeing today reflect our steadfast commitment to ensuring these carriers cover critical mental health services and don’t restrict access to care.”

Last month, the Trump Administration indicated in a federal court filing that it does not intend to enforce certain mental health parity regulations, including rules requiring insurance companies apply fair standards for behavioral health services. These regulations prevent insurers from imposing additional barriers — such as prior authorization requirements or restrictive provider networks — making it harder for patients to access mental health and substance use care as compared to physical health services.

In contrast, New York State has been actively taking steps to ensure Medicaid managed care plans are complying with regulations and providing New Yorkers with the coverage they are entitled to receive under law. The State Office of Mental Health reviewed six nonquantitative treatment limitations — provisions that are sometimes manipulated by these plans to restrict access to necessary behavioral health care — and found all carriers in compliance.

In addition, OMH’s comprehensive and rigorous examination also determined that both the Capital District Physicians’ Health Plan, Inc., and Excellus BlueCross BlueShield were fully compliant with all 19 nonquantitative treatment limitations.

OMH, however, also found that most managed care plans did not fully demonstrate compliance with other provisions with the Mental Health Parity and Addiction Equity Act. Some continually applied a different rate-setting process for behavioral health services and reimbursing providers for less than they would for medical and surgical services.

New York State has worked to hold managed care plans accountable for these violations. During a similar review of behavioral health claims filed between 2018 to 2020, OMH uncovered high levels of inappropriate denials for specialty services claims, including $39 million between December 2017 and May 2018. New York State took enforcement action on all 15 Medicaid managed care plans, issuing a total of 95 citations between 2019 and 2021, resulting in fines to 11 carriers totaling more than $1 million.

Resulting fines were used to fund the Community Health Access to Addiction and Mental Healthcare Project, also known as CHAMP. This program is the State’s independent health insurance ombudsman program for behavioral health care, which helps New Yorkers access treatment and insurance coverage for substance use and mental health treatment.

New York State Department of Health Commissioner Dr. James McDonald said, “Access to harm reduction and mental health services saves lives and the measures taken under Governor Hochul’s leadership ensures Medicaid managed care plans are complying with the regulations and are creating no limitations to care for New Yorkers who rely on these services. Access to affordable coverage is a matter of health equity and the State Department of Health will continue to work with our state and local partners to expand access to harm reduction and mental health services and eliminate health disparities in New York State.”

OMH monitors managed care organizations on an ongoing basis to ensure they are properly providing behavioral health services to their members. The agency works in partnership with the Department of Health, which has the legal authority to apply fines and enforce compliance in the Medicaid program.

New York is leading the nation in requiring health insurers to cover behavioral health services and continues to develop tools to ensure these companies are following all applicable laws. New York State’s new network adequacy standards will go into effect starting in July, entitling New Yorkers to an initial appointment for behavioral health care within 10 business days of the request, or seven calendar days following hospital discharge. Insurers unable to meet these timeframes will have to offer out-of-network mental health or substance use disorder coverage without increasing the cost for the consumer.

The state now also requires commercial insurers to reimburse covered outpatient mental health and substance use disorder services provided by in-network OMH and Office of Addiction Services and Supports facilities at no less than the Medicaid rate. In the FY 2026 Enacted State Budget, Governor Hochul also secured $1 million to ensure that insurers are providing the mental health care coverage policyholders deserve including new resources to strengthen compliance oversight, educating consumers and providers, and investigating and mediating complaints.

Gov. Hochul also helped secure a state Medicaid waiver to cover social determinants of health, required commercial and Medicaid health plans to use transparent, nonprofit clinical guidelines and cover all medically necessary treatments.

https://suncommunitynews.com/news/118836/states-medicaid-managed-care-plan-compliance-improving/



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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.

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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 – Medicaid work requirements in reconciliation bill revive calls to update managed care texting ban

MANAGED CARE – Medicaid work requirements in reconciliation bill revive calls to update managed care texting ban


Alternative Headline: Medicaid Cuts, Texting Battle

[MM Curator Summary]: Trump’s Medicaid overhaul would cut millions from coverage and revives calls to lift outdated texting restrictions on managed care plans, restrictions which add to the difficulty of communication between providers and health-care users. 

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Stricter Medicaid eligibility checks look destined to be included in President Donald Trump-backed reconciliation legislation charging through Congress, dubbed the One Big Beautiful Bill.

New work requirements are likely to make it more difficult for current Medicaid enrollees to keep their insurance coverage, leading to a push aimed at exempting managed care plans from a 1991 law restricting their ability to text members.

The charge is led by Abner Mason, chief strategy and transformation officer at GroundGame.Health, who has worked with plans to change the law for the last decade but is viewing the situation with renewed vigor. He is beginning to speak with a coalition of stakeholders including America’s Health Insurance Plans and the Medicaid Health Plans of America, hoping to leverage their expertise and lobby senators for the policy’s inclusion in the bill.

His plan could have motion among lawmakers hoping to reduce spending but minimize the disruptions brought about by work requirements.

“The need to modernize communication has increased tenfold,” he told Fierce Healthcare in an interview.

President H. W. Bush signed the Telephone Consumer Protection Act into law to stop intrusive robocalls and telemarketing practices. Part of that law says a person can’t be texted unless they give permission. Because Medicaid enrollees are assigned a health plan by a state or county, legal teams at health plans say implied consent is not present like it would be through another line of business, such as Medicare Advantage or the individual market.

Some insurers have sent members a text asking for permission to continue texting, but other health plans have refused since even an initial text could be considered a violation. Each infraction, or text, could result in a $500 to $1,500 fine. Multiplied over hundreds of thousands of members, those costs add up quick.

In Virginia, only about 3% of Medicaid enrollees agreed to opt into receiving messages from the state’s program, reported KFF.

An inability to text enrollees in 2025 is staggeringly inconvenient and unrealistic for health plans, said Mason. It’s important plans are able to text updates about an upcoming diabetes screening appointment, for example. If Republicans’ bill passes—requiring states to conduct eligibility checks every six months among the latest provisions—members should not face any additional complications in remaining enrolled.

The Medicaid and CHIP Payment and Access Commission expressed similar concerns in 2022 for members that do not receive mailed notices and are then subject to coverage loss.

Managed care plans have been able to text enrollees in two instances. During the COVID-19 public health emergency, plans were allowed to communicate strictly about the pandemic. That flexibility disappeared when the emergency ended.

The Centers for Medicare & Medicaid Services and the Federal Communications Commission, under the Biden administration, also issued guidance allowing plans to text about Medicaid redeterminations once the public health emergency was lifted, though that guidance could be easily revoked.

If texting is not an option, members are forced to communicate with their insurers through traditional mail or even fax. Some low-income members on Medicaid may have a phone but not have easy access to a computer.

Ideally, said Mason, texting a member would incentivize them to follow a care navigation plan, remember critical preventive screenings and get better educated on how to live a healthy life. He sees a path, if a narrow one, to convince Republicans the importance of exempting managed care plans of requirements he deems outdated.

Trump has repeatedly said he does not want Medicaid cut other than by rooting out waste, fraud and abuse. Some senators on the right are wary of touching the program, concerned at how constituents back home would react. Hardliners justify the changes, saying the program needs to be reined in to support Medicaid’s original intent. Meanwhile, leadership across the Department of Health and Human Services has shown a desire to modernize the department in the name of efficiency and effectiveness.

“We’ve got to thread that needle,” Mason said of the push to update the texting restrictions. “Why would you force people to use a horse and buggy when you know there are more modern ways of getting people from point A to point B?”

Republicans have steadily pushed the reconciliation bill out of the House, despite blowback from health systems, patient advocates and insurers over how reduced Medicaid spending could affect the healthcare ecosystem.

Today, the Congressional Budget Office projected the proposal’s work requirements would slash spending by $344 billion. Medicaid changes alone would result in 7.8 million fewer insured individuals—10.9 million people when factoring in other changes.

Overall, the reconciliation bill would reduce spending in healthcare by more than $1 trillion. The Trump administration hopes to sign the bill into law in July.

https://www.fiercehealthcare.com/payers/medicaid-work-requirements-trump-bill-revives-calls-update-managed-care-texting-ban



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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.

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, /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. 

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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.com: https://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 – Mission Mobile Medical Group Launches Executive-in-Residence Program; David B. Vliet Named to Inaugural Cohort

MANAGED CARE – Mission Mobile Medical Group Launches Executive-in-Residence Program; David B. Vliet Named to Inaugural Cohort


Alternative Headline: EIR Program Targets Rural Care

[MM Curator Summary]:  Mission Mobile Medical launches an Executive-in-Residence program to improve Medicaid quality metrics and expand scalable care access in underserved rural areas.

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Accelerating the improvement in Quality measures for Medicaid populations for managed care organizations (MCOs), Mission Mobile Medical Group announced today the appointment of the first member of the Executive-in-Residence (EIR) Team, embedding national healthcare leadership directly into frontline strategy and operations.

David B. Vliet, BHA, MBA, a respected healthcare executive and innovation leader, has joined as the first member of the cohort. This is another signal that Mission Mobile Medical Group is driving bold, outcomes-based change in some of the country’s most underserved regions.

“Most organizations hire board members to help put more dollars in their pockets; we are recruiting a team of value-aligned leaders to help us in making a greater difference in the world,” said Dawn Berg, Vice President of Community Health Alliances at Mission Mobile Medical. “This team knows how to execute; they have built scalable systems of care and understand the realities of vulnerable populations. David is a tremendous leader, and his presence will accelerate our mission to deliver care to every corner of the country.”

David Vliet previously led LifeLong Medical Care, one of California’s largest Federally Qualified Health Centers (FQHCs), where he advanced systemwide innovation in care delivery, operations, and community engagement. He is known for pioneering the nation’s first Firehouse Clinic, bringing primary care services into trusted community spaces to address entrenched access barriers.

Vliet also serves as CEO of VlietHealth, a healthcare consulting firm that focuses on infrastructure development and operational transformation in both domestic and international markets. He recently founded Mobile Health Strategies: Guatemala, a nonprofit organization dedicated to expanding mobile healthcare in Central America. Vliet is a nationally recognized advocate for healthcare equity and operational excellence, and he is the namesake of the David B. Vliet Changemaker Award, established by Advocates for Community Health.

“Healthcare innovation must be grounded in reality; it has to be actionable, scalable, and serve the communities that have been left behind,” said David Vliet. “Mission Mobile Medical is proving that flexible, high-performing care models can move the needle where traditional systems have failed. I’m honored to join this mission and help drive an operational blueprint that delivers results.”

By leveraging AI-driven analyses of claims and EHR data, Mission Mobile Medical pinpoints high-need communities and deploys Satellite Clinics in trusted local settings. The Networks aggregate sparse populations and provide comprehensive primary, preventive, and behavioral care, addressing long-standing challenges such as transportation barriers, provider shortages, and the rising burden of chronic disease.

"Securing leaders of David’s caliber reflects both the seriousness of our mission and the maturity of our model,” said Amanda LeFever, President and CFO of Mission Mobile Medical Group. “We continue to prove that Satellite Primary Care clinic networks deliver results, and that this care model can be scaled systematically and sustainably. David brings unmatched insight into how to operationalize complex care systems, and his leadership will strengthen every facet of what we do."

As the inaugural member of the Executive in Residence cohort, Vliet will advise on strategic initiatives, mentor emerging leaders within Mission Mobile Medical, and help design delivery frameworks that translate into high-engagement, high-performance networks across the country.

The EIR team will continue to expand with additional leaders with deep experience in Medicaid and Medicare operations, FQHC transformation, rural health innovation, and value-based care, playing a critical role in shaping the future of its data-informed, decentralized, and outcomes-driven delivery network.

Vliet added, "This is a moment of great urgency and great potential in healthcare. The work we do through Mission Mobile Medical can help redefine how we serve rural and vulnerable populations, not just in pockets of innovation, but at scale. I look forward to working alongside the Mission Mobile Medical team to advance that vision."

###


About Mission Mobile Medical Group

Mission Mobile Medical Group supports the world’s largest network of mobile healthcare programs (250 operational sites in 42 states, Puerto Rico, and Canada). As a B-Corp, the company partners with MCOs frustrated with efforts to implement scalable care delivery programs to rural and underserved populations. The model improves rural network adequacy and equips and empowers local providers to assist MCOs in enhancing engagement with beneficiaries. The results are rapid, significant, and sustainable improvements in key Quality measures, including reductions in unnecessary Emergency Department visits, improved Controlled Blood Pressure and Controlled Diabetes, prenatal and postnatal Care, and Behavioral Health screenings and treatments. www.missionmobilemed.com.

https://fox5sandiego.com/business/press-releases/ein-presswire/830161696/mission-mobile-medical-group-launches-executive-in-residence-program-david-b-vliet-named-to-inaugural-cohort/




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MANAGED CARE – MCO cuts impacting Kentucky addiction recovery centers

MANAGED CARE – MCO cuts impacting Kentucky addiction recovery centers


Alternative Headline: Medicaid Cuts Hit Recovery Care

[MM Curator Summary]: Kentucky’s Medicaid cuts are straining addiction recovery providers, limiting peer support and forcing program reductions — which will endanger the recovery process. 

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LEXINGTON, Ky. (LEX 18) — Treatment providers across Kentucky are trying to adapt following cuts from managed care organizations. These are big insurance companies the state contracts with to manage Medicaid.

Providers were notified at the end of May and cuts went into effect June 25.

Isaiah House, Kentucky’s largest non-profit addiction recovery organization, tells LEX18 it is projecting a significant reduction in revenue.

"It’s very detrimental to the recovery community as a whole," Kara Bell, Isaiah House chief development officer said.

Ball is primarily concerned about peer support.

"They’re going to cut it down to 54 hours a year," she said.

Now, not only do peer support hours require prior authorization, they are limited. Before these cuts, there was no approval necessary.

"Once you use your total 54 hours, you’re done when it comes to peer recovery," Ball said. "That’s going to hurt a lot of people because that is how a lot of people stay sober."

The cuts treatment centers are experiencing are a result of state law. A spokesperson for the Kentucky Association of Health Plans tells LEX 18 News that the General Assembly passed HB 695 this past session to crack down on fraud in Medicaid. We received this statement in response to our story.

Due to growing waste, fraud, and abuse in Kentucky Medicaid, the Kentucky General Assembly passed HB 695, which reinstitutes rules that were in place prior to COVID-19. In fact, the largest provider of behavioral health and substance use disorder treatment provider in Kentucky Medicaid is under FBI investigation. Program integrity and guardrails are critical. They ensure patients receive quality, clinical care and protect taxpayers. 

Spokesman, Kentucky Association of Health Plans

However, at Ethan Health, Residential Director Roger Fox helps people recover from addiction every day. He is putting peer support in perspective as far as the recovery process.

Peer support hours vary depending on the MCO. Most MCOs have cut them down between 50 to 52 a year.

"It’s not the right thing to do…it’s so valuable to have someone with that shared experience and that lived experience to be there to guide you through the process," Fox said.

At Ethan Health, Fox said that the cuts are forcing them to shorten the length of stay for a client in their outpatient program. They’re hoping to open a rural health clinic to expand medical services.

MCO cuts are also impacting psycho education. Making plans moving forward, for Ball, this is the reality.

"We’re scared to death that we’re going to lose a lot of people because insurance is really forcing the hand of making folks go to short term treatment versus long term treatment," Ball said.

Isaiah House tells LEX18 it is adjusting, trying hard to find corporate donors, getting creative in talks with individual donors as well as churches. They’re also hosting a Hope and Healing 5K July 19 in Lexington at Coldstream Park.

"Every dollar that is raised is going to go to a fund that is called the Hope and Healing Fund and that is going to supplement those who are cut off during their treatment from their insurance or it is going to supplement and pay for those who can’t afford treatment, don’t qualify for Medicaid, don’t qualify for a voucher, those kinds of things," Ball said.

Isaiah House said that it’s also been forced to lay a lot of people off as a result of the cuts.

Copyright 2025 Scripps Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


https://www.lex18.com/news/covering-kentucky/mco-cuts-impacting-kentucky-addiction-recovery-centers



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MANAGED CARE – Digitizing Prior Authorization Could Ease Burden on Patients and Providers

MANAGED CARE – Digitizing Prior Authorization Could Ease Burden on Patients and Providers


Alternative Headline: Insurers Simplify Prior Authorization

[MM Curator Summary]: Insurers’ pledge to streamline prior authorization aims to speed care and ease burdens on providers and patients.

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In an interview with Managed Healthcare Executive, Yosi Health CEO Hari Prasad praised insurers’ new voluntary pledge to simplify prior authorization, calling it a key step toward faster care and reduced administrative burdens for providers and patients.

Major health insurers recently pledged to simplify and reduce prior authorization across commercial plans, Medicare Advantage and Medicaid managed care. Hari Prasad, CEO of Yosi Health, sees the move as a significant step forward for both patients and healthcare providers.

“This is a really welcome move by the health insurance plans, especially because this comes (as) voluntary,” Prasad said, adding that prior authorization delays have caused 74% of patients to abandon care in the past.

He added that streamlining the process could lead to faster treatment and better outcomes for patients, while also reducing stress on clinicians.

Founded in 2015, Yosi Health has focused on reducing administrative burdens in healthcare from the start. The company’s mission aligns closely with the insurers’ pledge, which also includes efforts to digitize the prior authorization process and enable real-time approvals.

Prasad shared that the current process often involves manual, paper-based or phone-based steps, causing delays and inefficiencies. By switching to digital systems, providers can avoid redundant paperwork, speed up care decisions, and track outcomes more effectively.

He also pointed to broader financial implications: with U.S. healthcare spending projected to reach $7.7 trillion by 2033, eliminating unnecessary administrative costs is becoming increasingly important.

The voluntary nature of the insurers’ pledge adds to its impact, as it shows a willingness across the industry to address a known pain point in care delivery, he shared.

Prasad hopes this is the beginning of more industry-wide efforts that put patients and outcomes at the center of care processes.

https://www.managedhealthcareexecutive.com/view/digitizing-prior-authorization-could-ease-burden-on-patients-and-providers



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MANAGED CARE – 30-day public comment period underway for new Medicaid managed care program

MANAGED CARE – 30-day public comment period underway for new Medicaid managed care program


Alternative Headline: Florida Expands IDD Care Pilot

[MM Curator Summary]: Florida is expanding a pilot Medicaid managed care program for people with developmental disabilities statewide, affecting over 21,000 waitlisted individuals.

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Florida is readying to take statewide a managed care pilot program for people with intellectual and developmental disabilities. (Getty Images)

Medicaid officials are moving quickly to expand statewide a managed care pilot project for people with intellectual and developmental disabilities championed by Miami Republican and House Speaker Daniel Perez.

The Agency for Health Care Administration last week solicited public input on the proposed changes to the Medicaid managed care program for people with these disabilities (sometimes called “IDD”) through July 31. The state is required to give the public 30 days to comment before sending the changes to the federal government for approval. No changes can take place until the federal government agrees.

Florida requires most Medicaid beneficiaries to enroll in managed care plans. The managed care mandate doesn’t apply to people with intellectual and developmental disabilities. The home- and community-based services those beneficiaries require are delivered through what’s called the Medicaid iBudget program. But the iBudget program has long waiting lists and traditionally has been underfunded.

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In 2023, then-speaker designate Perez pushed for a managed care pilot program designed to provide care for up to 600 individuals in Medicaid regions D and I, who were on the iBudget wait list. Medicaid Regions D and I serve Hillsborough, Polk, Manatee, Hardee, Highlands, Miami-Dade, and Monroe counties.

As of July 7, 378  people were enrolled in the IDD managed care pilot project, said Carol Gormley, vice president for government affairs for Independent Living Systems. That is the parent company of Florida Community Care, the state-contracted managed care plan that operates the program.

The policy update reflects changes contained in HB 1103, which Gov. Ron DeSantis signed into law last month.

The new law lifts the 600-person cap on the IDD managed care pilot program effective on Oct. 1, expanding enrollment statewide for qualifying disabled people on the wait list. Some 21,000-plus people are on the waitlist, according to a legislative analysis.

Effective in July 2026, people enrolled in the iBudget program can switch to the IDD managed care program if they choose. So can people with IDD who are enrolled in a different Medicaid managed-care program known as the Statewide Medicaid Managed Care long-term care program.

There are mixed feelings in the IDD community about the expansion of the program.

Valerie Breen, executive director of the Florida Developmental Disabilities Council, told the Florida Phoenix that there hasn’t been enough experience with the pilot program to take it statewide.

“[The] council believes there should be more data before it goes statewide. In addition, we believe that people should have the ability to choose their long-term support and services,” Breen said. She added, “Communication and choices and understanding what they are going to get and what they are going to give up will be essential.”

The Arc of Florida, though, doesn’t oppose statewide expansion of the pilot program because enrollment in it isn’t mandatory, former ARC executive director Alan Abramowitz told the Florida Phoenix in May.

https://www.yahoo.com/news/30-day-public-period-underway-172546488.html



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