Tag: State News

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Iowa in ‘uncharted territory’ as Medicaid numbers swell

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Iowa’s enrollment in traditional Medicaid has surged 16% while enrollment by the expansion population has surged 30%.

 
 

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.

 
 

COVID pandemic fuels surge in sign-ups for health insurance program

 
 

 
 

A stethoscope sits on an examination table in an exam room. (Bloomberg News)

DES MOINES — Enrollment in Medicaid and Iowa’s related Health and Wellness insurance programs saw double-digit surges in Iowa due to the COVID-19 pandemic, according to data compiled by a state forecasting group.

Since the pandemic hit Iowa in March 2020, Iowa’s regular Medicaid program added 64,134 individuals through last month while an additional 51,669 individuals enrolled in the Health and Wellness program that offers slightly fewer benefits for recipients between the ages of 19 and 64 who are not pregnant and do not earn more than 133 percent of the federal poverty level.

That represented a 15.56 percent increase when comparing July’s 487,193 Medicaid enrollees to the 423,059 enrolled when the pandemic began, said Jess Benson, a senior Legislative Services Agency fiscal analyst who provides data for the state’s Medicaid Forecasting Group.

The increase in the Health and Wellness program was even steeper, jumping 30 percent, from 176,903 participants in March 2020 to 228,572 last month.

Last month’s Medicaid total included 280,905 children, 90,436 adults, 83,231 disabled Iowans and 32,621 elderly residents.

“We’ve never experienced anything like this before so this is kind of uncharted territory for all of us,” Benson said.

The influx of more than 115,000 new enrollees gradually built as Iowans lost their jobs – and their employer-based health insurance – as the pandemic took hold. State officials project Medicaid and the Health and Wellness program will continue to add 3,000 to 7,000 individuals per month through December. At that point, the eligibility parameters may change, lifting a current prohibition on “dis-enrolling” individuals while a federal public health emergency is in effect.

The suspension of program dis-enrollments is a condition for Iowa receiving a 6.2 percent matching fund rate in federal assistance as part of the COVID-19 relief package. That adjustment of nearly $135 million in fiscal 2020 and $275.4 million last fiscal year enabled Iowa’s Medicaid program to amass “huge carry-forward” balances, Benson noted. Those balances are projected at $244 million for fiscal 2021 and $228 million in the current fiscal year that began July 1.

The matching federal funds helped provide some relief to states struggling to afford the increasing pace of sign-ups for Medicaid, a program for low-income and disabled people.

Once the state is allowed to drop individuals who no longer need or qualify for Medicaid, Benson said he expects enrollment will gradually decline by 100,000 or more. He said reviews will take place to remove people who “normally would have fallen off,” but he was not certain the numbers would settle back to the previous levels around 425,000 Medicaid participants.

“It seems like whenever we go through one of these massive expansions, when we pull back we never get back to that level that we were at before,” he said.

Earlier this year, the federal Centers for Medicare and Medicaid Services released data indicating that nearly 9.9 million people enrolled in Medicaid and the Children’s Health Insurance Program between February 2020 and January 2021 because of the COVID-19 pandemic – a 13.9 percent increase nationally. Iowa’s increase at that time was in the 12 percent range.

Comments: (515) 243-7220; rod.boshart@thegazette.com

 
 

Clipped from: https://www.thegazette.com/health-care-medicine/iowa-in-uncharted-territory-as-medicaid-numbers-swell/

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Florida Medicaid Could Face Hefty Deficits

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Florida budget analyst release the first look at what the impact of ending the additional 6.2% in pandemic funding.

 
 

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 estimates show an anticipated $417 million deficit in Medicaid for the current fiscal year, which will end June 30, and a $1.434 billion deficit in the 2022-23 fiscal year.
 

Florida’s swelling Medicaid rolls are expected to help create a nearly $1.9 billion deficit in the safety-net health care program over the next 22 months, according to new estimates drawn up by a state panel.

The estimates, posted Friday, show an anticipated $417 million deficit in Medicaid for the current fiscal year, which will end June 30, and a $1.434 billion deficit in the 2022-23 fiscal year.

In 2022-23, economists estimate the state will need to spend $35.4 billion to keep the Medicaid program operating at current levels. During that year, economists project that lawmakers will need an additional $1.1 billion in general revenue to fund the state’s portion of Medicaid, which is jointly financed with the federal government.

Along with facing increased enrollment amid the COVID-19 pandemic, the state will need to boost spending because of an anticipated loss of enhanced federal Medicaid funding.

Congress agreed in March 2020 to beef up the amount it spends on Medicaid by 6.2 percentage points to help states during the pandemic. The more the federal government contributes to the costs of the program, the less the state has to pay.

The Biden administration has extended the increased funding through this calendar year, but state economists did not plan on any of the additional funding beyond Dec. 31.

Economists assumed an average 1 percent rate increase in payments to Medicaid long-term care plans and an average 3.6 percent increase in payments to Medicaid managed “medical assistance” plans, effective Oct. 1.

Managed medical assistance plans provide managed care to the broadest group of Medicaid beneficiaries.

The new forecast came after recent estimates that more than 5 million residents will be enrolled in Medicaid between now and June 30.

 
 

Clipped from: https://health.wusf.usf.edu/health-news-florida/2021-08-25/florida-medicaid-could-face-hefty-deficits

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Ambulance carveout is latest Illinois Medicaid managed care battleground

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Ambulance providers are lobbying to go back to fee for service payment, but advocates oppose the move saying it will be more difficult to ensure quality member outcomes.

 
 

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.

 
 

 
 

Multiple ambulances are housed at the LeRoy Emergency Ambulance shed, pictured here Friday.

DAVID PROEBER, THE PANTAGRAPH

SPRINGFIELD — Stakeholders are calling on Gov. J.B. Pritzker to sign a bill that passed the General Assembly unanimously and would remove non-emergency ambulance services from the state’s Medicaid managed care program in favor of a fee-for-service model.

While an association group representing ambulance services says House Bill 684 is needed to counter arbitrary denials of claims by private insurers, the governor’s office and the state agency that oversees Medicaid expressed “serious concerns for patient safety and cost” as Pritzker continues to review the bill.

While the bill is a targeted carveout of ambulance services from the state’s Medicaid managed care program, or the privatization of Medicaid, it marks the latest catalyst for debate over the effectiveness of that program which was greatly expanded in 2017 under former Gov. Bruce Rauner.

 
 

Chris Vandenberg, president of the Illinois State Ambulance Association, said in a phone call Monday the bill was in response to the “arbitrary” denial of ambulance claims by Medicaid managed care organizations, or MCOs.

MCOs are private insurance companies that contract with the state to manage the care of individuals enrolled in Medicaid. Among other things, that involves working with patients to make sure they receive routine exams and preventive care, and coordinating services provided by their primary physicians and other specialists.

Vandenberg said that leads to MCOs padding profits through denial of claims.

“Since managed care began in Illinois, it’s been a struggle,” Vandenberg said. “So, we have EMTs and paramedics that are working, trying to transport patients, and really, we’re not able to get any of this reimbursement. …And so it’s really impacted the ability to attract and retain EMTs and paramedics, and really it’s causing a serious impact to Medicaid beneficiaries in that they’re not able to find transport as easily as they used to.”

Putting ambulances back in the fee-for-service system would allow providers to submit claims directly to the state Department of Healthcare and Family Services, which Vandenberg said would provide predictability and certainty to the billing process.

Jamie Munks, a spokesperson for HFS, said in a statement the department “remains strongly opposed” to the ambulance carveout, “because it has the potential to negatively affect the quality of service, create longer wait times for medical transports and payment delays for providers, and could create confusion for customers and providers.”

They protect and serve often at minimum wage or no pay at all.

DAVID PROEBER david.proeber@lee.net

Munks said about $3 million of potential lost revenue due to the state’s tax on MCOs which generates greater federal reimbursement resulting in hundreds of millions of dollars in revenue annually. She also noted unspecified “administrative costs” in switching ambulances back to fee-for-service.

If Pritzker doesn’t act on the bill by the end of the week, it would become law even without his signature. If he vetoes it, lawmakers would be able to override the action with a three-fifths majority when they meet for the veto session this fall.

Pritzker spokeswoman Jordan Abudayyeh said in a statement the governor “will take the appropriate action” before this weekend’s deadline, but “the administration is concerned that this legislation has the potential to disrupt care and reduce the quality of provided services to some of the most vulnerable Illinoisans.”

Specifically, the governor’s office said a Medicaid enrollee needing a non-emergency ambulance ride can currently contact their MCO and be connected with an ambulance transport that’s contractually obligated to respond “in a timely fashion.”

The administration fears if the governor signs the bill, “a consumer will be forced to use the vendor contracted with by the fee-for-services program — a vendor that is not contractually bound to provide timely services.”

“Consumers would be forced into the uncertain position of not knowing which of their health care services are covered by their MCO, and whether they will be able to secure transport in a timely fashion,” Abudayyeh said in the statement. “During the COVID-19 pandemic, the Department of Healthcare and Family Services received consumer complaints regarding the difficulty of securing transport from their fee-for-service vendors to get to non-emergency health care services like check-ups and dialysis.”

Advocates for the bill, including Rep. Will Davis, D-Homewood, who is one of its chief co-sponsors, argued the current MCO structure is what’s threatening response times.

Davis said private ambulance companies often handle the 911 calls for communities that are underserved medically. While companies contracting with those municipalities are already on the fee-for-service structure for emergency services due to changes made in April, payment uncertainty for other transportation services those providers render could affect staffing levels, Davis said.

“It’s not just, you know, the providers trying to get paid,” Davis said. “Their ability to receive resources helps their ability to keep their staffing levels up so they can bring down response times when people call 911. So there’s the staffing aspect of it, there’s the idea of making sure that they can provide services to underserved communities.”

Representatives of the Ambulance Association said an early amendment to HB 684 removed non-ambulance medical transports in an effort to address transportation concerns. The current bill is simply a way to “get paid for the services provided,” which they’ll still be obligated to provide under a fee-for-service system.

Samantha Olds Frey, CEO of the Illinois Association of Medicaid Health Plans, cited concerns similar to Pritzker’s about how the bill “impacts our most vulnerable members that need non-emergency ambulances for routine care such as dialysis treatments, doctor’s appointments, or scheduled hospital trips.”

She noted MCOs can offer higher reimbursement rates than HFS can for such a transportation service, so moving it back to a fee-for-service plan could further jeopardize those Medicaid enrollees. While MCOs have care coordinators that make follow-up calls to transporters to connect a customer to a service, HFS does not, she added.

“IAMHP met with the industry during the legislative session to try and find a solution that doesn’t jeopardize the care our members receive,” she said. “The ambulance industry refused to come to the table in good faith. However, we are still willing to understand what the systematic issue is and work toward a solution.”

Davis, meanwhile, said concerns over “arbitrary” claim denials from MCOs are nothing new or unique to the ambulance industry.

That’s why, as part of a health care reform backed by the Illinois Legislative Black Caucus earlier this year, lawmakers created a Managed Care Oversight Commission to, according to Davis, “really dive deep into if we’re going to continue to have an MCO structure – which, you know, some really don’t want – that we can have more oversight and input into how they operate versus kind of the autonomy that they enjoy right now.”

While Davis said HFS has “abdicated” its oversight role of MCOs, Munks said for over two years the agency has been “holding frequent meetings with providers and health plans, a forum to bring everyone together to resolve issues.”

She said HFS put in place a “claims clearinghouse” creating greater transparency into claim denials, “allowing the department to have better oversight of certain billing issues.”

She said claim denial rates for non-emergency ambulance services within the fee-for-service program are 40 percent, while MCO denial rates are between 10 and 15 percent, although the Ambulance Association disputed that claim, saying the denials it experiences are through MCOs.

As well, while HFS cited a billing complaint portal that has received only four claims in more than 17 months, the Ambulance Association dismissed that portal as “another way to give the providers the runaround.”

 
 

Clipped from: https://www.kpvi.com/news/national_news/ambulance-carveout-is-latest-illinois-medicaid-managed-care-battleground/article_cdd448f2-4b76-57b8-a6b0-7bd9ed444fb0.html

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Ohio Medicaid chief dodges when asked to explain business with company AG said “fleeced” taxpayers

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Ohio Medicaid officials are given hard questions about awarding a contract to Centene, who recently paid an $88M fine related to the PBM spread-pricing scandal.

 
 

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.

 
 

Massive contract restarted after settlement

 
 

The Centene Corporation headquarters. Photo from Google Maps.

Ohio Medicaid Director Maureen Corcoran didn’t give many straight answers Wednesday when she was pressed about why her agency restarted a massive contract with a company that earlier this year was accused of “fleecing” taxpayers out of tens of millions of dollars.

At one point, Corcoran even invoked lawyer-client privilege to avoid answering a question.

Appearing on WOSU’s “All Sides With Ann Fisher,” Corcoran was asked by Fisher why her agency would again trust Centene, the largest Medicaid managed-care contractor in the United States. The department earlier this month restarted negotiations for a 2022 contract with the company. 

That was just six months months after Ohio Attorney Dave Yost announced that Centene had agreed to pay $88.3 million to settle claims that the company had improperly inflated pharmacy claims by massive amounts. Centene also announced that it was setting aside more than $1 billion to settle similar claims in 21 other states. 

The company has emphasized that it didn’t admit to any wrongdoing in the settlement. But in March, Yost was unequivocal when he filed the suit.

“Corporate greed has led Centene and its wholly owned subsidiaries to fleece taxpayers out of millions,” he said.

The Medicaid department announced that it was restarting negotiations with Centene by posting a press release to its website saying the agency was giving Ohio Medicaid clients “more options.” It only alluded to the lawsuit by saying negotiations had been paused because of it and now that the suit had been settled, a contract would be awarded.

Asked at the time why the agency should now trust Centene with taxpayers’ billions, a Medicaid spokeswoman didn’t answer, other than to refer to the press release.

Fisher on Monday sought to press the question with Corcoran, asking why the agency would trust a company the state AG had just accused of fleecing taxpayers. Corcoran’s response was meandering.

“The action that was brought by the attorney general was really separate from the procurement process that we were engaged in which was of course very rigorous,” she said. “It is very common, normal practice in Medicaid that when there are any kinds of legal actions against any kind of managed care provider or a hospital or whomever, we have them identify that, we look into that. 

“So we are aware of and looking into legal actions whether here in Ohio or elsewhere is part of the normal Medicaid application process. So of course when we heard the attorney general was going to bring this action, we in similar fashion as I just mentioned took a step back and said we are going to make our own assessment. The attorney general then settled the case.

“There were still several weeks as you know that passed and we were making our own assessment at the same time and determined that we were going to proceed with them as part of our newly selected group of plans. They also, you may remember, scored the second-highest score (in a competitive procurement) from a quality point of view, so they provide good care, they’ve been a partner in Ohio.”

Transcripted excerpt of Corcoran’s interview on “All Sides with Ann Fisher.”

 
 

Ohio Medicaid Director Maureen Corcoran. Official photo.

Corcoran then pointed out that Centene’s alleged ripoff had to do with pharmacy benefits. She seemed to imply that since Centene wouldn’t have responsibility for the service under the new setup, there’s nothing to worry about.

“But I also think one thing that’s important to mention is that the issue that the attorney general brought has to do with pharmacy benefit managers and the role that they play with medications,” Corcoran said. “Two years ago, our General Assembly passed a law taking that responsibility away from the managed care plans and instructing the Department of Medicaid to set up a separate pharmacy benefit manager. 

“So, in essence, it was important for us to have good business partners, but in essence the underlying problem… and corporate oversight has changed and that set of responsibilities as part of our new design will not be with the individual plans, but will be managed directly by the state.”

How, Fisher asked, had Centene’s corporate oversight changed. Corcoran didn’t really answer, saying instead “we interact with them as a business partner” and that her team was making sure there will “be appropriate ethical training and that there be oversight and compliance monitoring.”

Then Corcoran was asked, since the Ohio attorney general acts as the Medicaid department’s lawyer, whether she had sought legal advice from Yost before deciding to continue the state’s business with Centene.

“As you know, attorneys and clients have a certain legal protection that, if I were aware of any of that, I wouldn’t be able to share it with you anyway,” Corcoran said in a reference to attorney-client privilege. That’s a doctrine that prevents an attorney from discussing privileged matters, but places no such restriction on the client.

Fisher again tried to get Corcoran to explain why she trusted Centene to be a good steward of Ohio’s money — this time in the toughest terms.

“Why would you continue to do business with a company that, as Attorney General Yost said, fleeced taxpayers out of millions?” Fisher asked. “It sounds like you’re doing business with a con man.”

Corcoran didn’t answer the question, instead launching into a 270-word talk about how rapidly the Medicaid program had grown and how the General Assembly has taken steps to reform how the agency handles drug transactions.

Corcoran did, however, answer one question directly.

It came to light this week that Michael Kiggin — a longtime friend of Gov. Mike DeWine — registered to lobby on Centene’s behalf just before Yost sued the company. Among the agencies Kiggin said he’d lobby were the governor’s office and the Medicaid department.

Asked if she knew Kiggin and whether Kiggin had communicated with her about the Centene contract, Corcoran said, “I don’t know Michael Kiggin. I’ve not talked with him, so I can’t really comment on that.”

Asked if Kiggin had communicated with Medicaid staff — including those involved in the Centene contract, Corcoran said, “Absolutely not.”

Clipped from: https://ohiocapitaljournal.com/2021/08/26/ohio-medicaid-chief-dodges-when-asked-to-explain-business-with-company-ag-said-fleeced-taxpayers/

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FL- Medicaid plans offer incentives to boost vaccinations

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FL MCOs are now offering gift cards to Walmart for $25 if members get the vaccine.

 
 

 
 

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

 
 

 
 

TALLAHASSEE — As the delta variant of the coronavirus sweeps across the state and brings a record number of COVID-19 hospitalizations, managed-care plans that serve hundreds of thousands of Medicaid beneficiaries are offering incentives to get people vaccinated.

Gov. Ron DeSantis’ administration did not provide to The News Service of Florida the percentage of people in Medicaid managed-care plans who are 12 or older and are vaccinated against COVID-19.

But at least three Medicaid health maintenance organizations have started offering financial incentives to their members to get at least one vaccine dose.

The moves have come after a call by state Medicaid director Tom Wallace to increase COVID-19 vaccination rates, particularly for people age 50 or older.

Related: COVID is still a deadly threat to older Floridians

In a June 18 memo to health plans, Wallace called vaccines a “critical” prevention measure.

Simply Healthcare Plans sent a memo to its Medicaid network providers in July encouraging them to advertise the incentive program to patients who they thought could be good candidates for vaccination. The plan is offering $25 gift cards to Walmart.

Marc Kaprow, chief medical officer for Simply Healthcare, told the News Service that the initiative was partly in response to the state’s efforts to have at least 50 percent of Medicaid beneficiaries who are 50 or older vaccinated.

Simply has about a 10 percent market share in part of the Medicaid program that provides long-term care. It also has a presence in part of Medicaid that serves a broader population — known as Medicaid managed medical assistance — and in HIV/AIDS specialty markets where it operates under the Clear Health Alliance moniker.

“We do better when our patients stay healthy. The vaccines create a tremendous opportunity for that to happen,” Kaprow said, adding, “We want our folks to not be in the hospital, we want our folks to do well.”

Related: Biden to require COVID-19 vaccines for nursing home staff

Simply Healthcare did not provide to the News Service a breakdown of its vaccination rates among Medicaid beneficiaries.

Florida Department of Health data shows that 47 percent of the state’s overall population of people ages 12 to 19 had received at least one vaccine dose as of Thursday. Rates for people ages 50 to 59 and 60 to 64 were 72 percent and 80 percent, respectively, according to a department report published Friday.

Related: Florida adds 150,118 coronavirus cases, 1,486 deaths in past week

The state uses managed-care plans to oversee health services for about 3.8 million people in the Medicaid program.

The plans are paid monthly premiums by the state to oversee care, including preventive care, for low-income, elderly and disabled people. By focusing on prevention, the plans are supposed to avoid more costly hospital care.

Community Care Plan, a Broward County-based plan, is offering access to $20 gift cards to members who are willing to receive at least one vaccine dose. Suzanne Tamargo, a spokeswoman for the plan, owned by the North and South Broward hospital districts, said about 100 people have taken advantage of the offer.

While Tamargo did not disclose vaccination rates, she said the incentives helped the health plan exceed the state’s goal of vaccinating at least 50 percent of beneficiaries age 50 or older.

Vivida Health Plan, which operates in Lee, Collier, Charlotte, Sarasota, DeSoto, Glades, Hendry, Lee and Sarasota counties, also has been providing gift cards since Aug. 5 to people willing to get vaccinated, according to its website.

Audrey Brown, chief executive officer of the industry group Florida Association of Health Plans, said gift cards are unusual but that the plans are looking at “every possible action that we can think of in order to get the Medicaid recipients vaccinated.”

While she said she did not have updated data, Brown said she had seen numbers from several weeks back that indicated several health plans had met the 50 percent mark for people 50 or older.

“It’s been an uphill battle, but incredibly important,” Brown said.

While health plans are offering incentives to their members, the state also is offering incentives to the plans to increase vaccination rates.

In the June memo, Wallace said the state would be willing to lower what are known as “liquidated damages” assessed against health plans if every plan met the 50 percent vaccination rate in the 50-plus population by Aug 31. The state levies liquidated damages against health plans when they don’t meet terms of their Medicaid contracts.

Wallace revised the policy last week, eliminating the requirement that all managed care plans meet the 50 percent threshold before reductions in liquidated damages could be triggered. Under the revised policy, any health plan that hits the 50 percent vaccination rate for people age 50 or older could qualify for lower liquidated damages.

Longtime social services lobbyist Karen Woodall said the policy is a “little screwed up.”

“It’s screwed up because it’s their job. Their job is to ensure adequate health care to their members,” Woodall said. “So they should already be focused on encouraging vaccines for their members.”

Woodall said the policy suggests that the plans have subpar vaccination rates. If they don’t, she said, the state is providing incentives to the health plans for goals they already are reaching.

By Christine Sexton, News Service of Florida

Clipped from: https://www.tampabay.com/news/health/2021/08/23/medicaid-plans-offer-incentives-to-boost-vaccinations/

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Ohio children on Medicaid can get $100 gift card for first COVID shot

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Ohio MCOs are paying kids to get the vaccine.

 
 

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.

 
 

 
 

As students return to classrooms in the fall, Ohio’s Medicaid managed care plans expanded their $100 incentive for getting a first COVID-19 shot to child members age 12 and older.

“Getting students 12 and up vaccinated will provide peace of mind to parents, caregivers and educators,” said Kelly O’Reilly, CEO of the Ohio Association of Health Plans, in a statement. “Vaccination is the surest way to protect teens against COVID-19.”

Adult Medicaid participants already qualify for the incentive, which will now run through the end of the year instead of Sept. 15. 

Will more Ohio families on Medicaid get vaccinated against COVID-19?

With the incentives now available to children, health care plans hope that will be an additional motivating factor for families on Medicaid to get vaccinated. It’ll also play a role in combating any coronavirus outbreaks that might occur with the delta variant circulating in in-person school settings.

Medicaid is the state- and federally-funded health insurance program that serves more than 3 million low-income or disabled people across the state.   

Gov. Mike DeWine in May had challenged Medicaid managed care organizations to help increase vaccinations. The health care plans had originally set up a goal of 900,000 Medicaid members inoculated by Aug. 15.

The Medicaid population, however, is one that is hard to reach, and incentives were doubled from $50 at the end of July along with a deadline extension to September. 

The former September deadline is reachable, though the original August deadline seemed just out of reach. As of Aug. 8, more than 800,000 Ohioans on Medicaid had received one COVID-19 vaccine dose.

Overall, Ohio has seen a 57% increase in the number of Medicaid members who have completed vaccination since DeWine urged Medicaid managed care organizations to increase inoculations.

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

Clipped from: https://www.cantonrep.com/story/news/coronavirus/2021/08/25/children-medicaid-can-get-100-gift-card-first-covid-19-shot-ohio-incentive-dewine/5584354001/

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MO- Medicaid expansion applications ‘will sit there’ until October, official tells Missouri state workers

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Newly eligible expansion members won’t get their applications processed for another month while the state works on system changes.

 
 

 
 

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.

 
 

 

JEFFERSON CITY — A Department of Social Services official told employees recently that forms from Missourians seeking health care coverage under Medicaid expansion “will sit there” for nearly two months while the state makes system updates.

“The applications will sit there until we have the eligibility piece in, which will be Oct. 1,” Kim Evans, director of the Family Support Division, told workers in a video obtained by the Post-Dispatch through an open records request.

Despite the planned delay, the Aug. 11 video also indicates the state currently has the ability to enroll new applicants, a departure from a news release sent out the same day by Gov. Mike Parson’s office, which suggested it didn’t.

“Staff will go ahead and do the verifications that are needed on the applications,” Evans said. “But what we will do is, we will not — we will not run a determination. We will not finalize these applications. We will let the system do that on October the first.”

Parson’s news release didn’t mention DSS’ apparent ability to “run a determination” or “finalize” applications prior to Oct. 1.

The recorded message, as well as Parson’s newsrelease, followed a Cole County judge’s Aug. 10 order directing the state not to deny Medicaid applications from individuals eligible under expansion, which 53% of voters supported in an August 2020 referendum.

 
 

Clipped from: https://www.stltoday.com/news/local/govt-and-politics/medicaid-expansion-applications-will-sit-there-until-october-official-tells-missouri-state-workers/article_458dad33-b8a7-53c8-8e72-65d2126d7826.html

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Ohio delays rollout of revamped Medicaid system to July 2022

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Ohio managed care and PBM changes will begin 6 months later than originally planned.

 
 

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

 
 

 
 

Ohio pushed back its projected launch date of its revamped and reformed Medicaid managed care system to July 1 of next year,  the Ohio Department of Medicaid announced Wednesday.

The initial timeline set the launch of the long-awaited system in January.

“Our priority since the beginning of this administration has been on doing this right for the people we serve,” said Ohio Medicaid Director Maureen Corcoran. “A July 2022 go-live gives us time to support and inform our members about the new program, to work with community leaders and respond to the feedback received from the plans and providers.”

The “next generation” managed care system is the result of an extensive process that started in 2019, looking at ways to improve and overhaul the system after years of issues and without any reform.

More:Six companies will split $20B in managed-care work under biggest contract in Ohio history

More:Ohio children on Medicaid now eligible for $100 COVID-19 vaccine incentive

Medicaid, the governmental health insurance for more than 3 million low-income or disabled Ohioans, is typically the state’s largest expenditure, with billions of dollars at stake.

The department already has many of the reforms planned and designed out; it’s just a matter of feedback and implementation. Of note are the additions of OhioRISE, which would treat children with severe behavioral and mental problems so parents don’t have to give up custody, and a single pharmacy benefit manager system, to fix the issue of such prescription drug “middlemen” overcharging taxpayers.     

The delay in rolling out these reforms is partly due to the unanticipated “persistence of COVID-19 and its impact on individuals served by the program and their providers,” said the Medicaid department.

There’s uncertainty on when the end of the federal public health emergency declaration for COVID-19 will be. The declaration’s end will impact the department’s plans in terms of whether there will be additional federal money, said Corcoran in a media briefing. Medicaid officials were also worried how the transition could cause instability for consumers amid a pandemic.  

Other factors will complicate the situation. As part of the overhaul, the department re-selected which health plans got its lucrative contracts to handle Medicaid managed care, and those who lost out have complained.

Buckeye Community Health Plan and its parent company Centene were initially deferred due to an ongoing lawsuit from the state alleging the company unlawfully took Medicaid money. But that has since been settled, and Centene was recently granted a contract.

Paramount Advantage, owned by Toledo-based ProMedica, is the only current Medicaid managed care organization that lost out on a contract. It tried to reverse that by appealing the decision and asking state lawmakers for help, but those efforts failed.

The Toledo company now has a lawsuit in the state seeking to halt the overhaul and invalidate the contracts. If successful, that could further derail the department’s timeline.

According to court records, a trial assignment was scheduled for July 25, 2022. A hearing for a preliminary injunction is set for earlier, on Oct. 12.    

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

 
 

Clipped from: https://www.coshoctontribune.com/story/news/healthcare/2021/08/25/ohio-delays-rollout-revamped-medicaid-system-july-2022-procurement-reform-pharmacy-managed-care/5589283001/

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Texas Wins Preliminary Victory Against Biden Administration in Medicaid Lawsuit

MM Curator summary

 
 

A federal judge has delayed the termination by CMS of the approved DSRIP waiver.

 
 

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 impending cancelation of a Medicaid waiver that funds certain instances of uncompensated health care has been paused by a preliminary injunction from the U.S. District Court for the Eastern District of Texas.

The court denied the federal government’s motion to dismiss and approved Texas’ request for a preliminary stay on the waiver cancelation.

Back in April, the Department of Health and Human Services (HHS) announced it had retroactively denied Texas’ Section 1115 waiver under Medicaid. The waiver was applied for and approved by the Trump administration’s HHS and Centers for Medicare & Medicaid Services.

The waiver allows certain categories of uncompensated care to be paid for by the federal government without expanding the welfare program under Obamacare — that would expand the qualifications for coverage under the law.

Without it, Texas hospitals and other health care facilities would find themselves on the hook for billions of dollars that the patients cannot pay for themselves.

Biden’s HHS denied Texas’ approved waiver under the justification that the state had not adequately demonstrated its urgent necessity to skip the typical public notice requirements before approval. Texas had obtained an exemption from those requirements by the Trump administration’s HHS due to the pandemic.

While not part of its official ruling, many in the state on both sides of the political aisle took the denial as a warning shot from the federal government over Texas’ refusal thus far to expand Medicaid.

Texas Attorney General Ken Paxton sued Biden’s HHS director, Chiquita Brooks-LaSure, over the retroactive cancelation. Multiple Texas Republican congressmen joined the suit with the Texas Public Policy Foundation filing an amicus brief on their behalf.

After the injunction, Paxton said, “This deplorable attempt to force our state into expanding Medicaid — the Biden Administration’s ultimate goal — was illegal, and we will continue to fight against every political ploy this Administration throws at us.”

In its ruling, the court said the waiver’s recission has resulted in “[t]urmoil in the State’s Medicaid program.”

A final decision on the case must now be issued and the court will consider the case in full. The Texas Eastern District Court may not be the case’s final stop, either. Whichever way the district court rules, it will likely be appealed by the losing side.

And while this occurs, Texas’ health care industry will rush to cobble together a contingency plan. Texas’ current 10-year waiver expires in September of 2022 and the state would have to expedite a new application should the courts ultimately rule with the federal government.

Clipped from: https://thetexan.news/texas-wins-preliminary-victory-against-biden-administration-in-medicaid-lawsuit/

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Nevada awards Medicaid contracts to 4 insurers

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NV MCO winners announced.

 
 

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

 
 

Dive Brief:

  • The state of Nevada intends to award four insurers separate $11 billion contracts to coordinate care for the state’s Medicaid beneficiaries.
  • The four-year contracts with UnitedHealthcare, Molina, Centene and Anthem are set to begin on Jan. 1 and run through the end of 2025, according to a notice of award. The insurers have an optional two-year extension in the contract if they can agree to terms with the state.
  • The awards must still gain final approval from the Governor’s Board of Examiners, Theresa Carsten with the state’s Department of Health and Human Services, said via email.

Dive Insight:

It’s a big contract win for Molina, which currently does not provide services to Nevada, per its latest annual report.

The payer, which posted a profit in the second quarter despite increases in utilization and COVID-19 inpatient costs, had 3.9 million Medicaid members as of June 30, a year-over-year jump of nearly 25%.

Molina joins three incumbents, UnitedHealthcare (Health Plan of Nevada), Centene (SilverSummit Healthplan) and Anthem Blue Cross Blue Shield (Community Health Care Plan of Nevada).

A total of eight insurance companies bid on the work, including Aetna, according to state scoring documents related to the request for proposal.

The insurers will offer coverage to about 630,000 Medicaid beneficiaries in Clark and Washoe Counties, representing the Las Vegas and Reno areas respectively.

Nevada, like other states, has reported record Medicaid enrollment as a result of the pandemic, which spurred an economic downturn.

Officials in Nevada said enrollment peaked at 810,000 in February, a new record for the state following the previous high of 690,596 set in August 2018.

The Medicaid and Children’s Health Insurance Program overall now cover one in four people in the U.S., a record high. That was helped in part by the freeze on disenrollment for the COVID-19 pandemic, which will run until the end of the public health emergency that is expected to last at least through this year, as well as an increase to the federal matching rate.

 
 

Clipped from: https://www.healthcaredive.com/news/nevada-awards-medicaid-contracts-to-4-insurers/605514/