HMA Weekly Roundup

Colorado

Colorado Receives Approval for Community-Based Mobile Crisis Services SPA. The Centers for Medicare & Medicaid Services approved on December 4, 2023, the Colorado community-based mobile crisis state plan amendment (SPA) with an effective date of July 1, 2023. The state can now utilize federal Medicaid funding to create mobile intervention teams to provide Medicaid crisis services 24/7 to eligible youth and adults experiencing a mental health or substance use crisis. Read More

Connecticut

Connecticut Appropriations, Human Services Committees Authorize New Paid Family Caregiver Waiver Requirement. CT News Junkie reported on December 14, 2023, that the Appropriations and Human Services Committee approved a new waiver requirement for services through the Department of Development Services (DDS), allowing the state to pay immediate family members if they are the primary caregivers for Medicaid enrollees with intellectual and developmental disabilities. The requirement applies to three home and community-based Medicaid waivers administered by DDS that serve people with intellectual disabilities. Read More

Florida

Florida to Submit Renewal Application for Section 1915(c) iBudget Waiver. The Florida Agency for Health Care Administration announced on December 19, 2023, that it will submit a Section 1915(c) renewal request for the Medicaid Developmental Disabilities Individual Budgeting (iBudget) waiver, which serves individuals with developmental disabilities under a home and community-based services waiver, to the Centers for Medicare & Medicaid Services (CMS). Changes made under the renewal application include the title changed to “Unique Abilities Individual Budgeting Waiver”; the definition of Intellectual Disability revised to include those with a secondary impairment/limitation; unduplicated number of participants expanded; Support Coordination service definition updated from “Transitional Support Coordination” to “Enhanced Support Coordination”; and “waitlist” changed to “pre-enrollment”. The public comment period will be open through January 19, 2024. Read More

Florida Delays $154 Million MMIS Contract, Plans to Complete Two Others by the End of 2024. Florida Politics reported on December 15, 2023, that Florida has delayed work for at least one year on a $154 million information technology contract with Gainwell Technologies to transition its Medicaid management information system to a modular format. The delay, voted on by the Health Care Connections Executive Steering Committee, was attributed to a resource constraint within the Florida Agency for Healthcare Administration and will return between $20 million and $33 million back to the state’s coffers. The Committee also voted to complete a $140 million contract for a unified operations center with Automated Health Systems and a $33 million provider services module contract by December 2024. Read More

Medicaid Managed Care Plans Return Approximately $1 Billion in Excessive Profits Between 2019 and 2022. Florida Politics reported on December 14, 2023, that Florida’s Medicaid managed care plans returned approximately $1 billion in excessive profits from 2019 through 2022, according to a presentation from Florida Medicaid deputy secretary for health care finance and data Tom Wallace before the House Appropriations Subcommittee on Health and Human Services. Specifically, managed care plans returned $326.3 million in 2022, $316.3 million in 2021, $274.8 million in 2020, and $129.2 million in 2019. Wallace attributed the increase in returned profits to the COVID-19 public health emergency and increased enrollment. Read More

Georgia

Georgia Announces $54 Million to Aid Medicaid Redeterminations, Provides 12-Month Continuous Medicaid, CHIP Coverage for Children. The Georgia Department of Community Health announced on December 18, 2023, that more than $54 million will be allocated to support Medicaid redetermination processing as part of a short term “surge” effort, beginning in January 2024. Funding will be used to ensure those who are eligible for Medicaid remain covered by increasing the number of contracted workers, process improvement, and providing overtime and stipends to state eligibility workers. Georgia is also expanding its Express Lane eligibility and implementing 12 months of continuous eligibility and enrollment for children on Medicaid and PeachCare, beginning in early 2024. The announcement comes after the U.S. Department of Health and Human Services sent a letter to the Governor citing high disenrollments for children. Read More

Illinois

Illinois Law Increasing Medicaid Provider Rates Set to Take Effect January 1. On January 1, 2024, Illinois Senate Bill 1298 takes effect, increasing Medicaid reimbursement rates for several services and providers. Under the new law, rates will increase for medically complex and developmentally disabled children, inpatient substance use disorder treatment, supportive living facilities, community-based mental health services, inpatient psychiatric care at hospitals, and speech and physical therapy. Read More

Indiana

Indiana Faces $984 Million Medicaid Shortfall. The Indiana Capital Chronicle reported on December 19, 2023, that Indiana’s April Medicaid expenditure forecast had a $984 million shortfall, primarily due to a combination of state budget reversions and an unanticipated demand for home and community-based services and long-term services and supports. Other lesser contributing factors were increased Medicaid reimbursement for physicians and applied behavioral analysis therapy and the reduction of federal COVID-19-related funding. The state budget director attributed the $525 million reversion to the general fund to a miscalculation in the April 2023 forecast which predicted a $570 million surplus. Read More

Indiana Delays Return of Medicaid Premiums. WFYI reported on December 13, 2023, that Indiana has delayed the resumption of charging Medicaid premiums, which were initially paused due to the COVID-19 public health emergency. The state intends to release its plan to restart the premiums, which are required for Healthy Indiana Plan Plus members, in January. The Centers for Medicare & Medicaid Services has not indicated if the agency plans to review this matter, but in November 2023, federal regulators did revoke similar authority for Wisconsin Medicaid to charge premiums. Read More

Kansas

Kansas Lawmakers Reject Governor’s Medicaid Expansion Proposal. The Kansas Reflector reported on December 15, 2023, that Republican leadership within the Kansas Legislature has opposed Governor Laura Kelly’s recent Medicaid expansion proposal, which would provide coverage to approximately 150,000 residents and include a work requirement. The legislators criticized the proposal because they do not expect federal regulators to approve a work requirement. Read More

Governor Proposes Medicaid Expansion Plan With Work Requirement. Kansas Governor Laura Kelly proposed on December 14, 2023, a plan for Medicaid expansion with the inclusion of a work requirement for enrollees. An estimated 150,000 individuals stand to gain coverage. The Cutting Healthcare Costs for All Kansans Act would be financed by drug rebates, a hospital fee, savings from higher reimbursement rates for existing Medicaid recipients, and additional federal funding. The governor’s plan also proposes to improve access to coverage for individuals who are incarcerated in county jails. Read More

Minnesota

Minnesota Announces $9.5 Million in Grants to Help Aging Population Stay at Home. The Minnesota Department of Human Services announced on December 18, 2023, that over $9.5 million in new Live Well at Home state grants are being allocated among 45 organizations that help aging individuals stay in their homes longer through services such as caregiver support, housekeeping, retrofitting to prevent falls, and other assistance. Projects funded in this round of grants include updating multiple assisted living units to provide better accessibility and safety features for memory care residents, reducing the racial gap in homeownership by preserving wealth among older adults in Indigenous communities and communities of color, and expanding caregiver services. Read More

Mississippi

Mississippi Disenrolls 7,448 Medicaid Beneficiaries During November Redeterminations. Mississippi Today reported on December 19, 2023, that Mississippi has disenrolled 7,448 Medicaid beneficiaries during November redeterminations, 5,004 of which were due to procedural reasons. The state renewed coverage for 27,919 beneficiaries in November. Since June, the number of children covered by Mississippi Medicaid has dropped by more than 61,000. Read More

Mississippi Extends Medicaid Postpartum Coverage to 12 Months. The Centers for Medicare & Medicaid Services approved on December 13, 2023, Mississippi’s state plan amendment to extend postpartum Medicaid and Children’s Health Insurance Program coverage to 12 months, effective April 1, 2023. Read More

Mississippi Receives Federal Approval for Hospital Provider Assessment. The Magnolia Tribune reported on December 13, 2023, that the Centers for Medicare & Medicaid Services (CMS) has approved part one of Governor Tate Reeves’ Mississippi Medicaid reimbursement reforms, which allows the state to impose a provider assessment on hospitals that will generate approximately $700 million more for all hospitals across the state. The approved initiative will allow hospitals to be reimbursed near the average commercial rate for serving managed Medicaid patients. The second initiative, awaiting federal approval, would supplement Medicaid hospital payments in the fee-for-service delivery system. Read More

Missouri

Missouri Receives Federal Approval for SUD, SMI Section 1115 Demonstration. The Centers for Medicare & Medicaid Services approved on December 6, 2023, Missouri’s Substance Use Disorder (SUD) and Serious Mental Illness (SMI) Section 1115 demonstration request, effective through December 31, 2028. Under the demonstration program, the state will receive federal funding for providing SUD and SMI treatment services to Medicaid beneficiaries aged 21-64 temporarily residing in facilities qualifying as institutions for mental diseases (IMDs). These otherwise covered services are not currently covered when furnished in IMDs. Read More

Nebraska

Nebraska Extends Medicaid Postpartum Coverage to 12 Months. The Centers for Medicare & Medicaid Services approved on December 8, 2023, Nebraska’s state plan amendment to extend postpartum Medicaid coverage to 12 months, effective January 1, 2024. Read More

New Hampshire

New Hampshire Disputes Federal Reporting of Medicaid Disenrollment Numbers for Children. The New Hampshire Bulletin reported on December 20, 2023, that New Hampshire officials claim that the Centers for Medicare & Medicaid Services (CMS) is inflating Medicaid disenrollment counts by including children differently than the state, counting individuals up to age 23 versus individuals up to age 18. The U.S. Department of Health and Human Services sent a letter to the state’s governor citing the high numbers. According to CMS, New Hampshire has disenrolled 19,810 children from Medicaid during redeterminations between March and September. New Hampshire has extended its “reopen” deadline to allow children who lost coverage in the last 120 days to get a review without having to complete a Medicaid application. Read More

North Carolina

North Carolina Auto-enrolls 273,000 Individuals on First Day of Medicaid Expansion. CBS17 reported on December 19, 2023, that the North Carolina Medicaid expansion program, expected to cover an additional 600,000 individuals, automatically enrolled 273,000 people when the expansion launched on December 1. Of those enrolled, 60,000 are 50 or older. In 2024, the state plans to focus on behavioral and mental health needs, including an investment of $835 million for behavioral health. Read More

North Carolina DHHS Secretary Approves Consolidation of Trillium, Eastpointe, In Effort to Decrease Regional LME-MCO’s From Six to Four. Trillium Health Resources announced on December 18, 2023, that North Carolina Department of Health and Human Services Secretary Kody H. Kinsley approved the consolidation of Eastpointe Human Services and Trillium Health Resources, which are Local Management Entity-Managed Care Organization (LME-MCOs) providing specialized behavioral services for individuals with severe mental health conditions or intellectual and developmental disabilities. The consolidation reduces the number of state-funded regional behavioral health management companies from six to four. As part of the agreement, Eastpointe and Sandhills Center, another LME-MCO, will also be consolidated. Trillium will operate in a total of 46 counties in the combined region, effective January 1, 2024. The consolidation transition for members and providers will occur on February 1, 2024. Read More

North Carolina Awards Acentra Health Comprehensive Assessment Entity Contract to Implement, Operate Consolidated LTSS. Acentra Health announced on December 14, 2023, that it was awarded the Comprehensive Independent Assessment Entity contract to implement and operate the new North Carolina Medicaid Linking Individuals & Families for Long Term Services and Supports (NCLIFTSS). NCLIFTSS will consolidate the state’s non-managed Medicaid LTSS programs in order to improve access and health outcomes. The LTSS programs included are State Plan Personal Care Services, Community Alternatives Program for Children, Community Alternatives Program for Disabled Adults, Preadmission Screening and Resident Review Level II, and Transition of Care Coordination. The $56.9 million contract has a three-year base term with two one-year extension options. Read More

Pennsylvania

Pennsylvania House Passes Bill to Expand Medicaid Dental Services. Butler Radio reported on December 14, 2023, that the Pennsylvania House passed a bill that would expand Medicaid dental coverage to include root canals, periodontal disease work, emergency exams and other services that were cut from the program in 2011. The bill, sponsored by Representative Gina Curry (D-Delaware), will next be reviewed by the state senate. Read More

Rhode Island

Rhode Island Releases Medicaid Managed Care Program RFP. The Rhode Island Executive Office of Health and Human Services (EOHHS) released on December 15, 2023, a statewide, capitated risk-bearing Medicaid managed care program request for proposals (RFP). New contracts will be implemented in three phases, starting with adding long-term services and supports benefits to Medicaid managed care for Medicaid-only beneficiaries beginning on July 1, 2025. Under the second phase, current fully dual eligible members will transition to Medicaid managed care plans on January 1, 2026. Finally, beginning January 1, 2027, default enrollment will begin for Medicaid members who become newly eligible for Medicare. Proposals are due February 23, 2024. EOHHS will award contracts to two to three Medicaid managed care organizations. Incumbents are Neighborhood Health Plan, Tufts, and UnitedHealthcare, which serve approximately 371,752 members under the RIte Care (children/families), Rhody Health Partners (ABD), and adult expansion programs. Read More

South Dakota

South Dakota Legislators Propose Medicaid Work Requirements for Expansion Program. The Argus Leader reported on December 15, 2023, that South Dakota Representative Tony Venhuizen (R-Sioux Falls) and Senator Casey Crabtree (R-Madison) introduced a resolution that would allow voters to decide if the state should consider work requirements for Medicaid expansion beneficiaries on the 2024 ballot. Work requirements would not affect Medicaid enrollees living with physical or mental disabilities. Venhuizen previously introduced a similar resolution last year that failed to pass. The resolution would require federal approval; however the Biden administration does not currently approve work requirement waivers. Read More

Texas

Texas Disenrolls Nearly 1.7 Medicaid Beneficiaries Since Redeterminations Began. The Texas Tribune reported on December 14, 2023, that Texas has disenrolled nearly 1.7 million Medicaid beneficiaries since April, approximately 65 percent of which were due to procedural reasons. According to the Texas Health and Human Services Commission, 311,150 Medicaid beneficiaries were disenrolled during November redeterminations, including 194,122 for procedural reasons and 117,028 due to ineligibility. Read More

National

HHS Pushes States to Reduce Barriers to Medicaid Coverage for Children. The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra sent on December 18, 2023, letters to the governors of the states with the highest child Medicaid and CHIP disenrollment rates: Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota, and Texas. Becerra urged states to adopt federal strategies, remove fees and premiums, reduce wait times, and expand Medicaid programs to preserve coverage for children and families. The action coincides with HHS’s release of new data on Medicaid renewals. The data shows that on-expansion states have disenrolled more children than expansion states. In conjunction with the data, the Centers for Medicare & Medicaid Services published new guidance to states addressing strategies to protect Medicaid and CHIP coverage for children, including the extension of existing flexibilities through at least the end of 2024. Read More

Health Insurance Marketplace Enrollment Exceeds 15 Million for 2024. The Centers for Medicare & Medicaid Services announced on December 20, 2023, that over 15.3 million individuals have already enrolled in a health insurance Marketplace plan for 2024 in states that use Healthcare.gov, representing a 33 percent increase compared to 2022. More than 19 million people are expected to enroll across all states. December 15 was the last day to enroll in coverage that starts January 1, 2024. The Marketplace open enrollment period for HealthCare.gov ends January 16, 2024. Read More

Medicaid Prescription Drug Spending Increases in Fiscal 2022 Despite Lower Utilization. KFF released on December 19, 2023, an analysis showing net spending on Medicaid prescription drugs has increased 47 percent between 2017 and 2022, despite lower utilization in the total number of Medicaid prescriptions in fiscal 2022 compared to fiscal 2017 levels. Growth in Medicaid prescription drug rebates was slower than gross spending while net spending per prescription increased from $39 to $58 between 2017 and 2022. Read More

State Directed Payment Program Spending Reached $38.5 Billion in 2022, GAO Finds. The U.S Government Accountability Office (GAO) released a study in December 2023, which found that states directed Medicaid managed care plans to make expenditures related to delivery system and provider payment initiatives of at least $38.5 billion in 2022, under federal regulations established in 2016. GAO indicated that its analysis likely understates the total amount of state directed payments in that year and that the federal approval process lacks sufficient oversight of state-directed payments. States also often relied on provider taxes rather than state general funds to finance the nonfederal share of state directed payments. GAO recommends that CMS enhance the agency’s fiscal guardrails for approving state directed payments; review outcome information at renewal; and make publicly available additional approval documents. Read More

DOJ Files Motion to Transfer or Dismiss Humana’s Lawsuit Over Medicare Advantage Clawback Rule. Modern Healthcare reported on December 18, 2023, that the U.S. Department of Justice (DOJ) filed a motion to transfer or dismiss Humana’s lawsuit over a plan that would allow the U.S. Department of Health and Human Services to claw back overpayments to Medicare Advantage plans. DOJ argued that since the Centers for Medicare & Medicaid Services has not yet begun auditing Medicare Advantage insurers’ 2018 data, Humana has not been harmed and therefore does not have standing to make a legal claim. Read More

Over Half of Medicaid Enrollees Using LTSS are Dual Eligible, KFF Analysis Finds. KFF released on December 14, 2023, an analysis examining the characteristics of the six million Medicaid enrollees who use long-term services and supports (LTSS), which found 62 percent of LTSS enrollees are also enrolled in Medicare. The share is higher among those who use institutional LTSS compared with those who use home and community-based services. Approximately 56 percent of Medicaid enrollees who use LTSS are under 65. Read More

MACPAC Releases 2023 MACStats Medicaid, CHIP Data Book. The Medicaid and CHIP Payment and Access Commission (MACPAC) released on December 15, 2023, the 2023 MACStats: Medicaid and CHIP Data Book, which includes Medicaid and Children’s Health Insurance Program (CHIP) data on eligibility and enrollment, benefits, service use, access to care, and state and federal spending. Total Medicaid spending grew 10.2 percent in fiscal 2022 to $830.6 billion, driven by increased enrollment during continuous coverage. Total CHIP spending was $22.3 billion. Read More

CMS Releases New Care Delivery Model to Improve Maternal Health Access, Health Outcomes for Medicaid, CHIP Beneficiaries. The Centers for Medicare & Medicaid Services (CMS) announced on December 15, 2023, the Transforming Maternal Health Model, a new payment and care-delivery model aimed at supporting state Medicaid agencies in developing and implementing a whole-person approach to pregnancy, childbirth, and postpartum care for women with Medicaid and CHIP coverage. The 10-year plan is intended to increase access to various maternal care providers and provide personalized care to improve health outcomes. Each participating state Medicaid agency will be eligible to receive up to $17 million during the 10-year period. Read More

CMS Releases Revised Guidance for Medicare Prescription Drug Inflation Rebates. The Centers for Medicare & Medicaid Services (CMS) released on December 14, 2023, revised guidance on requirements and procedures for calculating the Medicare Prescription Drug Inflation rebates and invoicing manufacturers that owe rebates for certain drugs covered under Medicare Part B and Part D. CMS also released a list of 48 prescription drugs that Medicare Part B beneficiaries may pay a lower coinsurance for, effective from January 1, 2024, to March 31, 2024. Read More

U.S Medicaid Spending Reaches $805.7 Billion in 2022. The Centers for Medicare & Medicaid Services announced on December 13, 2023, that Medicaid spending increased 9.6 percent to $805.7 billion in 2022, the third year of growth over 9 percent, while enrollment increased 7.2 percent in 2022. Medicare spending increased 5.9 percent to $944.3 billion, a slower rate compared to the 7.2 percent in 2021. Overall, the national health expenditures increased 4.1 percent reaching $4.5 trillion in 2022. Spending for hospital care services increased 2.2 percent and physician and clinical services spending increased 2.7 percent in 2022, both slower rates compared to the prior year. Read More