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Ohioans on Medicaid Will Get $100 if They Get Their First COVID Vaccine by Sept. 15

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They tried $50 first but that didn’t increase vax rates very much.

 
 

 
 

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.

 
 

While 45% of Ohioans had received their first shot by May, the number was about half for Medicaid recipients.

 
 

 
 

While 45% of Ohioans had received their first shot by May, the number was about half for Medicaid recipients.Photo: Maryland National Guard/FlickrCC
 

Ohio Medicaid recipients who get their first COVID vaccine shot between now and Sept. 15 will receive a $100 gift card, the state’s managed care organization announced this week.

It previously had been offering $50 to those who received their first dose by Aug. 15, but the timeline was extended and the reward boosted in an effort to get shots into low-income Ohioans.

While 45% of Ohioans had received their first shot by May, the number was about half for Medicaid recipientsStudies have shown hourly workers have been left behind in the state’s vaccine push.

As Ohio health officials warn of the dangers and probability of contracting COVID, especially the Delta variant, among those who are unvaccinated, public health outreach campaigns and novel reward incentives have been deployed to boost Ohio’s vax rate, which has become stubbornly sluggish this summer.

“The effort has taken on new urgency as Ohio continues to lag most other states in vaccination rates and as the Delta variant of the COVID-19 virus, believed to be significantly more contagious than other variants, spreads,” the Ohio Association of Health Plans said in a statement.

Unvaccinated people account for 99% of recent deaths and 97% of hospitalizations.

Ohio Medicaid recipients can also schedule a free ride to a vaccine appointment.

Clipped from: https://www.citybeat.com/news/blog/21154322/ohioans-on-medicaid-will-get-100-if-they-get-their-first-covid-vaccine-by-sept-15

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Managed care group reports improved vax rate among W.Va. Medicaid recipients

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MCOs in West Virginia are starting a second attempt to increase the low vax rate for Medicaid members.

 
 

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.

 
 

CHARLESTON, W.Va. — The companies which administer West Virginia’s Medicaid programs report success in vaccination rates among the state’s poorest population against Covid 19.

Unicare, Aetna, and The Health Plan are the state contracted companies which are serving the poor with health care coverage in West Virginia. As it stands the average age of the clientele of those three skews very young in West Virginia’s Medicaid roles.

Ben Beakes, executive director of the West Virginia Association of Health Plans, said it’s the demographic in the Mountain State most in need of vaccination.

“The early folks who were just getting the shot on their own was the older population. Now we’re trying to push some of the younger populations,” Beakes said on MetroNews “Talkline” Tuesday.

The Justice administration’s Covid 19 task force asked Beakes and the association to help reach the Medicaid population and to hopefully up the vaccination rate earlier this year. Beakes said they’ve had several different drives to reach their clients and they are starting to see success.

Initially the managed care organizations used social medial, email, and similar campaigns to get younger people in the Medicaid population more interested in the vaccination. They plan to use additional campaigns coming up like back to school vaccinations and working to insure every person is aware of the opportunity and able to get the information about the vaccination.

“Persistence is the key. This is going to be a long-term effort, there isn’t going tob e a silver bullet to solve this issue,” he explained.

In their most recent surveys the Association found 18,000 additional Medicaid patients have been vaccinated since the effort began.

Beakes said there are two keys to their campaign. First , make sure people have all of the necessary information to answer their questions and concerns so they can make an informed decision. Secondly, he said they are working to make sure people know where they can go to get the shots.

“We understand this is a personal decision, not a requirement. Our role is to try and give them as much information as possible so they can make an informed decision. We also want to connect them with a primary care physician so they can get even more information,” he explained.

According to Beakes the top question young people had about the vaccine was how it will impact an expectant mother and her unborn baby.

 
 

Clipped from: https://wvmetronews.com/2021/07/27/managed-care-group-reports-improved-vax-rate-among-w-va-medicaid-recipients/

 
 

 
 

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NCDHHS announces Medicaid Managed Care Regional Behavioral Health I/DD Tailored Plans

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The behavioral health managed care contract award winners have been announced.

 
 

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.

 
 

RALEIGH — The North Carolina Department of Health and Human Services today announced the selection of seven organizations to serve as Behavioral Health and Intellectual/Developmental Disability Tailored Plans.

Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/developmental disability or traumatic brain injury may be eligible to enroll in a Behavioral Health I/DD Tailored Plan.

Following a competitive selection process, the following organizations were awarded a contract to serve as regional Behavioral Health I/DD Tailored Plans:

  • Alliance Health
  • Eastpointe
  • Partners Health Management
  • Sandhills Center
  • Trillium Health Resources
  • Vaya Health
  • Cardinal Innovations Healthcare*

*While Cardinal Innovation Healthcare was awarded a contract, it is anticipated they will not operate a Behavioral Health I/DD Tailored Plan at launch due to the consolidation with Vaya Health. 

Behavioral Health I/DD Tailored Plans will provide integrated physical health, behavioral health, long-term care, pharmacy services and will address unmet health-related resource needs for qualifying North Carolinians under one plan. These plans will provide the same services as NC Medicaid Standard Plans with additional specialized services to serve individuals with significant behavioral health conditions, including those utilizing 1915(c) Home and Community-Based Services waivers and those utilizing State Funded Services. 

“NCDHHS looks forward to working with the awardees to make this innovative design a reality for the thousands of North Carolinians who will benefit from a whole person centered, well-coordinated system of care,” said NCDHHS Secretary Mandy K. Cohen, M.D. “Today moves us closer to that goal as we begin to implement this important program design.” 

At launch, Behavioral Health I/DD Tailored Plans will operate regionally, offering robust care management to approximately 200,000 individuals estimated to enroll. An additional unique feature of Behavioral Health I/DD Tailored Plans is the combination of Medicaid and state funding to support enrolled populations. 

The contract award covers counties in each catchment area as of July 26, 2021, as well as realignments approved by Secretary Cohen effective Sept. 1, 2021. Given additional county requests for disengagement, NCDHHS anticipates county alignments for Behavioral Health I/DD Tailored Plans will be significantly different at launch. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require DHHS Secretary’s approval. The list below indicates the anticipated county alignments at go-live. 

“We will work closely with LME/MCO’s to assure a smooth transition to Behavioral Health I/DD Tailored Plans while they continue to oversee the crucial services currently provided through the LME/MCO’s” said Deputy Secretary of NC Medicaid, Dave Richard. 

Only entities operating as LME/MCOs were eligible to apply to become Behavioral Health I/DD Tailored Plans. The first Behavioral Health I/DD Tailored Plans contract term will last four years. The Department has the authority to award no more than seven and no fewer than five regional Behavioral Health I/DD Tailored Plan contracts and may not award any statewide contracts.

Under Medicaid Managed Care, Standard Plans and the Eastern Band of Cherokee Indians (EBCI) Tribal Option launched on July 1, 2021, followed by Tailored Plans on July 1, 2022. 

The Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) and Division of Health Benefits (NC Medicaid) will host a webinar today to share information about this important announcement.  

Please register for Joint DMH/DD/SAS and NC Medicaid webinar on July 26, 2021, 2 p.m. ET at: https://attendee.gotowebinar.com/register/640620970643161360.

 After registering, you will receive a confirmation email containing information about joining the webinar.

For Closed Captioning please login to the event by clicking on the following link at 2 p.m. ET at: https://www.captionedtext.com/client/event.aspx?EventID=4834089&Customer

For information specific to Behavioral Health and I/DD Tailored Plans, please visit the Behavioral Health I/DD Tailored Plans page. 

More information about the transition to NC Medicaid Managed Care can be found on the Medicaid website at medicaid.ncdhhs.gov/transformation.

Projected County Alignments at Tailored Plan Launch for July 1, 2022

This list reflects projected county assignments based on disengagements requested or approved. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require approval by the NCDHHS Secretary. 

  • Alliance Health: Cumberland, Durham, Johnston, Orange, Mecklenburg and Wake. 
  • Eastpointe: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne and Wilson.
  • Partners Health Management: Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanley, Surry, Union and Yadkin.
  • Sandhills Center: Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham. 
  • Trillium Health Resources: Bladen, Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell and Washington.
  • Vaya Health: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Rutherford, Swain, Transylvania, Vance, Watauga, Wilkes and Yancey.
  • Pending: Chatham, Halifax, Stokes and Warren. 

 
 

 
 

 
 

Clipped from: https://www.richmondobserver.com/national-news/item/12939-ncdhhs-announces-medicaid-managed-care-regional-behavioral-health-i-dd-tailored-plans.html

 
 

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Centene’s Medicaid Enrollment Rises By 1.3 Million As Pandemic Drags On

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The managed care giant has added nearly $5B in revenues in Medicaid due to the pandemic.

 
 

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.

 
 

 
 

Centene’s Medicaid enrollment grew by more than 1 million in the second quarter of 2021 as the … [+] Covid-19 pandemic drags on. In this photo, Chairman and CEO of Centene, Michael F. Neidorff attends 2019 Forbes Healthcare Summit at the Jazz at Lincoln Center on December 05, 2019 in New York City. (Photo by Steven Ferdman/Getty Images)

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Centene’s membership grew by more than 1.3 million in the second quarter compared to a year ago thanks to a big increase in enrollment in its Medicaid plans during the Covid-19 pandemic.

Centene’s revenue was up 12% to $31 million in the second quarter ended June 30 compared to $27.7 billion in the year-ago period, largely due to the growth of Medicaid enrollment, the company reported Tuesday. Centene reported a loss of more than $530 million in the quarter compared to a $1.2 billion profit a year ago.

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Still, the company met Wall Street’s earnings expectations and maintained its 2021 guidance as membership rises across its diversified portfolio of Medicaid plans for poor and low-income Americans, Medicare Advantage plans for seniors and Obamacare policies to individuals sold under the Affordable Care Act.   

Centene’s total membership at the end of the second quarter was 25.4 million, an increase 3% or 800,000 members, compared to June 30, 2020.

“Our scale and diversification provide a solid foundation to execute through this environment as we focus on implementing various initiatives to deliver on our stated margin goals,” Centene chairman and chief executive Michael Neidorff said.

The health insurer, which is one of the nation’s largest providers of government subsidized health benefits, has seen an uptick in members as it adds more state Medicaid contracts providing coverage for poor Americans. In addition, Centene has seen more people sign up for Medicaid after losing their jobs in the last year due to poor economic times during the Covid-19 pandemic.

In the second quarter, Medicaid enrollment grew to 14 million compared to 12.6 million in the year-ago period. That helped Medicaid revenue grow by 12% to $20.8 billion in the quarter.

Enrollment in Medicaid generally has surged during the pandemic, according to a report last month from the Centers for Medicare & Medicaid Services, which showed a “record high, over 80 million individuals have health coverage through Medicaid and the Children’s Health Insurance Program.” Such growth has benefited health insurers like Centene that administer Medicaid via contracts with states across the country.

 
 

Clipped from: https://www.forbes.com/sites/brucejapsen/2021/07/27/centenes-medicaid-enrollment-rises-as-pandemic-drags-on/?sh=6256b73a54e7

 
 

 
 

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MetroPlusHealth ranks #1 in 2020 Medicaid Quality Incentive Program

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MetroPlus Health Plan in NY was rated first out of 15 Medicaid plans for 2020 quality results.

 
 

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.

 
 

In a year that saw unprecedented challenges within the entire health care community, MetroPlusHealth, New York City’s Health Plan, was ranked number one among all 15 New York State Medicaid plans in overall quality, according to the New York State Department of Health’s 2020 Quality Incentive results. “While we have consistently scored high in quality, having achieved the #1 spot during a global pandemic speaks volumes about the dedicated people at our company who rose to the occasion,” said Dr. Talya Schwartz, President & CEO of MetroPlusHealth.

As New York City shut down in March of 2020, the staff of MetroPlusHealth pivoted to remote work as entire departments were redeployed. As part of Covid-19 operations, while family, friends and co-workers were dealing with personal challenges as a result of the spreading virus, new protocols were put into place and support and communications to members were intensified. “Navigating through unchartered territories was key during this time,” said Dr. Schwartz. “We were there for our members assisting with needed care, Covid-19 testing, and day-to-day essentials. It was during this time that our membership surged by 15% to over 600,000 and then continued growing to over 620,000 members this year,” she added.

Key factors contributing to the top ranking, where MetroPlusHealth scored above 90% of State benchmarks, included care related to diabetes, hypertension, substance abuse disorders and mental illness. The plan cites its streamlined process of working with NYC Health + Hospitals and its community providers in exchanging data, education, member support, and working to bring members in for care, especially those with the highest and most immediate needs.

The New York State Quality Incentive program is based on reporting and measurement from medical care in the prior calendar year. A plan’s score and ranking in the program indicates the quality of care provided to the plan’s members relative to all plans in the Medicaid Managed Care market. The data evaluated considers national standards of care, State specific measures and consumer input and assessment.

Rates of performance in Medicaid managed care have increased steadily over the last decade. New York State Medicaid plans have demonstrated a high level of care compared to national averages, and for many domains of care the gap in performance between commercial coverage and Medicaid managed care has been decreasing and, in some cases, has been completely closed since the Quality Incentive Program was implemented.

“Just a few months ago,” Dr. Schwartz said, “we and other Medicaid Managed Care plans were concerned about the viability of this program given some of the State cuts. Fortunately, some of those cuts were partially restored and allowed us and others to continue to focus on quality and adherence to standards of care for our members.” Partial restoration of State funding also allowed MetroPlusHealth to support the provider community, through monetary means, as well as operationally, to create and sustain the infrastructure and the personnel needed to focus on this aspect of care delivery. “We could not be prouder of our team and our provider partners,” Dr. Schwartz stated. “We are grateful to the MetroPlusHealth staff who once again demonstrated the enormous value of MetroPlusHealth and the Health + Hospitals’ system to all New Yorkers.”

 
 

Clipped from: https://www.amny.com/health/metroplushealth-ranks-1-in-2020-medicaid-quality-incentive-program/

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Paramount takes legal action to halt, end Medicaid procurement process

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After trying to undo their loss via the legislature, Paramount is now trying their luck in court.

 
 

 
 

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.

 
 

 
 

It tried to appeal, but the agency wouldn’t stop the Medicaid overhaul. It went to the state legislature, but Gov. Mike DeWine vetoed the effort.

So now, Toledo-based health care company ProMedica is going to the courts.

ProMedica, which owns Medicaid managed-care organization Paramount Advantage, announced Tuesday that it is has sued the Ohio Department of Medicaid. It’s seeking injunctive relief to halt the ongoing overhaul of the state’s Medicaid system and invalidate recently awarded contracts.

Paramount brings this lawsuit to ensure the integrity of Ohio’s… selection process is fair, free, and open, as required by law, and to invalidate the fundamentally flawed black-box process that Defendants improperly conducted, without any authority to do so and without implementing the necessary safeguards against… biases toward Paramount,” the complaint filing read.

After a years-long procurement process, and as part of the overhaul, the Medicaid department in April chose six new companies to handle the governmental health insurance for more than 3 million low-income or disabled residents. Those contracts are worth around $20 billion, potentially the largest award in state history.  

Paramount Advantage was the only current provider to lose out.

The company alleged bias in favor of large, out-of-state companies over Ohio-based ones and sought in the state budget to redo the process so it “protected Ohio jobs.” But that was vetoed by the governor. 

The company filed an appeal to the Medicaid department itself, but that was rejected late June. The department said that ProMedica’s application for a contract made very few references to new elements of the Medicaid overhaul, such as OhioRISE, a program treating children with severe behavioral and mental problems. 

In the court filing, attorneys for the company listed multiple problems as to why it believes the procurement process was faulty and unfair.

Attorneys cited a lack of transparency due to the Medicaid department’s refusal to satisfy open records requests related to the process. ProMedica questioned whether the department even had authority to preside over the selection process, saying the Medicaid department didn’t file necessary paperwork to the proper agency. Attorneys claim other legally required procedures were not followed.

A spokesperson for the Department of Medicaid said it has not yet received the complaint.

Many expected the lawsuit to come, and if it’s successful, health advocates have the same fears as they did when lawmakers were looking at redoing the procurement process. Critical reforms like OhioRISE or the implementation of a single pharmacy benefit system would be delayed.

Regardless, ProMedica is not backing down, saying jobs are at stake.

“ODM’s unlawful…. decision to deny Paramount a contract award will result in the loss of hundreds, if not thousands, of jobs in northwest Ohio at a time when the local, state, national and even global economies are still reeling from the effects of the year-and-a-half long pandemic,” it said in its filing.

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

 
 

Clipped from: https://www.dispatch.com/story/news/courts/2021/07/13/paramount-takes-legal-action-halt-end-medicaid-procurement-process/7956356002/

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Iowa Medicaid Officials To Seek Another Medicaid Managed Care Organization

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Iowa MCO contracts are up for grabs at the end of this year.

 
 

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.

 
 

State Medicaid Director Liz Matney told the Council on Human Services the state will seek a third managed care organization later this year.

Iowa Medicaid officials said the state plans to start taking applications for a third managed care organization later this year.

Iowa has had just two managed care organizations for its Medicaid program since United Healthcare left the state in June 2019.

Amerigroup and Iowa Total Care, which joined the state on July 1, 2019, the day after United Healthcare officially pulled out, are the state’s two current MCOs.

State Medicaid Director Liz Matney, who started in her new position last month, told the Council on Human Services on Thursday that the state intends to search for another MCO.

“We did put up our notice for intent to do a request for proposal. So we are going to be soliciting bids later this year,” she said.

According to the notice, the state is going to release the request for proposals on or around Dec. 22.

Matney said Amerigroup’s contract ends in 2023, and Iowa Total Care’s contract ends in 2025.

State Releases $44 Million To Iowa Total Care

Matney also told the council that the state has released $44 million back to Iowa Total Care that was withheld over payment issues.

The state announced in January of last year that it would withhold the money from Iowa Total Care after it failed to pay 106,000 Medicaid claims.

Matney said the MCO completed the final phase of its claims audit review this spring.

“We had the report back and they met the threshold of what we had determined to be, you know, a successful outcome,” she said.

The state’s Medicaid program serves more than 700,000 Iowans.

Clipped from: https://www.iowapublicradio.org/state-government-news/2021-07-08/iowa-medicaid-officials-to-seek-another-medicaid-managed-care-organization


 
 

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Division of Medicaid and Medical Assistance to Gather Feedback on Managed Care Organizations, Ways to Improve Program

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Delaware is beginning the process to shape its next Medicaid managed care RFP.

 
 

 
 

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.

 
 

NEW CASTLE (July 13, 2021) – The Department of Health and Social Services’ Division of Medicaid and Medical Assistance (DMMA) is beginning the process of identifying Managed Care Organizations (MCOs) to operate its Medicaid Managed Care Program beginning Jan. 1, 2023.

DMMA currently contracts with two MCOs, AmeriHealth Caritas Delaware and Highmark Health Options. to provide physical health, behavioral health, and long-term services and supports to individuals, families, children, and seniors enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in Delaware. Those contracts expire at the end of 2022.

Delaware’s Medicaid managed care program provides comprehensive health coverage to more than 240,000 eligible Delawareans, or almost 25% of the state’s population.

This procurement process is an opportunity for DMMA to reexamine and improve the program and expectations for the MCOs. Strategic principles for the 2023 procurement include:
Member focus: Medicaid innovation should improve quality and outcomes for members and advance health equity.
Accountability: MCOs will have increased accountability to the Delaware Department of Health and Social Services (DHSS) for program costs, performance, and creativity.
• Lead by example: Medicaid, in partnership with the MCOs, will lead by example when it comes to innovation across Delaware’s health care system.
• Promote program evolution: DMMA will use the procurement process as an opportunity to build upon the existing contract and our successes in Medicaid and CHIP.
Cross-agency collaboration: DMMA will look for ways to align with other DHSS programs and state initiatives.

DMMA will host four virtual town hall meetings to get input on goals and procurement priorities for the managed care delivery system. Meetings are open to the public; however, each meeting will focus on getting feedback from either members or providers. Closed captioning and an ASL interpreter will be available for all meetings.

“Medicaid managed care offers flexibility to implement innovative programs that support health care providers and enhance health outcomes for our members,” said Steve Groff, Director of DMMA. “We hope the Town Halls will give interested parties the opportunity to share best practices and provide input with regard to program improvements.”

The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

 
 

Clipped from: https://news.delaware.gov/2021/07/13/division-of-medicaid-and-medical-assistance-to-gather-feedback-on-managed-care-organizations-ways-to-improve-program/

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Costs Watched as Medicaid Managed Care Begins in N. Carolina

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After 6 years, the North Carolina managed care implementation has finally arrived.

 
 

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.

 
 

Written by GARY D. ROBERTSON

After six years of preparations and delays, most of North Carolina’s Medicaid recipients switched over to managed care Thursday with its developers hopeful the changes will mean improved health outcomes and controlled costs.

“It’s been a long time coming,” said Rep. Donny Lambeth, a Forsyth County Republican who helped pass the managed care law in 2015 and other legislative adjustments, some finalized just this week.

Four statewide health plans and one multi-regional plan will now handle care for roughly 1.6 million of the nearly 2.5 million consumers covered by Medicaid — mostly poor children and older adults — as well as from another program for children in low- and middle-income families. Another smaller plan for Eastern Band of Cherokee Indians members also has started.

More Medicaid consumers, particularly those with substance abuse issues, developmental disabilities and severe mental health troubles, shift to similar managed care coverage in July 2022.

“It’s the biggest change to our program in its history,” said Health and Human Services Secretary Mandy Cohen, whose agency awarded the five-year plan contracts — expected to cost $6 billion annually — and carries out the law.

The Medicaid overhaul initially was supposed to start in 2018 or 2019. But it got delayed as Republican legislators and Democratic Gov. Roy Cooper were knotted in a budget impasse centered on whether to expand Medicaid to cover hundreds of thousands of adults through the federal Affordable Care Act. Expansion still has not happened.

As the largest state by population yet to switch to managed care, North Carolina’s foray into privatized Medicaid will be watched closely by other states and Medicaid experts. In mid-2018, almost 70% of the nation’s Medicaid enrollees were participating in managed care plans in nearly 40 states, or about 54 million people, according to Kaiser Family Foundation data. Enrollment

For decades, Medicaid has used a traditional fee-for-service process, whereby providers bill the state for each test or procedure. Now health plans will receive monthly payments for each patient enrolled. For example, health plans initially will receive on average $170 monthly for each covered child and $420 for each adult, according to Department of Health and Human Services data.

The plans’ financial gains or losses will depend on what’s left over after medical expenses and other costs. Healthier patients could mean monetary bonuses, with financial penalties possible for poorer outcomes.

Patients have signed up for a health plan — some operated by Blue Cross and Blue Shield and United Healthcare and others with less familiar names like WellCare and AmeriHealth Caritas — or have been enrolled automatically in one. Medical providers have entered into contracts with plans and consumers are being told what to expect.

“We feel very good at this point,” state Medicaid director Dave Richard said. “There will be things that don’t work anytime you have something this big, but I think we’re as prepared as possible come July 1.”

Managed care was embraced by former Republican Gov. Pat McCrory after Medicaid cost overruns in the late 2000s and early 2010s.

Initially, Medicaid spending under managed care will increase, with new administrative and underwriting expenses and more consumers still covered in the COVID-19 pandemic. Medicaid spending this coming year is projected at $18.3 billion, with 70% paid through federal funds and the rest from the state and other sources. Medical service spending is projected to decline as managed care matures.

Lambeth, a former hospital executive, is hopeful eliminating medical redundancies will curb overall costs. Keeping costs under control will require significant DHHS and legislative oversight of the health plans, said Hemi Tewarson, executive director of the National Academy for State Health Policy.

State officials must “really push them to do all the things that they should be doing or could be doing,” Tewarson said in an interview.

Tewarson said she’s anxious to see how North Carolina conducts pilot projects that will target further ways to address the non-medical needs of Medicaid patients such as homelessness, transportation and access to healthy foods.

Lambeth said he’s concerned some providers are not ready to handle the paperwork that managed care requires. Other small-town doctors or personal care agencies may not have entered contracts with multiple health plans, meaning some patients may learn they can’t use those providers.

Michelle White, a director of Cone Health’s HomeCare Providers, covering four central counties, said consumers who have been struggling during the pandemic may not realize how managed care could affect them.

“What’s going to happen July 1 and the days and the weeks to follow will be somewhat of an awakening as people start to understand that there have been changes with their Medicaid,” said White, whose agency will serve about 100 Medicaid managed care patients daily. “We’re going to have work to do as an industry to really help them get settled into the right plan, the plan that’s going to meet their needs.”

 
 

Photo via Robert Willett/The News & Observer and the Associated Press.

Clipped from: https://chapelboro.com/news/state-government/costs-watched-as-medicaid-managed-care-begins-in-n-carolina

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Anthem completes acquisition of Puerto Rico-based MA, Medicaid plans

 
 

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Anthem completed the purchase this week, adding 3% to its overall Medicaid enrollment numbers.

 
 

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.

 
 

 
 

Dive Brief:

  • Anthem on Wednesday announced it had completed its acquisition of Puerto Rico-based MMM Holdings, a vertically integrated health plan, in a move that will expand the payer’s presence in Medicare and Medicaid.
  • Anthem nabbed MMM from value-based payer InnovaCare Health in a deal first announced in February that represents the payer’s first foray into Puerto Rico. Financial terms of the acquisition were not disclosed.
  • MMM is the ninth-largest MA plan in the U.S. and the biggest in Puerto Rico, with more than 275,000 members, and Puerto Rico’s second-largest Medicaid plan, with 314,000 beneficiaries.

Dive Insight:

With the acquisition, Anthem is doubling down on its government business, which fueled the majority of its enrollment growth last year amid COVID-19 as commercial rolls stayed largely stagnant.

The Indianapolis-based payer’s commercial business makes up about three-fourths of its membership, but its government products have been growing rapidly, according to recent financial filings. At the end of the first quarter, Anthem covered 9.2 million people in Medicaid and 1.5 million people in MA.

With the addition of MMM’s beneficiaries, the payer is swelling its Medicaid rolls by 3% and its Medicare Advantage rolls by 18%.

In statements announcing the news, Anthem executives said MMM’s vertically integrated organization fit well with Anthem’s whole-person approach. MMM operates a series of physician groups and specialized clinics, which all together gives it a network of more than 10,000 providers across Puerto Rico.

Anthem, which covers 43 million Americans, said when announcing the acquisition earlier this year it wouldn’t have a material effect on 2021 earnings. The payer did originally cut its 2021 outlook after experiencing a rebound in care in the fourth quarter, depressing net income, but its finances had largely bounced back by the first quarter of this year.

In the quarter, Anthem reported year-over-year profit growth of over 9% — helped significantly by a major increase in Medicaid membership.

Now, Anthem expects 2021 net income to be greater than $24.05 a share. Part of its strategy to drive income growth coming out of the tumultuous economic and coverage environment created by the pandemic is building up its end-to-end care offerings and diversifying into health services, a step most major insurers are also taking as the line between traditional payers and providers increasingly blurs.

As part of that strategy, Anthem in February completed its acquisition of Beacon Health Options, previously the biggest independent behavioral health organization in the U.S., serving more than 34 million people. Two months later, Anthem finalized a second acquisition, this time of post-acute benefits management company myNexus.

The insurer has also been upping its tech investments in a bid to streamline back-end functions and create more cohesive consumer platforms. In February, Anthem pledged to invest at least $25 million in Sharecare, a digital health company that aims to help consumers manage different elements of their health in one platform. Then, in April, Anthem launched a joint venture in partnership with investment giant Blackstone and digital health startup K Health focused on leveraging technology to better triage patient care and cut costs.

Anthem is now grabbing MMM from White Plains, New York-based InnovaCare, which manages more than 500,000 lives. InnovaCare is a portfolio company of global growth equity investor Summit Partners, which has invested in a number of healthcare companies, including dialysis operator U.S. Renal Care and MD VIP, a concierge physician practice.

Clipped from: https://www.healthcaredive.com/news/anthem-completes-acquisition-of-puerto-rico-based-ma-medicaid-plans/602626/