Tag: State News

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Nevada lawmakers told Medicaid will require nearly $12 billion over 2 years

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Medicaid now consumes more than 33% of the Nevada budget, and will spend $2B next year than the year before.

 
 

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.

 
 

Lawmakers were told Thursday that the total Medicaid budget will consume $11.87 billion over the coming two-year budget cycle, more than a third of the total state budget for the coming two years.

That is an increase of $2.3 billion over the current budget, largely the result of the economic collapse caused by the pandemic.

Medicaid Administrator Suzanne Bierman told members of the Senate Finance and Assembly Ways and Means committees the reason is that the number of people receiving Medicaid coverage increased 128,139 since February 2020. By the end of the coming biennium, officials predict Medicaid will be serving 788,000 Nevadans — more than a quarter of the state population.

The federal government is currently covering 68 percent of that amount through the enhanced federal contribution that historically pays most of Medicaid for the states. Bierman said projections are that the percentage will decrease to 63 or 64 percent in the coming two years.

Officials are hoping the enhanced match percent will be extended but that decision hasn’t yet been made.

The total budget proposed by Gov. Steve Sisolak is $31.4 billion for the coming two years. While Medicaid is the majority of HHS spending, the department’s total budget is fully half the entire state budget at just over $15 billion when its other divisions are added in.

The proposed Medicaid budget does restore the 6 percent Medicaid provider rate reduction enacted by the special legislative session last summer. But Bierman said clearing that reduction through the Centers for Medicare and Medicaid Services takes time and it has not yet been authorized.

She said, however, her division is in contact with hospitals and other providers, advising them that, if and when the reductions are approved, the payments to those providers will be reduced retroactively back to August. Providers, she said, are still getting paid at the pre-reduction rates.

Several lawmakers questioned some of the reductions in other parts of the department.

There will be reductions in other divisions including Child and Family Services, Behavioral Health, Aging and Disability Services and Welfare that officials concede could impact clients in a long list of programs to achieve the necessary budget reductions and extend some waiting lists for different services. Dozens of positions will remain vacant in fiscal 2022 but the proposed budget says most will be restored and filled in 2023 as the state continues to recover.

HHS provides all those social, mental health and health services relied upon by the poor, mentally and physically disabled, the medically frail, children and the elderly including those in all categories in long-term care facilities.

In most cases, department officials say there won’t be a reduction in services in most cases but it may take longer for new clients to get services.

Lawmakers expressed concerns about holding some professional positions vacant in the northern and southern Nevada Mental Health facilities but division officials said they are having extreme difficulties filling those posts because private facilities pay significantly more for doctors, nurses, mental health professionals and other medical and psychiatric professionals.

The legislative briefings continue Friday with overviews of the K-12 and the Nevada System of Higher Education budgets along with the military department budget.

 
 

 
 

Clipped from: https://www.nevadaappeal.com/news/nevada-lawmakers-told-medicaid-will-require-nearly-12-billion-over-2-years/

 
 

 
 

 
 

 
 

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State senators argue over plans to move Medicaid onto managed care contractors (Oklahoma)

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Lawmakers do the normal “big bad managed care” dance on the eve of managed care coming to Oklahoma.

 
 

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) – Oklahoma lawmakers are duking it out over plans to move Medicaid patients to managed care contractors. On Thursday, a group of Republican state senators joined ranks with those who oppose the change.

As the state heads toward expanding Medicaid, Gov. Kevin Stitt is seeking a managed care contractor who will take on those new patients and others.

OKDHS announces retroactive rate adjustment for Medicaid Waiver providers

But on Thursday, State Sen. George Burns and eight other state senators sent him a letter urging him to change course. The letter pointed out that the move won’t save the state money, and that those Sen. Burns knows who are familiar with managed care companies said they only benefit out-of-state insurance companies and their stockholders.

Their objections fall in line with those of several state healthcare associations who point out that while the current Medicaid program run through the Oklahoma Health Care Association works with about 3 percent overhead, a managed care company requires something closer to 12-15-percent for administrative costs.

But a different Republican lawmaker, State Sen. Kim David, is a big believer in making the change.

“We’re 48th in the nation and we have been forever,” she said. “Forty-eighth in the nation for healthcare outcomes.”

State representatives talk what’s next for Oklahoma’s Medicaid expansion funding following SQ814 failure

After years of researching solutions to Oklahoma health outcome issue, she said she’s confident managed care will provide something our current healthcare system lacks: hands-on help to navigate healthcare for Oklahomans.

“[Someone who] helps people get those appointments with those primary care providers, make those appointments, make sure they have a ride to the doctor, make sure they get prescriptions filled,” she said.

Sen. David insists this will improve patient outcomes.

As for the money issue, she said that’s not where the focus should be.

“Money does not equate health outcomes,” Sen. David said. “What they like is they like the fact that we pay in two weeks.”

Dr. Mary Clarke with the Oklahoma State Medical Association agrees that managed care does typically reimburse providers more slowly, sometimes taking several months to pay a doctor for their care.

“We may not get paid for months and that’s hard to keep the small rural practices open,” Dr. Clarke said.

Medicaid expansion leads to battle over TSET funds in SQ 814

She argued that not only did managed care not work in Oklahoma in the 1990s, but that the higher cost of the care will result in patient claims being denied.

“It’s easy to think this is going to save money and improve quality, but we have lots of historical research that will show that it does not. Trying it again is not going to come out with a different outcome,” Dr. Clarke said.

The OHCA also advocates for making the move to managed care.

Gov. Stitt was not available for an interview, but sent KFOR the following statement Thursday:

“Our state is stuck near the bottom of the list in almost every major health outcome. Oklahomans hired me to bring a fresh set of eyes to all areas of state government, and as governor, I can’t stand by and continue with business as usual when the system isn’t working. Moving to a managed care model will deliver better health care for Oklahomans and provide the cost certainty needed to protect our investment in other priorities like education and transportation.”

GOV. KEVIN STITT

Clipped from: https://kfor.com/news/local/state-senators-argue-over-plans-to-move-medicaid-onto-managed-care-contractors/

 
 

 
 

 
 

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Amazon surpasses Walmart for most Nevada employees and dependents on Medicaid

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7,892 Amazon employees are on Nevada Medicaid now, up from 4,040 last 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.

  
 

Amazon has surpassed Walmart to become the employer with the most employees and dependents on Medicaid in Nevada, according to a new report from the state. 

The number of Nevada Amazon employees and dependents on Medicaid nearly doubled year over year, increasing from 4,040 to 7,892, despite statements on the company’s website that they offer medical, prescription drug, dental, and vision coverage to all of their employees, regardless of their level or position. Amazon reports having more than 10,500 full and part time jobs in the state.

The massive jump in Amazon employees and dependents covered by Medicaid came alongside a significant jump for Integrity Staffing Solutions, a job placement company that has two of its three listed Nevada offices located at Amazon fulfillment centers.

Integrity Staffing Solutions was the fifth-largest Nevada employer of Medicaid-covered employees and dependents in the 2020 fiscal year, increasing from less than 500 in the previous year to 1,746.

Walmart, the leading employer of Nevada Medicaid recipients in the last three fiscal years, fell behind Amazon, but its number of Medicaid-covered employees and dependents also continued to rise, increasing about 11 percent from the previous year to 7,725 in the last fiscal year.

Nevada Medicaid Recipients Employed by Employers with 50 or More Employees
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Of the nearly 8,000 Nevada Walmart employees and dependents on Medicaid, 3,429 were company employees. The company reports having 14,548 employees in the state. Amazon would not indicate how many people it employs in the state.

Quentin Savwoir, the political director of Make It Work Nevada, a progressive non-profit and advocacy group, sees a problem with these increasing numbers. 

“If these corporations like Walmart, like an Amazon, invested in things like paying families quality, affordable childcare, or even just paying their employees equal pay, that would go a long way to making the lives of the women and families we work alongside a little bit better,” said Savwoir. “They wouldn’t have the need to rely on the social safety net.”

When asked for comment, Walmart’s communications department offered information about the pay and health care coverage provided to employees, including that the average total compensation and benefits for its hourly employees, both full- and part-time, is more than $18 an hour as of last January — and that eligible full- and part-time employees can receive medical coverage beginning at a cost of $30.50 per biweekly pay period. It also stated that the company’s goal is “moving people beyond entry-level jobs.”

An Amazon spokesperson said that the figures in the report are misleading because they include part-time workers and people who were only employed by Amazon for a short time, including seasonal employees.

“We have hundreds of full-time roles available, however, some prefer part-time for the flexibility or other personal reasons,” an Amazon spokesperson said.

In Nevada, households with annual incomes of up to 138 percent of the federal poverty level — $16,753 per year for an individual or $34,638 per year for a family of four — may qualify for Medicaid. A single adult with three children would have to earn almost $17 per hour while working 40 hours per week to no longer be eligible for Medicaid.

That means that even full-time employees working for companies like Amazon and Walmart could qualify. Amazon pays its employees a minimum wage of $15 per hour, and Walmart employees in Nevada earn an average wage of $14.84 per hour.

The report from the Department of Health and Human Services’ Office of Analytics, which was mandated by a bill the Legislature passed in 2017, comes on the heels of a nationwide report released last November by the Government Accountability Office (GAO) that showed some similar trends.

The GAO report found that across the 11 states studied, Walmart was consistently one of the top employers of Medicaid and SNAP recipients. The report also showed that Amazon was among the top employers of workers on Medicaid. 

Sen. Bernie Sanders of Vermont, who commissioned the GAO report, called the findings “morally obscene.”

“U.S. taxpayers should not be forced to subsidize some of the largest and most profitable corporations in America,” Sanders said in a press release.

The growth in Medicaid recipients from employers with 50 or more employees resulted in an increased cost to Nevada Medicaid of $2.8 million from the 2019 to 2020 fiscal year.

That increase was much less than the combined increase for Amazon and Walmart employees — which in 2020 was nearly $12 million more than the previous year. However, that was offset by the decrease in the number of employees and dependents covered by Nevada Medicaid at other companies, including Clark County School District, Smith’s Food and Drug and Wynn Resorts.

During the 2020 fiscal year, Amazon and Walmart employees and dependents’ cost to Nevada Medicaid was more than $43 million. In that same period, the cost to Nevada Medicaid from companies with 50 or more employees was approximately $737 million.
As of November, more than 761,000 Nevadans were enrolled in Medicaid, which was 120,000 more than the 2019 Legislature had predicted. To account for that growth, Nevada will spend an additional $153.5 million on Medicaid in fiscal year 2022, according to the latest state budget proposal.

 
 

Clipped from: https://thenevadaindependent.com/article/amazon-surpasses-walmart-for-most-nevada-employees-and-dependents-on-medicaid

 
 

 
 

 
 

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New Mexico leads nation in Medicaid health care enrollment

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43% of all people in New Mexico are on Medicaid now.

 
 

 
 

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.

  
 

SANTA FE, N.M. (AP) — New Mexico has surpassed all other states in its reliance on Medicaid health care as the coronavirus wreaks economic havoc and shifts the way people receive health care, the state’s Medicaid director told a panel of lawmakers on Friday.

Residents have flocked to the federal- and state-subsidized health care program for people living in poverty or on the cusp, with 43% enrollment statewide as of November. States including Louisiana and Kentucky rely on heavily on Medicaid to insure about one-third of their populations.

Nicole Comeaux, director of the state Medicaid Assistance Division, says enrollment has grown by about 1.5% a month since the outset of the pandemic.

That has helped deliver a windfall of federal contributions to Medicaid spending in New Mexico. The federal government provides $4.76 for every dollar in state general funds spent on the program, up from $3.65 pre-pandemic.

That equation is providing the state with an additional $385 million, under the condition that it keep Medicaid patients enrolled even as they climb into jobs and out of poverty.

The recent expansion could be costly if bonus federal matching funds expire as scheduled in April. Comeaux said the state could see a $170 million shortfall for the coming fiscal year that starts July 1.

The Legislature convened this week to craft a spending plan for the coming fiscal year.

“Only half of that population is going to fall off” Medicaid insurance, she said. “Our base budget doesn’t account for those extra folks.”

States have begun lobbying the administration of President Joe Biden for a more gradual reduction in the Medicaid match, Comeaux said.

Highlighting New Mexico’s increasing reliance on Medicaid, Comeaux said that the program pays for three-quarters of births across the state. In rural Torrance and Sierra counties, more the three-quarters of the population is insured through Medicaid and the Children’s Health Insurance Program, for families that earn too much money to qualify for Medicaid but not enough to buy private insurance.

 
 

Clipped from: https://the-journal.com/articles/199839

 
 

 
 

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Feds boost Florida’s Medicaid coffers by extending COVID-19 public health emergency

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The public health emergency was extended to April, sending $130M more to FL alone.

 
 

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.

 
 

TALLAHASSEE — Florida lawmakers have gotten a well-timed budget break thanks to a decision by the federal government to extend the nation’s public-health emergency due to the COVID-19 pandemic.

U.S. Health and Human Services Secretary Alex Azar extended the public-health emergency last week.

Azar’s decision means the federal government will continue to allocate a 6.2 percentage-point increase in money for Medicaid, the joint federal-state health care program. Before the extension, the additional funding was slated to expire in March.

Justin Senior, chief executive officer of the Safety Net Hospital Alliance of Florida, estimated that each month the extension is in effect frees up about $130 million in state money that would otherwise be needed to fund Medicaid. Senior’s association represents 14 of the state’s public, teaching and children’s hospitals.

“That’s a huge boost to the budget, both this year and potentially next year, that can help lawmakers avoid cutting health care in the middle of a pandemic,” said Senior, a former secretary of the state Agency for Health Care Administration, which runs much of the Medicaid program.

The good budget news came as lawmakers return to Tallahassee this week for the first round of committee meetings before the March 2 start of the 2021 legislative session. With the pandemic reducing state tax revenues, finding a way to balance the budget will be a major issue during the session.

Recognizing the national economic problems caused by the pandemic, Congress initially agreed in March to boost the federal Medicaid match for all states by 6.2 percentage points.

The decision by Azar to extend the emergency means that Florida should continue to receive the increased federal funding through the June 30 end of the state’s 2020-2021 fiscal year.

Medicaid provides health coverage to poor, elderly and disabled people. Enrollment in the program is countercyclical, increasing in tough economic times when there is reduced state tax revenue to help pay for it. When the economy is thriving and money to fund the program is available, enrollment decreases.

Before the COVID-19 pandemic, enrollment in Florida’s Medicaid program had usually been below 3.9 million people. As of Nov. 30, 4.475 million Floridians were enrolled in the program, a nearly 19 percent increase from the 3.76 million who were enrolled in  March 2020, prior to the economic shutdown associated with the pandemic.

While enrollment in Medicaid programs is increasing nationwide, Florida, which did not expand Medicaid eligibility under the federal Affordable Care Act, has seen some of the largest increases, according to Tom Wallace, the state Agency for Health Care Administration’s assistant deputy secretary for Medicaid finance analytics.

The Medicaid program does not cover all low-income Floridians and has different eligibility criteria based on age, income and assets and medical conditions. But increases have been seen in nearly every eligibility category, from children to poor seniors, according to Amy Baker, coordinator of the Legislature’s Office of Economic & Demographic Research.

While the federal extension means additional funds for the state, it also means additional restrictions. During the pandemic, state Medicaid officials cannot alter the program to make enrollment more restrictive than what it was prior to January 2020.

Additionally, so long as the public health emergency continues, the state is largely precluded from disenrolling anyone who was enrolled in Medicaid on March 18 or who enrolled due to the pandemic, with some limited exceptions. For instance, states can disenroll people who have been incarcerated or people who were presumed to be eligible for Medicaid but were ultimately determined ineligible.

Clipped from: https://thecapitolist.com/feds-boost-floridas-medicaid-coffers-by-extending-covid-19-public-health-emergency/

 
 

 
 

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Ohio names one pharmacy benefit manager for Medicaid to save cash

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Gainwell will become the new PBM in Ohio, beating out 5 other bidders including Express Scripts and Magellan.

 
 

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.

 
 

Ohio’s grand quest to finally slay the dragon of overcharges by pharmacy benefit managers starts Monday with the rollout of a new $158 million contract by the state Medicaid agency.

The Buckeye State’s premise, a unique approach just approved by the federal government: It takes a PBM to beat a PBM.

Bearing the sword on behalf of the state is Gainwell Technologies, a single PBM newly hired to work on behalf of Ohio taxpayers. The company will replace the multibillion-dollar conglomerates such as CVS Caremark and Express Scripts that currently serve as middlemen in the prescription drug supply chain for 3 million poor or disabled Ohioans.

At last count, those privately run PBMs were making off with nearly a quarter billion dollars a year, charging up to six times the going industrial rate, a state consultant found.

Ohio Medicaid Director Maureen Corcoran said the switch to a single, state-controlled PBM alone will save roughly $150 million to $200 million per year. However, the new arrangement also would cost the state revenue, such as about $23 million from a tax on health insuring corporations that no longer could be collected. And additional staff must be hired to handle duties the agency is taking over from managed-care organizations.

The bottom line will be revealed when Gov. Mike DeWine unveils his budget on Feb. 1, she said.

How PBMs make money often has been called a “black box” because even outside experts cannot figure it out. The new setup is designed to “break open the black box and be better accountable for tax dollars,” Corcoran said.

Medicaid, funded jointly by the state and federal governments, covers about $3.5 billion worth of prescription drugs a year in Ohio. (It is separate from Medicare, a federal program that pays for health care of those 65 and older.) 

“We will have a very-good-quality, experienced manager of these medications that will save the state money and will allow transparency about the care and the expenditures for this program that did not exist in the past,” Corcoran said.

Big changes for children, recipients on the way

Hiring Gainwell as Medicaid’s single PBM is one part of a huge restructuring of the state’s biggest agency that won’t be completed for another year. Still to come is the hiring of a pharmacy operational support vendor, designed to monitor the performance of Gainwell.

Also on the agenda is the OhioRise plan to cover specialized behavioral services for children with complex health needs. Those crushing expenses often aren’t covered by parents’ insurance, causing many to make the heart-breaking decision to voluntarily give up custody to the government so their children can be treated outside of Ohio. Thousands of other children are forced to live in group settings to get the care they need.

Starting in 2022, a federal waiver will allow the state to set up a specialized managed care organization with expertise in providing services for the most complex “multi-system” youth. Corcoran said the goal is to serve 50,000 children by the end of next year.

“We don’t have to take away custody; we can keep them in their family,” she said.

And likely the biggest state contract in history is set to be awarded later this month to winners of an 11-way competition to handle Medicaid’s managed care operations starting next year. The current contract, shared by six outfits, totals about $20 billion.

When what Corcoran calls a “new generation of Medicaid” is finally put in place, both Medicaid recipients and health-care providers will notice the difference.

One simple change will occur when a person on Medicaid changes managed-care plans. Now, they must make sure that their preferred Pharmacy A is on the new plan, or whether they must change to Pharmacy B. But with the state using a new centralized credentialing setup to decide which pharmacies and which drugs are covered, there will be no difference when making the switch.

On the other end of the drug-supply chain, doctors and pharmacists — which currently must fill out as many as seven similar forms to make sure they can get Medicaid reimbursement, a process that can take months — will need to complete only one standardized state form.

Big PBM, lobbyist’s favorite lose out

The competition for the single PBM contract started out with six companies. But three — including Express Scripts, the second-biggest in the country — were eliminated along the way.

One of the final three considered was MagellanRx Management, which was represented by longtime lobbyist Neil Clark when then-House Speaker Larry Householder inserted the single PBM plan into the state budget in mid-2019. Both Clark and Householder are now under federal indictment for a what authorities say was a $60 million scheme culminating about the same time to build the Perry County Republican’s political power and pass a $1 billion bailout of Ohio’s two nuclear power plants via House Bill 6.

Corcoran noted that Householder’s original budget language was revised before the bill was passed, and that Gov. DeWine vetoed several specific mandates about the procurement process.

Deputy Medicaid Director Steven Voigt said the competition “was very fair, diligent, with plenty of safeguards. Every bidder had the same chance.”

Gainwell wound up with the highest score from the panel that evaluated the proposals, and the company also offered the lowest price.

Gainwell or its predecessor has received 16 Centers for Medicare and Medicaid Services certifications since 2010 — more than all other vendors within the same period, the Ohio Medicaid department said. It provides pharmacy services for 29 state Medicaid programs, and implemented 21 Medicaid system modules in eight states.

“They are not like CVS or Express Scripts or whatever; they are more of an entity that has specialized in IT, clinical support, not like traditional PBMs focus on drug market,” Corcoran said.

“They have all of the skills and tools and requirements that are needed. The combination of their pharmacy, various types of pharmacy experiences across 29 (states), means they have demonstrated boots on the ground experience in every element of this PBM design that we have selected.”

Gainwell would be paid $158.2 million if it remains for the entire 7.5 years of the state contract. The pact, which must be approved by the bipartisan state Controlling board, includes financial penalties and an “out” for the state if the new single PBM does not measure up to state standards, Corcoran said.

Gainwell, which says it has more than 7,500 employees, was created on Oct. 1 by the $5 billion sale of DXC Technology’s U.S. state and local health and human services business to Veritas Capital, a leading investor in Gainwell.

“As a construct of the words ‘gain’ and ‘well,’ the name reflects the company’s mission to empower its clients through technology in order to deliver health and human services programs that enable successful health outcomes for beneficiaries nationwide,” Veritas said in a Sept. 16 press release.

Clipped from: https://www.dispatch.com/story/news/healthcare/2021/01/11/pharmacy-benefit-managers-ohio-medicaid-saving-pbm/6556793002/

 
 

 
 

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California proposes expanding Medicaid coverage of continuous glucose monitors

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California wants to add $12M in the next fiscal year’s budget to pay for CGM for adults with Type 1 diabetes.

 
 

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:

  • California Gov. Gavin Newsom proposed providing $12 million to expand coverage of continuous glucose monitors (CGMs).
  • The 2021-22 budget proposal is intended to increase access to CGMs among adults with Type 1 diabetes who are covered by California’s Medicaid program Medi-Cal. Abbott, Dexcom, Medtronic and Senseonics compete for the U.S. CGM market.
  • Trade group AdvaMed welcomed the proposal, arguing it will reduce overall healthcare costs, and called on other states to take similar steps to ensure access to CGMs.

Dive Insight:

Sales of CGMs such as Abbott’s FreeStyle Libre and the Dexcom G6 have grown quickly in recent years as Type 1 and Type 2 diabetics have identified the devices as ways to improve the management of their conditions. However, Medicaid coverage of CGMs is patchy with some states providing no coverage and others limiting access to the pediatric population.

California was one of the states with a Medicaid program that only provided CGMs to children who met certain criteria. Lawmakers sought to expand access in 2019, only for Newsom to veto the bill. Newsom said expanded access should be considered through the annual budget process.  

State lawmakers reminded the Democratic governor of his comments about the budget process late last year, adding that the COVID-19 pandemic has emphasized the need for improved access to CGMs. The lawmakers framed CGMs as a way to control spending on adult diabetes patients. 

The pressure has paid off. Newsom wants to include $12 million in funding to enable adults with Type 1 diabetes to access CGMs in California. The funding, which is set to kick in at the start of next year, is the start of an ongoing commitment to CGMs. Newsom’s office sees CGM funding as a way to boost health equity. Overall Medi-Cal funding is set to increase more than 10% in 2021-22.

The budget proposal comes shortly after an American Diabetes Association survey found 20% of people have foregone or delayed getting a CGM or other device due to financial constraints during the COVID-19 pandemic. Among people with a CGM or insulin pump, 15% have delayed sourcing consumable supplies for the devices, typically due to financial constraints.

AdvaMed praised the funding proposal, stating Newsom “is exactly right to push for expansion of Medi-Cal’s coverage of CGMs.” The trade group said providing the Medi-Cal population with CGMs is both the right thing to do and “a smart way” to reduce healthcare costs.

The California legislature will determine whether the budget request is enacted, and the proposal will take effect Jan. 1, 2022, if approved. 

 
 

Clipped from: https://www.medtechdive.com/news/california-proposes-expanding-medicaid-coverage-to-CGMs/593127/

 
 

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Medicaid transformation initiative remains on pace for July 1 launch (NC)

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North Carolina is set to roll out managed care for the first time this July.

 
 

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 ambitious Medicaid transformation initiative remains on track for a July 1 debut, state health officials told legislators Tuesday.

Dave Richard, the state’s deputy secretary for Medicaid, said that “we’re on target, we’re on schedule and our commitment to you is that we’re going to do everything possible” to go live with the managed care plans.

At stake with Medicaid transformation: three-year prepaid health plan contracts for four insurers that are projected to be worth $6 billion a year starting with the 2021-22 fiscal year which begins July 1.

With two optional one-year extensions, a contract could be worth a total of $30 billion — among the largest vendor contracts awarded in state history.

The state Department of Health and Human Services announced in February 2019 that the four PHPs are Centene (operating as WellCare of N.C.), AmeriHealth Caritas N.C., Blue Cross and Blue Shield of N.C. (operating as Healthy Blue) and UnitedHealth Group.

The next rollout steps are an online tool launching Jan. 25 that lists providers and the four PHPs, and insurers submitting their tailored plans by Feb. 2.

Statewide enrollment is projected to begin March 15 and end May 14. There is a 90-day “change period” that allows beneficiaries to switch PHPs. 

 
 

Clipped from: https://journalnow.com/news/local/medicaid-transformation-initiative-remains-on-pace-for-july-1-launch/article_0a710280-55ab-11eb-9824-5701b0d4908b.html

 
 

 
 

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Corrado Bill Raising Reimbursement Rates for Medicaid Private Duty Nurses Advances (NJ)

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New Jersey legislation would raise home-based nursing care rates by about 50%.

 
 

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.

 
 

Bipartisan legislation sponsored by Senator Kristin Corrado that would boost minimum Medicaid reimbursement rates paid for private duty nursing services (PDN) was advanced by the Senate Health, Human Services and Senior Citizens Committee.

PDN services are individualized nursing tasks provided by licensed nurses on a continuous basis in the homes of certain qualifying patients.

“Skilled medical professionals are delivering high-quality, in-home care, but reimbursement rates have failed to keep up with the true cost of services,” said Corrado. “Thousands of residents rely on PDN nurses to improve their health and maintain their standard of living. To ensure a reliable roster of skilled nurses to meet the need, it makes sense to escalate reimbursement rates to a level that more reasonably reflects the work. Reimbursing more money to the providers will allow them to increase pay to the hard-working professionals caring for patients.”

The bill, S-2191, is also sponsored by Senator Loretta Weinberg. It would establish minimum Medicaid reimbursement rates for PDN services provided in the Medicaid fee-for-service delivery system or through a managed care delivery system. The minimum reimbursement for services rendered by a registered professional nurse would increase to not less than $60 per hour, and $48 per hour for a licensed practical nurse (LPN).

Under current State regulations, the maximum Medicaid reimbursement rate is not more than $40 per hour when a registered nurse provides the services, and not more than $28 for an LPN.

The bill will require all providers that receive reimbursement for PDN services under a Medicaid managed care contract to annually report to the State Division of Medical Assistance and Health Services (DMAHS) regarding the use of funds as reimbursement for the healthcare workers.

 

Clipped from: https://www.insidernj.com/press-release/corrado-bill-raising-reimbursement-rates-medicaid-private-duty-nurses-advances/

 
 

 
 

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Info of hundreds of Wisconsin Medicaid members may have been exposed

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A data breach in Wisconsin may have revealed personal health information of 1,200 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.

 
 

(WCAX)

MADISON, Wis. (WBAY) – The personal information of hundreds of Wisconsin Medicaid participants may have been exposed.

Gainwell Technologies LLC has announced that an “unauthorized individual” gained access to an account on Oct. 29, 2020. The tech firm says that may have exposed names, member identification numbers and billing codes.

Gainwell provides services to the Wisconsin Department of Health Services Medicaid Program.

On Jan. 15, notifications were sent to 1,281 Wisconsin Medicaid members who may have had their information exposed.

These members are being offered free credit monitoring for one year.

The hack was discovered on Nov. 16. Gainwell says it has been working with DHS to prevent future incidents.

 
 

Clipped from: https://www.wsaw.com/2021/01/15/info-of-hundreds-of-wisconsin-medicaid-members-may-have-been-exposed/