Weekly Roundup

HMA Weekly Roundup

Trends in Health Policy

View All Roundups

November 13, 2024

Print

This week's roundup:

In Focus

Health Policy Priorities on the Table: Understanding the Post-Election Landscape for Marketplace, Medicaid, and Medicare Programs

This week, our In Focus section addresses post-election implications and initial considerations for understanding President-Elect Donald J. Trump’s possible federal healthcare policy agenda. Though healthcare was not the highest priority campaign issue, the president-elect and his team have signaled the policy agenda could include changes to the Affordable Care Act (ACA), Medicaid, and the nation’s public health programs. 

Additionally, President Trump’s first term policy agenda and how these policies fared, provide critical insights into the policy direction for his second term, including policies on Medicare drug pricing, ACA marketplaces, and interoperability. Also vital to understanding and planning for a second term will be the appointees to key healthcare positions at the Department of Health and Human Services and in the White House. 

Policy officials and specific policy agendas are still nascent, and Health Management Associates, Inc., federal and state experts are continuing to monitor these developments. The remainder of this article focuses on a few key considerations for the Marketplace, Medicaid, and Medicare healthcare insurance programs heading into 2025. 

ACA Marketplace Issues to Watch 

President-Elect Trump signaled he is uninterested in revisiting a legislative initiative to repeal and replace the ACA. However, one of the major defining issues facing the president-elect and the next Congress is the temporary policy providing enhanced tax credits that lower ACA premiums, which expires at the end of 2025. This and other tax policies are very likely to be on the table, particularly as budget reconciliation is an available tool in unified government. 

Key considerations for healthcare stakeholders regarding the subsidy policy and federal funding for Marketplace outreach and education programs include: 

  • The Congressional Budget Office (CBO) estimates that extending the present enhanced subsidy policies would cost more than $300 billion over 10 years. The CBO also reports that ACA marketplace enrollment would drop from 22.8 million in 2025 to 18.9 million in 2026 if  the subsidy policy is not renewed. 
  • The loss of subsidies would increase the number of uninsured individuals in the United States, but the size of the increase would depend on the state-specific landscape. For example, states that have not adopted the ACA’s Medicaid expansion for adults are expected to have a higher increase relative to states that have more expansive Medicaid eligibility. One potential approach is for lawmakers to modify the enhanced subsidy policy, rather than let it expire entirely.  
  • Marketplace plans should be prepared for a change in the acuity mix of enrollees while providers should expect a change in their payer mix, with more uninsured individuals in states that have not expanded Medicaid. 

Federal and state policymakers may pursue a combination of alternatives to fill gaps in access to healthcare coverage and services. For example, the president-elect and incoming congressional leaders may focus on alternative coverage options and other state-driven reforms to Marketplace programs. Alternatives that could become part of the regulatory policy agenda include: 

  • Supporting association health plans (AHPs) and high-risk pools 
  • Reverting to a federal regulatory environment that supports short-term limited-duration healthcare insurance (STLDI) plans 
  • Approving Section 1332 waivers to allow state-designed programs 

Medicaid Policy Outlook 

During Mr. Trump’s first term, one of his administration’s signature Medicaid initiatives was approving Section 1115 demonstrations that allowed states to apply work requirements to certain populations, including adult expansion populations. The first Trump Administration also revised the demonstration parameters for Section 1115 Institutions for Mental Disease (IMD), allowed coverage lockout for beneficiary noncompliance with premium payments, and approved a pilot program to test interventions addressing health-related social needs (HRSNs). 

Key considerations for healthcare stakeholders regarding Medicaid flexibilities and funding include: 

  • Officials in the first Trump Administration approved North Carolina’s Medicaid 1115 demonstration program to address HRSNs. President Biden’s Administration expanded these policies and approved demonstrations in more than 10 states, with additional state applications pending. Incoming officials may maintain the overall policy direction  with regard to HRSNs. However, they could pivot to narrow the scope of future state HRSN proposals. Another approach could include directing states to use in lieu of services (ILOS) authority in managed care delivery systems to address HRSN.  
  • During President-Elect Trump’s first term, Centers for Medicare & Medicaid Services (CMS) officials prioritized work requirements and capped allotments for certain components of a state’s Medicaid program. Some states might consider revisiting these options, with modifications. If this policy direction is refreshed, federal and state officials would benefit from the foundational work conducted during the first term. 
  • New CMS officials could prioritize work on transparency in Medicaid financing and reimbursement to providers. Federal officials, regardless of political affiliation, historically have sought to improve their understanding of the flow of Medicaid funding. Incoming officials could prioritize this issue again, which would have a varied effect on health plans and providers. 

Medicare Priorities: 

Relative to Marketplace and Medicaid, first term Trump Medicare policies were advanced with less conflict. Notable policy initiatives included a focus on healthcare-related challenges in rural communities, improving transparency, and reducing provider burden —all of which were also cross-cutting issues that encompassed policy work beyond Medicare and could continue to be central to the next Medicare policy agenda.  

Key considerations for healthcare stakeholders regarding Medicare policy are as follows: 

  • The president-elect’s first term approach to Medicare Advantage (MA) plans sought to maximize enrollment in MA and encourage innovation and value-based design. It’s reasonable to expect second term CMS officials to maintain an overall favorable approach to MA too. Incoming officials could narrow their scrutiny of MA plans to bipartisan concerns, for example MA plans’ prior authorization policies. 
  • While improving outcomes for dually eligibles beneficiaries generally is a bipartisan issue, state agencies, MA and Medicaid managed care plans, and other interested stakeholders should monitor the incoming Administration’s policy agenda for dually enrolled beneficiaries in Medicare and Medicaid. During the Biden Administration, CMS issued final rules for Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) to improve integration for the Medicare-Medicaid dually eligible population., Incoming Trump officials could revisit the approach, including the breadth of requirements and compliance timelines.  
  • During his first term, President Trump was highly engaged in elevating concerns about prescription drug prices and HHS and CMS announced models and policies to lower drug prices for patients. In his second term, however, the President could seek to rein in certain aspects of the Inflation Reduction Act (IRA), while revisiting some of his prior proposals. 

What to Watch 

The incoming Administration and its transition team are moving expeditiously to nominate new Cabinet Secretaries and to identify key staffers. The individuals appointed to departmental, agency, and advisory leadership positions will have significant leeway in shaping the federal and state healthcare policy landscapes – determining which existing policies to review and potentially revise, new policies to develop, and the approach to working with state and local officials and stakeholders. This includes the Secretary of Health and Human Services, CMS Administrator, Director of the Centers for Disease Control and Prevention, Food and Drug Administration Commissioner, and Director of the National Institutes of Health, all of which require Senate confirmation. Additionally, healthcare stakeholders should continue to monitor the leadership races for the House and Senate and the primary congressional committees with jurisdiction over healthcare programs. These leaders will be key to a second term Trump legislative policy agenda. 

Connect with Us 

This article focuses in on a subset of issues within Marketplace, Medicaid, and Medicare and in the overall healthcare sector. Our 2024 Political Checkpoint webinar features our experts discussing these and other insights on the election results. They provided an overview of what to expect from Congress and the Administration, focusing on key legislative priorities and executive actions.  

Join us for our next two webinars in the series exploring the election results:  

HMA Roundup

Delaware

Highmark BCBS to Offer D-SNP in Delaware. Delaware Business Now reported on November 11, 2024, that Highmark Blue Cross Blue Shield (BCBS) will offer Dual Special Needs Plans (D-SNP) for dual eligibles in Delaware, beginning January 1, 2025. The D-SNP will include enhanced benefits including transportation assistance and dental; vision and hearing services; care coordination; and community collaboration.

Florida

Florida Cannot Reclaim Medicaid Payments on Emergency Care for Undocumented Immigrants, Appellate Court Rules. Law 360 reported on November 6, 2024, that Florida’s First District Court of Appeals reaffirmed a previous legal decision stating that the Agency for Health Care Administration (AHCA) cannot reclaim Medicaid payments that covered emergency care for qualified undocumented immigrants. The court’s ruling specifically bars AHCA from conducting general retrospective audits on preauthorized claims for emergency services for undocumented immigrants. The agency previously conducted these audits and ordered hospitals to repay claims that the Centers for Medicare & Medicaid Services deemed beyond what federal regulations defined as an emergency, since federal Medicaid dollars cannot be used on care for undocumented immigrants unless the care was an emergency. The current lawsuit was filed by North Broward District Hospital.

Idaho

Idaho Seeks to End Family and Personal Care Services Program. The Idaho Capital Sun reported on November 8, 2024, that the Department of Health and Welfare is requesting approval from the Centers for Medicare & Medicaid Services (CMS) to end its Family and Personal Care Services Program earlier than originally planned. The state’s request is driven by rising costs, enrollment levels, and fraud. The program started during the pandemic to address a shortage of personal care workers and allows parents, spouses, and other legally responsible individuals to care for people with disabilities. If CMS agrees to the state’s request, the program could end January 31, 2025 rather March, as currently planned. The state will still cover personal care services provided by direct care workers.

Illinois

Illinois Announces Funding to Organizations Addressing Health Disparities. Health News Illinois reported on November 12, 2024, that the Illinois Department of Public Health (IDPH) is seeking proposals from local health departments and community-based organizations interested in participating in a health equity pilot program. IDPH will award $500,000 each to two organizations to help address health disparities in specific geographic areas. The department will prioritize proposals that outline collaboration to address healthcare, public health, housing, and transportation. The pilot program is a part of the IDPH’s five-year plan for addressing health disparities.

Kansas

Aetna Drops Protest Over KanCare Awards Following Judicial Review Petition Denial. State Affairs reported on November 11, 2024, that Aetna has dropped its appeal and ended its case against Kansas and its KanCare Medicaid capitated managed care contract awards. Appellate Judge G. Gordon Atcheson accepted a joint dismissal of the appeal. This decision comes after Kansas Judge Thomas Luedke denied Aetna’s petition for judicial review of the KanCare Medicaid capitated managed care contract awards.

Michigan

Michigan to Rebid Contracts for Coordinated Health HIDE SNP. Health Payer Specialist reported on November 13, 2024, that Michigan is retracting the previously issued award recommendations and rebidding contracts for the MI Coordinated Health program, the state’s new Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP), launching January 1, 2026, according to a regulatory filing from Molina. New bids are due November 21. No reason for the rebid was identified.

Michigan Seeking Public Feedback on Medicaid Health Plan Common Formulary. The Michigan Department of Health and Human Services (MDHHS) announced on November 7, 2024, that it is seeking public feedback on the Michigan Medicaid Health Plan Common Formulary, which applies to pharmacy claims paid by Medicaid managed care organizations. Comments are being solicited for drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other related topics. The next drug classes to be reviewed by the state Medicaid Health Plan Common Formulary Workgroup include Cardiac, Ophthalmic, Electrolyte Balance-Nutritional Products and Smoking Deterrents. Public comments will be accepted through December 13, 2024.

Nebraska

Nebraska Mental Health Providers Consider Leaving Medicaid Over New Audits. The Flatwater Free Press reported on November 8, 2024, that some of Nebraska’s mental health providers are ending, or have considered ending, their Medicaid contracts over audits initiated by the state’s Medicaid managed care organizations. The providers claim that the audits are aggressive, require unnecessary documentation, and conflate minor notetaking mistakes with fraud, resulting in the health plans reclaiming money the providers were paid. The state Department of Health and Human Services sees the audits as necessary to protect taxpayer dollars.

New York

New York Selects 24 Home Care Subcontractors to Administer CDPAP Services. Crain’s New York Business reported on November 12, 2024, that New York has selected 24 home care companies to help administer the state’s consumer directed personal assistance program (CDPAP), which operates the Medicaid home care system for 250,000 New Yorkers. The subcontractors will work with New York’s single statewide fiscal intermediary, Public Partnerships LLC. This selection is a part of the state’s plan to overhaul the $9 billion program. The state plans to select more subcontractors in the coming weeks.

New York Faces Delay in Releasing Health Costs Transparency Database. Crain’s New York Business reported on November 11, 2024, that the state’s healthcare cost database remains unavailable to the public, despite signing a $168 million contract with UnitedHealth’s Optum to create the database in 2016. The database is meant to use claims data from private insurers, hospitals, Medicaid, and Medicare to show actual costs of healthcare in the state. The New York State Department of Health cites logistical issues and problems collecting data from insurers and hospitals during the pandemic for the delay.

New York to Reimburse $407 Million for Medicare ACO Shared Savings Program Participants. Crain’s New York Business reported on October 31, 2024, that 35 accountable care organizations (ACOs) serving Medicare enrollees in New York are set to receive a $407 million payout for their efforts to cut federal health costs through the Medicare shared savings program. Organizations that serve New Yorkers had savings totaling more than $255 million in 2023. The more than 450 organizations nationwide that participated in the initiative saved $2.1 billion in 2023.

South Carolina

South Carolina Names Eunice Medina Medicaid Director. South Carolina Daily Gazette reported on November 6, 2024, that South Carolina has named Eunice Medina as director of the Department of Health and Human Services (DHHS), succeeding former Medicaid director Robby Kerr who retired November 1. Medina spent three years managing staff and programs for DHHS, and was previously a bureau chief for the Florida Agency for Health Care Administration.

South Dakota

South Dakota Releases Medicaid Dental ASO RFP. The South Dakota Department of Social Services Division of Medical Services (DMS) released on November 6, 2024, a request for proposals (RFP) seeking an administrative service organization (ASO) to handle dental and orthodontic claim adjudication and other administrative services for all of the state’s Medicaid dental providers in the Indian Health Service system, Federally Qualified Health Centers, and private practices. Proposals are due December 18 and awards are anticipated on January 14, 2025. The contract will run from June 1, 2025, to May 31, 2028, with two one-year renewal options.

Tennessee

Tennessee Submits Amendment Request for 1115 TennCare III Demonstration. The Centers for Medicare & Medicaid Services announced on November 8, 2024, that Tennessee has submitted an amendment request for its Section 1115 TennCare III demonstration. The proposed amendment seeks to include services for individuals with serious mental illness or serious emotional disturbance receiving treatment in an Institution for Mental Diseases; support the implementation of a new access/quality improvement program for hospitals; and improve the efficiency and transparency of the home and community-based services programs. The public comment period will be open through December 7.

Vermont

Vermont OneCare ACO to Shut Down in 2025. Health Payer Specialist reported on November 8, 2024, that OneCare Vermont, the state’s only accountable care organization, is shutting down in 2025. A state auditor reported in 2021 that Vermont had spent nearly $30 million supporting OneCare from 2016 to 2020 and had yet to realize Medicaid health care savings. Blue Cross Blue Shield of Vermont had also cut ties with the ACO in 2022.

Virginia

Virginia Medicaid Program Faces Budget Deficits in Fiscal 2025, 2026. The News Virginian reported on November 8, 2024, that the Virginia Department of Medical Assistance Services submitted its annual forecast to assembly budget committees which shows a shortfall of $337 million for fiscal 2025 and $295 million for fiscal 2026. The shortfall includes $160 million in bills that the state carried over from 2024 after the Medicaid unwinding resulted in delays that drove up costs. Although, the state did collect an additional $1.2 billion in revenues from 2024, that will carry over into the revised budget that will be proposed on December 18.

Virginia to Submit 1115 Building and Transforming Coverage, Services, and Supports for a Healthier Virginia Demonstration Amendment in December. The Virginia Department of Medical Assistance Services announced on November 8, 2024, that it intends to submit an amendment to the Section 1115 Building and Transforming Coverage, Services, and Supports for a Healthier Virginia Demonstration in December 2024. The current demonstration is scheduled to expire on December 31, 2024 and the state submitted a request for a five-year renewal of the demonstration on August 2, 2024. The amendment will add coverage for individuals with serious mental illness in Institutions for Mental Diseases. Public comments will be accepted through December 11.

Washington

Washington to Sign IHCP Coordination Services Contract with American Indian Health Commission. The Washington Health Care Authority (HCA) announced on November 7, 2024, that it intends to enter a sole source contract with the American Indian Health Commission (AIHC) to facilitate engagement, coordination, and communication with the state’s 31 Indian Health Care Providers (IHCPs) as part of the state’s Medicaid Transformation Project (MTP) 2.0. The four year contract will begin once it has been signed and expires June 30, 2028, with optional extensions up to two years. HCA is also seeking capability statements from other potential vendors that could coordinate services. Interested vendors must meet various requirements, including demonstrable relationships with Tribes and IHCPs in the state, knowledge of the overlap between Medicaid and Indian healthcare purchasing, and knowledge of the MTP; however, it will enter the sole source contract with AIHC if there are no other qualified vendors. Statements are due November 22.

National

Medicaid Unwinding: Wakely Survey of Capitation Rate Approaches for Emerging Experience. Wakely, an HMA company, is hearing from community associated plans and large national for-profit plans about their concerns with rates in 2024, which is leading to concerns around actuarial soundness of 2025 rates. Wakely has conducted a survey of acuity adjustments and other approaches to mitigate uncertainty during the Medicaid unwinding. In the second paper in a new series on Medicaid managed care rates, Wakely experts focus on approaches taken by actuaries in 27 states to address additional emerging trends beyond changes in acuity related to the unwinding.

CMS Releases NEMT Fact Sheet to Drive Collaboration with Medicaid Agencies, State DOTs. The Centers for Medicare & Medicaid Services (CMS) announced on November 12, 2024, that it has released a new fact sheet on Medicaid non-emergency medical transportation (NEMT) with the the Federal Transit Administration, which builds on the Medicaid Transportation Coverage Guide issued in 2023. The fact sheet encourages partnerships between the state departments of transportation and state Medicaid agencies to improve the accessibility and efficiency of NEMT for low-income individuals, people with disabilities, and older adults.

ACO REACH Model Generates $695 Million in Net Savings in 2023. Modern Healthcare reported on November 11, 2024, that the federal Realizing Equity, Access and Community Health (ACO REACH) model generated $1.6 billion in gross savings and $695 million in net savings in 2023, according to a report published by the Centers for Medicare & Medicaid Services (CMS).This has led participants to request extending the initiative past its scheduled expiration in 2026. CMS continues to aim for all people with traditional Medicare to be in an accountable care relationship by 2030. The National Association of Accountable Care Organizations is also encouraging CMS to extend ACO REACH another four years, which would align with the 2030 goal and make it a 10-year model.

Uninsured Rate at 7.6 Percent in 2024, CDC Reports. Modern Healthcare reported on November 11, 2024, that 7.6 percent of Americans, or 25.3 million people, had no health insurance between April and June 2024, according to a report released by the Centers for Disease Control and Prevention (CDC). During that time period, 39 percent of Americans had healthcare coverage through a public health program like Medicaid, Medicare, and the Children’s Health Insurance Plan (CHIP), and 62.1 percent had private health insurance through job-based plans, the Affordable Care Act Marketplace, and state-based exchanges. Some individuals were covered by both public and private plans and were included in both counts by the CDC.

A Third of Hospitals Fail to Publish Prices in Accordance with Transparency Laws, HHS OIG Audit Finds. Modern Healthcare reported on November 8, 2024, that the U.S. Department of Health and Human Services Office of the Inspector General (HHS OIG) audited 100 health systems to assess compliance with price transparency rules. The HHS OIG found a third of reviewed hospitals have not been publishing prices in accordance with a 2021 federal law, and most violations include failure to disclose rates with insurers, metadata errors, outdated information, or failure to post machine-readable files. Hospitals cited a lack of sufficient staff or help from the Centers for Medicare & Medicaid Services (CMS) to meet the requirements. HHS OIG recommends that CMS review noncompliant hospitals, consider implementing changes suggested by hospitals to clarify the rule, and continue to strengthen its internal controls. According to CMS, 11 of the 37 hospitals flagged by the report have already corrected their mistakes or are under review.

Industry News

DOJ, AGs Sue to Prevent UnitedHealth Group’s Acquisition of Amedisys. Health Payer Specialist reported on November 12, 2024, that the U.S. Department of Justice and the attorneys general of Illinois, Maryland, New Jersey, and New York have filed a lawsuit to stop UnitedHealth Group’s $3 billion acquisition of home healthcare and hospice provider Amedisys. Amedisys operates in 38 states and serves approximately 400,000 Americans per year. According to regulators, the sale would cause healthcare costs to rise.

Johnson & Johnson Files Lawsuit Over 340B Hospital Payment Terms. Stat News reported on November 12, 2024, that Johnson & Johnson has filed a lawsuit against the U.S. Health Resources and Services Administration (HRSA), claiming the agency incorrectly interpreted a law regarding how rebates from the 340B Drug Pricing Program can be used. Recently, Johnson & Johnson wanted to change payment terms for a blood thinner, Xarelto, and a plaque psoriasis treatment, Stelara, but HRSA deemed the change unlawful. Johnson & Johnson initially backed out of the changes after warnings they could be fined or removed from the program for proceeding but filed a lawsuit after unsuccessful negotiations with HRSA.

Cigna Will Not Pursue Merger with Humana. The Cigna Group announced on November 11, 2024, that the company is not pursuing a merger with Humana. The Cigna Group stated it remains committed to its established mergers and acquisitions criteria and would only consider acquisitions that are strategically aligned, financially attractive, and have a high probability to close.

CVS Appoints Steve Nelson President of Aetna. CVS Health announced on November 6, 2024, that Steve Nelson has been appointed as President of Aetna, effective immediately. Nelson was most recently the CEO of primary care company ChenMed and is the former CEO of UnitedHealthcare.

Centene President Ken Fasola to Retire in July 2025. Modern Healthcare reported on November 12, 2024, that Ken Fasola, the president of Centene Corporation, will retire from the company on July 1, 2025. He will remain as a strategic advisor to CEO Sarah London until his departure. Fasola was previously CEO of Magellan Health, which was acquired by Centene in 2022.

Sunshine Health Appoints Charlene Zein as Plan President, CEO. Centene’s Florida-based Sunshine Health announced on November 7, 2024, that Charlene Zein has been named Plan President and Chief Executive, effective November 3. Zein has had various leadership roles at Sunshine Health since joining in 2019, with most recently serving as Sunshine Health Chief Product President.

RFP Calendar

HMA News & Events

HMA Webinars:

The Future of Medicare Advantage: How the Election Results Impact the Program. Tuesday, November 19, 2024, 12:00 PM ET. More than 50 percent of Medicare enrollees now choose Medicare Advantage (MA) as their preferred coverage option. This increased growth has brought with it increase scrutiny, with elected officials, regulators, think tanks, and news organizations all raising questions about the current makeup of the program. With MA reform potentially on the table in 2025, come learn about how the election results impact what policy changes could be considered in the coming year. Register Here

Electoral Consequences: Impact on the ACA Marketplace. Wednesday, November 20, 2024, 12:00 PM ET. The 2024 elections could create dramatic changes in the ACA marketplace. Enhanced ACA subsidies passed during the pandemic are set to expire in 2025, and a new CMS administrator will shape policy and regulatory components that affect marketplace and consumer dynamics. This webinar is designed for health plans currently participating in the ACA marketplaces, plans who are considering attending, as well as state regulators and marketplace leaders who need to understand changes that might be coming their way. The webinar will cover not only what is expected to change (2026 Notice of Benefit and Payment Parameters, AVC) but also what could possibly change that will affect 2025 Marketplaces and beyond. Register Here

How Community Care Hubs Can Enhance Family Caregiver Support Services. Tuesday, December 3, 2024, 12 PM ET. To better support family caregivers and the older adults who they care for, Area Agencies on Aging and other aging network agencies are creating Community Care Hubs (CCH) to address social determinants of health, integrate health and social care, and reduce care costs. In this webinar with LTSS policy experts and providers, we will describe the implementation of the CCH model in projects in Massachusetts and New York. Register Here

NEW THIS WEEK ON HMA INFORMATION SERVICES
(Exclusive Access for HMAIS Subscribers):

HMAIS Reports

  • Medicaid MCO Financial Filings Including Medical Loss Ratio by State, 2023
  • Updated Medicaid Managed Care Procurement Tracking Report
  • Updated Medicaid Managed Behavioral Carve-Out Calendar
  • Updated Nevada State Overview
  • HMA Federal Health Policy Quick Takes

Medicaid Data

Medicaid Enrollment:

  • Georgia Medicaid Managed Care Enrollment is Down 7.3%, Nov-24 Data
  • Illinois Medicaid Managed Care Enrollment is Down 8.1%, Aug-24 Data
  • Illinois Dual Demo Enrollment is Down 19.2%, Aug-24 Data
  • Indiana Medicaid Managed Care Enrollment Is Up 3.1%, Aug-24 Data
  • Maryland Medicaid Managed Care Enrollment Is Down 5.9%, Sep-24 Data
  • Pennsylvania Medicaid Managed Care Enrollment is Down 9.7%, Aug-24 Data
  • Pennsylvania Medicaid LTSS Enrollment is Down 4.9%, Aug-24 Data
  • MLRs Average 89% at Washington Medicaid MCOs, 2023 Data
  • Wyoming SNP Membership at 2,872, Mar-24 Data

Public Documents: 

Medicaid RFPs, RFIs, and Contracts:

  • Ohio Next Generation MyCare RFA, Proposals, Evaluations, and Related Documents, 2024
  • Ohio Medicare Advantage D-SNP Model Contract, 2025
  • South Dakota Medicaid Dental ASO RFP, Nov-24
  • Washington Medicaid Transformation Project 2.0 IHCP Coordination Contract and Related Documents, 2024

Medicaid Program Reports, Data, and Updates:

  • Connecticut DSS Accenture, Manatt Statement of Work for Husky Health Analysis, Oct-24
  • Florida OIR Quarterly Managed Care Reports, 2020-24
  • Georgia Department of Community Health Annual Reports, 2014-23
  • Georgia Hospital Statistical & Reimbursement (HS&R) Reports, 2012-23
  • Pennsylvania HealthChoices HEDIS Performance Measures Rate Charts, 2015-23
  • Rhode Island Medicaid Expenditure Reports, SFY 2020-23
  • Tennessee TennCare III 1115 Waiver Documents, 2021-24
  • Texas Rural Hospital Services Strategic Plan Progress Report, Nov-24
  • Texas Prescription Drug Rebate Program Annual Performance Report, Nov-24
  • Texas Medically Dependent Children Program Monitoring Report, Sep-24
  • Vermont ACO Quality Measures, 2018-24
  • Virginia Department of Medical Assistance Services Medicaid Forecast, 2024
  • Virginia BTCSSHV 1115 Waiver Documents, 2021-24

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
Maddie McCarthy
View All Roundups

Get the free HMA
Weekly Roundup