HMA Weekly Roundup

Arizona

Arizona Expands Investigation Into Medicaid Provider Fraud. Native News Online reported on August 10, 2023, that Arizona has expanded an investigation into Medicaid provider fraud targeting Native Americans. More than 100 providers are now under investigation.

Colorado

Colorado Hospitals Continue to Post Operating Losses. The Colorado Sun reported on August 15, 2023, that approximately half of Colorado’s hospitals continue to lose money on patient care, according to the Colorado Hospital Association. First quarter financial 2023 filings suggest some larger hospitals with more resources returned to profitability. Read More

Delaware

Delaware Medicaid to Cover Doula Services By January 2024. Delaware Public Media reported on August 11, 2023, that Delaware Medicaid will cover doula services under a new law. Services must be covered by January 1, 2024. Read More

Florida

Florida Projects $600 Million Medicaid Budget Deficit for Fiscal 2024. Florida Politics reported on August 14, 2023, that the Florida Agency for Health Care Administration (AHCA) has projected a Medicaid budget deficit of nearly $600 million for the current fiscal year, ending June 30, 2024. The state’s share of the shortfall is about $227 million. AHCA further projects the program will require an additional $934 million in fiscal 2025. The deficit stems in part because the state assumed higher disenrollments following the resumption of Medicaid eligibility redeterminations. Read More

Florida May Be Non-compliant With Federal Requirements on Medicaid Eligibility Redeterminations, CMS Says. The Florida Phoenix reported on August 15, 2023, that Florida may be non-compliant with federal requirements concerning Medicaid eligibility redeterminations, including long call center wait times and abandoned calls, according to a letter from the Centers for Medicare & Medicaid Services (CMS). Healthcare policy groups in the state held a press call to raise concerns. Read More

Idaho

Idaho Medicaid Managed Care Task Force Holds Second Hearing. The Idaho Press reported on August 9, 2023, that Idaho legislators held a second round hearing on the potential transition to Medicaid managed care, with provider organizations voicing concerns and calling for a continuation of the existing value-based approach. The Medicaid Managed Task Force, co-chaired by Senator Julie VanOrden (R-Pingree) and Representative John Vander Woude (R-Nampa), will meet again on August 31. Read More

Illinois

Illinois May Be Non-compliant With Federal Requirements on Medicaid Eligibility Redeterminations, CMS Says. Health News Illinois reported on August 16, 2023, that Illinois is experiencing long wait times and high call abandonment rates at call centers handling Medicaid eligibility redeterminations. The Centers for Medicare & Medicaid Services (CMS) said in a letter to the state that individuals may be impeded from renewing Medicaid and Children’s Health Insurance Plan coverage. Read More

Governor Signs Law Increasing Oversight of Healthcare Mergers. Health News Illinois reported on August 14, 2023, that Illinois Governor JB Pritzker signed a law aimed at increasing oversight of healthcare mergers, including providing the state with advance notice of merger and acquisition plans. The law is effective January 2024. Read More

Illinois to Implement Recommended Changes to Children’s Behavioral Health. Health News Illinois reported on August 14, 2023, Illinois Governor JB Pritzker signed legislation to implement recommendations aimed at improving behavioral healthcare for children. The recommendations, which were released in February 2023 by the Illinois Children’s Behavioral Health Transformation Initiative, include establishment of a centralized intake portal to provide families guidance and referrals to state and community-based programs, creation of a navigator assistance program, and statutory language to pave the way for annual mental health screenings to all K-12 students. Read More

Illinois to Seek $601 Million in Missed Federal Medicaid Matching Funds. Health News Illinois reported on August 14, 2023, that Illinois is looking to recoup $601 million in federal Medicaid matching funds the state failed to claim for the period covering the end of 2020 through June 2022. The state blamed a computer error for the missed claims, which were for services provided to individuals with developmental disabilities. Read More

Indiana

Indiana Parents, Advocates Call on Governor to Reconsider Funding Cut for Autism Therapy. Fox59 reported on August 11, 2023, that advocacy group Indiana ACT for Families, comprised of nearly 60 parents and advocates, signed a letter addressed to Indiana Governor Eric Holcomb calling for a halt to potential funding cuts of up to 50 percent for Applied Behavior Analysis Therapy (ABA) for autism. Indiana Medicaid provided 6,200 children with ABA services in 2022. Read More

Massachusetts

Massachusetts to Raise Income Eligibility Limits for ConnectorCare. WBUR reported on August 15, 2023, that the Massachusetts Health Connector, the state’s Exchange, announced plans to raise income eligibility limits from 300 percent of the federal poverty level to 500 percent as part of a two-year pilot aimed at increasing Exchange plan enrollment. The pilot, which is effective on January 1, is expected to reach an additional 50,000 people. The changes were approved by the Connector board on an emergency basis; public hearings will be held over the next few months. Read More

Massachusetts Disenrolls 33,989 Medicaid Beneficiaries During June Redeterminations. The Massachusetts Executive Office of Health and Human Services reported on August 9, 2023, the disenrollment of 33,989 Medicaid beneficiaries during June redeterminations, including 9,081 due to procedural reasons. Coverage was renewed for 57,176 beneficiaries.

Michigan

Michigan Disenrolls 22,911 Medicaid Beneficiaries Following June, July Redeterminations. Michigan Radio reported on August 15, 2023, that Michigan disenrolled 22,911 Medicaid beneficiaries following June and July redeterminations. The state renewed coverage for 224,757 beneficiaries. Read More

Minnesota

Minnesota Governor Launches Task Force on Future of UMN Health System. The Minnesota Daily reported on August 10, 2023, that Governor Tim Walz signed an executive order to launch a state task force on the future of the University of Minnesota (UMN) Health Care System. A summary of recommendations is due by January 15, 2024. Read More

Nebraska

Nebraska to Lift $750 Cap on Medicaid Dental Benefits. Nebraska Public Media reported on August 10, 2023, that Nebraska will lift a $750 annual cap on Medicaid dental benefits in January 2024 among other changes in hopes of improving access to dental care and compensation for dentists. In 2022, 378 dentists in Nebraska served at least one Medicaid beneficiary, down from nearly 600 dentists in 2017. Read More

Nevada

Nevada Launches Eligibility Redeterminations Data Dashboard. FOX5 reported on August 9, 2023, that the Nevada Department of Health and Human Services has launched a redeterminations data dashboard with monthly snapshots of enrollment changes, application processing, renewal outcomes, and call wait times. Read More

New Jersey

New Jersey to Provide $1.5 Million in Grants to Help Enroll Eligible Children in Medicaid. Insider NJ reported on August 10, 2023, that the New Jersey Department of Human Services will provide $1.5 million in grants through the state’s Cover All Kids Initiative to enroll eligible, uninsured children in Medicaid. Up to six grants of $250,000 each are expected to be announced in the fall. Applicants must submit a statement of intent to apply by August 11, 2023, and proposals must be submitted by September 1, 2023. Read More

New Mexico

New Mexico to Award Previously Announced Medicaid Plan Contracts in Defeat for Governor. The Santa Fe New Mexican reported on August 10, 2023, that New Mexico will release notices of intent to award contracts to four previously selected Medicaid managed care plans: Blue Cross and Blue Shield of New Mexico; UnitedHealthcare of New Mexico; Molina Healthcare of New Mexico, Inc.; and Presbyterian Health Plan. Contract implementation is set for July 1, 2024. The state ethics commission reached an agreement with Governor Michelle Lujan Grisham to reverse her unilateral decision to cancel the request for proposals and block the awards. Read More

New York

New York City Cannot Switch Retirees to Aetna Medicare Advantage Plan, Judge Rules. Beckers Payer Issues reported on August 14, 2023, that a New York Supreme Court judge permanently blocked New York City from switching 250,000 retired individuals and their dependents from traditional Medicare to an Aetna Medicare Advantage Plan. The contract was worth $15 billion over five years. The city plans to appeal the judge’s decision. Read More

Fidelis Care to Expand Medicaid Advantage Plus Plan to Three More New York Counties. Fidelis Care announced on August 9, 2023, that it will expand its Wellcare Fidelis Dual Plus Medicaid Advantage Plus plan into Westchester, Nassau, and Suffolk counties. Fidelis Care now offers Wellcare Fidelis Dual Plus in 52 New York counties. Read More

North Carolina

North Carolina Medicaid Behavioral Health Plans Sandhills Center, Eastpointe to Merge. North Carolina Health News reported on August 14, 2023, that Sandhills Center and Eastpointe, two of the six North Carolina Local Management Entity-Managed Care Organizations covering behavioral health, have announced plans to merge. The new entity would serve more than 100,000 people in 21 counties. Read More

Rhode Island

Rhode Island Announces Availability of $100,000 in Additional Grants for Medicaid Eligibility Redeterminations Outreach. Rhode Island announced on August 9, 2023, the availability of a second round of grants totaling $100,000 for community organizations to assist in Medicaid eligibility redeterminations outreach. Organizations may apply to the state Executive Office of Health and Human Services for up to $4,950 each. Read More

Texas

Texas Seeks Repayment of More Than $17 Million in Medicaid Funds from Planned Parenthood. The Associated Press reported on August 15, 2023, that Texas is looking to recoup more than $17 million plus fines from Planned Parenthood, alleging in a lawsuit that the organization improperly received Medicaid payments before being removed from the program in 2021. A hearing in the false claims case was set for today. Read More

Vermont

Vermont All-Payer ACO Model Lowers Medicare Spending, Hospitalizations, Analysis Finds. AJMC reported on August 11, 2023, that the Vermont all-payer accountable care organization (ACO) model reduced Medicare spending and hospitalizations from 2018 to 2021, while improving patient care, according to an analysis from NORC at the University of Chicago. The voluntary model promotes risk-sharing and population-based payments for hospitals. Read More

Wyoming

Wyoming Disenrolls 10,100 Enrollees for Procedural Reasons. Wyoming News Now reported on August 15, 2023, that Wyoming disenrolled 10,100 Medicaid beneficiaries for procedural reasons since eligibility redeterminations began in April. Read More

National

4.8 Million Medicaid Beneficiaries Are Disenrolled from Medicaid Following Redeterminations, Analysis Finds. Kaiser Family Foundation released an analysis on August 15, 2023, showing that nearly 4.8 million Medicaid beneficiaries have lost coverage across 42 states and the District of Columbia since the reinstatement of eligibility redeterminations. Of enrollees who applied for Medicaid coverage renewals, 38 percent were disenrolled and 62 percent maintained coverage. Overall, 75 percent of those disenrolled lost coverage due to procedural reasons. Read More

CMS Launches Changes to Encourage Participation in Medicare ACO REACH. Modern Healthcare reported on August 14, 2023, that the Centers for Medicare & Medicaid Services (CMS) will raise financial reserve requirements and reduce enrollment minimums as part of an effort to encourage provider participation in the Medicare Accountable Care Organization Realizing Equity, Accountability and Community Health (ACO REACH) program. Under the program, which launched this year, providers form ACOs to manage care for traditional Medicare members, receive capitated payments, and take shared or full risk. Read More

5.6 Million Medicaid Enrollees Utilize Long-term Services, Supports in 2020, KFF Finds. KFF reported on August 14, 2023, that 5.6 million people utilized Medicaid long-term services and supports (LTSS) in 2020. About 4 million (72 percent) utilized home and community based care, 1.4 million (24 percent) utilized institutional care, and 200,000 (4 percent) used both. Individuals utilizing LTSS comprised 6 percent of Medicaid enrollment but 37 percent of federal and state Medicaid spending. Read More

CMS Seeks Public Comment on Technical Specifications of Certain LTSS Quality Measures. The Centers for Medicare & Medicaid Services (CMS) announced on August 15, 2023, that it is seeking public comments on technical specifications for long-term services and supports (LTSS) assessment and care planning measures and for LTSS rebalancing and utilization measures. The comment period closes on August 28, 2023. Read More

Prices Have Tripled for Top 25 Medicare Part D Drugs, Report Finds. Axios reported on August 11, 2023, that prices have tripled for the top 25 Medicare Part D drugs since first hitting the market, according to a report from AARP. Top drugs are defined as those that accounted for the most Medicare Part D spending in 2021. Read More

House Bill Would Allow States to Hire Outside Contractors to Help with Medicaid Eligibility Redeterminations. Becker’s Payer Issues reported on August 11, 2023, that U.S. Representatives Earl Carter (R-GA) and Neal Dunn (R-FL) introduced legislation that would allow state agencies to hire outside contractors to help with Medicaid eligibility redeterminations. The Medicaid Staffing Flexibility and Protection Act, which was introduced in the House Energy and Commerce committee, targets coverage losses for procedural reasons. Read More

Medicaid FFS Coverage of Substance Use Disorder Treatment Improves, Study Finds. JAMA Network published on August 11, 2023, a study showing that coverage of substance use disorder treatment for Medicaid fee-for-service (FFS) beneficiaries improved from 2014 to 2021. Meanwhile, prior authorization restrictions declined. Read More

Federal Regulators Push States to Improve Medicaid Redeterminations Compliance. Becker’s Payer Issues reported on August 11, 2023, that the U.S. Department of Health and Human Services has indicated that 36 states are failing to meet at least one of three key regulatory requirements for Medicaid eligibility redeterminations, and five (Alaska, Florida, New Mexico, Montana, and Rhode Island) were deficient in all three categories. Categories include call center wait times, rates of procedural terminations, and application approval wait times. Read More

Over Half a Million Children Lose Medicaid Coverage Since April Redeterminations. Bloomberg Law reported on August 11, 2023, that since redeterminations resumed in April more than half a million children have lost Medicaid coverage, according to data compiled by the Georgetown Center for Children and Families. Florida, Ohio, and Washington were among the states showing heavy losses. Results may be understated because several major states have not yet released their redetermination numbers on children. Read More

CMS Releases Toolkit Aimed at Improving Quality, Access to Postpartum Care in Medicaid, CHIP. The Centers for Medicare & Medicaid Services released on August 10, 2023, a toolkit aimed at enhancing equity, quality, and access to postpartum care in Medicaid and the Children’s Health Insurance Program (CHIP). The toolkit includes strategies for states in partnering with managed care plans and better utilizing existing authorities. Read More

Medicare Advantage Plans to Receive $12.8 Billion in Quality Bonus Payments in 2023, Analysis Finds. KFF released on August 9, 2023, an analysis showing that Medicare Advantage plans will receive a minimum of $12.8 billion dollars in quality bonus payments from the federal government in 2023, up nearly 30 percent from the prior year. About 85 percent of Medicare Advantage recipients are in plans receiving bonus payments, which reflect quality ratings from 2022. Read More

Medicare Advantage Enrollment is Highly Concentrated, KFF Finds. KFF reported on August 9, 2023, that Medicare Advantage enrollment is highly concentrated, with United Healthcare and Humana alone serving about 47 percent of all 2023 enrollees. Read More