Tag: State News

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Hospitals question fee increase to help pay for Medicaid expansion

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OK hospitals are not happy about a proposed 1.5% increase on the “taxes” they pay to get more federal draw down funds.

 
 

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 CITY — Despite an influx of hundreds of millions of federal dollars earmarked to help pay for Medicaid expansion, lawmakers are proposing increasing fees paid by hospitals with the money to be used for the same purpose.

“While we’re not opposed to doing our part to increase access to care, we are disappointed that the Legislature chose not to use the hospital fee as a backstop considering that we have federal funds available for the next eight quarters,” said Patti Davis, president of the Oklahoma Hospital Association.

She said the state’s hospitals are still in “recovery mode” from the pandemic, and they would prefer legislators would first use the hundreds of millions in additional federal funding before increasing their assessment rate.

The state’s Supplemental Hospital Offset Payment Program, or SHOPP fee, is a self-assessment that allows hospitals to maximize federal Medicaid matching funds by supplementing state Medicaid funding.

Senate Bill 1045, which already cleared the state Senate this week, would increase that assessment rate from 2.5% to 3% for calendar year 2022, then raise it to 3.5% in 2023 and finally to 4% in 2024.

Currently, 68 hospitals are obligated to pay the fee out of their annual operating budget, including those in Duncan, Claremore, Chickasha, Enid, McAlester, Stilwell, Ada, Norman, Tahlequah, Muskogee, Oklahoma City, Tulsa and Stillwater.

In a bid to help states, Davis said the federal American Rescue Plan Act earmarked specific funds to states to cover costs of Medicaid expansion. Oklahoma received more than enough to cover its expansion for the first two years, she said.

“While we understand it’s one-time funds, we were certainly hoping that that might provide a little bit more gap for hospitals,” she said.

Davis also said she hasn’t gotten any clarity from the Health Care Authority or the Legislature just how exactly they’re going to use that supplemental federal funding.

Melissa Richey, a spokeswoman for the Oklahoma Health Care Authority, said there is no explicit directive from the federal government over how those American Rescue Plan and Families First Coronavirus Response Act funds are to be used.

The state agency has received only $240 million in enhanced federal funds to date, she said. The benefit is received over time and not as a lump sum.

State Rep. Kyle Hilbert, R-Bristow, the House author, said the federal coronavirus funds went toward Medicaid expansion, which freed up $164 million in state money to be put into a rate preservation savings account. That brings the fund’s balance up to about $197 million.

In 2019, the Legislature created the fund to save a portion of the match the state receives on its federal dollars when its reimbursement rate is high. The amount the state receives from the federal government fluctuates based on the health of the state’s economy, Hilbert said.

Because Oklahoma’s economy is thriving and its budget has seen a $1 billion surplus, lawmakers are bracing for a steep drop in the reimbursement rate in the next three years.

In the past those drops resulted in provider rate cuts, but the new rate preservation fund is designed to prevent cuts across the board, Hilbert said. The state’s current match rate is 68%, but could drop as low as 50% depending on the health of the economy, he said.

Every 1% drop in federal matching funds will cost taxpayers about $54 million, he said.

The new SHOPP fee is expected to generate $37 million in the first year, and will help offset some of the $164 million price tag to pay for Medicaid expansion, he said. Lawmakers expect an additional 200,000 people to be eligible for the program.

Hilbert said it’s irresponsible to pay for ongoing expansion expenses with one-time revenue sources.

“It’s just like drawing down your retirement fund to start making payments on your mortgage,” he said. “Eventually you’re going to run out of retirement money. You’ve got to have some revenue source to help fund your ongoing expenditures, and that’s why the increase in SHOPP is necessary to fulfill the will of the Oklahoma voters and funding Medicaid expansion.”

Janelle Stecklein covers the Oklahoma Statehouse for CNHI’s newspapers and websites. Reach her at jstecklein@cnhinews.com.


Clipped from: https://www.stwnewspress.com/news/hospitals-question-fee-increase-to-help-pay-for-medicaid-expansion/article_689342fc-b900-11eb-b270-37fd5e8a42d4.html

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Potential seen for big financial paybacks from insurers to Medicaid

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Georgia is getting ready for its next round of MCO procurements.

 
 

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.

 
 

The state’s Medicaid agency is setting up plans for a health insurer bidding competition that will award a new multibillion-dollar medical contract.

“We’ll be looking for the best bang for the buck,” Frank Berry, commissioner of the Georgia Department of Community Health (DCH), said last week at an agency board meeting.

 
 

Berry

The current Medicaid insurers are being paid a total of about $4 billion a year for delivering medical services to more than 1 million members.

Long before a new contract is reached, there could be a substantial payback of money by the insurers, called care management organizations (CMOs), to the government program.

According to industry rumors, the “clawbacks” of money from these insurers in Georgia could exceed $200 million.

Medicaid is jointly financed by the state and federal governments, covering low-income and disabled residents. The CMO insurers – Peach State, Amerigroup and CareSource – are paid a per-member, per-month rate to care for Medicaid members.

DCH officials told GHN that they are “reviewing for any clawbacks that may currently be unresolved.”

Clawbacks come when an organization believes it has overpaid for services, and “claws back that money,” said Bill Custer, a health insurance expert at Georgia State University. “It happens quite a bit in Medicare and Medicaid. Depending on the amount, it may be a big deal or not.”

State officials did not disclose the amount under review.

An insurance industry official who represents the CMOs, Jesse Weathington, also did not specify the amount of money being scrutinized.

“We appreciate Commissioner Berry’s willingness to have further discussion about the true effects of the COVID-19 pandemic on Medicaid,” said Weathington, executive director of the Georgia Quality Healthcare Association, in a statement Wednesday. “Like other health plans, we saw [medical care] utilization bounce back to normal levels very quickly following the statewide shutdown last year.  We look forward to working with DCH to ensure their estimates are based upon factual data.

“Our mission to improve health care outcomes in the most cost-efficient manner for over 1.5 million Georgians remains the same,” he said, “and not even a 100-year pandemic will deter us from that objective.”

Expanding managed care?

The current CMO contract is set to expire June 30, 2022. But DCH says it’s looking to extend the contract for another two years ”to allow for additional time to complete the new procurement.” That would mean an expiration date of June 30, 2024.

DCH officials said the state aims to focus primarily “on quality, performance and [medical] outcomes” with the new contract.

An open question is whether the state will eventually launch managed care for members who are eligible for Medicaid because they are “aged, blind or disabled.”

DCH said it “will first seek to explore what is best for this population in terms of quality, performance and outcomes prior to making this determination.

Many states have moved their aged and disabled Medicaid beneficiaries into managed care.

Georgia State’s Custer said such a shift would require the formation of provider networks to serve that population, such as nursing homes.. An estimated 75 percent of nursing home residents in Georgia are covered by Medicaid.

Managed care for the aged, blind and disabled “would look very different” from the current format, Custer said. “The idea is to develop a medical home for that person.” A “medical home” is a model of care in which a patient’s total medical needs are coordinated by a specific provider.

The state would have to focus on monitoring quality of care for such an arrangement to succeed, he added.

 
 

Clipped from: http://www.georgiahealthnews.com/2021/05/potential-big-financial-paybacks-georgia-insurers-medicaid/

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Group ‘reluctantly’ suspends Medicaid expansion ballot push

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The group pushing for expansion in MS has stopped its efforts after the state supreme court ruled the ballot initiative process in general is flawed.

 
 

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.

 
 

 
 

JACKSON, Miss. (AP) – A group that was pushing to get Medicaid expansion on the ballot in Mississippi is “reluctantly” suspending its campaign.

The decision comes after the state Supreme Court ruled Friday that a medical marijuana initiative passed by voters this fall is void because Mississippi’s initiative process is outdated. That effectively killed other initiatives for which people are already petitioning.

Organizers of Initiative 76 said in a statement that it is halting its campaign “until there is once again a functional ballot measure process in Mississippi.” Medicaid is a health insurance program for the needy, aged, blind and disabled. It is paid by federal and state money.

 
 

Clipped from: https://www.wxxv25.com/2021/05/19/group-reluctantly-suspends-medicaid-expansion-ballot-push/

 
 

 
 

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GOP leaders reject Tony Evers’ proposal for Medicaid expansion

 
 

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Wisconsin Medicaid expansion has been rejected by the legislature during a special session.

 
 

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.

 
 

MITCHELL SCHMIDT

State Republican leaders have rejected Gov. Tony Evers’ proposal to expand Medicaid access in the state and use a large chunk of the $1 billion in one-time federal funds that would come with expansion toward economic development projects across Wisconsin.

Evers on Wednesday called the Legislature into session to expand BadgerCare to reach an estimated 91,000 new residents. Hours after the Democratic governor’s proposal, Republicans signaled they remain opposed to expanding Wisconsin’s federally funded health care program for low-income individuals, which has been one of Evers’ signature policy priorities.

During a news conference at Middleton’s Benevolent Specialist Project Free Clinic, the Democratic governor put what he called “a billion-dollar signature” on his executive order calling on the GOP-led Legislature to hold a special session next Tuesday on BadgerCare expansion, which Republicans in the state budget committee stripped from Evers’ proposed 2021-23 biennial budget earlier this month.

“It’s time for Republican leadership to put politics aside and recognize this is a great deal for all of us,” Evers said. “Enough politics. Let’s get to work.”

Later that day, Assembly Speaker Robin Vos, R-Rochester; Senate Majority Leader Devin LeMahieu, R-Oostburg; Assembly Majority Leader Jim Steineke, R-Kaukauna; Senate President Chris Kapenga, R-Delafield; and budget committee co-chairs Sen. Howard Marklein, R-Spring Green, and Rep. Mark Born, R-Beaver Dam, issued a joint statement rejecting the governor’s proposal.

 
 

Clipped from: https://www.lakegenevanews.net/news/state-and-regional/govt-and-politics/gop-leaders-reject-tony-evers-proposal-for-medicaid-expansion/article_1feadcf8-1d94-58ee-b86e-239a7977fda2.html

 

 
 

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Missouri pulls Medicaid expansion

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MO officially withdrew its plan to CMS for Medicaid expansion this week after lawmakers failed to provide the separate funding required by law.

 
 

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.

 
 

 
 

 

The Missouri Department of Social Services today submitted a letter to the Centers for Medicare and Medicaid Services withdrawing its Medicaid expansion plan.

Gov. Mike Parson’s office issued a news release indicating the executive branch lacks authority to expand MO HealthNet, the state’s Medicaid program, since the ballot initiative was not self-funding and the legislature voted to not appropriate funds.

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” Parson said in the release. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time.”

Amendment 2, the Medicaid expansion ballot initiative, was passed by voters in August 2020 by a roughly 53% margin. Opponents of the legislation have said the state cannot afford Medicaid expansion. In his January 2020 State of the State address, Parson warned expansion could come at the cost of education, workforce development and infrastructure funding, according to past reporting.

The Missouri Senate late last month voted against funding the expansion by a 14-20. According to the St. Louis Post-Dispatch, the decision impacts as many as 275,000 low-income Missourians and likely sets up a court battle.

The nonprofit public policy Missouri Budget Project has estimated the American Rescue Plan Act approved by Congress this year could lower the state’s Medicaid contribution by more than $1 billion over a two-year period, according to statehouse reporter Phill Brooks of Missouri Digital News. The estimated state cost for Medicaid expansion is $130 million per year, he said.

Missouri House Minority Leader Crystal Quade, D-Springfield, said the Medicaid decision amounts to Parson “breaking his promise to the people of this state.”

“Whatever reputation he once had for respecting the law is gone forever, and he is just another politician whose word can’t be trusted,” she said in a statement. “Medicaid expansion will still happen as the constitution requires, but because of the governor’s dishonorable action, it will take a court order to do it.”

 
 

Clipped from: https://sbj.net/stories/missouri-pulls-medicaid-expansion,74164

 
 

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Oklahoma lawmakers seek to put ‘guardrails’ on privatized Medicaid expansion

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OK anti-managed care sentiment pivots into increasing the oversight function of MCOs once implemented.

 
 

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 CITY (KFOR) – Gov. Kevin Stitt has been pushing for privatized Medicaid expansion for months and it looks like he will get his wish.

It looks like legislators have given up their fight to keep the expansion, voted for by Oklahomans last year, in the hands of the state, but that doesn’t mean they are done with the issue.

House of Representatives votes on legislation to challenge Gov. Stitt’s plan to privatize Medicaid

They are now focusing on making sure Oklahoma doesnt repeat the mistakes made by the 42 other states that have some sort of managed care.

“There are some things that we have seen in other states that managed care companies have done that make it really hard for providers to be successful,” said Sen. Greg McCortney.

The Republican from Ada is talking about the rewriting of Senate Bill 131. Instead of pushing for state-run Medicaid expansion. The authors say it puts guardrails on the Governor’s privatized plan to make sure Managed Care Organizations keep up their end of the deal.

Gov. Stitt criticizes House Public Health Committee’s challenge to his Medicaid privatization effort

“Making sure our providers get paid in time, making sure that the Medicaid patients themselves don’t have to wait long for prior authorizations,” said Rep. Marcus McEntire, the bill’s co-author.

“In rural Oklahoma, we want to make sure that we protect those providers so our hospitals stay open, our doctors can stay in small town Oklahoma. So we put some guardrails in to make sure that the way they work with these managed care organizations can make everybody successful,” said McCortney.

The bill also makes sure that if MCO’s don’t follow rules they would be breaking state law

“Unfortunately, a lot of these policies have been around for a long time, since it took Oklahoma so long to accept Medicaid expansion. There are a lot of lessons to be learned from other states mistakes,” said Senator Mary Boren.

Oklahoma’s top physician & health groups file motion for injunction against Gov. Stitt’s Medicaid managed care plan

Lawmakers are calling this a compromise bill, but some still think state-run expansion was the way to go. They say only two of the four MCO’s involved are Oklahoma based.

“I just personally don’t want to see Oklahoma’s tax dollars going to enrich huge companies. I’d rather use that money to invest back into our healthcare system within the state,” said McEntire.

“It’s absolutely not my dream come true bill. I’ve come to believe that good policy is policy where everyone is angry and right now we have very good policy, I believe,” said McCortney.

Governor Stitt and Oklahoma Health Care Authority announce managed care organizations to assist with Oklahoma Medicaid, despite pushback from lawmakers

If the bill passes through the House and Senate as expected it would likely face a veto from the Governor.

“If the Governor vetos the bill, I very much expect the legislature to take up an override on the veto,” said McCortney.

We reached out to the Governor’s office. They say they don’t have any comment on the bill at this time. The guardrail bill did pass through the Senate today; it now moves to the House.

 
 

Clipped from: https://kfor.com/news/oklahoma-legislature/oklahoma-lawmakers-seek-to-put-guardrails-on-privatized-medicaid-expansion/

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Texas sues Biden admin over decision to pull Medicaid waiver

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The lawsuit accuses CMS of breach of contract and abuse of federal power to compel the state to adopt Medicaid expansion.

 
 

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.

 
 

Texas has sued the Biden administration over its decision to revoke a waiver that extends the state’s Medicaid program.

The federal lawsuit, filed Friday, calls for the waiver surrounding the state’s Medicaid program to be reinstated. It said the original decision by the Biden administration last month was without warning or proper authority.

“The Biden administration cannot simply breach a contract and topple Texas’ Medicaid system without warning,” said Texas Attorney General Ken Paxton in a statement Friday. “Not only does this violate agency regulations and threaten to rip a $30 billion hole in Texas’ budget.”

The Centers for Medicare & Medicaid Services said in a letter to the state last month that the process to approve the waiver was flawed and that it did not include time for public comment. The agency was also concerned with the length of the extension, which runs through 2030 and is typically longer than waivers for other state Medicaid programs.

Texas’ Healthcare Transformation and Quality Improvement Program expires Sept. 30, 2022, and administers benefits for Medicaid enrollees via the state’s managed care program.

The Trump administration fast-tracked the original waiver and approved it on Jan. 15.

 
 

The lawsuit charges that the Biden administration’s decision is part of an effort to compel the state to expand Medicaid under the Affordable Care Act and called the threat unconstitutional.

It calls for the Biden administration’s decision to be set aside as it imposes “unconstitutional conditions on federal funding for Texas’ Medicaid program.”

Rep. Michael Burgess, R-Texas, grilled Department of Health and Human Services Secretary Xavier Becerra about the waiver withdrawal during a recent hearing before the House Energy and Commerce Committee.

Becerra told lawmakers that the current Medicaid program runs through September 2022, and there is plenty of time to renegotiate a new extension.

He said if there were an extension of an existing waiver, it must comply “with all aspects of the law and the notice and public comment was deficient.”

Clipped from: https://www.fiercehealthcare.com/payer/texas-sues-biden-admin-over-decision-to-pull-medicaid-waiver

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State Sues Feds Over $97.57 Million In Medicaid Money

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FL is suing CMS over supplemental payments the feds denied.

 
 

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.

 
 

 
 

The dispute stems from a decision by the HHS “disallowing” Medicaid reimbursements from July 1, 2006 to June 30, 2013, according to the lawsuit filed in federal court in South Florida.

The Florida Agency for Health Care Administration has filed a lawsuit against the federal government in a dispute about $97.57 million in Medicaid payments, primarily involving Jackson Memorial Hospital in Miami.

The lawsuit, filed Tuesday in federal court in South Florida, stems from a decision by the U.S. Department of Health and Human Services “disallowing” Medicaid reimbursements from July 1, 2006 to June 30, 2013, according to the lawsuit.

The dispute involves supplemental Medicaid payments through what is known as the Low Income Pool, or LIP, program. That program is designed primarily to help hospitals such as Jackson that treat large numbers of poor and uninsured patients.

The federal Centers for Medicare & Medicaid Services, which is part of the Department of Health and Human Services, disallowed $146.1 million in costs in September 2016 and later revised the amount to $97.57 million.

The lawsuit said more than $92 million of the disallowed amount involved LIP payments to Jackson in 2012 and 2013.

A Department of Health and Human Services appeals board on Feb. 25 upheld the disallowance, which was based on a dispute about calculations.

 
 

Clipped from: https://wusfnews.wusf.usf.edu/politics-issues/2021-04-30/state-sues-feds-over-97-57-million-in-medicaid-money

 
 

 
 

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This state is strongly considering a 10% Medicaid pay boost, and officials likely will dictate precisely how providers spend it

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NJ and other states are considered upping nursing home rates, but want to see it tied to increased wages.

 
 

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 Jersey’s governor has proposed a 10% Medicaid pay increase for nursing homes, with the kinds of strings attached that providers might ultimately view as needed lifelines.

Gov. Phil Murphy (D) is touting plans to spend $134.4 million next year to improve wages for direct care staff in nursing homes. But of the targeted 10% increase in the Medicaid nursing facility rate, facilities would be required to spend at least 60% to boost wages, while the rest would have to be used toward statewide infection control requirements. 

Murphy’s spending plan, which could be amended or replaced by the state legislature before passage next month, also includes $30 million to fund annual direct-care minimum wage increases.

“The committed workers showing up daily to care for some of our most vulnerable deserve to know they’re valued and supported,” Human Services Acting Commissioner Sarah Adelman said in a statement Tuesday.

Unlike many states grappling with their budget process, New Jersey has come through the pandemic on relatively solid financial footing, which the governor acknowledged while outlining the broader budget earlier this year. Murphy’s new support for long-term care staff would be funded without a tax increase.

Trending in other states

Provider associations in other states also are clamoring for Medicaid increases, and several have said they’d be willing to accept restrictions like the ones Murphy is proposing.

In March, LeadingAge Texas President and CEO George Linial said low Medicaid rates were a major contributor to nursing home staff turnover. He has advocated for a link between provider reimbursement increases and wage hikes.

“We really want any increase in Medicaid rates to be tied to staff wages and benefits,” Linial told McKnight’s Long-Term Care News at the time. “We definitely know that we need more funding, but there has to be accountability for that.”

While states including Florida and Pennsylvania have proposed flat (or lower) Medicaid funding for next year, others are joining New Jersey in considering more funding for nursing homes.

Maine leaders Tuesday held a hearing to consider a bill that requires the state to reconsider the base rate for its MaineCare Medicaid program every two years, which would enable the state to support providers in giving frontline workers raises.

Following up on recommendations from a long-term care task force, the bill would require direct care workers across the long-term care spectrum to be paid at least 125% of the minimum wage, which hit $12.15 per hour as of Jan. 1.

The bill also charges state officials to “take into account” costs of providing care and services, such as training requirements; quality and safety standards; future increases in the minimum wage; earned paid leave; electronic visit verification; and “other costs that are not provided for in the current reimbursement.”

 
 

Clipped from: https://www.mcknights.com/news/this-state-is-strongly-considering-a-10-medicaid-pay-boost-and-officials-likely-will-dictate-precisely-how-providers-spend-it/

 
 

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Medicaid agency poised to extend contract with Centene, embattled insurer and big campaign donor

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Mississippi will use the optional renewals in the current contract to extend its agreement with Centene next 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.

 
 

 
 

Centene has been filling the campaign coffers of Mississippi officials for years and is one of Gov. Tate Reeves’ largest donors.

Mississippi’s contract with Centene, an insurance company state officials are currently investigating over suspicions it overcharges taxpayers to boost its profits, is set to expire at the end of June, providing an opportunity for the state to end business with the company.

But the Mississippi Division of Medicaid, an agency under the governor’s office, expects to extend the contract for another year without issuing a new bid, agency spokesperson Matt Westerfield told Mississippi Today last Wednesday.

Centene, parent company to Magnolia Health, is one of three insurance companies the state pays to provide health coverage to the state’s most vulnerable residents, mostly children of poor families. Meanwhile, the insurer has been filling the campaign coffers of Mississippi officials for years and is one of Gov. Tate Reeves’ largest donors, contributing as large as $50,000 at a time to his campaign for a total of more than $200,000.

In the managed care program, called MississippiCAN, the state pays the insurers an up-front, per-member rate every month to cover about 485,000 recipients, as opposed to the state paying health care providers and pharmacies their fees and prices directly. About 64% of Medicaid recipients are in managed care and the rest — typically the more medically fragile patients — have fee-for-service Medicaid.

Centene pulls millions in taxpayer dollars for its role as middleman, and the state auditor and state attorney general are now investigating whether it used deceptive practices within its pharmacy benefits, the Northeast Mississippi Daily Journal first reported in March. Officials say the investigation resembles a lawsuit in Ohio, in which state officials allege Centene inflated drug dispensing fees, hid the true cost of pharmacy services and double-dipped its reimbursement.

A Magnolia Health spokesperson told Mississippi Today that the claims are unfounded and that the company has actually saved taxpayers millions of dollars. A written statement said Magnolia expects to return about $75 million to Mississippi “as a result of lower utilization brought on by COVID-19.”

“Recent criticisms and inaccuracies have been largely driven by parties with a longstanding agenda against Medicaid Managed Care,” the Magnolia statement reads.

Often when a state contract ends, the corresponding agency issues a Request for Proposals, or RFP. Vendors respond and the state awards a new contract based on how they score the proposals.

The Division of Medicaid typically takes its direction from the governor, but Westerfield said the agency believes it can extend its contract with Magnolia for another year “on its own” as long as it has approval from the Public Procurement Review Board.

Reeves’ office did not respond to Mississippi Today’s questions regarding the governor’s support for a contract extension.

The original three-year contract, which began in 2017 and was extended last year, is set to expire at the end of June, but contains an optional renewal through 2022. The Medicaid tech bill lawmakers passed this year also allows for an one-year emergency extension on the contract. Either would allow Magnolia to continue receiving millions from the state, even as the investigation continues.

“We as taxpayers deserve better than we’re getting,” said state Rep. Becky Currie, R-Brookhaven. “We need to let the RFP run its course in September (sic) just like it always does. I just believe that putting it off a year is just going to give Centene time to sweep things under the rug.”

Officials expect the investigation to conclude as early as this summer.

Investigators are focusing on the actions of Centene’s pharmacy benefit managers, third-party companies that manage pharmacy benefits for insurers. Magnolia paid its PBMs, extra middlemen that pharmacists have long bemoaned, more than $1.1 billion from 2016 to 2020, according to data the Medicaid division provided Mississippi Today.

The Mississippi Legislature addressed PBMs in 2018 when it prohibited the companies from including “gag clauses” in their contracts with pharmacies. These provisions had prevented pharmacists from telling patients cheaper ways to pay for their medication, such as if their copay is higher than the cash price of the drug.

When State Auditor Shad White took office later that year, his first announcement was that his office had found $600,000 worth of improper Medicaid payments to managed care companies. The office’s ongoing investigation into Centene began not long after; it sought help from a local firm in April of 2019, Daily Journal reported.

The lawsuit in Ohio is ongoing; Centene argues it adhered to its contract and followed state law. The Ohio attorney general Dave Yost alleged Centene’s “corporate greed” led its Ohio subsidiary to inflate costs through its pharmacy benefit managers.

“So why would we extend their contract?” Currie said. “Do we want to have a company with such corporate greed taking care of the most vulnerable people in our state? The sickest, fragile people in our state. I mean, it’s a no-brainer for me. We don’t want that.”

— Article credit to Anna Wolfe of Mississippi Today —

 
 

Clipped from: https://www.hubcityspokes.com/politics-state/medicaid-agency-poised-extend-contract-centene-embattled-insurer-and-big-campaign-60916a95579dd