Tag: State News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[MM Curator Summary]: All of the OH Medicaid reforms except OH Rise are on hold while the state deals with the PHE wind-down efforts.

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 projected launch date of Ohio’s revamped and reformed Medicaid managed care system will still be July – except this month, given a potential crisis where many may be kicked off Medicaid, the state pushed back most of the reforms to the end of this year.

“It seems like this new phased approach still allows them to move forward with everything, but in a way that is manageable…to maybe take smaller bites of the apple,” said Loren Anthes, who chairs Community Solutions’ Center for Medicaid Policy.

Medicaid, government-paid health insurance for more than 3 million low-income or disabled Ohioans, is typically the state’s largest expenditure totaling billions of dollars. The “next generation” system is the result of an extensive process that started in 2019, looking at ways to overhaul the system after years of issues and lack of reform.

According to the Ohio Department of Medicaid, one of those reforms will still be up and running in July. OhioRISE is a new coverage system to treat children with severe behavioral and mental problems so parents don’t have to give up custody.

But all the other more complicated changes, such as a single pharmacy benefit manager to prevent prescription drug “middlemen” from overcharging taxpayers, won’t happen until October at the earliest. The same applies to the two to three new health plan options entering the system: AmeriHealth Caritas, Humana, and Anthem Blue Cross and Blue Shield.

Why the delay?

The planned July launch date could coincide with the end of the federal government’s COVID-19 emergency declaration, which prevented states from kicking ineligible people off Medicaid. When that ends, almost everybody will have to go through eligibility checks – a daunting task for an understaffed system that could also leave Ohioans confused over if they still have health insurance.

Spreading the Medicaid reforms out to later in the year would prevent a disaster scenario where both the eligibility checks and the new reforms go awry at the same time, said Anthes, the Medicaid policy expert.

“It is important that the reforms and improvements embodied in the Next Generation program are not compromised with a hurried launch, or potentially confusing communications,” the Medicaid department said in a document sent to lawmakers.

Despite the later timeline, Medicaid participants still can choose to enroll into one of the new plan options now, said department spokesperson Lisa Lawless. They’ll just remain on their current health plan until the end of the year when the switch occurs.

Starting dates for the new system were pushed back before, and some lawmakers have been concerned with how long implementation has taken. But the department insists they are not rushed.

“Doing this correctly is more important than meeting an administratively imposed timeline,” it told lawmakers.

Clipped from: https://insurancenewsnet.com/oarticle/rollout-of-medicaid-reforms-delayed