HMA Weekly Roundup

Arizona

Arizona Disenrolls 457,753 Medicaid Beneficiaries Since Resuming Redeterminations. The Arizona Health Care Cost Containment System announced on January 11, 2024, that 457,753 Medicaid beneficiaries, or 18 percent of those reviewed during the Medicaid eligibility redeterminations process, have lost coverage since the process began in April. Approximately 1.4 million enrollees have maintained coverage. Read More

California

California Governor’s Proposed Budget Includes Medicaid for Undocumented Immigrants. California Governor Gavin Newsom released on January 16, 2024, the fiscal 2025 executive budget proposal which lays out $253.4 billion for the state’s Health and Human Services (HHS) agency. Under HHS, The Medi-Cal budget includes $157.5 billion in 2023-24 and $156.6 billion in 2024-25. The budget includes $3.4 billion to expand Medi-Cal eligibility to eligible adults aged 26 to 49 regardless of immigration status; about $2.4 billion for CalAIM; $200 million for reproductive health services; over $8 billion total funds to expand behavioral health services; and $7.6 billion to implement the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration. Read More

California Proposes CalAIM Amendment to Provide Continuous Medicaid, CHIP Coverage for Children. The California Department of Health Care Services proposed on January 12, 2024, an amendment to the CalAIM Section 1115 Medicaid demonstration to provide continuous Medicaid (Medi-Cal) and Children’s Health Insurance Program (CHIP) coverage for eligible children through age 4. The public comment period will run through February 12, 2024. Read More

California Launches Behavioral Health Virtual Services Platform for Youth, Families. The California Department of Health Care Services (DHCS) launched on January 17, 2024, the Behavioral Health Virtual Services Platform, which consists of two free behavioral health services applications for individuals up to age 25. BrightLife Kids supports parents, caregivers, and children through age 12, while Soluna offers services to individuals aged 13 to 25. The platform is a major component of California Governor Gavin Newsom’s Master Plan for Kids’ Mental Health and the Children and Youth Behavioral Health Initiative. Read More

Florida

Florida Proposed Bills Would Boost Physician Workforce, Develop Advanced Birth Centers. Health News Florida reported on January 16, 2024, that Florida House Majority Leader Michael Grant (R-Port Charlotte) sponsored a bill that would expand medical residency programs to increase the number of doctors in the state and establish advanced birthing centers, which provide cesarian-section deliveries for women with low-risk pregnancies. A similar bill sponsored by Senate Health Policy Chairwoman Colleen Burton (R-Lakeland) now heads to the full Senate. These bills, in conjunction with Senate and House bills that would fund low-interest loans promoting health innovation, comprise Senate President Kathleen Passidomo’s “Live Healthy” legislation package aimed at improving healthcare access. Read More

Idaho

Idaho Legislator Introduces Bill that Would Require New Medicaid Waivers to Receive Legislative Approval. The Idaho Capital Sun reported on January 16, 2024, that Idaho House Majority Leader, Megan Blanksma (R-Hammett), introduced a bill that would require new Medicaid waivers to receive legislative approval prior to implementation, and it prohibits Section 1915 waivers, which states use to provide home and community-based services for individuals that do not otherwise qualify for Medicaid. The bill would not affect current waivers and requires a full public hearing in the House Health and Welfare Committee before it can progress. Read More

Iowa

Iowa Legislature Considers Bill to Create Tiered Medicaid Reimbursement System for Children’s Mental Health. The Telegraph Herald reported on January 15, 2024, that the Iowa Legislature is considering a new bill which would created a tiered Medicaid reimbursement rate system for mental health providers serving children based on the severity of the children’s needs. Read More

Kentucky

Kentucky Submits Medicaid Section 1115 Amendment to Improve Care for Individuals Leaving Public Institutions. The Centers for Medicare & Medicaid Services (CMS) announced on January 12, 2024, that Kentucky has submitted an amendment to its TEAMKY Section 1115 demonstration program to improve care for adults and youth transitioning out of state prisons and youth development centers. Specifically, the amendment would provide case management services to individuals pre- and post-release from public institutions, medication-assisted treatment for substance use disorder 60 days pre-release, a 30-day supply of necessary prescription medications, and Recovery Residence Support Services for Behavioral Health Conditional Dismissal Program participants. The federal comment period will be open through February 11, 2024. Read More

State Bill Would Reduce Maximum Number of Medicaid Managed Care Contracts. WEKU NPR reported on January 10, 2024, that the Kentucky legislature is considering a bill, co-sponsored by Senators Stephen Meredith (R-Leitchfield) and Mike Wilson (R-Bowling Green), that would limit the state to awarding no more than three Medicaid managed care contracts, effective January 1, 2025, in order to promote administrative savings. Kentucky currently contracts with six Medicaid managed care contracts and has rejected six previous attempts to reduce the number of contracts. The bill received bipartisan support in the Health Services Committee and has since been passed to the Rules Committee. Read More

Maine

Maine Long-term Care Facilities at Risk of Closure Due to Funding, Staffing Shortages. McKnights Long Term Care News reported on January 17, 2024, that Maine’s $96 million dollar shortfall in Medicaid funding, coupled with workforce shortages, is expected to cause additional long term care facility closures and make providing care in the future more difficult. Federal funding will cover $65 million of that shortfall, leaving the state to cover the remaining $31 million. Read More

Minnesota

Minnesota Disenrolls 103,150 Medicaid Beneficiaries After Six Months of Processing Redeterminations. State of Reform reported on January 11, 2024, that 103,150 Medicaid beneficiaries have been disenrolled since the Medicaid eligibility redeterminations process began in July. Minnesota officials expect to disenroll the largest number of beneficiaries in January due to an extended timeline and the shift from determining eligibility based on household information to assessing eligibility at an individual level. Read More

Mississippi

Mississippi Hospital Directed Payments Bring in Additional $658.2 Million Under New Program. SuperTalk Mississippi Media reported on January 10, 2024, that the newly approved Mississippi Hospital Access Program (MHAP) has delivered $658.2 million to hospitals. The MHAP provides directed payments to hospitals serving Medicaid managed care beneficiaries, effectively reimbursing hospitals at the federal ceiling for Medicaid managed care reimbursements, or the same average rate compensated by commercial insurance. Read More

Missouri

Missouri Disenrolls 158,756 Medicaid Beneficiaries After Six Months of Processing Redeterminations. ABC 17 KMIZ reported on January 11, 2024, that Missouri disenrolled 158,756 Medicaid beneficiaries between June and November. Of those disenrolled, approximately 125,142 individuals lost coverage due to procedural reasons and 33,614 lost coverage due to ineligibility. According to the Centers for Medicare & Medicaid Services, to date 340,534 Missourians have enrolled in the Marketplace program during the open enrollment period for 2024, which ends Jan. 16. Read More

Montana

Montana Experiences Delays in Paying Medicaid Providers. KFF Health News reported on January 11, 2024, that the Montana Department of Public Health and Human Services (DPHHS) is experiencing delays in paying Medicaid providers due to new legislative mandates, changes in staff, and high volumes of contracts. More than 200 contractors, including crisis mental health care and other critical local services, have been affected. DPHHS and the Department of Administration have hired additional employees to finalize remaining contracts. Read More

New Mexico

New Mexico Governor’s Fiscal 2025 Budget Proposes Additional Medicaid Funding For Rural Hospitals, Provider Reimbursement. New Mexico Political Report reported on January 17, 2024, that New Mexico Governor Michelle Lujan Grisham announced details of her legislative priorities during her State of the State address, including a request for an additional $100 million for the Rural Health Care Delivery Fund, and significant increases in Medicaid funding to boost provider reimbursement rates. The Governor’s budget proposal for Medicaid includes $87.9 million for Medicaid provider rate increases to 150 percent for maternal/child health, primary care, and behavioral health. Read More

New York

New York Governor Releases Fiscal 2025 Budget Proposal. New York Governor Kathy Hochul presented on January 16, 2024, details of the fiscal 2025 executive budget proposal during her State of the State address. The budget proposal includes $87.5 billion in Medicaid spending, including funding over the next three years for the state’s Medicaid Section 1115 demonstration program, which contains a series of actions to advance health equity, reduce health disparities, invest in the healthcare workforce and stabilize certain hospitals. The budget also includes $315 million per year to provide health insurance subsidies on the Exchange for individuals up to 350 percent of the federal poverty level. Read More

New York Grants More Than $950 Million to Fund Healthcare Facility Upgrades, Technological Modernization. Crain’s New York Business reported on January 11, 2024, that New York has granted more than $950 million for hospitals, nursing homes, and health providers to upgrade facilities, integrate care, and modernize technological platforms. The funding, available through the fourth and fifth stages of the Statewide Health Care Facility Transformation program, includes up to $250 million for investments, $650 million for technological and cybersecurity measures, and $50 million to support nursing homes. Read More

New York To Grant $50 Million for Residential, Community-based Alternatives to Nursing Home Care. The New York State Department of Health released on January 9, 2024, a request for applications (RFA) that will offer $50 million in grant funding to support residential and community-based alternatives to the traditional model of nursing home care as a part of stage four of the Statewide Health Care Facility Transformation Program. Applications are due April 9, 2024, and contracts are anticipated to run from October 1, 2024 through September 30, 2029.

Oregon

Oregon Behavioral Health and Medicaid Programs to Become Separate Divisions. The Oregon Health Authority (OHA) announced on January 11, 2024, a restructuring that will create separate divisions for the Behavioral Health and Medicaid programs to more effectively allocate funding, administer the programs, and promote equitable health outcomes. The transition, which is expected to be complete in April 2024, will result in phasing out the Health Systems Division that previously housed both programs. OHA indicated that each division will maintain its current leadership and no reductions in staffing will occur. Read More

West Virginia

West Virginia Selects Highmark as Fourth Medicaid Managed Care Organization. The West Virginia Department of Human Services announced on January 17, 2024, that it has approved Highmark/Highmark Health Options West Virginia’s application to become a Medicaid Managed Care Organization in the state, allowing the organization to begin offering coverage on July 1, 2024, for four years. Highmark did not participate in West Virginia’s last Medicaid managed care procurement; however, the state legislature passed a bill which removed the procurement process in March 2023, and now permits any eligible plan to apply to participate. West Virginia currently contracts with Aetna, The Health Plan of West Virginia, and Elevance/UniCare. Read More

West Virginia Governor’s Fiscal 2025 Budget Proposes Additional Medicaid Surplus Funding. The Inter-Mountain reported on January 16, 2024, that West Virginia Governor Jim Justice’s fiscal 2025 state budget proposal includes $40.6 million in surplus funding for Medicaid, and an additional $114 million for the program to support legislation creating a managed care tax to fund projected shortfalls. The Medicaid program, which serves more than 36 percent of the state’s population, is projected to face a $114 million deficit in fiscal 2025, due in part to the phase out of the enhanced federal match in place during the public health emergency. Senate Finance Committee Chairman Eric Tarr (R-Putnam) has raised concerns that surplus funding may lead to on-going expenses and budget growth. Read More

Wisconsin

Wisconsin Releases Medicaid Managed LTC RFP for GSR 5. The Wisconsin Department of Health Services (DHS) released on January 12, 2023, a request for proposals (RFP) for the Medicaid managed long-term care (LTC) programs for low-income frail, elderly and adult individuals with developmental, intellectual, or physical disabilities. This procurement, which covers geographic service region (GSR) five is part one of a three part process that will award multiple managed care organizations (MCOs) with contracts for the Family Care and Family Care Partnership programs. DHS is currently in the process of transitioning GSRs, and the new region will consist of former GSRs 5, 12, and 14. For Family Care, DHS seeks to award between two to four MCOs for the GSR and for Family Care Partnership, one to three MCOs. Contracts are expected to begin on January 1, 2025, and will run for two years with three two-year renewals. Proposals are due March 7 with intent to award expected on June 14, 2024. Read More

National

CMS Releases Final Rule Aimed At Improving Electronic Exchange of Health Information, Prior Authorization Processes. The Centers for Medicare & Medicaid Services (CMS) finalized on January 17, 2024, the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health information and prior authorization processes for medical items and services for Medicare Advantage organizations, fee-for-service, and managed Medicaid, Children’s Health Insurance Program plans, and issuers of Qualified Health Plans offered on the Federally-facilitated Exchanges. Beginning in 2026, the rule requires payers to streamline prior authorization by setting deadlines for decisions, providing justification for denied requests, publicly reporting metrics, and implementing an application programming interface (API). Payers must also expand their current Patient Access API to include prior authorization information and implement a Provider Access API to broaden provider access to patient information beginning in 2027. These policies are expected to result in approximately $15 billion of estimated savings over ten years. Read More

CMS Releases Value-based Insurance Design Model RFI. The Centers for Medicare & Medicaid Services (CMS) released in January 2024, a request for information (RFI) to seek input on considering health-related social needs and a newly defined area deprivation index in advancing health equity and structuring hospice care policies to provide high quality care within the Medicare Advantage Value-Based Insurance Design Model (VBID). CMS has extended the comment period through February 16, 2024. Read More

Government Funding Stopgap Plan Provides Temporary Relief For Certain Healthcare Programs. Modern Healthcare reported on January 16, 2024, that Congress has reached a tentative government funding deal to prevent a partial government shutdown and advance a third stopgap appropriations bill which would secure funding for key healthcare programs through March 8. The legislation offers short-term relief to programs such as community health centers, graduate medical training and the National Health Service Corps while awaiting approval for funding through the rest of fiscal 2024. Funding for hospitals and other healthcare industries remain in an uncertain state. Read More

MedPAC Meeting Highlights Overpayments in Medicare Advantage. Health Payer Specialist reported on January 17, 2024, that the Medicare Payment Advisory Commission (MedPAC) discussed its status report of Medicare Advantage (MA), which sparked criticism that the report was unfavorable toward the program. MedPAC suggested that MA would cost $88 billion more than what fee-for-service Medicare would cost, and claimed that MA plans are incentivized to code more diagnoses than Medicare, resulting in higher payments as well as wide inequity across plans. The report also found that from 2020 to 2022, chart reviews and health risk assessments made up nearly half of MA coding intensity. MedPAC recommends removing health risk assessments from risk adjustment to improve equity. Read More

HHS Launches Online Hub to Expand Access to Medicaid, CHIP Renewal Resources. The U.S. Department of Health and Human Services (HHS) announced on January 11, 2024, that it has launched an online hub to expand access to Medicaid and Children’s Health Insurance Program (CHIP) renewal and transition resources. Read More

Health Plans Seek Increased Medicaid Rates Amid Rising Costs. Modern Healthcare reported on January 11, 2024, that health plans, including Centene and Molina, are securing higher Medicaid capitation rates amid rising costs due to worsened risk pools. Centene gained funding increases in 22 of the 25 states in which it administers Medicaid and Molina achieved similar increases in 10 of the 12 states where it administers the program. Medicaid managed care claims totaled $407.5 billion through the third quarter of 2023, adding up to close to 90 percent of 2019 annual spending, according to a TD Cowen analysis. Read More

Medicaid Disenrollments Exceed 14 Million Following Redeterminations. KFF reported on January 10, 2024, that nearly 14.4 million Medicaid beneficiaries have been disenrolled since eligibility redeterminations resumed last year. States are attempting to utilize a number of measures to streamline the process and effectively conduct Medicaid renewals, including various outreach strategies, additional training or hiring of staff, and increased ex-parte renewals. Read More