Tag: State News

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Democrats are working on a ‘Plan A’ for finally getting full Medicaid expansion

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A new plan from Dems would bypass the state nature of Medicaid entirely.

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.

with Alexandra Ellerbeck

Republicans’ long effort to ditch Obamacare seems finally in the rearview mirror, now that the Supreme Court has thrice upheld it.

The road ahead will look very different for the law, as it enters what many view as a new phase of life.

“The ‘Repeal and Replace’ Era Is Over; The ‘ACA Expansion’ Era Begins,” Chris Condeluci, a health policy consultant, wrote in an email to clients this week.

First up: Medicaid expansion.

Democrats have been devising several different strategies for getting health insurance to people in the “coverage gap” — a population that would have otherwise been eligible for expanded Medicaid except for the fact that their states refused to expand the program. This includes roughly 4.3 million Americans in a dozen states.

Their first approach — incentivizing states to expand by giving them extra federal money to do so — hasn’t seemed to work, at least so far. A second approach rolled out by Rep. Lloyd Doggett (D-Tex.) is creative but could be logistically difficult to implement and perhaps even impossible under persistent state resistance (we wrote about Doggett’s bill here).

© Sergio Flores/Getty Images Rep. Lloyd Doggett speaks at a rally in Austin. (Sergio Flores/Getty Images)

So Democrats are working on a third approach.

The legislation — which two health policy experts described to me as Democrats’ “Plan A” for Medicaid expansion — is being crafted by staff members on the House Energy and Commerce Committee. 

The main thrust of the pending legislation is to circumvent the GOP-led states still refusing to expand Medicaid, and find a way to get the free or low-cost coverage to people in the coverage gap, who typically earn at or below the federal poverty level. The bill could take two basic routes to get there — and it’s unclear which one staffers have settled on.

  • One approach would be to allow the coverage gap population to buy fully subsidized plans on HealthCare.gov or the state-run marketplaces. As Judy Solomon writes at the Center on Budget and Policy Priorities, this would require policymakers to make changes in benefits, cost-sharing and enrollment processes.
  • Another approach would be to set up a federalized Medicaid program. It probably would involve direct contracts between the Centers for Medicare and Medicaid Services and managed-care companies to administer Medicaid benefits to people in the coverage gap.

The first method — using the marketplace — could raise some cost concerns, considering it’s far more expensive to insure people through private plans than through Medicaid, which pays providers lower rates. There’s also a worry that both approaches could incentivize states that already expanded Medicaid to drop the coverage, if the federal government starts fully funding the expansion population through a new route.

Democrats are keeping their plans close to the vest.

An Energy and Commerce Committee spokesman declined to offer any details about the legislation, offering only a generic statement about the committee’s work.

“The committee is continuing to work on a comprehensive solution to provide coverage to Americans who are trapped in the Medicaid coverage gap through no fault of their own,” the statement said. “Our priority is crafting a policy fix that provides coverage and access to care to everyone in the states that have not expanded and not limited to certain counties.”

Whatever the bill ends up looking like, Democrats are hoping to include it in any budget reconciliation package Congress tries to pass this year. But those plans are still up in the air, as a bipartisan group of senators tries to negotiate an infrastructure deal with the White House, which would allow Democrats to wait on passing a partisan reconciliation bill until later in the year.

The Post’s Jeff Stein, who has been covering the negotiations:

Ahh, oof and ouch

AHH: The White House said the United States will miss Biden’s July 4 vaccination goal.

Clipped from: https://www.msn.com/en-us/news/politics/the-health-202-democrats-are-working-on-a-plan-a-for-finally-getting-full-medicaid-expansion/ar-AALlLvr?ocid=BingNewsSearch

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Mississippi is probing another Medicaid contractor over pharmacy benefits

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After getting a $55M payout from Centene, MS is thinking UHC/Optum may also be willing to make financial atonement for PBM gaffes.

 
 

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 member of the Senate Medicaid Committee reviews a Mississippi Division of Medicaid handout that reviews the managed care rule in this 2018 file photo. Mississippi officials recent reached a settlement with managed care provider Centene following an investigation into its billing practices.

Rogelio V. Solis | AP

JACKSON • Mississippi announced a $55 million settlement with its largest Medicaid contractor, Centene, last week related to allegations it was overcharging taxpayers for prescription drugs, but state authorities say they are not finished scrutinizing pharmacy benefit management practices at other companies that are paid with public money.

State Auditor Shad White told the Daily Journal last week that his office has been probing another Medicaid contractor, UnitedHealthcare, and its subsidiary, OptumRx, over pharmacy benefits. He declined to provide more details.

From 2016 to 2020, Mississippi’s Medicaid program paid $916 million for pharmacy benefit management services provided by OptumRx, according to agency data. OptumRx, a subsidiary of UnitedHealth Group, the fifth-largest company in the U.S., did not respond to a Daily Journal request for comment.

UnitedHealth and its PBM subsidiary are also facing investigations in other states, according to a recent report by The Wall Street Journal. And Ohio sued OptumRx in 2019, alleging the company bilked that state’s workers’ compensation program out of millions of dollars worth of generic drug discounts.

Meanwhile, the investigation into Centene and its subsidiary Envolve Pharmacy Solutions may be over after the recent settlement, but the mega corporation is apparently not finished doing business with the state. A Division of Medicaid spokesman said earlier this month the agency will exercise an optional one-year contract extension with Centene’s subsidiary Magnolia Health, as well as the state’s other two managed care providers, including UnitedHealthcare. New five-year managed contracts will be bid out by the state and begin next summer.

The three companies provide health insurance benefits for about 485,000 poor adults and children, disabled people, pregnant women, and others. They employ the pharmacy benefit managers as subcontractors to manage drug benefits, negotiate drug prices and reimburse pharmacists.

In the $55.5 million settlement agreement drawn up between Centene and Mississippi — in which Centene did not admit fault — the state had to acknowledge “Centene’s good faith and responsible corporate citizenship” by agreeing to settle. And it agreed that the company and its subsidiaries “have provided high quality pharmacy benefit services to the State and are qualified to continue to provide such services.”

Centene acknowledged it has an “obligation to comply with the requirements of Mississippi’s laws” as it delivers benefits for Medicaid patients going forward, and that the company will “provide full transparency” around its pharmacy benefit claims. Centene is set to pay the state in two installments, with some of the money going to attorney’s fees and the rest to compensate the Division of Medicaid.

Centene also will pay Ohio $88 million to settle a lawsuit alleging the company had inflated its pharmacy costs to the state in order to pad its profits. On top of the settlements with Mississippi and Ohio, the company has set aside another $1.1 billion for payments to 20 additional “affected states,” according to a U.S. Securities and Exchange Commission filing. It is negotiating with a pair of law firms that includes Ridgeland-based Liston & Deas to settle those states’ claims.

But neither Centene nor Mississippi officials have yet gone into detail about specific findings from the investigations into the company, including how much Centene may have cost taxpayers overall. White said the key finding from Mississippi — which was different than Ohio — was that Centene’s PBM had been billing the state for drugs at a higher price than its contract with the Division of Medicaid allowed.

Centene’s top executive only described the allegations in vague terms during a Wednesday call with shareholders, according to an Ohio Capital Journal report.

“The agreement addresses a situation from 2017 to 2018,” Michael Neidorff, the chairman, president and CEO of Centene, said of the settlement deals. “The policies and practices that created the situation were changed in 2019, making the matter very much a thing of the past. With this agreement, Centene will be able to put the situation behind us in a timely manner.”

Centene is the largest Medicaid managed care firm in the country, and the 24th-largest company overall. It brought in $111 billion in revenue last year. And this year, according to its Wednesday investor presentation, it expects to bring in more than $120 billion.

Rep. Becky Currie, R-Brookhaven, a nurse who serves on the House Medicaid Committee, said the state’s $55 million settlement with Centene is “ridiculous” and a “slap on the wrist, with nothing else happening to them, and a possible new contract.”

Currie, who has long raised concerns about the state’s Medicaid managed care system, said she was also disappointed that Centene did not admit fault in the deal.

“If I stole $55 million, how am I not at fault?” Currie asked. “If Becky Currie stole $55 million, I would be in jail. Somebody would (be).”

Currie said she doesn’t believe it’s smart for the state to extend Centene for another year, despite the company’s assurances of reform since 2017 and 2018.

She said she recently sent a letter to Gov. Tate Reeves and other state leaders urging them to take a careful approach as they bid out the next five-year managed care contracts. State officials, she said, need to provide more active oversight of the managed care firms.

Clipped from: https://www.djournal.com/news/state-news/mississippi-is-probing-another-medicaid-contractor-over-pharmacy-benefits/article_676e499e-3c9a-51b4-85c6-236e19ce2e7f.html

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Ohio overhauling $20B Medicaid program, but budget could pump the brakes

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The Senate insistence on reinstating Paramount as an MCO no jeopardizes various improvements to the program.

 
 

 
 

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 DeWine administration’s overhaul of the more than $20 billion Ohio Medicaid program could halt under a budget amendment that would essentially restart the process.

Ohio Medicaid is already over two years into transforming its clunky bureaucracy and re-awarding billions of contracts with a new set of spending conditions, which should translate to better care for the 3 million Ohioans covered by the health insurance program for the poor and disabled.

 
 

The sweeping reforms range from stopping parents from having to give up custody when they can’t afford their child’s mental health care, slashing provider paperwork hassle and implementing long-demanded pharmacy reforms.

The new system is supposed to be in place early 2022.

But that could change because of the proposed state operations budget that just cleared the Ohio Senate. The budget now has an amendment that would prompt the state to give out Medicaid contracts under new rules — most notably requiring that the contracts awarded lean toward companies based in Ohio with Ohio-headquartered parent companies.

 
 

“A couple of the Ohio companies, who for many years have been providing this service, and of course their employees and everyone else are here in Ohio, those folks were concerned what the process was and how it went forward,” Senate President Matt Huffman, R-Lima, said when discussing the Senate’s budget version, according to the Columbus Dispatch.

 
 

This would impact Paramount Advantage, which was one of the bidders based and headquartered in Ohio that just lost out on its bid to keep doing business with Ohio Medicaid. Paramount is operated by Toledo-based ProMedica and is appealing the decision.

Dayton-headquartered CareSource is another bidder also based in Ohio, but it won its contract.

It’s not clear what the proposed Ohio budget would mean for the locally based company, whose primary business line is its Ohio Medicaid contract. A message was left with a company spokesman.

The amendment drew criticism and concern from some of the people banking on an urgent overhaul.

One of the hallmarks of the new system will be a specialty program called OhioRISE to coordinate care for children with complex needs. Those includes kids with significant mental health needs, who have sometimes spent time in foster care, in juvenile detention, or multiple other state systems.

Every year some Ohio parents choose to give up their child’s custody, sometimes returning an adopted child back to state care, because kids in state custody get all their expensive residential treatment covered. OhioRISE would help parents and children navigate these systems with experienced care coordinators and would cover residential treatment.

The Ohio Senate budget amendment does not call for a redo of the OhioRISE contract. But critics of the amendment noted the new overhauled system is full of interlinked programs that only work with the other parts in place, like how OhioRISE would be paid for with with savings from the other parts of the overhaul.

Lisa Norris, who has also been following the OhioRISE proposal, surrendered custody of her 12-year-old daughter on Tuesday in Franklin County because she had been unable to get the nearly $80,000 cash she would need up front to secure her daughter an open residential treatment spot. Norris said as an experienced special educator she knows the resources and there wasn’t another way to get her daughter care.

“I want no other family to ever have to sit in the court and make that decision yesterday because it’s devastating,” Norris said.

The DeWine administration’s overhaul is already underway. All the contracts awards have been announced and the administration did 18 months of pre-work before the bid, got feedback from 1,100 different people and organizations in the lead up to opening up bidding.

 
 

“The Department of Medicaid, from our perspective, spent a really incredible amount of time listening. They listened to providers they listened to consumers, they listened to families, they listened to stakeholders and advocates,” said Teresa Lampl, CEO with The Ohio Council of Behavioral Health & Family Services Providers, who is concerned the proposal could undo the work.

Pausing the overhaul would also pause the overhaul of Ohio Medicaid’s $3 billion pharmacy benefit system. The old system had been roiled in controversy over spending and transparency for years, and pharmacists had celebrated the incoming changes.

“The problem started in 2016, it didn’t see the light of day until the beginning of 2018. And here we are in 2021 with the ball on the tee to fix the problem, and this could throw a wrench into all of it,” said Antonio Ciaccia, pharmacy consultant with 3 Axis Advisors, who had lobbied for years for the changes with Ohio Pharmacists Association.

The new system is five contracts, which have already been awarded: one transparent pharmacy benefit manager instead of a handful of contractors; a central stop to get credentialed; a single clearinghouse for all provider claims and prior authorization requests; a new system to coordinate benefits for kids with complicated needs; and several large contracts for insurance companies to manage benefits and care.

The large contracts went to UnitedHealthcare, Human, Molina, AmeriHealth, Anthem and CareSource.

 
 

Clipped from: https://www.daytondailynews.com/blog/ohio-politics/ohios-overhauling-20b-medicaid-program-but-budget-could-pump-the-breaks/EBES6EYMDBBE5KHTKUQZNGMAX4/

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Senate Budget Derails Ohio’s Medicaid Managed Care Process

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The Senate insistence on reinstating Paramount as an MCO no jeopardizes various improvements to the program.

 
 

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 — A plan to revamp Ohio’s Medicaid managed care system could be thrown off course.

After two years of input from key stakeholders, the state announced six managed care plans in April, but the Senate-passed budget calls for a re-do of the managed care procurement process, and stipulates managed care organizations based in Ohio be significantly considered.

LeeAnn Brooks, chemical dependency counselor for Health Recovery Services in Athens, is concerned about the impact on her patients.

“It’s going to make this whole managed care plan start all over,” Brooks contended. “And then that in turn is going to affect Southeast Ohio and Appalachia, and it’s going to take services away from people in the region as well as others in the state. That’s going to be a bigger setback, and it’s going to cost the state more money.”

It’s estimated more than $400 million in administrative costs would be wasted by stopping the procurement process.

Backers of the amendment claim there was not enough transparency in the bidding process for the $20 billion in contracts, and they argued Ohio companies should get special consideration.

This week, a budget conference committee will assemble. The final biennium budget is due June 30.

Brooks pointed out the Medicaid program is a crucial tool in helping those impacted by the opioid epidemic, many of whom don’t have any other type of insurance. She explained because addiction is a brain disease, it is important treatment not be interrupted.

“That’s planting a seed with people and getting them to understand that what they’re doing is really making their life unmanageable,” Brooks asserted. “With Medicaid, we can continue those treatment services in hopes of changing behaviors, in hopes of getting people into recovery.”

One of the current providers that did not make the list, Toledo-based Paramount Advantage, complained out-of-state companies were favored over those with headquarters in Ohio. The state countered the procurement process is competitive and included extensive public outreach.
 

Clipped from: https://www.clevescene.com/scene-and-heard/archives/2021/06/14/senate-budget-derails-ohios-medicaid-managed-care-process

 
 

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Florida asks for more time on potential Medicaid boost

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Florida is interested in the extra HCBS money, but needs more time to consider the implications.

 
 

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, Fla. – Gov. Ron DeSantis’ administration is asking the federal government for additional time “to consider the potential impacts” of drawing down hundreds of millions of dollars in additional federal Medicaid money for home- and community-based services.

In an email to the federal Centers for Medicare & Medicaid Services, Karen Williams of the state Medicaid office said Florida wants a 30-day extension, which would give the state until July 12 to submit a plan to the federal government.

“Please consider this email as the state of Florida’s formal request for the 30-day extension. This additional time will allow the state of Florida to continue coordinating with all impacted stakeholders to consider the potential impacts of this increase,” Williams wrote in the email late Friday afternoon.

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The American Rescue Plan Act, a stimulus package signed in March by President Joe Biden, included provisions that allow states to tap into additional federal Medicaid funding for a number of different groups and services, some of which Florida has taken advantage of, and others not.

For instance, the federal law provided incentives for 12 states, including Florida, to expand Medicaid to low-income childless adults. The law, at least in part, offers states a 5 percentage- point increase in their regular federal Medicaid matching rates for two years after expansion would take effect. But as they have done for years, Florida Republican leaders shunned the idea of expanding Medicaid during this spring’s legislative session.

The American Rescue Plan Act also allows states to tap into additional funds to extend by 10 months the length of time that postpartum women can qualify for Medicaid. Florida is taking advantage of that provision, with House Speaker Rep. Chris Sprowls, R-Palm Harbor, leading the charge.

The federal law also provided states with an opportunity to draw down a 10 percentage-point increase in federal Medicaid funds for home- and community-based services, such as services provided in Florida’s “iBudget” program for people with developmental and intellectual disabilities.

Tom Rice, a program manager with the state Agency for Persons with Disabilities, told members of the Florida Developmental Disabilities Council last month that the state was putting together plans to access the enhanced Medicaid funding. But advocates for people with disabilities grew worried that the state wouldn’t submit a plan to the federal government — or request an extension — by a Sunday deadline.

With the request for an extension filed Friday, Jim DeBeaugrine, a lobbyist and former director of the Agency for Persons with Disabilities, said he remains hopeful that Florida can tap into the additional federal money.

DeBeaugrine, also a former staff member of the House Appropriations Committee, estimated that Florida could tap into an additional $450 million in Medicaid funds for services provided through the iBudget program.

“I am cautiously optimistic that we can work with AHCA (the state Agency for Health Care Administration) and APD and hopefully come up with a good plan to use the dollars, at least associated with our population,” DeBeaugrine said.

While the 10 percentage-point increase has been a focus of providers that care for people with developmental and intellectual disabilities, the increased funding would be available for all home- and community-based services.

According to guidance issued by the Centers for Medicare & Medicaid Services, states could use the increased funds for a number of other services such as medical or remedial services recommended by physicians, including mental health and substance-use disorder services; private duty nursing services; and programs for all-inclusive care for the elderly, what is known as PACE.

“This is potentially a lot bigger than the population I am concerned with,” said DeBeaugrine, referring to people with disabilities.

Clipped from: https://www.clickorlando.com/news/2021/06/15/florida-asks-for-more-time-on-potential-medicaid-boost/

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Missouri lawmakers expect special session next week to renew important Medicaid tax

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Republicans are fighting to prevent Medicaid paying for abortion drugs via withholding support for continuing a financing scheme that sends more money to large hospitals.

 
 

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, Mo. – Missouri lawmakers could be headed back to the capital city as soon as Monday to renew an important tax that funds the state’s Medicaid program after members could not reach a compromise before they adjourned from the legislature’s regular session.

Governor Mike Parson said he’s still planning to make budget cuts if there’s not a solution by July 1 to pass a new Federal Reimbursement Allowance (FRA) program.

“We’re going to have to move forward because I can’t delay it any longer,” Parson told reporters Tuesday. “July 1 there will be withholds, there is no other option for us.”

The FRA is a tax collected from medical providers like hospitals to support Medicaid. House Budget Committee Chairman Rep. Cody Smith (R-Carthage) said the tax brings in $1.6 billion a year.

“For about every FRA dollar we get, we get about two federal dollars for that and then we take all that money and we put it towards our Medicaid program,” Smith said.

The holdup for the General Assembly is if abortion providers and affiliates and certain contraceptives like Plan B should be covered for women who are already on Medicaid. What’s on the line is billions of dollars for the state’s program.

“The Republican party in the state of Missouri has shown no abandonment for women’s reproductive rights,” Senate Minority Floor Leader John Rizzo (D-Independence) said. “They’re trying to conflate abortion and birth control and the two things are not the same.”

Since lawmakers didn’t get it done before they adjourned, they have to come back for a special session since the FRA expires Sept. 30.

“I’m optimistic that we will be able to come to some compromise on a plan that enables us to go in legislate this fairly quickly and get it to the governor’s desk by the end of the month,” Smith said.

Lawmakers said the problem in finding a compromise is whether or not to allow Medicaid to cover contraceptives. During the last week of session, Sen. Paul Wieland (R-Imperial) attached an amendment to Senate Bill 1 that bans the use of FRA funds for contraceptives and abortions.

“You are literally putting $4 billion dollars in flux that is used to provide healthcare for Missourians over contraception, over birth control,” Rizzo said.

Republican Senators met with Parson Tuesday afternoon to try and find a compromise to renew the FRA. Part of the new language in the drafted legislation says:

Family planning as defined by federal rules and regulations; provided that such family planning services shall not include abortions or any abortifacient drug or device unless such abortions are certified in writing by a physician to the MO HealthNet agency that, in the physician’s professional judgment, the life of the mother would be endangered if the fetus were carried to term.

It goes on to say that an “abortifacient drug or device” include Plan B and intrauterine devices (IUD).

“We have a pro-life super majority on the Republican side and many of our members care about those issues,” Smith said.

Missouri has used the FRA for more than 20 years to fund the state’s Medicaid program. Parson said if it’s not renewed, it will more than a billion-dollar hole in the budget.

“If we can stay in the guidelines, if we can have language in there that doesn’t jeopardize the FRA and doesn’t jeopardize our CMS [Centers for Medicare and Medicaid Services], then we would be willing to take a look at something like that,” Parson said.

Rizzo said he hopes the governor “narrows” the call for the special session so lawmakers can pass a “clean FRA.”

“I think that there is still a lot of fence mending that needs to happen that hasn’t happened yet, I also think that we are adults, and we understand that this is something that could be catastrophe to the state of Missouri if we don’t get it done,” Rizzo said.

He believes lawmakers will be back at the Capitol starting Monday to start working on a plan to renew the FRA. Rizzo said the legislation will start in the Senate and then move over to the House.

Parson’s office has not confirmed when legislators will be back in Jefferson City.

Clipped from: https://fox2now.com/news/missouri/missouri-lawmakers-expect-special-session-next-week-to-renew-important-medicaid-tax/

 
 

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Gov. Abbott Signs Bill Extending Medicaid Coverage For New Texas Mothers

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TX added 6 months of post-birth care for mothers.

 
 

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 Texas Legislature passed a bill this session that increases coverage for new mothers on Medicaid from 60 days to six months.

Gov. Greg Abbott signed a bill this week that expands health care for new moms on Medicaid.

Women who’ve just given birth in Texas currently can receive health care services through Medicaid only for up to 60 days after they have the baby. Starting Sept. 1, new mothers will get a full six months of coverage before being removed from the program.

The Maternal Mortality and Morbidity Task Force and Department of State Health Services have been combing through maternal death data for years to come up with solutions on how to reduce deaths in Texas. Several years ago, they recommended Medicaid coverage be extended up to a year after a woman gives birth.

According to their report from July 2016, extending coverage for up to a year would “improve continuity of care, promote safe birth spacing, and reduce maternal morbidity,” which includes near-death experiences or serious health complications that arise during a pregnancy.

Members of the state health agency and task force also told lawmakers it could save the state money.

“Increasing access to care throughout the first postpartum year would improve interconception health while also reducing cost in the Medicaid program by decreasing the rate of unintended pregnancy,” the task force wrote, “and by preventing, detecting and managing chronic conditions and other risk factors, such as obesity, hypertension, smoking, and mental and behavioral health issues, that increase risk for maternal morbidity and mortality and lead to costly adverse pregnancy and birth outcomes including severe maternal morbidity, preterm birth, and low birth weight.”

After years of failed efforts to extend coverage, lawmakers did manage to pass a version of the task force’s recommendation this year. But House Bill 133 falls short of what was advised; instead of one year of postpartum coverage, lawmakers agreed to extend the coverage to only up to six months.

Adriana Kohler, a policy director at Texans Care for Children, said in a statement that HB 133 is a critical bill.

“Six months of health coverage after childbirth is an important step forward to support moms during this critical time for their health and their baby’s development, so we urge state and federal leaders to work together to quickly implement the legislation,” she said after Abbott signed it into law. “We also encourage state leaders to build on this effort and develop a plan to ensure that moms have health coverage before their pregnancy [and] after the six months of postpartum coverage expires.”
 

 
 

Clipped from: https://www.kut.org/health/2021-06-16/gov-abbott-signs-bill-extending-medicaid-coverage-for-new-texas-mothers

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Louisiana Senate scuttles post-pregnancy Medicaid extension

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LA has now declined the extra maternity coverage in the COVID relief bills, citing concerns over the state-share of the increased costs.

 
 

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.

 
 

People would have been able to stay on Medicaid for 12 months postpartum

The Louisiana Senate Finance Committee killed legislation Thursday that would have allowed people who were pregnant to stay on Medicaid for a year postpartum. The federal government would have had to sign off on the approval before it went into effect. 

Currently, people who use Medicaid during their pregnancy lose their health care coverage two months after their pregnancy — unless they qualify for Medicaid in another way.

People who are pregnant can make more money than most Medicaid enrollees and still use the program. They may use Medicaid while pregnant, but make too much money to qualify for government-backed health insurance afterwards. State Rep. Mandie Landry, D-New Orleans, was attempting to fill that gap with this bill. 

The Louisiana House voted 95-0 for Landry’s legislation, House Bill 468, but the Senate Finance Committee said the bill was too expensive to approve. Expanding postpartum access would have cost Louisiana between $4.3 million and $4.6 million in state funding annually over the next five years.

The Senate Finance Committee scuttled several other bills — including legislation that would have eased criminal record expungement — because they were deemed too expensive. 


The committee did so even though Louisiana has more funding this year than it has since a financial windfall from recovery after hurricanes Katrina and Rita. The state has received billions of dollars from the federal government in recent months to help the state rebound from the COVID-19 pandemic.

After receiving the federal funding boost, lawmakers voted to spend over $70 million on local earmarks in their budget plan. Those projects  include a skate park, town hall renovations, lighting upgrades for certain cities, the installation of “cooling fans” in a neighborhood park and funding for a nonprofit entity created by a sitting senator. Lawmakers have also set aside $15 million next year for technology upgrades at the state Capitol. 

 
 

Clipped from: https://lailluminator.com/2021/06/03/louisiana-senate-scuttles-post-pregnancy-medicaid-extension/

 
 

 
 

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Illinois Selects CNSI to Support Ongoing Medicaid Modernization Efforts

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CNSI has won the IL MMIS contract.

 
 

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.

 
 

CNSI to Assist with Claims and Encounter Data Processing, Managed Care Coordination, and AWS Cloud Migration

MCLEAN, Va., June 8, 2021 /PRNewswire/ — CNSI, a leading provider of innovative, healthcare technology-driven products and solutions that improve health outcomes and reduce healthcare costs, announced today that Illinois has selected CNSI’s Medicaid Management Information System (MMIS) for core claims processing, encounter data processing, and MC-Track® managed care coordination platform. CNSI will also support Illinois’ MMIS migration to the Amazon Web Services (AWS) secure public cloud to power their infrastructure, become more agile, and lower costs. The Centers for Medicare & Medicaid Services (CMS) approved the four-year contract, which includes CNSI’s Fast Healthcare Interoperability Resources® (FHIR) based interoperability solution.

The Illinois Department of Healthcare and Family Services (HFS) is responsible for providing healthcare coverage for adults and children who qualify for Medicaid. Illinois’ medical assistance programs, consisting of Medicaid and numerous other associated health and human services programs, provide comprehensive health-care coverage to about 3.2 million Illinoisans.

“The state of Illinois is dedicated to creating a more efficient, accountable and integrated healthcare system, and providing better quality care and positive outcomes for our customers,” Illinois Department of Healthcare and Family Services Director Theresa Eagleson said. “CNSI’s partnership helps us avoid significant loss of time and inefficiencies as we work to modernize our 35-year old payment system and allows us to better focus our resources on connecting the Illinoisans we serve with quality care and services.”

Todd Stottlemyer, CEO of CNSI, added, “We have expanded the CNSI modular product suite to encompass claims and encounter data processing for care provided in a multitude of settings – each with their own data interoperability nuances. Illinois’ adoption of FHIR-based standardization will reduce the work required to implement, track, and report on health quality measures – all part of their long-term vision for growth and scalability.”

Central to the Illinois MMIS contract, CNSI received the top overall score in the 2020 NASPO ValuePoint™ multi-state evaluation of MMIS Claims Processing and Management Services.

 
 

Clipped from: https://www.prnewswire.com/news-releases/illinois-selects-cnsi-to-support-ongoing-medicaid-modernization-efforts-301307542.html

 
 

 
 

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OHIO- Senate Proposal To Change Medicaid Procurement Process Draws Criticism

MM Curator summary

 
 

Ohio lawmakers are working to ensure local plans win government bids.

 
 

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 state has selected six managed care organizations to carry out Medicaid services, amounting to a $20 billion contract, but a provision in the Senate’s budget proposal would stop that procurement process and require the state to consider other measures.

The Senate plan would require the state to “significantly take into account” if the managed care organization applying for a contract is based in Ohio.

Other things to take into account, according to the bill language, is the number of jobs created or lost in this state by the award of the contracts; other economic impacts in this state resulting from the award of contracts; and whether the managed care organization has a proven track record of “providing quality services and customer satisfaction.”

Paramount Advantage, based in the Toledo area, was the only current provider not selected for a contract set to begin in 2022.

Critics of the procurement process say there was not enough transparency.

Loren Anthes, policy fellow with The Center for Community Solutions disagrees with that assessment.

“The idea that there’s a lack of transparency, after the dozens of hearings I’ve been to, the dozens of meetings I saw, the fact that the state has a website with all this material, is at least misleading, at most it’s manipulative,” Anthes says.

Anthes says the state used a thorough process to determine which companies provide the best coverage and the Senate’s amendment threatens to lower that bar.

 
 

Clipped from: https://www.statenews.org/post/senate-proposal-change-medicaid-procurement-process-draws-criticism