Category: MM Curator

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Quality Improvement Lead – Cincinnati | Humana

Clipped from: https://careers.humana.com/job/17568456/quality-improvement-lead-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Description

The Quality Improvement Lead implements performance improvement projects, interventions and programs for Ohio Medicaid business including collaborative health plan quality improvement performance projects, activities and monitors performance and metrics for Ohio Medicaid populations. . The Quality The Quality Improvement Lead implements performance improvement projects, interventions and programs for Ohio Medicaid business including collaborative health plan and Ohio Department of Medicaid quality improvement performance projects, activities, and interventions. This position is responsible for monitoring performance improvement and metrics for Ohio Medicaid populations. The Quality Improvement Lead works independently, sometimes in ambiguous situations, and work may be performed with minimal direction. The Quality Improvement Lead will be expected to lead a team

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Medicaid System Access Manager (Medicaid Health Systems Administrator 1) Ohio Department of Taxation

Clipped from: https://www.ziprecruiter.com/c/Ohio-Department-of-Taxation/Job/HYBRID-Medicaid-System-Access-Manager-(Medicaid-Health-Systems-Administrator-1)/-in-Columbus,OH?jid=40e0884479e7c809&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.

 
 

About Us:

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care. 

The goals of the next generation of Ohio Medicaid are:

  • Emphasize a personalized care experience
  • Improve care for children and adults with complex behavioral health needs
  • Improve wellness and health outcomes
  • Support providers in better patient care
  • Increase program transparency and accountability

 
 

What You Will Do At ODM:

Working Title: Medicaid System Access Manager

Classification: Medicaid Health Systems Administrator 1 (PN 20100580)

Office: Legal Counsel

Bureau: Privacy/HIPAA

 
 

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking a Medicaid System Access Manager to be a part of our Access Request team. As a Medicaid System Access Manager your responsibilities will include:

  • Reviewing system access for Ohio Medicaid Enterprise System (OMES) and Single Pharmacy Benefit Manager (SPBM)
  • Reconciling of user’s access to systems to ensure adherence to the Principle of Least Privilege and Minimum Necessary access to Medicaid member information
  • Formulating and implementing policies and procedures related to accessing Medicaid information systems to support ODM program needs for ODM Staff, Contractors, and Sister State Agencies
  • Facilitating end user access to Medicaid information systems through established ODM processes
  • Overseeing the Access Request mailbox, communication with ODM system vendors, and other partners as needed
  • Responding to requests for information from internal and external auditors related to Medicaid information systems access

 
 

What’s in it for you:

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

Medical Coverage

  • Quality, affordable, and competitive medical benefits are offered through the available Ohio Med plans. 

Dental, Vision and Basic Life Insurance

  • Dental, vision, and basic life insurance premiums are free after completed eligibility period. Length of eligibility period is dependent on union representation.

Time Away From Work and Work/Life Balance

  • Paid time off, including vacation, personal, and sick leave 
  • 11 paid holidays per year
  • Childbirth/Adoption leave

Employee Development Funds

  • The  State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.

Ohio Public Employees Retirement System

  • OPERS is the retirement system for State of Ohio employees.  The employee contributes 10% of their salary towards their retirement.  The employer contributes an amount equal to 14% of the employee’s salary.  Visit the OPERS website for more information.

Deferred Compensation

  • The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).


Or 12 months experience has Medicaid Health Systems Specialist, 65293.


Note: education & experience is to be commensurate with approved position description on file.


-Or equivalent of Minimum Class Qualifications for Employment noted above.

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Reform- Georgia establishes its own health insurance portal, Georgia Access

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Georgia even had to fight to do its healthcare marketplace website the way it wants to- and now their new one won’t really point people to “free” (subsidized) plan options.

 
 

 
 

Clipped from: https://www.gpb.org/news/2022/12/30/georgia-establishes-its-own-health-insurance-portal-georgia-access


Caption

The homepage for the new Georgia Access website, set to go live in January, was built by the state government in fall 2022.

Credit: Screenshot

ATLANTA — After failing to win federal approval to exit the federal insurance marketplace earlier this year, Georgia has established its own health insurance portal directing people to private insurers and brokers to buy health insurance. 

The new website, called Georgia Access, includes links to 10 health insurance companies — including big players such as United, Kaiser Permanente, and Aetna — as well as seven online brokers, organizations that help people shop for and enroll in health insurance.  

The dueling state and federal websites each offer a different route to the same destination: signing up for health insurance.  

Georgians can use the links on GeorgiaAccess.gov to explore the insurance companies’ and brokers’ offerings, which include but are not limited to the same marketplace plans offered on the federal website.  

The new Georgia Access site also includes links to companies and brokers that offer dental and vision plans, basic information about Medicaid and PeachCare for Kids, and links to state health care agencies that assist with mental health.  

But notably absent from the state’s new portal is a link to the federal HealthCare.gov, a one-stop shop for buying health insurance coverage through the Affordable Care Act. The HealthCare.gov website provides comparisons of the different companies’ health plans.

The state decided to set up the GeorgiaAccess.gov portal with the resources it had initially devoted to its plan to exit the federal marketplace, said Gregg Conley, executive counsel for the Georgia Department of Insurance.  

Republican Gov. Brian Kemp first sought permission to exit the federal health insurance marketplace back in 2020. But the Biden administration rejected the Georgia plan earlier this year after analyses showed it would cover fewer, not more, Georgians than the federal marketplace.  

According to Georgia Access, 1.3 million Georgians lack health insurance.

“I would encourage people to sign up for health [insurance],” Conley said. “What we don’t want is people not to have health care.”

But many advocates argue that online brokers and private insurers are not the best custodians of consumers’ interests.  

Insurance companies and brokers, most of which are for-profit entities, may push people to enroll in “substandard” plans that don’t cover all services, Joan Alker, a research professor at Georgetown University, wrote earlier this year.  

Brokers may fail to help people enroll in Medicaid or other state health insurance plans for people with low incomes and they may not adequately cater to the needs of racial and ethnic minorities and people who are not proficient in English, Alker wrote. 

In Georgia, legislative Democrats have called for expanding Medicaid to address the state’s large population of uninsured people.  

“Georgia should expand Medicaid,” House Minority Leader James Beverly, D-Macon, said Wednesday. “I am calling on the governor and the Georgia legislature to make it priority No. 1 to ensure every Georgian has access to quality health care benefits.”

Open enrollment for marketplace plans ends on Jan. 15, 2023. That gives Georgians just two more weeks to select their plans for next year, whether through the links provided on GeorgiaAccess.gov or the federal HealthCare.gov. 

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.

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Fin/Budget: Colorado HCPF requests $14.8 billion budget, plans to increase provider reimbursements and eliminate Medicaid copays in FY 2023-2024

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Workforce issues, provider rate increases and continuing the accountable care collaborate experiment top the list of things included in the $15B budget ask this year.

Clipped from: https://stateofreform.com/featured/2023/01/colorado-hcpf-requests-14-8-billion-budget-plans-to-increase-provider-reimbursements-and-eliminate-medicaid-copays-in-fy-2023-2024/

 
 

Boram Kim | Jan 3, 2023 | Colorado

Led by Executive Director Kim Bimestefer, the Colorado Department of Health Care Policy and Financing (HCPF) presented its FY 2023-24 action plan while addressing questions and concerns about its budgetary requests during a Joint Budget Committee hearing on Dec. 21st. 

 
 

 
 

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The Department is requesting $14.9 billion in the upcoming fiscal year to address a declining healthcare workforce while increasing quality and affordability, which is more than $700,000 higher than the appropriation it received in FY 2022-23. 

HCPF said 96% of that request will continue to go to paying providers, $192.2 million of which will in turn go to the initiation of a 0.5% across-the-board provider rate increase and the elimination of Medicaid members’ copays in 2023. 

Other investment areas include rebalancing provider rates based on the annual rate review cycle, addressing critical needs for Nursing Home and Home and Community-Based providers, and targeted incentive payments for rural hospitals. 

An additional $8.67 million will go to support primary care medical providers’ transition to value-based payments with up-front reimbursement for care expenses. Under the Department’s value-based payment methodology, providers will have the option of receiving at least 25% of their revenue up front to allow for increased investment in care improvement.

“We can’t just keep paying as we have been, it has no future,” Bimestefer said during the hearing. “[Value-based payment] must succeed because just paying for volume is how we got to this terribly fractured system … When we increase the payments to primary care, that’s a good decision. And when we give [primary care providers] the tools to be able to better refer [to] specialty care or to refer to the right hospital systems that prescribe the right drugs, and we get to the right place with primary care, we fix a world of woes in the healthcare system.”

HCPF said this funding will help promote attribution—the process by which the department connects a Medicaid member to a provider—and strengthen the member-provider relationship through outcome-based payment flexibility. 

HCPF requested $1.1 billion for Behavioral Health Community Programs as Colorado continues to transform its behavioral health delivery system. The Behavioral Health Administration (BHA) will continue developing the state’s Hybrid Managed Care Model which aims to provide whole-person, physical and behavioral, healthcare for all Medicaid members, including prevention services, care coordination, primary, behavioral health, and specialty care. 

The Accountable Care Collaborative (ACC) has been administering that model through the state’s seven Regional Accountable Entities (RAEs) with a cost and outcome focus. RAEs will eventually administer capitation behavioral health benefits which include medical, substance-use disorder, and community-based services. 

ACC 3.0, the state’s upcoming updated value-based payment model, has already initiated community and stakeholder engagement on standardizing the processes and policies for all publicly funded behavioral health providers. HCPF plans to administer these contracts in late 2024. 

The Department is working with the BHA, providers, and community partners on establishing Certified Community Behavioral Health Clinics (CCBHC) and their roles in providing essential services.

Counties have consistently exceeded appropriated funding in conducting Medicaid eligibility determinations, forcing them to use local funds to cover the shortfall. The current budget appropriation will allow HCPF to fund counties directly through incentive payments geared around timely eligibility administration. HCPF said the direct payments should improve access and save the state money by reducing the number of inaccurate eligibility determinations. 

HCPF will focus on ensuring continuity of coverage for its Medicaid members in 2023 when the public health emergency is anticipated to end. Redeterminations for its 1.7 million Medicaid members, which Congress recently announced can begin starting April 1st, 2023, are expected to disenroll some 300,000 Coloradans from coverage.

Additionally, HCPF has requested $1 billion for the Office of Community Living, $496 million for the Indigent Care Program, and $700,000 to advance birthing equity. The legislature is expected to expand doula services in the state during the 2023 session.

“Colorado has a strong history of providing a broad array of home visitation services that complement one another,” said Adela Flores-Brennan, the state’s Medicaid Director, addressing the committee’s concerns about doula services overlapping with current midwifery services. “The Nurse Home Visitor Program, also known as the Nurse Family Partnership or NFP, provides valuable nurse services to first time parents. 

And the doula benefit complements the nurse home visitor program while improving health outcomes and equity for many of our members who may not be eligible for NFP with a support person present at their birth and may only want or be able to commit to a shorter intervention model … the NFP and doula benefit would serve slightly different populations with different models of care and different providers. Because of this, the addition of the doula benefit is not projected to undermine the sustainability or duplicate the efforts of other established home visiting models including NFP.”

Colorado Medicaid currently covers services provided by certified nurse midwives, but the push to expand both coverage and availability for doula services will be decided by lawmakers. The Medicaid benefit would be focused on improving health outcomes and reducing costs for pregnant women of color.

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Fin/Budget- Nebraska hospitals ask for record Medicaid reimbursement bump

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Hospitals trying to deal with a reported 20% cost increase are driving the 10% Medicaid rate increase to them (on the heels of a 2% increase they got in 2021 and 2022). My costs have gone up a lot too, lately – how do I get this deal?

Clipped from: https://www.beckershospitalreview.com/finance/nebraska-hospitals-ask-for-record-medicaid-reimbursement-bump.html

The Nebraska Hospital Association is asking state lawmakers for a 9.6 percent Medicaid reimbursement rate in 2023 and a 7.7 percent rate in 2024, CBS affiliate KMTV reported Jan. 2. 

The request comes after Nebraska hospitals saw a 2 percent bump each of the last two years, according to the report.

Nebraska Hospital Association President Jeremy Nordquist said inflation has had a significant effect on hospitals in the state, according to the report. Overall costs are up more than 20 percent per patient compared to pre-pandemic levels, with most of that increase coming from labor costs. 

Mr. Nordquist said 54 percent of the state’s hospitals are operating in the red, according to the report. 

He said hospitals lose money on Medicaid and Medicare patients.

“For years a lot of that cost was shifted over to people who have private insurance,” Mr. Nordquist said, according to the report. “And everyone else has to pay more because the government’s not carrying its weight with Medicare and Medicaid. … In the past [commercial insurance] has been willing to … help with the shortfall. That negotiation is getting tougher for hospitals.”

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MH/BH/ Fin/Budget- Medicaid and mental health programs big winners in $1.7 trillion federal spending law

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Big buckets – Medicare docs magically avoid rate decreases for the 800th year in a row; Medicare adds $1B+ for mental health; states can start kicking people off their Medicaid rolls (if they want to) in April; extra Medicaid cash for maternity lives at least 1 more year; and rural health gets some stuff.

Clipped from: https://www.washingtonexaminer.com/restoring-america/courage-strength-optimism/medicaid-mental-health-omnibus-medicare

 
 

The $1.7 trillion catch-all federal spending bill, enacted by Congress and President Joe Biden just before lawmakers left town, won both praise and scorn. But supporters, most congressional Democrats, and Republican opponents, who called it a budget-buster, focused largely on spending provisions for defense, emergency assistance to Ukraine , and aid for various environmental crises.

Just as important in the 4,155-page bill, though, are spending provisions aimed at helping hospitals and healthcare systems. The law, cleared by the outgoing Democratic House on Dec. 23 and signed by Biden shortly thereafter, allots $9.2 billion for the Centers for Disease Control and Prevention for “fundamental public health activities” — coupled with a $760 million boost over the 2022 fiscal year. The appropriations bill also includes $350 million in flexible funding for public health infrastructure.

HUGE $1.7 TRILLION OMNIBUS SPENDING BILL PASSES THE HOUSE DESPITE GOP OPPOSITION

However, funding for COVID-19 prevention and mitigation measures was not included in the bill. That’s a blow to public health advocates who say new coronavirus strains could wreak havoc this winter and beyond.

Still, Senate Majority Leader Chuck Schumer (D-NY) said the bill was the most significant done in a long time.

“The omnibus is aggressive, generous, and far-reaching in healthcare, making it more affordable, more extensive,” Schumer said.

In addition to increased funding for the CDC and public health, the bill includes the following major provisions:

Public Health

The bill aims to improve public health through better data collection, vaccine development, and agency oversight.

The bill does not include a proposal that would have created a bipartisan task force, such as the 9/11 Commission, to examine the national response to COVID-19. That’s a politically touchy subject that House Republicans, soon to be in the majority, plan to tackle once they run committees. While, in theory, there’s plenty of room for a bipartisan investigation of the national response to COVID-19, it’s unlikely to go in that direction.

Physician Payments
The appropriations curb a cut of almost 4.5% to the Medicare Physician Fee Schedule, the annual regulatory rule released by the Centers for Medicare and Medicaid Services that updates the standards for physician reimbursement and policies related to the delivery of healthcare. The fee schedule cut was scheduled to go into effect in 2023. The spending law effectively tightens the cut to 2% for 2023, with another 3.25% cut in 2024.

Value-Based Care
The value-based care bonus sent to eligible physicians who participate in alternative payment models will drop from 5% to 3.5% in the next year. The health incentive aims to offset losses in revenue for physicians who move from fee-for-service to value-based care models.

Medicaid
The bill allows states in April to begin Medicaid redeterminations. That’s the process states use to ensure that Medicaid enrollees continue to be eligible for coverage by the federal and state program, which aims to limit healthcare costs for people with limited income and resources.

Now, states will have an indicator on when they should start redeterminations. States will also be allowed in April to begin removing people from pandemic-enhanced Medicaid coverage.

Telehealth
The packages ensure that flexibilities for doctors to treat patients remotely via telehealth remain in place for two years. That’s to provide regulators with the proper time to determine which flexibilities should be made permanent. Still, the provision falls short of the blanket permanence many lawmakers pushed for.

Medicare and many Medicaid programs have expanded the types of originating sites that a patient could be at while receiving services via telehealth. Other telehealth changes have included delaying certain in-person requirements and extending coverage for audio-only services.

Mental Health
The spending bill includes several policies to improve mental health across the nation, such as allowing Medicare to cover therapists and counselors, along with increases in funding for mobile healthcare units focused on mental healthcare.

Over $1 billion will also go toward the Community Mental Health Services Block Grant, in addition to increased funding for the 988 mental health hotline.

Mothers and Postpartum Care
The bill also extends a policy that allows states to offer a year of postpartum coverage for those enrolled in Medicaid and the Children’s Health Insurance Program.

Another provision, the Pregnant Workers Fairness Act, requires employers to make accommodations for medical conditions related to pregnancy. A second act, the PUMP Act, also requires employers to support mothers by providing private places, not including a bathroom, to pump breast milk.

Rural Health
The Medicare Dependent Hospital program and Low-Volume Hospitals program have been extended through 2025, which increases payments for those facilities with a large portion of Medicare patients.

The bill also includes $2 million for a rural hospital pilot program that helps to improve current hospital management.

Opioids
And $5 billion will go to efforts to reduce opioid misuse, such as easing buprenorphine prescription regulations (which previously required extra certifications.) The law includes $1.6 billion offered to states through the State Opioid Response Grant, medication-assisted treatment, and opioid overdose surveillance at the CDC.

CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER

Increased Funding

The bill includes a 22% increase, totaling nearly $119 billion, for VA medical care. Another provision sends a 5.6% increase of almost $50 billion for the National Institutes of Health, along with $950 million for Biomedical Advanced Research and Development Authority.

It also dictates that the Advanced Research Projects Agency for Health, which receives $1.5 billion of the allotted funding, will be housed under the NIH.

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PHE/Elig: Budget Act Includes Items on Medicaid Eligibility, Telehealth, Mental Health

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Technically what the new law does is it allows states to start redeterminations back. It doesn’t actually declare the PHE funding over. And you better believe people are looking for ways to keep that $40B+ annual bump alive.

 
 

Clipped from: https://achi.net/newsroom/budget-act-includes-items-on-medicaid-eligibility-telehealth-mental-health/

 
 

After a nearly three-year pause, states may resume eligibility redeterminations for Medicaid beneficiaries beginning in April. This is one of several health-related provisions included in the Consolidated Appropriations Act of 2023, the federal budget bill signed into law Dec. 23.

During the COVID-19 public health emergency, state Medicaid programs received enhanced federal Medicaid funding, and in exchange, state officials were not permitted to terminate coverage for most Medicaid enrollees. That limitation ends in April under the federal budget act.

Notably, Arkansas law requires Medicaid officials to complete the redetermination process within six months.

In separate but related provisions, the act will also require state Medicaid programs to keep children continuously enrolled for 12 months after they are deemed eligible. The law also makes permanent the option for states to continue coverage for pregnant women 12 months postpartum. The American Rescue Plan previously offered states the option to extend coverage for up to five years postpartum.

Many federal health agencies will receive boosts in funding under the budget act. The U.S. Department of Health and Human Services will receive approximately $10 billion more in funding compared to last year ($120.7 billion in total). The Centers for Disease Control and Prevention will receive an increase of $760 million ($9.2 billion in total) to enhance public health infrastructure and surveillance efforts.

Medicare telehealth flexibilities permitted during the public health emergency will now be continued through the end of calendar year 2024. A few examples of these flexibilities include allowing telehealth care delivery at any site at which a patient is present (including their home), continuing to allow federally qualified health centers and rural health clinics to provide telehealth services, and extending coverage of audio-only telehealth services. Medicare physician reimbursement rates, which were set to decrease by 4.5% in 2023, will instead be reduced by 2% in 2023 and by about 3% in 2024.

The budget act also includes provisions designed to protect pregnant and breastfeeding workers. It requires employers to provide reasonable accommodations for medical conditions related to pregnancy and prohibits employers from refusing employment to workers needing such accommodations. The act also requires employers to provide time and space for breastfeeding mothers to pump breastmilk, further clarifying that the space provided must be private and cannot be a bathroom.

The act also includes enhanced funding opportunities for programs aimed at improving mental health, substance use disorder, and crisis intervention services. Examples include funding for mobile health sites for mental health services, Medicare coverage for family and marriage counseling services, and a requirement that Medicaid programs offer searchable directories of mental health service providers.

Finally, the act includes efforts to bolster the physician workforce. In 2026, an additional 200 Medicare-funded graduate medical education positions will be established, with half of the positions dedicated to psychiatry and psychiatry subspecialty residencies. Ten percent of these positions will be dedicated to rural hospitals, hospitals that serve in health professional shortage areas, and hospitals in states with new medical schools.

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PHE: Citing Medicaid, DeSantis joins other governors seeking to end the COVID health emergency

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Ronnie et al want Joey to send a letter making his intentions clear about the actual PHE end date. Give us the letter, they say. We need closure, they say.

Clipped from: https://news.wjct.org/state-news/2022-12-30/medicaid-desantis-covid-health-emergency

Gov. Ron DeSantis last week joined 24 other Republican governors in asking President Joe Biden to end a COVID-19 emergency declaration that has helped lead to a surge in enrollment in Florida’s Medicaid program.

The governors sent a letter that urged Biden to allow a federal “public health emergency” to expire in April. The emergency declaration was initially issued in 2020 and has been repeatedly extended. The letter said it has been extended until at least Jan. 11, though states believe it will be extended to April because they have not received notification that it will end.

“We ask that you allow the PHE (public health emergency) to expire in April and provide states with much needed certainty well in advance of its expiration,” the letter said.

Medicaid is jointly funded by state and federal governments. During the emergency, the federal government has increased its share of the tab by 6.2 percentage points through a formula known as the Federal Medical Assistance Percentage.

But at the same time, state Medicaid programs have not been able to drop beneficiaries who might otherwise be ineligible for coverage. That has helped swell Medicaid rolls in Florida and other states.

For example, Florida had about 3.76 million people enrolled in Medicaid in March 2020, when the pandemic slammed into the state. In November 2022, it had nearly 5.58 million people enrolled, according to data posted on the state Agency for Health Care Administration website.

“The PHE is negatively affecting states, primarily by artificially growing our population covered under Medicaid … regardless of whether individuals continue to be eligible under the program,” the governors’ letter said. “While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily.”

In an Oct. 13 decision to extend the public health emergency to January, the U.S. Department of Health and Human Services pointed to the “continued consequences” of the COVID-19 pandemic.

Medicaid, which serves low-income Floridians, seniors and people with disabilities, is a massive part of each year’s state budget. Lawmakers in March approved a 2022-23 budget that included $38.6 billion for the Agency for Health Care Administration, which operates most of the program.

Other governors signing the letter were from Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Massachusetts, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia and Wyoming.
Copyright 2022 Health News Florida.

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MCOs: Centene Bounces Back With California Medicaid Contracts

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A single state Medicaid win- CA- upped Centene earnings per share and the companies overall financial outlook.

Clipped from: https://www.forbes.com/sites/brucejapsen/2023/01/03/centene-bounces-back-with-california-medicaid-contracts/?sh=6446c0171a39

 
 

Centene has landed several new contracts to administer Medicaid benefits in California, boosting the … [+] health insurer’s financial outlook after the recent loss of some other government business. The building housing Centene Corporation headquarters is seen Thursday, July 2, 2015, in Clayton, Mo. (AP Photo/Jeff Roberson)

ASSOCIATED PRESS

Centene has landed several new contracts to administer Medicaid benefits in California, boosting the health insurer’s financial outlook after the recent loss of some other government business.

With the Tuesday announcement that the California Department of Health Care Services has selected Centene subsidiary Health Net of California for “direct contracts in Los Angeles and Sacramento counties,” Centene has raised its projected 2024 adjusted earnings per share “floor to $7.15 from $7.00.” The state’s decision increases the “number of direct county contracts by DHCS to 10” in California.

“We are pleased that DHCS selected us to continue serving Medi-Cal members in 10 counties across the state, including as prime carrier in Los Angeles County,” Cemtene chief executive Sarah London said. “We believe their decision is in the best interest of millions of members, and we look forward to working with DHCS to address health disparities and improve how healthcare is delivered to Medi-Cal members across the state.”

Medicaid contracts are huge for Centene, which is one of the nation’s largest administrators of health benefits for poor Americans. Government-subsidized health insurance remains Centene’s sweet spot and the California news is welcome after Centene reportedly lost out a major western region Tricare contract from the U.S. Defense Department.

The new California contracts will begin January 1, 2024. “In total, Health Net will provide Medi-Cal managed care services in Los Angeles, Sacramento, Amador, Calaveras, Inyo, Mono, San Joaquin, Stanislaus, Tulare and Tuolumne counties,” Centene said in a statement.

It’s the first major business award Centene has announced since a management shake up less than a month ago.

In December, London announced some key changes to her management team, elevating Ken Fasola to become president of the health insurer while promoting others into new roles in her management team.

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MCOs- Amerigroup Maryland is Now Wellpoint

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The brand position for Elevance (nee Anthem) started in 2022 continues, with legacy local brands shifting into Wellpoint as a stop along the way.

Clipped from: https://www.businesswire.com/news/home/20230103005106/en/Amerigroup-Maryland-is-Now-Wellpoint

Members’ health plan benefits, services and care provider network to remain the same

HANOVER, Md.–(BUSINESS WIRE)–The Maryland Medicaid managed care provider, formerly known as Amerigroup Maryland, is now officially Wellpoint. This name change, which took effect Jan. 1, is seamless for the member as benefits and services will be unchanged. In addition, there is no action required for previously contracted and credentialed healthcare providers as they continue administering to the healthcare needs of our members across Maryland.

“It is a name that illustrates our dedication to being a lifetime, trusted partner in health with a mission to help people live well across all life points.”

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“Wellpoint is a name that has been part of our heritage for more than 30 years,” said Vincent M. Ancona, President of Wellpoint Maryland. “It is a name that illustrates our dedication to being a lifetime, trusted partner in health with a mission to help people live well across all life points.”

Wellpoint is an affiliated health plan under Elevance Health and leading managed care company dedicated to improving lives and promoting healthier communities. It helps people from birth to retirement and beyond, by offering comprehensive support for not only physical health, but also for social and emotional wellbeing through a wide network of doctors and hospitals, easy-to-use technology to access care and strong ties to local resources.

“This step in the company’s rebranding is a continuation of our bold and ambitious purpose to improve the health of humanity by serving people across their entire health journey; connecting them to care, support and resources; and simplifying every step of the healthcare journey to make health more equitable and accessible,” said Ancona.

Wellpoint members will continue to receive the same healthcare benefits and have access to their established primary care providers, specialists, hospitals and other healthcare facilities. Also, healthcare providers who serve Wellpoint members across Maryland will have continued access to tools and resources to help streamline day-to-day administrative tasks. This rebrand does not impact Amerigroup members and providers in New Jersey or Washington D.C.

New Wellpoint member ID cards with the Wellpoint logo began arriving by mail late last year. Maryland members who have questions can contact Wellpoint Member Services at 833-707-0867 (TTY 711). Healthcare providers who have questions or need assistance can contact Wellpoint Provider Services at 833-707-0868. A new Wellpoint website has been launched to offer Maryland members and providers information and updates. The site is www.Wellpoint.com/md/Medicaid.

ABOUT WELLPOINT

Wellpoint, part of the Elevance Health family of brands, focuses on improving physical health as well as the behavioral and social drivers that impact it through a comprehensive suite of Medicare, Medicaid, and Commercial products. The Wellpoint companies offer healthcare services for consumers at any stage of life seeking to make the right care decisions and helps individuals and communities make real, positive progress with health plans that foster independence, confidence, and whole-person health. For more information, please visit www.wellpoint.com.