MM Curator summary

[MM Curator Summary]: Journos celebrating the Senate passing expansion may be missing the main point that the house is still waiting on an important impact study before it plans on discussing the plan.

 
 

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.

 
 

OPINION AND COMMENTARY

Editorials and other Opinion content offer perspectives on issues important to our community and are independent from the work of our newsroom reporters.

Opinion

For a long time, those pushing for North Carolina to expand Medicaid thought the biggest obstacle would be getting Senate leader Phil Berger and his Republican caucus on board.

Berger and top Senate Republicans have now joined the chorus of lawmakers advocating for Medicaid expansion, introducing a major health care package Wednesday and calling it “good state fiscal policy.”

“If there is a person in North Carolina who has spoken out against Medicaid expansion more than I have, I’d like to meet that person,” Berger said at Wednesday’s press conference. “In fact, I’d like to talk to that person about why my view on this has changed, because I think this is the right thing for us to do.”

Maybe he should start with his colleagues in the House.

House Speaker Tim Moore told reporters Wednesday that it won’t be happening this year. It’s a “contentious issue” and he doesn’t “see an appetite for it right now” in his caucus, he said.

Historically, the House has not been the chamber to take the harder line on something resembling Medicaid expansion. Over the years, they’ve floated proposals that would offer coverage to more people, albeit with small premiums and work requirements.

“It’s deeply strange. It’s like the parties in the House and the Senate have switched places in the last two years,” state Sen. Jeff Jackson, a Democrat from Mecklenburg County, told the Editorial Board. “It used to be that the Senate was the problem, and the House was basically for it. And now that appears to have switched. It’s not really clear to me why that’s the case.”

Unlike the Senate, many House Republicans aren’t as convinced that it doesn’t pose a fiscal risk to the state. Some still worry what burdens might be placed on the state’s budget if the federal government were to reduce its share of the costs.

“People aren’t sure about what that’s going to do to the state, how much the state’s going to be on the hook for,” attorney and Republican consultant Larry Shaheen said. “There’s just a lot of questions that are still out there. And I think that’s kind of what’s holding them back.”

The way the legislation was presented doesn’t seem to be helping. The bill would do other things, too, like allow advanced practice nurses to practice without physician supervision. Such a policy has had mixed support among House Republicans, and is opposed by many health care providers.

House Republicans also were under the impression that nothing would move forward until a joint legislative oversight committee, which was created last year to study Medicaid expansion, presented its findings and recommendations, Shaheen said. That hasn’t happened yet.

“Jumping the gun a little bit on this probably wasn’t the wisest decision,” Shaheen said.

Only a fraction of House Republicans need to support the legislation for it to pass, technically speaking. Assuming every Democrat votes for it, only about a dozen Republicans would need to join them. There are currently 69 Republicans serving in the House.

But whether a bill actually makes it to the House floor for a vote is at the discretion of Moore and other top Republicans. It’s not uncommon for legislation to fizzle out if the majority party doesn’t enthusiastically support it.

The result: As significant as it is for the Senate to finally support Medicaid expansion, it doesn’t make much of a difference in the end. It certainly doesn’t change much for the 600,000 people still stuck in the coverage gap: unable to qualify for Medicaid, unable to afford health insurance on their own.

There’s a real cost to waiting to expand Medicaid, and it’s not just the billions of federal dollars that legislators have passed up over the years. Research suggests that expanding Medicaid could save the lives of more than 1,000 North Carolinians each year. That’s 1,000 more lives that won’t be saved if the legislature closes yet another session with unfinished business.

The path to Medicaid expansion may have cleared one major obstacle, but there’s still plenty that’s standing in the way. We can thank the House for that.

BEHIND OUR REPORTING

What is the Editorial Board?

The Charlotte Observer and Raleigh News & Observer editorial boards combined in 2019 to provide fuller and more diverse North Carolina opinion content to our readers. The editorial board operates independently from the newsrooms in Charlotte and Raleigh and does not influence the work of the reporting and editing staffs. The combined board is led by N.C. Opinion Editor Peter St. Onge, who is joined in Raleigh by deputy Opinion editor Ned Barnett and opinion writer Sara Pequeño and in Charlotte by Pulitzer Prize winning cartoonist Kevin Siers and opinion writer Paige Masten. Board members also include McClatchy Vice President of Local News Robyn Tomlin, Observer editor Rana Cash, News & Observer editor Bill Church and longtime News & Observer columnist Barry Saunders. For questions about the board or our editorials, email pstonge@charlotteobserver.com.

 
 

Clipped from: https://www.charlotteobserver.com/opinion/article261821335.html

MM Curator summary

[MM Curator Summary]: The provider-led entity plan begins July 1.

 
 

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.

 
 

Oklahoma adopts new system for Medicaid management

 
 

Between July 1, 2021, when Oklahoma’ Medicaid expansion went into effect, and May 2022, more than 291,000 people were added to the program’s enrollment. Currently, more than 1.2 million people are enrolled in Medicaid in Oklahoma. (Photo by Online Marketing on Unsplash)

OKLAHOMA CITY – After years of battle in the courts and at the state Capitol over how best to manage the state’s $7 billion Medicaid program, Oklahoma lawmakers and Gov. Kevin Stitt are agreed on a new structure scheduled to go into effect on July 1.

Instead of contracting with large, out-of-state insurance companies to manage the state’s Medicaid program, as Stitt had previously attempted to accomplish, the new plan ensures that Oklahoma-based companies play a role in managing care for Medicaid enrollees. However, several of those locally owned entities will still likely have to partner with large, out-of-state companies in order to provide services to Oklahoma’s newly expanded Medicaid population.

The new system is better than the original plan, health care providers say, though some remain wary of how the program ultimately will be administered.

Voters set the stage for the state to expand Medicaid eligibility to an additional 190,000 Oklahomans when they approved State Question 802 in 2020. State leaders scrambled to find a way to manage the $162 million increase the expansion was projected to cost.

Stitt responded by directing the Oklahoma Health Care Authority to award $2 billion in contracts to four private companies to manage the Medicaid program. Several medical groups, including the Oklahoma State Medical Association, filed a lawsuit. The Oklahoma Supreme Court struck down the contracts in 2021, finding Stitt did not have the authority to implement such a plan without involving the Oklahoma Legislature in the process.

Health care provider groups had objected to Stitt’s managed care plan, claiming the managed care approach did not work well when the state last attempted it in the 1990s. Lawmakers eventually switched back to a state-run system after the number of participating health are providers dwindled to a point that challenged the state’s ability to provide adequate Medicaid services.

Providers had dropped out of the Medicaid plan because they claimed the for-profit management companies, seeking to increase profits, had slashed reimbursement rates and erected other barriers to reimbursement that made participation untenable. Returning to a managed care system would likely result in the same outcome, provider groups argued.

Stitt signed Senate Bill 1337 and SB 1396 into law on May 26, hailing the new plan as one that achieves the goals he had in mind when pushing for managed care.

“I have pushed since 2020 to find a solution that improves health outcomes for Oklahomans and also protects the taxpayers from rising costs,” Stitt said.

The new plan encourages provider-led entities, such as Integris, to expand their accountable care organizations statewide, said state Rep. Marcus McEntire, R-Duncan.

“This plan puts an Oklahoma provider-led entity in the middle of that,” McEntire said when he presented the measures before the House. “The money will stop there, in state.” The new system allows Oklahoma lawmakers to more easily step in and tweak the process as needed, he said.

The Oklahoma-based companies likely will partner with larger, national companies in order to secure the financial backing needed to take on the risk of overshooting the state’s cap on expenditures, McEntire said.

Companies contracted to provide Medicaid services will be expected to achieve measurable goals and develop strategies to address health disparities, said State Medicaid Director Traylor Rains.

“While SB 1337 implements managed care, it is vastly different from where we were last January, when the health care authority offered contracts to insurance companies without legislative oversight or guardrails to protect Oklahoma’s tax dollars or our Medicaid recipients,” said OSMA President David Holden, M.D.

The latest version of the bill is the result of a more collaborative process that allowed hospitals and physicians to have some input, Holden said.

“While we still have concerns about how this program will be implemented and administered, we are grateful for the thought that has gone into this effort,” Holden said. “Looking forward, the Oklahoma State Medical Association will continue to oppose any increases in administrative fees as, ultimately, that takes tax dollars away from patient care.”

SB 1396, the Supplemental Hospital Offset Payment Program, provides $130 million annually for the Medicaid program and benchmarks hospital inpatient and outpatient services at 90% of the average commercial rate.

Between July 1, 2021, when Oklahoma’ Medicaid expansion went into effect, and May 2022, more than 291,000 people were added to the program’s enrollment. Currently, more than 1.2 million people are enrolled in Medicaid in Oklahoma.

 
 

Clipped from: https://journalrecord.com/2022/06/01/oklahoma-adopts-new-system-for-medicaid-management/

MM Curator summary

[MM Curator Summary]: Centene, Anthem and UHC are all winners.

 
 

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.

 
 

 
 

On May 22, 2022, the Missouri Department of Social Services (DSS) announced it awarded the next MO HealthNet Medicaid managed care organization (MCO) contracts to incumbents Centene/Home State Health Plan, Anthem/Missouri Care, and UnitedHealthcare. The plans are responsible for physical health, behavioral health, and pharmacy. The contracts are slated to go live July 1, 2022, and the initial term will run for one year followed by four one-year renewal options. The state anticipates paying the MCOs $2 billion annually. DSS awarded Centene a separate contract for a single, statewide specialty plan for about 40,000 foster children . . .

Clipped from: https://openminds.com/market-intelligence/news/missouri-awards-medicaid-managed-care-contracts-to-incumbents-centene-awarded-new-specialty-plan-for-children-in-foster-care/

MM Curator summary

[MM Curator Summary]: Lawmakers successfully prevent the elected Governor from doing part of her official job.

 
 

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.

 
 

 
 

House Bill 2387 also blocks governors from closing churches because of public health emergency

 
 

Sen. Ethan Corson, D-Fairway, during debate Monday in the Senate objected to the lack of transparency or support for legislation extending current contracts for Medicaid providers. (Tim Carpenter/Kansas Reflector)

TOPEKA — Republicans in the Kansas Legislature on Monday blocked Gov. Laura Kelly from reworking contracts for the state-run Medicaid program, downplaying concerns from Democrats about political motivations and clandestine deal-making involved in extending the $3.9 billion deals.

Republicans favored the no-bid contract extension so Derek Schmidt could install new deals if he wins the governor’s race against Kelly in November. Republican supermajorities in both the Senate and House voted to override the Democratic governor’s veto of House Bill 2387.

Lawmakers previously gutted the legislation, which originally dealt with operating an aircraft while drunk, and inserted several bills that never passed either chamber. One of the provisions bans governors from closing churches, regardless of a public health emergency. The other delayed the bidding process for the managed care companies that provide Medicaid services to 500,000 Kansans.

Sen. Ethan Corson, a Fairway Democrat, said the forced extension of Medicaid contracts had to be joined with the religious freedom policy to secure enough support for overriding the governor’s veto. Nobody showed up to voice support for the no-bid contract extension during a House committee hearing, Corson said, and the Senate never held a hearing on the issue.

“How many times have we had a hearing on a bill where there’s literally not a single person who wants to be publicly associated with this policy?” Corson said during debate in the Senate.

Corson also questioned the lack of transparency in the process. GOP lawmakers who pushed the bill refused  to identify individuals, companies or organizations that support delaying the bidding process for new contracts.

“None of the folks who are obviously working behind the scenes to get these forced extensions want to be publicly identified with it,” Corson said. “So I would just have to really ask about why is there such secrecy, and why does nobody want to have their fingerprints on this?”

Sen. Richard Hilderbrand, a Baxter Springs Republican, and other GOP lawmakers objected to labeling the legislation as a no-bid contract extension.

Hilderbrand’s response to Corson’s speech: “That was entertaining.”

Rep. Brenda Landwehr, a Wichita Republican, said there is nothing in the legislation that prevents a competitive bidding process for the next round of contracts.

“So it’s somewhat disingenuous to say that there’s a no bid out here,” Landwehr said.

Rep. John Carmichael, a Wichita Democrat, said Landwehr’s comments suggest that a new governor will be prepared on his first day in office to put out a bid for Medicaid services. There is only one way that can happen, Carmichael said.

“And that is if the new RFP is already being written behind closed doors with cooperation of a gubernatorial nominee who thinks he will be the governor — and if that RFP is being written by the lobbyists for the managed care organizations,” Carmichael said. “If that’s the way you want to run the government, then this is the bill for you. Not for me.”

Landwehr also defended the provision of the bill that prevents the current or any future governor from closing churches. The policy is a response to Kelly’s attempt in April 2020 to avoid the spread of COVID-19 through an executive order limiting the number of people who could gather to worship in one place.

“This bill assures us that that cannot happen again — nor should it,” Landwehr said.

Rep. Boog Highberger, a Lawrence Democrat, said the GOP-controlled Legislature in 1901 passed a public health law allowing the closing of schools and churches during a pandemic, as well as restrictions on gatherings at other public places.

“I don’t think they cared less about their freedom than you or I do, but they did understand that a virus doesn’t care if you’re at a church service or you’re at a bar,” Highberger said.

By overriding the veto, Highberger said, “we’re turning the public health clock back over 120 years.”

“People will die because of it,” Highberger said.

 
 

 
 

Clipped from: https://kansasreflector.com/2022/05/23/kansas-legislature-overrides-veto-extends-medicaid-contracts-past-election/

 
 

[MM Curator Summary]: RI will give incumbents who would have been disqualified if procurement rules were followed a do-over.

 
 

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.

 
 

PROVIDENCE, R.I. (WPRI) – Rhode Island is starting over on a bidding process for the state’s huge Medicaid managed care contract, worth $7 billion over five years, effectively reopening the door for disqualified insurance companies to try again.

The R.I. Department of Administration confirmed the decision shortly after 4 p.m. Friday, citing policy changes made by federal regulators related to the Medicaid program – meaning the contract language would need to be updated and the process would have to start over. 

But the decision also comes just days after Target 12 first requested information about Blue Cross Blue Shield of Rhode Island’s bid, which had been submitted with a blank CD and no paper copy, raising questions about whether Rhode Island’s largest insurance company would be disqualified. 

Blue Cross Blue Shield refused to answer questions about the issue, and the state didn’t respond to multiple requests for comment on the matter before announcing the process would start over.

A document obtained by Target 12 shows state officials discovered the problem with the Blue Cross CD on March 8, and leaders at the Executive Office of Health and Human Services sought to scrap the entire bidding process soon after. But purchasing officials at the Department of Administration blocked the health agency from doing that, and in April repeatedly told Medicaid staffers to pick up the bid documents and move forward.

On April 27, Health and Human Services leaders cited the revised federal regulations as a new reason to throw out the original bids, and purchasing officials signed off on the decision Friday.

It’s unclear when Blue Cross learned about its disqualification. “We cannot discuss our bid at this time as the state is still in the midst of its procurement process,” Melanie Coon, a spokesperson for the insurer, told Target 12 earlier this week. She directed a follow-up question to the state.

This isn’t the first time there’s been an issue with the Medicaid bidding process, which will eventually turn into the most lucrative state contract awarded in Rhode Island’s state government.

As Target 12 first reported in March, Tufts Health Plan submitted its bid for the contract two minutes after the deadline, effectively disqualifying them from the process. Tufts blamed traffic ahead of a snowstorm.

The elimination of both Tufts and Blue Cross could have benefited the four remaining companies who apparently submitted their bids correctly: MolinaHealthcare of Rhode Island Inc., Neighborhood Health Plan of Rhode Island, United Healthcare of New England, and Commonwealth Care Alliance.

Under the current Medicaid managed care contact, which will expire a year from July, Neighborhood administers coverage for about 174,000 patients, while United Healthcare has 97,000 patients and Tufts has 17,000. The three companies together handle insurance for about 85% of all Medicaid recipients in Rhode Island. (The rest are not in managed care programs.)

TARGET 12: How 2 minutes may cost RI health insurer hundreds of millions

Eli Sherman (esherman@wpri.com) is a Target 12 investigative reporter for 12 News. Connect with him on Twitter and on Facebook.

Clipped from: https://www.wpri.com/target-12/ri-cancels-bid-process-for-7-billion-medicaid-contract-after-insurer-snafus/

[MM Curator Summary]: United won its MO renewal.

 
 

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.

 
 

• Missourians will continue to have access to UnitedHealthcare’s comprehensive care and preventive health and wellness programs for Medicaid
  

JEFFERSON CITY, Mo.: The state of Missouri has selected UnitedHealthcare Community Plan of Missouri as one of three managed care organizations to administer its MO HealthNet Managed Care Program for Medicaid members in Temporary Assistance for Needy Families (TANF) and the Children’s Health Insurance Program (CHIP).

UnitedHealthcare is committed to working closely with the Missouri Department of Social Services and its MO HealthNet Division, which administer the state’s Medicaid program, toward the shared goal of improving the overall health and well-being of members. Through UnitedHealthcare’s approach, Missouri Medicaid members will benefit from a value-based, whole-person and integrated care model that focuses on the unique health needs of members and the communities UnitedHealthcare is dedicated to serving.

“We have partnered with the state of Missouri for the last five years and are honored to have the opportunity to continue building a strong Medicaid program that offers innovative programs and solutions for individuals and families,” said Jamie Bruce, chief executive officer, UnitedHealthcare Community Plan of Missouri. “We are deeply committed to Missouri and are privileged to provide access to high-quality care that has a positive impact for our members’ health and the communities we serve.”

UnitedHealthcare Community Plan of Missouri will offer health benefits for a portion of the nearly 1 million adults and children who qualify for the general MO HealthNet Managed Care Program in Missouri. Benefits will include access to UnitedHealthcare’s comprehensive and preventive care including an integrated network of behavioral health and physical health providers, essential community providers, and long-term care providers beginning July 1, 2022.

 
 

Clipped from: https://www.unitedhealthgroup.com/newsroom/posts/2022/2022-05-12-uhc-selected-by-mo-to-serve-ma-beneficiaries.html

[MM Curator Summary]: Centene will continue as the single foster care managed care vendor in Missouri.

 
 

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.

 
 

ST. LOUIS, May 6, 2022 /PRNewswire/ — Centene Corporation (NYSE: CNC) announced today its Missouri subsidiary, Home State Health, has been awarded the MO HealthNet Managed Care General Plan and Specialty Plan. Under the General Plan, Home State will continue serving multiple MO HealthNet programs including Children’s Health Insurance (CHIP) members and the state’s newly implemented Medicaid expansion population, across all regions of Missouri.

As the sole provider of the Specialty Plan, Home State will serve approximately 40,000 foster children and children receiving adoption subsidy assistance. The Specialty Plan combines health services into a single, specialized health plan for children in the custody of the Missouri Department of Social Services (DSS) and children receiving adoption subsidy assistance. The plan establishes a trauma-informed, comprehensive, and integrated behavioral health and physical health delivery system. The contract is for one year with options for four renewals. Centene Corporation currently provides comprehensive healthcare services and programs to children served in the child welfare system in 19 states, with single source statewide contracts in four states.

“We look forward to the next chapter of our strong relationship with the state, our network of providers and community partners as we continue to deliver member-focused care and improve health outcomes,” said Brent Layton, Centene’s President and Chief Operating Officer. “We are honored to be selected to serve as the Specialty Plan for children involved with foster care. We look forward to bringing our innovative care management programs that address the whole health of these children in Missouri.”

More than 975,000 Missourians receive their healthcare through the state’s Medicaid managed care program (MO HealthNet), which provides access to physical health, behavioral health, pharmacy, hospital, and other services. Today, Home State Health serves more than 300,000 Medicaid enrollees and partners with 25,000 healthcare providers statewide.

Home State Health has served the Medicaid population in partnership with MO HealthNet since 2012. The organization also focuses on under-insured and uninsured individuals through its federal insurance marketplace plan, Ambetter. Additionally, Home State Health provides insurance for the Medicare population through its Medicare Advantage plan, WellCare.

 
 

Clipped from: https://investors.centene.com/news-events/press-releases/detail/1031/centene-subsidiary-selected-to-continue-serving-missouris