Tag: State News

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House speaker not budging on Medicaid extension for new moms

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[MM Curator Summary]: MS House Speaker Gunn refuses to endorse extending Medicaid coverage beyond two months post-delivery.

 
 

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

 
 

 
 

JACKSON, Miss. (AP) — Mississippi House Speaker Philip Gunn says he opposes efforts to revive a proposal that would let mothers keep Medicaid coverage for a year after giving birth.

“My position on the postpartum thing has not changed,” Gunn, a Republican, told reporters Tuesday at the Capitol.

Mississippi allows two months of Medicaid coverage for women after they give birth. Advocates for low-income women say expanding the government insurance coverage up to a year could improve health outcomes in a state with a high rate of maternal mortality.

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The Republican-controlled Senate voted 46-5 on Feb. 2 to pass Senate Bill 2033 to authorize a year of postpartum coverage. The bill passed the House Medicaid Committee on March 1 but died last week when Gunn and House Medicaid Committee Chairman Joey Hood chose not to bring it up for a vote before a deadline.

Republican. Lt. Gov. Delbert Hosemann said Monday that he wants to revive an effort to extend postpartum coverage, calling it “a good-faith effort to keep our babies healthy and our mothers healthy.”

Gunn told The Associated Press last week that he did not want anything that would appear to be a broader expansion of Medicaid. Mississippi is one of a dozen states that have not expanded Medicaid to working people whose jobs do not provide health insurance. The expansion is an option under the federal health overhaul signed into law by then-President Barack Obama in 2010.

About 60% of births in Mississippi in 2020 were financed by Medicaid, according to Kaiser Family Foundation, a nonprofit organization that tracks health statistics. Only Louisiana had a higher rate, at 61%.

The Mississippi State Department of Health issued a report in April 2019 about maternal mortality in the state from 2013 to 2016. A committee of physicians, nurses and others examined deaths that occurred during pregnancy or up to one year of the end of pregnancy, and it recommended expanding postpartum Medicaid coverage to a full year.

The report said that, for those years, Mississippi had 33.2 deaths per 100,000 live births, which was 1.9 times higher than the U.S. ratio of 17.3 deaths per 100,000 live births. The report also found the Black women had 51.9 deaths per 100,000 live births. The numbers for white women were 18.9 deaths per 100,000 live births.

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Follow Emily Wagster Pettus on Twitter at http://twitter.com/EWagsterPettus.

 
 

Clipped from: https://www.ncadvertiser.com/news/article/House-speaker-not-budging-on-Medicaid-extension-17004499.php

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Lawmaker Takes Aim at 1960s Law That Blocks Medicaid Funds for Psych Care

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[MM Curator Summary]: NY Senator Hoylman is pushing the state health agency to submit a waiver to avoid the IMD-exclusion rule in order to allow the state to house more patients in long term facilities for mental health.

 
 

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.

 
 

 
 

 
 

This article was originally published on Mar 10 at 9:13pm EST by
THE CITY.

Sen. Brad Hoylman wants New York to pursue a waiver to allow federal funding for long-term residential treatment, which could include innovative alternatives to incarceration.

As New York struggles to get treatment to people with serious mental illness, one barrier hasn’t budged: Medicaid is forbidden from covering long-term stays for most patients receiving mental health or substance abuse treatment in a facility with over 16 beds.

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That federal law, in place for more than half a century, blocks a major source of funding that could pay for residences that provide long-term treatment — anything from traditional psychiatric care to innovative efforts to divert people to therapy instead of prison.

But that could change in New York, under a bill recently introduced in Albany by State Sen. Brad Hoylman (D-Manhattan). It would require the state health commissioner to seek a waiver from the federal Centers for Medicare and Medicaid Services to make payments for long-term stays at large mental health institutions.

“Through this we will be creating an incentive to create new beds,” Hoylman told THE CITY. “We have to move swiftly to address this crisis. We see human suffering in our midst and it’s really time to take decisive action like this legislation. New Yorkers are in desperate need of treatment.”

Hoylman’s West Midtown district has been in the spotlight for a mental health crisis playing out in its streets and transit stations. One man with untreated mental illness is accused of fatally shoving Michelle Go into the path of a subway train at Times Square.

A spokesperson for the state Department of Health, Erin Silk, said the agency won’t comment on pending legislation.

The number of inpatient psych beds has sharply declined over the last two decades. A 2020 report from the New York State Nurses Association found that the state had reduced the number of overall psychiatric beds from 6,055 to 5,419 from 2000 to 2018 –– a 12% loss, with the bulk of the reduction coming from the private sector.

New York City has 3,991 inpatient psychiatric beds, according to the state Office of Mental Health, but about 600 aren’t in service. The state repurposed many of those beds for COVID patients at the start of the pandemic and is working to get them back, according to OMH spokesp

 
 

Michelle Go’s image was illuminated over Times Square during a vigil after she was fatally pushed onto the subway tracks in a random attack, Jan. 18, 2022.
Photo by Ben Fractenberg/THE CITY

erson James Plastiras.

Under Medicaid, the federal government picks up half of the costs and state government the other half, with New York budgeting $170 billion on all Medicaid services for this year and the next combined.

Already, Maryland, Oklahoma, Utah, Vermont, Washington, Idaho, Indiana and Washington, D.C. have successfully applied for such waivers to the ban on funding for “Institutions for Mental Disease” (IMDs), while several more states have applications pending.

New York State is already exploring the possibility. “The Department of Health is actively considering a waiver request to the Centers for Medicare & Medicaid Services,” Silk told THE CITY.

Hoylman decided to force the issue because the state hasn’t submitted an application or committed to sending one. He didn’t offer a cost estimate for a waiver, but claimed that it would save money in the long run by bringing down street crime.

Even within the current restrictions, Gov. Kathy Hochul is attempting to invest more in mental health care.

In February, she announced a $49 million initiative to improve psychiatric services across New York state. That includes $27.5 million to increase Medicaid’s payout for the psychiatric beds it does cover by 20%, which the state projects will bring at least 600 psychiatric beds back online in New York City. It also earmarks $9 million to recruit nurses and other staff as well as create 500 more supportive housing beds for people experiencing homelessness.

Good Intentions

The federal prohibition on Medicaid mental health payments to states applies to patients between the ages of 21 and 64, and dates back to the original creation of the health program in 1965.

Congress intended to discourage the creation of large psychiatric facilities in response to exposés documenting horrors of large residential institutions, and to shift the costs of mental health care onto the states, according to the Treatment Advocacy Center, an organization that promotes investment in inpatient mental health services.

“The point of the policy was to disincentivize long-term hospital care for people with the most severe illnesses. It was supposed to be accompanied by a massive investment in community based care that incidentally never really happened,” said Brian Stettin, policy director at the group.

Yet the need for long term hospitalization never went away for many individuals with mental illnesses, he added. “The idea was that hospital care is a bad thing, per se, which is clearly an overgeneralization of a well-intentioned policy that was taken too far.”

 
 

U.S. Sen. Charles Schumer, left, and State Sen. Brad Hoylman (D-Manhattan).
Photo by Javier Alejandro Duran/THE CITY

The Treatment Advocacy Center and others are pushing Congress for a full federal repeal of the exclusion, but has also supported states that are seeking waivers.

Supporters of a waiver say that the 16-bed limit hurts people who really need care by discouraging the creation of innovative, high quality treatment centers.

The nonprofit Greenburger Center for Social and Criminal Justice, which advocates for alternatives to incarceration, has for years been trying to build Hope House, a residential treatment center for women who’ve been convicted of felonies and have mental illnesses. They have a site near Crotona Park in The Bronx, but no ability to receive Medicaid reimbursement for inpatient psychiatric beds.

“We can’t go above 16 beds and get Medicaid because of the IMD exclusion. When you go above 16 beds, our folks can’t get Medicaid. So these kinds of facilities never get built,” said Cheryl Roberts, executive director of the Greenburger Center.

“You can’t really, without a lot of gap funding, make a facility that has high quality care work with 16 beds. You need more beds, not a lot more, but a few more to make the economies of scale work.”

 
 

THE CITY is an independent, nonprofit news outlet dedicated to hard-hitting reporting that serves the people of New York.

 
 

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Clipped from: https://brooklyneagle.com/articles/2022/03/16/lawmaker-takes-aim-at-1960s-law-that-blocks-medicaid-funds-for-psych-care/

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Jury acquits men of all counts in Medicaid fraud case

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[MM Curator Summary]: A WY behavioral health provider team has been acquitted, but the damage to their business has been done.

 
 

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.

 
 

 
 

POWELL — Over the span of eight days in a Cheyenne courtroom, federal prosecutors laid out a case that had been a decade in the making, arguing that a Powell treatment center had defrauded Medicaid out of millions of dollars.

After 5 1/2 hours of deliberations, however, a jury rejected the allegations.

The 12-member panel voted unanimously on Thursday to acquit former Northwest Wyoming Treatment Center employees Matthew “Ty” Barrus, Greg Bennett and Devin Dutson, finding them not guilty of all charges brought by the U.S. Attorney’s Office. The men didn’t present a formal defense, as their attorneys felt it wasn’t necessary, but sought to show that Northwest Wyoming Treatment Center provided good care and believed it was in compliance with Medicaid rules.

Barrus, who served as the center’s executive director, said the verdicts brought relief that a 6 1/2- year “nightmare” might have come to an end. He said he was also thankful for the ability to defend himself within a fair judicial system, his defense attorneys and the support of his family and friends, among other things. But Barrus said it was not a victory.

For one thing, he noted that Northwest Wyoming Treatment Center — which was shut down and had all of its assets seized by the federal government years ago — no longer exists.

“We really liked our program and felt that we were successful,” he said, “And it’s been tough.”

Until state and federal investigators came knocking on the center’s door in December 2015, Barrus said they “never thought that we were even close to doing anything wrong.”

Northwest Wyoming Treatment Center provided substance abuse treatment from 2009 to 2016, serving youth between the ages of 12 and 17 who were struggling with addictions to controlled substances.

At its peak, the center had roughly 20 employees, with Barrus as executive director, Bennett as clinical director and Dutson as a therapist.

Most of the center’s clients came from court-ordered placements — many from the Wind River Indian Reservation — and spent months in the program. They were, according to the defendants’ attorneys, “some of the most psychologically damaged, and hard to reach, children in the State of Wyoming.”

Barrus said the clients were addicts dealing with mental issues, trauma, abuse, generational addiction, homelessness and/or risky behavior, and they were there to receive 24/7 residential treatment.

“It was hard work dealing with some of the kids,” he said, noting the circumstances they came from.

But Barrus also called it a privilege, saying they were generally good kids dealing with addictions.

When the Commission on Accreditation of Rehabilitation Facilities surveyed the center in December 2015, it noted “strengths in many areas” and re-certified the facility for the three-year maximum.

“The staff at NWTC provides the consistent caring and nurturing that has often been missing in the lives of the clients served,” surveyor David Blondeau wrote in part, adding that the staff were “highly credentialed and utilize state-of-the-art interventions.”

However, roughly a week later, a team of investigators from the Wyoming Department of Health’s Medicaid Program Integrity and law enforcement officers came to the center’s door, as part of an investigation of the organization’s billing practices.

Most of the clients at the nonprofit center were Wyoming Medicaid beneficiaries. Over a period of six years, NWTC billed Medicaid more than $8.5 million for the careit provided to more than 100 clients — and authorities came to believe that much of the billing was excessive and inappropriate, including when compared to other facilities.

In January 2016, Program Integrity demanded that the center repay nearly $1.35 million, which effectively shut the operation down.

Then in March 2019, the U.S. Attorney’s Office moved to seize all of the center’s property — including three buildings, a vacant lot and cash — asserting that the assets represented the proceeds of false and fraudulent bills submitted to Medicaid; the center’s board agreed to forfeit the property. Then in September 2019, federal prosecutors indicted Barrus, Bennett and Dutson on a combined total of 14 felony charges.

A grand jury generally alleged that the men had submitted claims for activities that didn’t qualify as therapeutically necessary substance abuse treatment, for activities not covered by Medicaid and for services the center or their staffers weren’t authorized or licensed to provide.

The indictment also alleged the center had “up-coded” some claims — for instance, by billing what the government saw as group recreational activities at the higher rate for individual treatment. A federal prosecutor asserted earlier this year that NWTC had billed “all day every day for activities that are not covered by Medicaid (including sleeping, eating, playing video games, weightlifting and traveling the state for recreational activities) as if those activities were covered substance abuse treatment.”

 
 

Clipped from: https://www.thesheridanpress.com/news/regional-news/jury-acquits-men-of-all-counts-in-medicaid-fraud-case/article_6b5677c4-a488-11ec-932d-5f3d36b8b1ab.html

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Some Medicaid patients will start getting help with food and shelter

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[MM Curator Summary]: The NC Healthy Opportunities pilot will begin reimbursing plans for food delivered to Medicaid members this week, and a rental subsidy program for members begins soon.

 
 

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.

 
 

 
 

 
 

Bounty and Soul

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Bounty and Soul

Produce Market at Bounty & Soul

Starting Tuesday, up to 20,000 low-income North Carolinians will be able to get help with food, and it will be paid for by Medicaid.

It’s part of a $650 million experiment to test whether some Medicaid money would be better used to pay for patients’ underlying social needs.

There’s a lot of research that shows up to 80% of a person’s health is determined by things like access to healthy food, safe housing and adequate transportation. For example, senior citizens who get Meals on Wheels are less likely to end up in the hospital than those on the program’s waitlist.

North Carolina is now testing whether Medicaid managed care can get people healthier by paying for food, housing, transportation, even protection from violence. And it’s testing whether that will result in medical savings too. Jay Ludlam is leading the pilot program at the North Carolina Department of Health and Human Services.

“There has been a lot of conversations about it. A lot of conferences about it,” Ludlam said. “But North Carolina’s doing it in the field, and it ‘s absolutely exciting.”

The NC DHH S says it’s the first state to run a system-wide experiment to see how much social services will improve health. The pilot will take place in 33 of the state’s 100 counties. Mecklenburg is not include d. Counties closest to the Charlotte area that are part of the pilot include Rutherford, Burke and McDowell.


North Carolina Department of Health and Human Services

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North Carolina Department of Health and Human Services

Healthy Opportunities Pilot Project

Doctors of poorly-nourished patients in those counties can help them get healthy food.

“If they recognize that somebody has a food insecurity, then by making the referral, our organization will deliver that food,” Ludlam said.

Here’s how it works: A doctor refers a patient by entering the name in a computer system. Then managed care plans have to confirm that patient is eligible according to state rules. For example, an adult who’s had five emergency room visits in a year, or has multiple chronic illnesses could get help if they also have trouble accessing healthy food.

“That could be, for example, a member that’s obese and that also suffers from diabetes and depression,” said Hannah Tyson, who heads the pilot at AmeriHealth Caritas, one of the state’s managed care plans.

After Tyson’s staff gives the okay, the referral goes to a network of participating food banks and community organizations like Bounty and Soul in Black Mountain. It distributes fresh produce for free to those who need it. Paula Sellars is the deputy director .

“When the referral comes in, we make a call to each and every person that’s referred,” Sellars said. “And we will describe what we’re going to provide for them.”

One of the things they could provide is a box of food containing grains, peanut butter and lots of fresh local produce.

Sellars says they’ve been preparing for a huge increase in customers.

“We’ve had to look at every last logistic. Like where do we even get these physical boxes from, and can we get them at a cost that works just as a small example,” Sellars said.

State rules set the prices. For example , a large box of food — enough to feed four people two meals a day for a week — is $136.06 if it’s picked up, $141.06 if it’s delivered.

Food banks will bill the managed care plans, which are then paid by Medicaid.

And the computer system will notify the doctor’s office to let it know the patient got the food, so it can follow up.

UNC – Chapel Hill researchers will evaluate the impact on patient health.

N .C . Department of Health’s Jay Ludlam says the pilot will change as results come in.

“We’ll take down the interventions that don’t work, we’ll feed the interventions that do work.”

Ludlam says managed care companies will do their own analyses.

“We believe as part of our design that they will flow like water to those interventions that are improving the health of North Carolinians and they will continue to provide those services because they will help the managed care organizations be more profitable.”

But that’s way down the road. First , the rest of the pilot has to roll out. Assistance with housing and transportation is scheduled to start on May 1 . Eligible patients may then get help paying a security deposit or first month’s rent, for example. Victims of violence will get services like home visits starting on June 15 .

It’s not clear how long the pilot project will last. That’s under negotiation with the federal government.

 
 

Clipped from: https://www.bpr.org/bpr-news/2022-03-15/some-medicaid-patients-will-start-getting-help-with-food-and-shelter

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Pennsylvania health systems may be compelled to unionize by Medicaid contracts

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[MM Curator Summary]: PA union organizers just got access to a $16B bargaining chip by tie-ing Medicaid provider payments to workers being union-ized.

 
 

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 Center Square) – The Pennsylvania Department of Human Services is drafting Medicaid contracts that could compel health-care providers to unionize, making it more difficult for low-income patients to access health care and threatening more than a dozen hospital systems’ participation in Medicaid.

The HealthChoices Medicaid Managed Care agreements would take effect in July and would prevent a managed care plan from including in its network a provider that has had a work stoppage within five years – unless the provider has signed a collective bargaining agreement.

Effectively, health care providers would be compelled to unionize to be able to provide Medicaid services. If providers would not unionize after the provision takes effect, the threat of a work stoppage in the future could jeopardize their Medicaid participation.

The contracts concern the physical health portion of Pennsylvania’s Medicaid contracts, which were worth more than $16 billion in FY2021-22. Pennsylvania has almost 2.8 million Medicaid enrollees and the state’s Medicaid contracts have been worth $65 billion over the last 5 years, according to the Pittsburgh Post-Gazette. 

In testimony at a House Appropriations Committee hearing on March 9, Snead said the new provision’s language “was a collaboration between the administration and SEIU.” The language in the contracts is still in the process of negotiation and not finalized, though Snead noted the department wants to have a finalized version by April 1.

“My concern with all of this is that it could potentially limit health care options for low-income individuals,” said Sen. Kristin Phillips-Hill, R-Jacobus. 

“I think that the Wolf administration is taking us down a very dangerous path,” Phillips-Hill said. “It really comes down to putting patients at great risk to access their care.”

The provision had been little-noticed until it came up during committee hearings in the General Assembly.

“I think it was something the administration hoped would fly under the radar. They certainly did not want to bring this to the General Assembly,” Phillips-Hill said.

The Hospital and Healthsystem Association of Pennsylvania, which represents 240 hospitals and health systems, sent two letters to DHS in response to the provision. In the letters, HAP expressed concerns that the provision would “Improperly inject a subsidiary policy goal – mandating health care unionization – into a program that is designed to provide access to care to vulnerable and low-income Pennsylvanians.”

“From our perspective, the purpose of Medicaid programs should be to promote access to care and the state should be working to reduce hurdles for Medicaid patients to obtain care, not to cut off hospitals or other providers,” said Jeffrey Bechtel, senior vice president for health economics and policy at HAP.

 
 

Clipped from: https://www.theprogressnews.com/news/state/pennsylvania-health-systems-may-be-compelled-to-unionize-by-medicaid-contracts/article_a7a75d98-f1f2-5879-8747-c85259cc9755.html

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Oregon takes step toward covering thousands set to lose Medicaid

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[MM Curator Summary]: The Oregon legislature is working on a bill to require the HHS agency to have a plan for Medicaid eligibility redetermination efforts that do not push people back into uninsured status.

 
 

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.

 
 

 
 

 
 

PORTLAND, Ore. — Oregon is a step closer to creating a bridge plan for those who stand to lose their Medicaid coverage once the Covid-19 public health emergency ends.

House Bill 4035, which passed the Oregon Senate on Thursday, requires the Oregon Health Authority to develop plans for redetermining Medicaid eligibility and maintaining members’ access to insurance coverage.

During the pandemic, Oregon and other states hit the pause on doing regular redeterminations of Medicaid eligibility to ensure that no one lost access to care. The state’s Medicaid rolls grew by more than 300,000 to 1.4 million members, increasing Oregon’s insured rate to an all-time high of nearly 96%.

“Underinsurance has fallen precipitously for people of color,” said Sen. Elizabeth Steiner Hayward, a Portland Democrat and chair of the Joint Committee on Ways and Means, who carried HB 4035 on the Senate floor. 

Those earning between 138% and 200% of the federal poverty level, she noted, “are the most likely to churn on and off Medicaid, costing their own health and everyone money and our state (is) the poorer for it. It’s an important bill to allow Oregon to stay at the forefront of health system transformation.”

The state has a year to complete the eligibility redeterminations after the public health emergency ends, which is expected to happen in April. About 55,000 people could likely be disqualified from Medicaid but may not be able to afford to buy their own insurance through the Oregon Marketplace. The bill establishes goals, including maintaining access and minimizing disruptions by phasing in redeterminations for vulnerable populations.

Clipped from: https://www.kgw.com/article/news/health/oregon-steps-toward-covering-thousands-set-to-lose-medicaid/283-cfd8363a-74ba-4650-ac80-49be7994a91e

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FL- Will the Senate take up the House Medicaid managed care rewrite?

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[MM Curator Summary]: The Florida Medicaid managed care reform bill may stall in the upper chamber due to opposition from Dems.

 
 

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.

 
 

A bid to overhaul Florida’s Medicaid managed care process ahead of a mammoth multi-billion-dollar bidding process cleared the House on Tuesday and heads back to the Senate with an uncertain fate with just four days left in the Session.

The House voted 77-38 for the bill (SB 1950) as amended largely along party lines as Democrats said they were fearful the legislation would wind up harming public hospitals.

“It feels like the punishment isn’t worth the crime,” said Rep. Kelly Skidmore, a Democrat from Boca Raton.

More than 5 million Floridians are enrolled in Medicaid, with many of them receiving health care through managed care plans.

The House bill requires “essential providers” to enter into regional or statewide contracts with those Medicaid managed care plans. But it also includes a process where essential providers and managed care plans that can’t reach agreement will enter into mediation June 30. Mediators must submit a report to Agency for Health Care Administration (AHCA) by Oct. 1 showing the outcome of all mediation they presided over.

 
 

The state is required by Jan. 1 to withhold any supplemental payments from essential providers that do not have all the mandated contracts signed.

It was this “essential providers” language that drew the most criticism from those who lined up against the bill. But Rep. Sam Garrison, a Fleming Island Republican and the bill sponsor, defended the process.

“A mandate without an enforcement mechanism is really just a strong suggestion,” Garrison said.

Other Republicans also asserted changes included in the bill would result in better outcomes for Medicaid patients.

That essential provider mandate is a nonstarter for the Senate, according to top Republicans in the chamber. The House bill also would prevent Medicaid beneficiaries from being automatically assigned into any managed care plan that has a market share of 50% or more.

 
 

The Legislature in 2011 passed a rewrite of the state’s Medicaid statutes, requiring most beneficiaries to enroll in a managed care plan. In 2013, the Medicaid managed long-term care program was launched. The Medicaid managed medical assistance program, which provides services to women and children, followed in 2014.

Current law requires the Medicaid contracts to be competitively bid in 11 regions in the state. Winning health plans are awarded multiyear contracts worth tens of billions of dollars.

Agency for Health Care Administration Secretary Simone Marstiller told lawmakers last fall her agency wanted the Legislature to make changes to the program during the 2022 Session before her agency starts working on new Medicaid procurement. Florida’s existing Medicaid managed care contracts expire Dec. 31, 2024.

Clipped from: https://floridapolitics.com/archives/505928-will-the-senate-take-up-the-house-medicaid-managed-care-rewrite/

 
 

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OH- Ohio Medicaid managed care plan enrollment begins Tuesday

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[MM Curator Summary]: The new MCO contracts go live this summer, and members can enroll 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.

 
 

COLUMBUS, Ohio (AP) — Medicaid enrollees in Ohio can begin selecting from among a new slate of managed care plans beginning Tuesday.

As part of the Ohio Medicaid Next Generation initiative, millions of enrollees in the government health care program for low-income Americans must choose from seven managed care plans or be assigned one.

The approved plans are: Buckeye Community Health Plan, CareSource, Molina Healthcare, UnitedHealthcare Community Plan, AmeriHealth Caritas, Humana and Anthem Blue Cross and Blue Shield.

Next Generation is scheduled to go live July 1.

Eligible participants have several ways to make their selection, including visiting the Ohio Medicaid Consumer Hotline portal, calling the hotline or contacting their county Department of Job and Family Services.

Those not yet ready to make their selection are encouraged to update their contact information, so they can receive notices regarding the rollout.

 
 

Clipped from: https://www.recordherald.com/news/72692/ohio-medicaid-managed-care-plan-enrollment-begins-tuesday

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NC- Cooper administration makes new pitch for Medicaid expansion

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[MM Curator Summary]: NC officials are tying the PHE funding ending to the next push for Medicaid expansion.

 
 

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

 
 

 
 

North Carolina Gov. Roy Cooper has proposed a plan in which the share would be paid through an existing tax on private Medicaid plans and additional assessments on hospitals. (Robert Willett/The News & Observer via AP/File)

By Gary D. Robertson

Associated Press

RALEIGH — North Carolina Gov. Roy Cooper’s administration made perhaps its most promising pitch yet to legislators on Tuesday to expand Medicaid, with a key health regulator calling it more advantageous than ever to cover hundreds of thousands of additional low-income adults.

Addressing a House-Senate committee  created specifically to study expansion, state Medicaid director Dave Richard said a surge in traditional Medicaid enrollment during the coronavirus pandemic and a fiscal sweetener from Washington make taking the step even more appealing.

“We come to you and say that we think Medicaid expansion is a really good deal for North Carolina and that it’s a good deal for a lot of reasons,” Richard told lawmakers. “It just makes great sense to improve the health of North Carolina citizens.”

The study committee, which began meeting last month, formed as a result of budget negotiations last fall between Republican legislative leaders and the Democratic governor, a longtime expansion advocate. North Carolina is among a dozen states that haven’t expanded Medicaid under the 2010 federal health care law.

The GOP-controlled legislature would have to formally vote to permit expansion. Senate leader Phil Berger, who for years opposed expansion, is now open to it. Many House Republicans remain skeptical, and would have to be persuaded that covering an even-larger percentage of state residents with government health care is wise. GOP Rep. Donny Lambeth, a committee co-chairman, has said a package of health care access initiatives from the committee could come up for a General Assembly vote in September or October.

Other speakers Tuesday made presentations that linked expansion to increased health care industry employment and patient diagnoses and treatment, as well as improved rural communities, where uninsured rates are high.

Reducing “the coverage gap will improve the quality of life of rural North Carolinians in the communities that they call home,” said Patrick Woodie, president of the North Carolina Rural Center.

About 2.7 million North Carolina residents are now enrolled in Medicaid, the health care program for poor children and their parents and elderly low-income residents. That number has grown by over 500,000 alone since the pandemic began, in part because recipients who would be removed over time have remained on the rolls because of the COVID-19 emergency, according to Richard’s presentation.

Expansion would cover working adults and others who otherwise would make too much to qualify for traditional Medicaid. While expansion would likely benefit 600,000 residents over two years, about 200,000 people currently on Medicaid during the health emergency could qualify under an expansion, Richard said. Expanding soon would reduce paperwork needed to keep them on Medicaid, he said.

Currently, the federal government pays 73% of the state’s Medicaid costs, with the remainder coming from state tax revenues, monetary assessments on hospitals and other funds. Under the expansion plan, the federal government pays 90%.

The 2021 federal COVID-19 relief law would give North Carolina and other nonexpansion states more money to cover traditional Medicaid patients for two years if they accept expansion. Richard said that would provide $1.5 billion in additional revenues for the state.

An analyst in the General Assembly’s nonpartisan staff said Medicaid expansion would provide a fiscal net positive for state government in the first two years. In the years following, the state would have to locate an additional $500 million to $600 million annually to pay its share, analyst Mark Collins wrote.

Cooper has proposed a plan in which the share would be paid through an existing tax on private Medicaid plans and additional assessments on hospitals. Hospitals benefit from treating Medicaid patients who, without expansion, would be considered charity-care cases.

“This is a program that is financially self-sustaining,” Richard said.

Questions and comments on expansion from Republican committee members focused largely on doctor and nursing shortages the state is facing.

Members from both parties were encouraged about a report on the transition of 1.7 million Medicaid recipients to five managed care plans last summer. Peter Daniel with the North Carolina Association of Health Plans said the five are well-prepared to accept more enrollees should legislators agree to expansion.

 
 

Clipped from: https://www.salisburypost.com/2022/03/01/cooper-administration-makes-new-pitch-for-medicaid-expansion/

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Oregon withdraws a waiver request to run a closed Medicaid formulary

MM Curator summary

[MM Curator Summary]: While the OR waiver request contains many new features, a closed drug formulary will not be one of them.

 
 

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

 
 

 
 

In response to a raft of concerns, Oregon has withdrawn a request made to federal officials to restrict medicines covered by the state Medicaid program, which is currently required to provide coverage for all treatments. However, state officials are still seeking to exclude certain drugs from Medicaid when effectiveness evidence is lacking.

By seeking a so-called closed formulary, the same approach to coverage taken by private health insurers, Oregon officials had hoped to lower expenses by only covering one drug for each therapeutic class. So far, though, only Tennessee has been granted a waiver to use a closed Medicaid formulary and the Biden administration is reviewing that decision, which was issued by the Trump administration.

 
 

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Clipped from: https://www.statnews.com/pharmalot/2022/02/28/oregon-medicaid-cms-alzheimer-biogen/