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May 22, 2024

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This week's roundup:

In Focus

Minnesota’s Initiative to Build a Stronger Substance Use Disorder Ecosystem

This week, our In Focus section spotlights Minnesota’s innovative efforts to develop a comprehensive ecosystem that addresses substance use disorder (SUD).  

Overview  

Like many states, Minnesota experienced a significant surge in overdose deaths between 2018 and 2021, magnifying disparities in health outcomes linked to SUD and fatalities. For example, in 2021, Native American Minnesotans were 10 times more likely to succumb to a drug overdose than their white counterparts. Similarly, Black Minnesotans faced over three times the risk of dying from a drug overdose compared with White Minnesotans.

How do you create a more effective SUD prevention and treatment system? By fostering collaboration among the people who are directly affected, service providers, advocates, policymakers, and payors so they can learn from one another, offer support, and collectively commit to advancing change. 

The Minnesota Department of Human Services (DHS) Behavioral Health Division has enlisted Health Management Associates, Inc. (HMA), to facilitate the Minnesota SUD Community of Practice (CoP), with the goal of creating a culturally responsive system of care. A CoP has three primary elements: 

  • A common identity, purpose, or value that encourages engagement and mutual exploration 
  • A community that establishes a culture of learning and willingness to share, ask, and listen 
  • The cultivation of practices where the community develops, shares, and maintains frameworks, tools, and ideas that are evidence-based and usedii 

HMA understands that a well-established CoP, supported by solid processes, tools, resources, and expertise, is essential to realize and sustain a strong CoP foundation for translating knowledge into action. 

Many states, including Minnesota, are using the American Society of Addiction Medicine (ASAM) criteria as the guidepost of their efforts to improve the addiction treatment system. To develop a road map on how to implement the ASAM Fourth Edition Levels of Care in Minnesota, HMA convened workgroups to collect firsthand information about services available in participants’ communities, whether they can deliver services at the ASAM level, and the barriers to providing this level of care.  

The Approach  

To authentically engage the community, HMA has partnered with three community advisors, each representing communities with the most significant disparities. The community advisors are integral to ensuring all CoP efforts incorporate a cultural lens that is responsive to the needs of communities facing health inequities. They do so by amplifying the voices and experiences of individuals in populations disproportionately affected by SUDs. In addition, the community advisors provide tailored facilitation, training, and resources within their respective CoPs to promote culturally specific and responsive practices. This approach seeks to increase treatment engagement and reduce disparities in treatment outcomes. 

HMA is working with the CoP to create a report on SUD treatment gaps, a strategic planning and implementation summary, an ASAM implementation road map, a community advocacy capacity-building report, and an overview of culturally specific and responsive models of care.  

Connect with Us  

HMA brings experience in helping to build systems of care and expertise in assisting states with assessing ASAM levels of care and developing strategies, plans, and training to bolster these efforts. HMA is committed to empowering individuals with lived experience and people underserved by existing systems to play key roles in shaping new systems aimed at fostering equitable care. 

The May 2024 edition of HMA’s Podcast, Vital Viewpoints, features a discussion with HMA Principal Debbi Witham about her insights on the ASAM levels and the impact on systems of care.  She shares her in-depth understanding of the complexities of SUD and underscores the crucial need for quality measures and sustainable healthcare funding while warning against investing in ineffective systems. Ms. Witham further emphasizes how states might correct course now to ensure equitable distribution of funding and offers insights into the essential steps for coordinating a community response that enhances outcomes.  

For more information about HMA’s work in Minnesota and similar projects in other states contact Paull Fleissner, Boyd Brown, and Debbi Witham.  

 

Texas Releases STAR Kids RFP

This week’s second In Focus reviews the Texas STAR Kids request for proposals (RFP), which the Texas Health and Human Services Commission released on May 10, 2024. The STAR Kids Medicaid managed care program provides coverage to children and youth ages 20 and younger with disabilities. Nine plans currently participate in the program, with contracts worth approximately $4 billion annually.  

STAR Kids Overview  

The STAR Kids program operates under the Texas Healthcare Transformation and Quality Improvement Program 1115 demonstration project. To be eligible, individuals must receive Supplemental Security Income (SSI) and SSI-related Medicaid, participate in the Medically Dependent Children Program (MDCP) Section 1915(c) waiver, live in a community-based intermediate care facility, or participate in an intellectual or developmental disability (I/DD) waiver program.  

Medicaid managed care organizations (MCOs) provide acute, behavioral, and long-term services and supports (LTSS) to children in the MDCP program and acute services only to children covered under the other home and community-based services/IDD waivers. 

RFP 

Texas plans to award contracts to at least two MCOs for each of the 13 service areas (SAs). Each MCO can be awarded up to six SAs.  

MCOs will need to describe reimbursement strategies that incentivize high-quality and cost-effective healthcare while controlling spending and reducing ineffective service utilization in their proposals.  

MCOs must demonstrate progress toward advancing alternative payment model (APM) initiatives within an APM performance framework. MCOs will need to provide a proposed APM and a means of tracking its effectiveness, including implementation of processes that support and incentivize providers to apply value-based care models and reward high performers. 

Evaluation 

Technical questions in the proposals are divided into five broad categories, representing a total of 1,800 points. Plans can score up to 2,000 points, including oral presentations (see table below).  

Timeline 

Proposals are due July 11, with awards expected to be made between December 2025 and February 2026. The contract start date is anticipated to begin between December 2026 and February 2027. Contracts will run for six years with three two-year renewal options. 

Current Market

Incumbents CVS/Aetna, Elevance/WellPoint, Blue Cross Blue Shield of Texas, Centene/Superior Health Plan, Community First Health Plan, Cook Children’s Health Plan, Driscoll Children’s Health Plan, Texas Children’s Health Plan, and UnitedHealthcare served 150,000 beneficiaries as of November 2023.

Connect With Us  

Texas has an active Medicaid procurement schedule, with key deadlines and additional developments expected in the coming months. HMA experts in Texas are monitoring these activities as the state works to reprocure all its Medicaid managed care contracts. These programs include the State of Texas Access Reform (STAR) and CHIP for traditional Medicaid members, STAR+PLUS for members who are aged and disabled, and STAR Kids for individuals younger than 20 years old with disabilities. 

Through HMA’s Information Services, subscribers gain access to detailed information about the Texas and other state RFP landscapes and procurement documents, as well as historical data about plan contracts, enrollment, and financials.  

For more information about HMA’s work in Texas and our HMAIS resources contact Stephen Palmer [email protected],  Alona Nenko [email protected], and Andrea Maresca [email protected].  

HMA Roundup

Alabama

Alabama Organizations Urge Governor to Adopt Medicaid Expansion. The Alabama Daily News reported on May 19, 2024, that advocacy group Cover Alabama, along with more than 80 businesses and organizations, signed a letter requesting that Governor Kay Ivey expand the state’s Medicaid program to cover nearly 300,000 uninsured individuals in the state. The letter addresses the potential financial gains associated with Medicaid expansion, including access to $619.4 million in federal funds and the federal government paying $397 million in annual expenses currently covered by the state. Ivey’s office has indicated that she remains opposed to expansion, although some Republican lawmakers have engaged in expansion-related discussions in the past year. Read More

Arizona

Arizona Awards FFS PBM Contract to OptumRX. The Arizona Health Care Cost Containment System announced on May 20, 2024, that it has awarded a pharmacy benefit manager (PBM) contract to incumbent United/OptumRX to provide services for the state’s fee-for-service Medicaid populations. The contract is anticipated to start on October 1, 2024, and will run for three years with two one-year renewal options. Read More

California

California Bill to Create Universal Healthcare System Dies in Assembly Appropriations Committee. The San Joaquin Valley Sun reported on May 16, 2024, that a California bill to create CalCare, a state-run, single-payer, universal healthcare plan, has died in the Assembly Appropriations Committee. Since 2007, the state has unsuccessfully tried to enact a single-payer healthcare bill. Read More

Delaware

Delaware Receives Federal Approval for Medicaid 1115 Waiver Extension. The Centers for Medicare & Medicaid Services approved on May 17, 2024, Delaware’s five-year extension of its Section 1115 Diamond State Health Plan demonstration, effective through December 31, 2028. The extension will include clinically appropriate substance use disorder treatment services for short-term residents in residential and inpatient treatment settings that qualify as an institution for mental diseases; adult dental services; coverage for former foster care youth under age 26 who currently reside in Delaware; and contingency management services for certain adults with stimulant use disorder or opioid use disorder. Read More

Florida

Florida Centene Subsidiary, CityBlock Partner to Provide Primary Care, Care Coordination Services. Fierce Healthcare reported on May 21, 2024, that Medicaid value-based care provider Cityblock has entered a partnership with Centene subsidiary Sunshine Health to provide primary care and care coordination services to Medicaid beneficiaries in 11 counties in central Florida. The partnership, which began May 1, will provide services at home or in local clinics. Cityblock has previously partnered with Centene subsidiaries in New York and Ohio. Read More

Florida Lawsuit Over CHIP Guidelines Challenged by Biden Administration. Health News Florida reported on May 16, 2024, that the Biden administration filed a motion to dismiss Florida’s lawsuit challenging guidelines from the Centers for Medicare & Medicaid Services prohibiting the state from removing children from the Children’s Health Insurance Program (CHIP), KidCare, if parents stopped paying required premiums. The Biden administration contends that the guidelines adhere to the Consolidated Appropriations Act of 2023 while Florida has argued that the guidelines violate the Administrative Procedure Act. Florida initially filed the lawsuit in February and additionally requested a preliminary injunction, which has not yet been ruled upon. Read More

Illinois

Illinois House Committee Passes Bill to Strengthen Children’s Behavioral Health Transformation Initiative. Health News Illinois reported on May 21, 2024, that the Illinois House Mental Health & Addiction Committee approved a bill, sponsored by Representative Lindsey LaPointe (D-Chicago), that would further strengthen childhood mental health services as a part of the Illinois Children’s Behavioral Health Transformation Initiative. Specifically, the bill would establish a workgroup with the Department of Healthcare and Family Services, Medicaid managed care organizations, and other stakeholders to identify leading indicators for behavioral health crisis risk and make recommendations by September. The bill would also require the State Board of Education to work with agencies and stakeholders to develop a universal mental health screening of students, with a phased in plan slated to begin next April. The bill now heads to the full House for final review. Read More

Illinois Senate Committee Approves Bills Comprising Governor’s Insurance Reform Package. Health News Illinois reported on May 22, 2024, that the Illinois Senate Insurance Committee approved two bills comprising Governor JB Pritzker’s insurance reform package. HB 5395, sponsored by Senator Robert Peters (D-Chicago), would ban insurers from using step therapy, the practice of asking patients to try cheaper treatments prior to authorizing more expensive options; increase transparency standards; and streamline availability of providers’ information. It would also require insurers to cover the first 72 hours of inpatient mental treatment at a hospital if notified of the admission and treatment plan within 48 hours. HB 2499, sponsored by Senator Laura Fine (D-Glenview), would ban short-term, limited-duration plans that do not cover all essential benefits beginning in 2025. Both bills next head to the full Senate for further review. Read More

Illinois to Grant $200 Million in Additional Healthcare Transformation Grants. Health News Illinois reported on May 20, 2024, that Illinois will award $200 million to six to 10 projects in the next round of healthcare transformation grants. Safety-net hospitals will be prioritized. The Department of Healthcare and Family Services and Capital Development Board will accept applications through the end of June, and awards are expected to be announced later this year. Read More

Indiana

Indiana Faces Lawsuit Over Cuts that Remove Compensation for Family Caregivers. ABC News reported on May 17, 2024, that the American Civil Liberties Union of Indiana and Indiana Disability Rights groups, on behalf of parents of two children with disabilities, are suing the Indiana Family and Social Services Administration (FSSA) in response to the state’s decision to stop reimbursing family members and guardians for home care beginning July 1. The lawsuit alleges that the decision is a violation of the Americans with Disabilities Act and federal Medicaid laws and could result in the unnecessary institutionalization of children with complex medical needs. Affected families have spoken out against the decision, which was proposed to save costs in light of a nearly $1 billion Medicaid shortfall. The lawsuit states that the FSSA’s efforts to work with families, including new reimbursement rates, have not been sufficient. Read More

Kansas

Kansas Governor Signs Bill to Invest in Mental Health Pilot Program, New Psychiatric Hospital. KSNT reported on May 16, 2024, that Kansas Governor Laura Kelly signed the omnibus reconciliation spending limit bill, which will provide $4.5 million to the Mental Health Intervention Pilot and invest $26.5 million into building a new psychiatric hospital in Wichita. The pilot program authorizes school districts to enter into agreements with local community mental health centers to support students and families with mental health needs. Read More

Louisiana

Louisiana Senator Proposes Bill for Medicaid Doula Services. 7 KPLC reported on May 21, 2024, that Louisiana Senator Regina Ashford Barrow (D-Baton Rouge) proposed a bill that would require Medicaid to cover doula services before, during, and after childbirth. The bill currently awaits review in the Senate Finance Committee. Read More

Nevada

Nevada Solicits Public Input for Upcoming Coordination-only D-SNP RFP. The Nevada Division of Health Care Financing and Policy released on May 17, 2024, a solicitation of public input regarding an upcoming request for proposals (RFP) for the Coordination-Only Dual Special Needs Plan (CO D-SNP) Program. CO D-SNP State Medicaid Agency Contracts will be effective from January 1, 2026, through December 31, 2029, with awards to be announced in early January 2025. The solicitation will accept input from plans and stakeholders on items such as inclusion of health risk assessments, covered populations, expansion of service area, supplemental benefits, and quality measures through June 17. Read More

Nevada Extends Postpartum Medicaid Coverage to 12 Months. The Centers for Medicare & Medicaid Services announced on May 17, 2024, approval for Nevada’s Medicaid state plan amendment to extend Medicaid postpartum coverage to 12 months. Read More

New Mexico

New Mexico Sets Expectations for MCOs to Invest in Behavioral Health Accessibility Under New Contracts. The Santa Fe New Mexican reported on May 20, 2024, that New Mexico expects its four managed care organizations (MCOs) under the revamped Medicaid managed care program, called Turquoise Care, to make financial investments to address gaps in access to care, specifically for behavioral health accessibility. The new contracts include requirements regarding behavioral health appointment wait times and providing mobile crisis services. The state will impose sanctions on MCOs that fail to meet required standards. Read More

New York

New York Appeals Court Blocks State from Transitioning Municipal Retirees to Medicare Advantage Plans. Crain’s New York Business reported on May 22, 2024, that a New York State appeals court upheld a previous ruling barring New York City from transferring 250,000 municipal retirees from traditional Medicare to private Medicare Advantage plans. The state first announced the transition in 2018 in an effort to save money, though the decision was met with opposition from retirees, who noted that the transition may be more expensive and reduce their access to providers. In 2023, a class-action lawsuit was filed against the city to block the transition and a trial court granted the request. Read More

New York Comptroller Raises Concerns Over Managed Care Tax Revenue in Enacted Budget. Crain’s New York reported on May 20, 2024, that New York Comptroller Thomas DiNapoli has criticized the state’s enacted budget and its financial reliance on implementing a Medicaid managed care tax. The managed care tax has not yet received federal approval, although the state still included $350 million in expected revenue from it. The Division of Budget is expected to release an update to the state’s financial plan by the end of this month. Read More

New York Senator Introduces Bill to Increase Transparency in Medicaid Managed Long Term Care Plans. Spectrum Local News reported on May 16, 2024, that New York State Senator Rachel May (D-Syracuse) introduced a bill that would require the state to make Medicaid Managed Long Term Care (MLTC) data public, including the number of enrollees, types of services received, and amount of home care hours provided. The bill is intended to enhance accountability of MLTC plans and ensure allocated funding goes to home care services. The bill is currently being reviewed by the Senate Health Committee. Lawmakers previously proposed legislation to eliminate MLTC plans and revert to a fee-for-service model; however, it is unlikely to pass during the current legislative sessions. Read More

Tennessee

Tennessee Receives Federal Approval for Section 1115 TennCare III Waiver Amendment. The Centers for Medicare & Medicaid Services (CMS) approved on May 17, 2024, Tennessee’s request to amend its Medicaid section 1115 demonstration entitled, “TennCare III,” effective through December 30, 2030. The amendment allows for modifications including the expansion of eligibility for parents and caretaker relatives of dependent children, a new benefit to cover a supply of diapers for infants and young children, and enhanced home and community-based services for beneficiaries with disabilities. Read More

Washington

Washington Reentry Demonstration Initiative to Provide Pre-release Medicaid Services. The Washington State Health Care Authority announced on May 21, 2024, that it has invited the state’s carceral facilities to participate in the Reentry Demonstration Initiative, which provides pre-release Medicaid services for those leaving incarceration. The services include care management, substance use disorder treatment, and targeting of infectious diseases. The voluntary initiative functions under the Medicaid Transformation Project, the state’s Section 1115 demonstration, and the first cohort of participating carceral facilities will launch on July 1, 2025. Read More

Wisconsin

Wisconsin Medicaid LTC Contract Award Slated to Go to Molina. Molina Healthcare announced on May 22, 2024, that the Wisconsin Department of Health Services (DHS) plans to award the company the Medicaid long-term care (LTC) Family Care and Family Care Partnership program contract to provide services in Geographic Service Region 5. The contract is expected to begin on January 1, 2025, and last for two years with the option for three two-year renewals. Molina Healthcare of Wisconsin will offer the program benefits under the brand name, My Choice Wisconsin. Molina currently serves approximately 5,600 members in both the Family Care and Family Care Partnership program. The state has approximately 55,000 total members enrolled in the two programs. Read More

National

Biden Administration Releases National Maternal Mental Health Strategy. RollCall reported on May 15, 2024, that the Biden Administration’s Advisory Committee for Women’s Services’ (ACWS) Task Force on Maternal Mental Health has launched the first national maternal mental health strategy which recommends a whole of government approach to reducing untreated mental health and substance use conditions during and after pregnancy. The strategy includes initiatives and recommendations for states to support data and research; prevention, screening and diagnosis; intervention and treatment; community practices; and community engagement. The Administration also sent The Task Force on Maternal Mental Health’s Report to Congress, which catalogues best practices, existing federal programs and coordination, and feedback from stakeholders. Read More

CMS Launches Websource for EMTALA Complaints. The Centers for Medicare & Medicaid Services (CMS) announced on May 21, 2024, that it has launched a new websource to allow individuals to more easily file an Emergency Medical Treatment and Labor Act (EMTALA) complaint. Medicare-participating hospitals are required under EMTALA to provide medical screening exams for individuals arriving at hospital emergency departments to determine if the person has an emergency medical condition. Read More

Senate Finance Committee Chair Plans to Introduce Legislation Targeting Rogue Exchange Marketers. Modern Healthcare reported on May 21, 2024, that Senate Finance Committee Chair Ron Wyden (D-Oregon) informed the Centers for Medicare & Medicaid Services (CMS) of plans to introduce legislation that would allow federal regulators to fine rogue brokers and agents who sign individuals up for Exchange plans without their consent. CMS indicated this month that it is considering issuing monetary penalties for these faulty agents and brokers. The agency received approximately 40,000 complaints from people who had unknowingly been switched to Exchange plans in the first three months of 2024, and 50,000 complaints of unauthorized enrollments during the annual sign-up period for 2024. Read More

Senate Finance Committee Releases White Paper on Increasing Medicare Physician Reimbursement. Modern Healthcare reported on May 20, 2024, that the Senate Finance Committee released a white paper proposing adjusting Medicare doctor reimbursement to account for inflation. The white paper considers payment reform policies including incentives to increase provider participation in alternative payment models, potential changes to Medicare’s budget neutrality requirements, and ensuring clinicians can own and operate their practices. The paper also aims to identify solutions for better treatment and management of chronic conditions. Read More

U.S. House Energy, Commerce Health Subcommittee Passes Legislation to Extend Telehealth Flexibilities by Two Years. Stat News reported on May 16, 2024, that the U.S. House Energy and Commerce health subcommittee passed legislation to extend Medicare telehealth flexibilities by two years. Flexibilities include allowing visits to be conducted from any location and permitting additional providers to bill for telehealth. The legislation also would address payment disparities for rural providers and reimburse Rural Health Clinic and Federally Qualified Health Centers at parity with in-person visits. The bill will next be reviewed by the full committee. Read More

Senators Introduce Bill to Improve Pay for PCPs, Reduce Cost-Sharing For Medicare Beneficiaries. Fierce Healthcare reported on May 15, 2024, that United States Senators Sheldon Whitehouse (D-Rhode Island) and Bill Cassidy (R-Louisiana) introduced a bill, titled the Pay Primary Care Providers (PCPs) Act aimed at supporting and improving pay for PCPs. The bill would reward PCPs providing high-quality care and provide Medicare beneficiaries with reduced cost-sharing for some primary care services. The senators released a request for information for feedback on policy questions. The deadline to respond is July 15. Read More

Senators to Introduce Bill that Would Extend Acute Hospital Care at Home Bill for Five Years. The Hill reported on May 15, 2024, that U.S. Senators Tom Carper (D-Delaware) and Tim Scott (R-South Carolina) plan to introduce a bill that would extend the expiration date of the Acute Hospital Care at Home (AHCAH) waiver program for another five years. The program, currently set to expire December 31, 2024, permits inpatient-level hospital services to be conducted in patients’ homes. Read More

CMS Discards Stacking Provision Under Medicaid Drug Rebate Proposed Rule. The Centers for Medicare & Medicaid Services (CMS) announced on May 15, 2024, that it will not be finalizing the “stacking” provision under the proposed Medicaid Drug Rebate Program rule, which would have required companies to stack discounts and rebates throughout a transaction when reporting best prices. CMS will continue to gather information from manufacturers on best price stacking methodologies to better inform new rules. Read More

Industry News

Centene Invests $900 Million To Develop Affordable Housing Units in Eight States. Fortune reported on May 20, 2024, that Centene has pledged $900 million to develop a multi-year partnership with affordable housing developer McCormack Baron Salazar to create thousands of housing units in eight states. With this investment, Centene aims to address the rising rates of housing instability, a major social determinant of health. Read More

BrightSpring Announces New Acquisitions in Arkansas, Kentucky, Tennessee, Texas. BrightSpring Health Services, a provider of home and community-based services for complex populations, announced on May 22, 2024, new acquisitions across the country. Effective May 1, 2024, BrightSpring acquired an Arkansas-based home-based primary care group and an institutional special needs health plan (I-SNP) plan in Kentucky and Tennessee. The company also acquired a home and community pharmacy in Texas, a tuck-in to existing pharmacy operations in Texas and Oklahoma, effective May 3, 2024. Read More

Accenture Federal Services Completes Acquisition of Cognosante. Accenture Federal Services announced on May 20, 2024, that it has completed its acquisition of Virginia-based Cognosante, a provider of technology solutions for federal agencies. Read More

Addus Homecare to Sell NY Operations to HCS-Girling. Hospice care provider Addus HomeCare Corporation announced on May 21, 2024, that it has entered into a definitive agreement to sell its New York operations with New York-based HCS-Girling. The purchase price for the transaction will be up to $23 million. Read More

Private Equity Firm GTCR to Acquire Caravel Autism Health. Behavioral Health Business reported on May 20, 2024, that private equity firm GTCR is working on a deal to acquire Wisconsin-based Caravel Autism Health. Caravel Autism Health operates in eight states concentrated in the Upper Midwest. Terms of the acquisition were not announced. Read More

Steward Healthcare Sees Interest in Hospital Assets, Sets Proposed Timeline for Sales. Modern Healthcare reported on May 20, 2024, that Steward Health Care, which filed for Chapter 11 bankruptcy, has advanced discussions with UnitedHealth Group’s Optum to buy Stewardship Health physician network under a “stalking horse” bid. Steward’s hospitals for sale in Massachusetts and Arizona have also attracted several third party buyers and the system anticipates completing the sales in the summer, with a proposed June 24 bid deadline for all of its hospitals, excluding the facilities in Florida and Stewardship Health. The proposed bidding deadline for the Florida hospitals and any other assets is July 26. Read More

Jefferson Health, Lehigh Valley Health Network Health Systems to Merge. Modern Healthcare reported on May 15, 2024, that health systems Jefferson Health and Lehigh Valley Health Network have signed a definitive agreement to merge. The merger will establish a $15 billion regional nonprofit system operating 30 hospitals and more than 700 care facilities in Pennsylvania and New Jersey. The deal is expected to close this summer. Financial details have not been disclosed. Read More

RFP Calendar

Company Announcements

MCG White Paper:

New White Paper on AI in Utilization Management: MCG Health’s Director of Clinical Informatics, Jason Gillman, MD, FIDSA, has published a new white paper on the responsible use of artificial intelligence (AI) in Utilization Management. Dr. Gillman explores the evolution of this technology in healthcare management as well as its potential risks and rewards. Download the white paper here.

HMA News & Events

HMA Podcast:

How Can States Use Opioid Settlement Funds to Truly Transform Substance Use Disorder Treatment. Debbi Witham is a principal in the Health Management Associates behavioral health practice group. She shares her in depth understanding of the complexities of substance use disorder (SUD) treatment systems and highlights the critical need for quality measures and sustainable healthcare funding. Debbi emphasizes the importance of not throwing more money into systems that are not producing outcomes, and that states have an opportunity to course correct. The conversation explores topics such as the impact of reimbursement on care delivery, the urgency of addressing addiction within the larger healthcare ecosystem and provides insights into the necessary steps for coordinating a community response that improves outcomes. Listen Now 

NEW THIS WEEK ON HMA INFORMATION SERVICES (HMAIS):

HMAIS Reports

  • Medicaid Managed Care Accounts for 59.4 Percent of Total Medicaid Spending, 2023 Data
  • Special Needs Plans (SNP) Enrollment by State and Plan, Mar-24 Data
  • Updated Medicaid Managed Care RFP Calendar: 50 States and DC
  • Updated Section 1115 Medicaid Demonstration Inventory

Medicaid Data
Medicaid Enrollment:

  • Alaska Medicaid Fee for Service vs. Managed Care Penetration, 2014-23
  • Arizona Medicaid Fee for Service vs. Managed Care Penetration, 2014-23
  • Arkansas Medicaid Fee for Service vs. Managed Care Penetration, 2014-23
  • Colorado RAE Enrollment is Down 11.6%, Mar-24 Data
  • Connecticut Medicaid Fee for Service vs. Managed Care Penetration, 2014-23
  • Kentucky Medicaid Managed Care Enrollment is Down 5.3%, May-24 Data
  • Pennsylvania Medicaid LTSS Enrollment is Flat, Jan-24 Data
  • Tennessee Medicaid Managed Care Enrollment is Down 6.6%, Mar-24 Data
  • Washington Medicaid Managed Care Enrollment is Down 2.7%, Mar-24 Data

Public Documents: 

Medicaid RFPs, RFIs, and Contracts:

  • Iowa Pharmacy Benefit Administration Re-released RFP, May-24
  • Kansas KanCare Medicaid & CHIP Capitated Managed Care RFP, Award, Proposals, and Scoring, 2023-24
  • Nevada CO D-SNP Solicitation of Public Input, May-24
  • Wisconsin BadgerCare Plus and Medicaid SSI HMO Contracts, 2020-25
  • Wisconsin Medicaid D-SNP Model Contracts, 2019-24

Medicaid Program Reports, Data, and Updates:

  • Delaware Diamond State Health Plan Section 1115 Waiver Documents, 2014-24
  • New Jersey Medicaid, MLTSS Quality Technical Reports, CY 2020-22
  • Tennessee TennCare III 1115 Waiver Documents, 2021-24
  • Texas PHE Medicaid Redeterminations Monthly Reports to CMS, Apr-24

A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services. An HMAIS subscription includes:

  • State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
  • Downloadable ready-to-use charts and graphs
  • Excel data packages
  • RFP calendar

If you’re interested in becoming an HMAIS subscriber, contact Andrea Maresca at [email protected].

Edited by:

Alona Nenko
Andrea Maresca
Mary Goddeeris

Gabby Palmieri
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