Tag: State News

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Op-Ed- California should accept the federal government’s invitation to trim Medi-Cal rolls

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

 
 

[MM Curator Summary]: In which the op-ed writer suggests the un-thinkable.

 
 

Clipped from: https://www.ocregister.com/2023/01/11/california-should-accept-the-federal-governments-invitation-to-trim-medi-cal-rolls/

 
 

California should accept the federal government’s invitation to trim Medi-Cal rolls

Despite tougher fiscal conditions, Governor Newsom’s January budget proposal for California misses an opportunity to take advantage of a large cost-saving opportunity other states will be leveraging in the coming months.

Since 2020, the federal government has prevented states from removing no-longer-eligible Medicaid beneficiaries from the program’s rolls. Now that this pandemic emergency measure was eliminated by the omnibus budget bill Congress passed last month. California should join other states in enforcing eligibility requirements for those receiving healthcare benefits.

Of the $297 billion in state revenues Newsom expects to spend in 2023-2024, the largest share – $102 billion – is devoted to Health and Human Services. Most of the spending in this category will take the form of provider reimbursements by the state’s Medicaid program, known as Medi-Cal.

Normally, the federal government covers 50% of Medi-Cal reimbursements for most beneficiaries. But during the COVID-19 pandemic, Congress increased the federal percentage to 56.2%, as long as the state maintained continuous coverage for everyone using the program as of early 2020 or added to the program thereafter. Now, the federal share will gradually fall back to 50% in early 2024, and the continuous coverage mandate will be removed.

According to federal data, California’s population of Medicaid beneficiaries grew from 10.3 million at the beginning of the pandemic to 12.6 million in September 2022 (the last month that data was available). An additional, 1.3 million young people are enrolled in the Children’s Health Insurance Plan, meaning that over one third of the state’s population is now covered by federal/state health programs that do not require participant contributions.

Many states plan to respond to the federal policy change by systematically reviewing all Medicaid beneficiaries to see whether they still qualify for benefits. For example, Texas has identified a cohort of 1.4 million beneficiaries that are most likely to be deemed ineligible because they have reached the age of 65 (and should instead use Medicare) or no longer have an eligible dependent child in their household. Once the state is allowed to begin disenrollments in April 2023, it plans to run electronic data matching algorithms on this cohort to determine who should be removed from the program.

California appears to have no such plan. The governor’s budget summary projects a large increase in General Fund Medi-Cal spending due to the “loss of increased federal funding consistent with the end of the federal Public Health Emergency while costs for caseload persist through the year.”

This is unfortunate because the state expects to have a $22.5 billion budget shortfall in the next fiscal year and further deficits thereafter. Rather than make meaningful cuts to balance the budget, many of Newsom’s budget balancing measures involve taking on more long term debt and shifting resources between funds.

In California, where political leaders have emphasized the need for universal health coverage, the idea of disenrolling Medi-Cal beneficiaries may seem anathema. But it is necessary to minimize wasteful and fraudulent spending. Right now, Medi-Cal is covering highly skilled workers who, after being temporarily unemployed, got high paying jobs as the economy bounced back. These individuals can afford to pay for their company’s insurance coverage. Other beneficiaries may have moved out of state or stopped participating in the program for other reasons. Unless their names are removed from the rolls, unscrupulous providers could file claims under their names.

Medi-Cal beneficiaries who are now self-employed or who hold jobs at employers that do not provide healthcare benefits are eligible to buy policies on Covered California, often with large federal insurance subsidies. So, rather than contribute nothing to the cost of their care, they might expect to pay a relatively small amount for healthcare coverage.

While enforcing eligibility rules may seem cruel, it is necessary to ensure that state resources are available for the truly needy without bankrupting taxpayers or driving them out of the state. The previous Democratic-controlled Congress has invited all states to trim their Medicaid rolls; this is an invitation that California should accept.

Marc Joffe is a federalism and state policy analyst at the Cato Institute.

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Abortion- Montana DPHHS proposes new regulations on Medicaid-reimbursed abortions

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

 
 

[MM Curator Summary]: The state is looking to ensure its existing rules around payment for abortion are actually followed.

 
 

Clipped from: https://www.ktvh.com/news/montana-dphhs-proposes-new-regulations-on-medicaid-reimbursed-abortions

 
 

HELENA — This week, state regulators will hold a hearing on a proposed rule change that would add more requirements in order for an abortion to be covered by Medicaid.

The Montana Department of Public Health and Human Services announced the proposal, which would require prior authorization before Medicaid pays for abortion services. DPHHS leaders said additional documentation is needed to ensure that the state Medicaid program is only covering abortions that are medically necessary. However, some advocates say the change would be an unnecessary barrier to accessing an abortion.

The federal government’s Hyde Amendment prohibits Medicaid funding for abortions, except in cases of rape and incest and when the mother’s life is endangered. Montana, though, has a different standard. After a 1995 court ruling, the state has used its own general funds to cover abortions that have been determined to be “medically necessary,” even if the mother’s life isn’t endangered.

DPHHS leaders say, after a contractor reviewed Medicaid-reimbursed abortions, they concluded most claims lacked sufficient documentation to confirm medical necessity.

“The consistent lack of documentation, coupled with the conditions routinely provided on the MA-037 forms as the basis for medical necessity, lead the department to reasonably believe that the Medicaid program is paying for abortions that are not actually medically necessary, but are, in fact, elective, nontherapeutic abortions,” the rule proposal said.

The proposal would require a claim for Medicaid reimbursement to include a number of supporting documents, including a medical history, the results of a physical exam, and confirmation of a medical professional’s diagnosis. It would also say Medicaid reimbursement can only be made when a physician performs an abortion — not a physician assistant or advanced practice registered nurse.

In a statement to MTN, DPHHS director Charlie Brereton again argued the change was necessary.

“DPHHS must ensure that abortions paid for by Montana taxpayers under Medicaid are truly medically necessary, in accordance with the law,” he said. “We welcome comment on the proposed rule and look forward to further protecting the integrity of our Medicaid program through its finalization and implementation.”

But opponents of the change are expressing concerns about the impact it would have on those seeking an abortion.

“It’s functionally an abortion ban for low-income families,” said Aileen Gleizer, a communications consultant with Blue Mountain Clinic. “If individuals have private health insurance, they don’t have to go through these hoops.”

Gleizer says about half of the clinic’s abortion patients are covered by Medicaid, and that other clinics have seen similar numbers.

“Abortions are a time-sensitive service, so the mandatory prior authorization is particularly harmful,” she said. “It would delay abortions later in pregnancy, it would make them more expensive, more invasive, require a longer recovery.”

Gleizer also serves as a board member for the Susan Wicklund Fund, which provides financial support for people seeking an abortion. She said, since the vast majority of Montana counties do not have abortion providers, many of the patients they work with are traveling hundreds of miles. She said the additional requirements – especially the need for a physical exam, which she said could prevent approval by telemedicine – would hit those patients especially hard.

“Adding additional preauthorization, additional appointments, would delay,” said Gleizer. “And we don’t know what that process looks like, and what rejection looks like.”

DPHHS will hold a public hearing on this rule change Thursday, Jan. 12, at 1 p.m., via remote conferencing. The department will accept public comment through Jan. 20.

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Expansion- NC may be the last state to expand Medicaid for a while

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

 
 

[MM Curator Summary]: Another good example of the use of Rule #8 from Alinsky’s Rules for Radicals.

 
 

 
 

Clipped from: https://www.northcarolinahealthnews.org/2023/01/11/this-state-could-be-the-last-one-for-a-while-anyway-to-expand-medicaid/

Stateline/ Pew Trusts

For years, state Sen. Phil Berger says, there was nobody in North Carolina who opposed Medicaid expansion under the Affordable Care Act more vehemently than he did.

“If there was somebody in the state of North Carolina that had spoken out publicly in opposition to Medicaid expansion more than me, I’d like to talk to that person,” Berger said in an interview last month. From the time the ACA passed in 2010 until last spring, “my attitude was Medicaid expansion was wrong for North Carolina,” he said.

Berger, a Republican, is president pro tempore of the North Carolina Senate, the most powerful position in the chamber, so his opposition virtually guaranteed that the legislature would not expand the joint federal/state program to include an additional 600,000 adults with low incomes.

That’s why Berger’s recent conversion from opponent to proponent has shot North Carolina to the top of the list of the states that are most likely to break ranks with the other 10 that have refused to expand Medicaid.

But it’s hard to imagine the other states doing the same anytime soon, which means that an estimated 6 million Americans will continue to be denied coverage.

In November, South Dakota became the 39th state to approve expansion under the ACA, but it did so by a citizen-initiated ballot measure over the opposition of the state’s GOP governor and legislative leaders. Six other states also have expanded Medicaid that way. But among the holdouts, only Florida allows that option, and the pathway is so arduous there that proponents recently postponed their campaign for two years.

“We’re pretty close to the end” of expansion by way of citizen initiatives, said Kelly Hall, executive director of The Fairness Project, a national organization created to promote Medicaid expansion and other progressive goals through ballot initiatives.

Of course, it’s possible that GOP leaders in the remaining states, the largest of which is Texas, could have a change of heart like Berger did.

The North Carolinian said he had three objections to expansion: He feared that extending Medicaid coverage might discourage people from seeking work; he worried that the federal government could one day renege on its pledge to cover 90% of the cost of expansion, leaving states holding the bag; and he was concerned about adding to the unpredictability of North Carolina’s wildly fluctuating Medicaid expenses.

That last issue was resolved in 2021 with North Carolina’s transition to a Medicaid managed care system, which Berger says has made expenditures much more predictable. He abandoned his first objection, he said, after coming to realize that most of the younger, nondisabled adults who would be covered under expansion have jobs, are caregivers or are students.

As to the federal government backing out of its commitment on the federal match, Berger noted that it hasn’t done so under Democratic or Republican presidents, or with either party in control of Congress. “It ain’t going to happen,” he said.

Inducements for expansion

When former President Barack Obama signed the Affordable Care Act in 2010, it included a requirement that states expand Medicaid to enable all adults with low incomes to enroll in the program. In 2012, however, the U.S. Supreme Court ruled that Medicaid expansion was optional for states. Nearly half the states and Washington, D.C., expanded in 2014, as soon as the new law allowed, and more followed.

States that rejected expansion turned down substantial inducements. In the original Medicaid program, the federal government pays anywhere from 50% to nearly 78% in matching funds depending on a state’s per capita income. (Congress temporarily raised that federal match rate during the COVID-19 public health emergency.) But under the ACA, the federal match to cover the Medicaid expansion population is 90% for every state.

States that expanded Medicaid experienced job growth, particularly in the health care sector, as a result of the federal largesse. Expansion also reduced the amount hospitals needed to pay for uncompensated care, which was particularly helpful for financially strapped rural hospitals, many of which have closed in the past two decades.

In 2021, in response to the pandemic, the Biden administration added another inducement for the holdout states: a 5 percentage point bump in their federal match under traditional Medicaid for two years. That amounts to hundreds of millions of dollars in extra funding for those remaining states. Florida, for example, would pocket nearly $4 billion of extra federal money if it expanded, according to an analysis by Manatt Health, a research, legal and consulting organization. Mississippi would get $739 million.

“We’re losing money [in Mississippi] every minute we don’t expand, not to mention the human cost,” said Brandon Jones, campaign manager for the Southern Poverty Law Center, which supports Medicaid expansion.

Among the holdouts, only Florida allows for a ballot initiative process that could be used to expand Medicaid. (Wyoming’s law does not allow initiatives involving revenue or appropriations, as a Medicaid expansion would.) But even in Florida, the legislature has made qualifying for a ballot initiative so difficult that backers of Medicaid expansion recently decided to try to get on the ballot in 2026 rather than 2024 as they initially had intended.

“Given the complexities we have here in Florida that you don’t see in other states, even though the will of the people of Florida is there for expansion, but we need time to gather the funds to run a successful campaign,” said Jake Flaherty, campaign director of Florida Decides Healthcare, which is leading the expansion effort.

Flaherty acknowledged that hostility toward expansion from Republican Gov. Ron DeSantis and GOP leaders in the legislature make it virtually unthinkable that an expansion bill could pass. The same is true in many of the other holdout states, including Texas, where recently reelected Republican Gov. Greg Abbott and Lt. Gov. Dan Patrick remain staunchly opposed. Even if privately sympathetic to expansion, GOP lawmakers in Texas are unlikely to cross their party’s state leaders.

Ballot foreclosed in Mississippi

Until recently, Mississippi seemed to be fertile ground for a successful ballot campaign. In fact, several years ago, proponents of expansion launched an initiative campaign with an eye toward getting on the ballot in 2022. But in 2021, the state Supreme Court threw out the state’s ballot initiative process. The ruling pertained to an initiative concerning medical marijuana, but it scuttled the Medicaid expansion ballot campaign.

There have been proposals in the Mississippi legislature to devise a new initiative process that can withstand legal challenge. But for now, proponents of expansion say they don’t see a pathway, and passage in the legislature would have to overcome the steadfast opposition of Republican Gov. Tate Reeves and state House Speaker Philip Gunn.

The state’s GOP leaders remain opposed despite the fact that a majority of Mississippians want to see Medicaid expanded, according to polls. Jones, of the Southern Poverty Law Center, who is a former Mississippi House member, says his private conversations with Republican lawmakers have convinced him that they largely feel the same way. But, he said, they are fearful of crossing their leaders on the issue.

With Gunn’s announcement that he will not run again for his seat, Jones said he believes the legislature will eventually pass expansion.

“Do we do it this year? Probably not. It’s an election year, and we still have a speaker and a governor who are opposed,” Jones said. “But anything big we’ve ever done in Mississippi seems to happen real quickly … that’s what happened with changing the state flag. So, this could be the year it happens with Medicaid expansion.”

Reeves’ office didn’t respond to a request for comment, and Gunn’s office said he wasn’t available for an interview.

In Wyoming, proponents drew encouragement from state House passage of a Medicaid expansion bill for the first time in 2021, but the measure ran aground in the Senate that year.

Proponents in Kansas also have been heartened by newly reelected Democratic Gov. Laura Kelly’s plan to make another run at expansion next year. Polls there too indicate strong support for passage, with more than 70% in favor. Kansas is surrounded by states that have expanded. (Kansas does not have a citizen ballot initiative process. Last August’s referendum in which Kansas voters chose to keep abortion protections in the state constitution was placed on the ballot by the legislature.)

Nevertheless, April Holman, executive director of Alliance for a Healthy Kansas, a coalition of 128 Kansas organizations working toward expansion, said the Republican legislature and its leaders have proved impervious to popular opinion — though pressure is rising.

“For me, I’m always hopeful or I wouldn’t be able to do this work,” Holman said. “But it requires building a movement that is too large and too loud to ignore and that’s what we’ve been trying to do.”

Neither the new Republican House speaker in Kansas, Daniel Hawkins, nor Republican Senate President Ty Masterson responded to Stateline requests for comment.

That leaves North Carolina as the most likely domino to fall next. And if it does, Berger will be one of the key players toppling it.

Berger single-handedly changed the political landscape for expansion by announcing his support last year, putting himself alongside Democratic Gov. Roy Cooper, who has long advocated for expansion. The Senate passed expansion overwhelmingly in its 2022 session, but the bill failed to pass in the House, not because of objections to expansion itself but because of a provision that would have made it easier to create new health facilities or services in the state, which the hospital industry opposed.

Last year’s legislative session was the shorter one in its two-year cycle. As a result, Berger said, the House and Senate didn’t have time to negotiate their differences on the bill. This year, lawmakers will have more time, and Berger said he is optimistic about reaching a different result.

“I have told folks that I felt like by the time the two-year session is over, North Carolina will have expanded Medicaid,” he said. “There’s a deal in there somewhere.”

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This state could be the last one (for a while, anyway) to expand Medicaid

by Pew Trusts, North Carolina Health News
January 11, 2023

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

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

 
 

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

 
 

 
 

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


Caption

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

Credit: Screenshot

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
 

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

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

 
 

Boram Kim | Jan 3, 2023 | Colorado

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

 
 

 
 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
 

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

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

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

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

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

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

He said hospitals lose money on Medicaid and Medicare patients.

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

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

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

 
 

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

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

 
 

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

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

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

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

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

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

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

Public Health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER

Increased Funding

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

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

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MCOs: Centene Bounces Back With California Medicaid Contracts

MM Curator summary

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

 
 

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

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

 
 

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

ASSOCIATED PRESS

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

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

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

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

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

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

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

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MCOs- Amerigroup Maryland is Now Wellpoint

MM Curator summary

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

 
 

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

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

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

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

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

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

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

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

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

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

ABOUT WELLPOINT

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

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MCOs- Scan Group Merges with Oregon Managed Medicare and Medicaid Nonprofit

MM Curator summary

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

 
 

[MM Curator Summary]: The 2 organizations will a footprint of 800,000 members and a revenue footprint of $7B. And a whole box of toys to play with when it comes to various acquired solutions and provider groups.

 
 

Clipped from: https://labusinessjournal.com/healthcare/medical-center/scan-group-merges-with-oregon-managed-medicare-and-medicaid-nonprofit/

Long Beach-based Scan Group, a senior health care nonprofit, and Portland, Oregon-based CareOregon, a managed care nonprofit, have agreed to merge under the new name HealthRight Group.

The merger, which was announced last month, is intended to give both nonprofits more clout in a marketplace for government-funded health care programs increasingly dominated by for-profit managed care providers such as Long Beach-based Molina Healthcare Inc. and St. Louis, Missouri-based Centene Corp., parent of Woodland Hills managed care provider Health Net. The deal is expected to close sometime this year. Scan Group, which has about 1,600 employees, is the parent company of Scan Health Plan, which had revenue of around $3.6 billion last year. It has about 275,000 members, mostly in California but also in Arizona and Nevada. Later this year, it plans to start enrolling people in Texas, pending approvals.

 
 

Scan Group’s Long Beach headquarters.

CareOregon has been focused on providing managed care for low-income individuals through government subsidy programs, especially Medicaid. It’s similar to Westlake-based L.A. Care, which provides health care for the nearly 25% of Angelenos who meet low-income thresholds. It has about 515,000 members, with nearly 320,000 of those in various Medicaid plans.

Financial terms of the deal were not disclosed. According to the Dec. 14 announcement, the new combined HealthRight Group entity will have revenues of about $6.8 billion and will serve nearly 800,000 health plan members through its Medicare and Medicaid managed care offerings.

While the announcement did not say where HealthRight Group will be headquartered, its designated chief executive, Sachin Jain, and board chair Linda Rosenstock currently hold those same posts with Scan Group in Long Beach. CareOregon Chief Executive Eric Hunter will retain that post and serve as president of HealthRight’s Medicaid Division.

Jain specifically referenced the aim of gaining more clout in the government-funded health care provider space.

“For far too long, America’s not-for-profit managed care organizations have operated at a scale disadvantage to their larger for-profit competitors,” Jain said. “HealthRight aims to bring together two complementary organizations to benefit from greater scale, while maintaining focus on the people and communities they serve.”

In addition to its health plans, HealthRight will operate a diversified business unit comprising assets from both organizations including Welcome Health, a geriatric home-based primary care medical group; Housecall Providers, an in-home primary and palliative care provider; MyPlace Health, a joint venture between Scan Health and Boston-based Commonwealth Care Alliance; Healthcare in Action, a medical group for people experiencing homelessness; and HomeBase Medical, a medical group focused on improving chronic disease management and palliative care for Medicare beneficiaries.