HMA Weekly Roundup

California

California Renews Managed Care Tax, With Funds to Bolster Medicaid, Hospitals. Politico reported on June 24, 2023, that California Governor Gavin Newsom reached an agreement with lawmakers to renew a tax on managed care organizations, with the funds to be used to bolster Medicaid and hospitals. The tax is expected to generate $19 billion, plus billions more in matching federal funds. The original tax expired in 2022. Read More

Connecticut

Connecticut Disenrolls 46,000 Medicaid Beneficiaries Following May Redeterminations. CT News Junkie reported on June 26, 2023, that Connecticut disenrolled more than 46,000 Medicaid beneficiaries following May redeterminations. About a third of the disenrolled membership have enrolled in coverage through the state Exchange or the Covered Connecticut premium assistance program. Read More

Delaware

Delaware Senate Approves Additional $49 Million for Fiscal 2024 to Address Growth in Medicaid Expenditures. The Associated Press reported on June 28, 2023, that the Delaware Senate passed the fiscal 2024 operating budget, which includes an additional $48.7 million to address the expected growth in Medicaid expenditures. A supplemental bill also includes $69.1 million in one-time funding for Medicaid. The budget package now goes to Governor John Carney for his signature. Read More

District of Columbia

DC Council Considers Bill to Require Medicaid Coverage of Infertility Treatment. The Washington Post reported on June 27, 2023, that the DC Council is considering a bill that would require Medicaid to cover the infertility treatment and diagnosis, three rounds of in vitro fertilization, and medical costs related to an embryo transfer to a surrogate. The Council passed the bill, but needs to vote again on a technical amendment before it goes to Mayor Muriel Bowser for her signature. The measure also requires federal regulatory approval. Read More

Georgia

Georgia Directs $118 Million to Medicaid Expansion in Fiscal 2024. The Georgia Budget and Policy Institute (GBPI) reported on June 27, 2023, that the Georgia fiscal 2024 budget directs about $118 million in total state funds to Pathways to Coverage, the state’s Medicaid expansion program for individuals up to 100 percent of poverty who meet certain work requirements. The funding will cover about 47,500 expansion members, GBPI says. In contrast, GBPI notes, a full expansion to 500,000 eligible individuals up to 138 percent of poverty would cost the state 80 percent less per person. Read More

Idaho

Idaho Awards Centene/Magellan Healthcare Behavioral Health Plan Contract. The Idaho Department of Health and Welfare announced on June 27, 2023, that it has awarded Centene/Magellan Healthcare the Idaho Behavioral Health Plan (IBHP) contract, worth $1.2 billion. The new contract will integrate inpatient, residential, and outpatient behavioral health services into a single comprehensive behavioral plan and serve 425,000 Medicaid and non-Medicaid members. Currently IBHP is a pre-paid ambulatory health plan served by United’s Optum. The contract will run for four-years. United/Optum and Elevance/Beacon Health also bid for the contract. Read More

Illinois

Illinois Requests Extension for Behavioral Health Transformation Section 1115 Waiver. The Centers for Medicare & Medicaid Services (CMS) announced on June 28, 2023, that Illinois submitted an extension application for the five year renewal of the Behavioral Health Transformation Section 1115 Demonstration Waiver. The goals of the waiver are to improve Medicaid services for substance use disorder and address structural factors affecting behavioral health outcomes. The extension would be effective July 1, 2023, through December 31, 2023, while Illinois works towards approval of the five year renewal. The state has requested that the waiver, previously approved by CMS in 2018, be renamed the “Illinois Healthcare Transformation Section 1115 Demonstration.” The federal public comment period will be open from June 28, 2023, through July 28, 2023. Read More

Illinois Governor Creates State-based Insurance Exchange. WQAD/Capitol News Illinois reported on June 27, 2023, that Illinois Governor JB Pritzker signed House Bill 579 to create a state-based health insurance Exchange. The legislation also gives the state Department of Insurance the authority to modify or reject proposed rate increases. Under the plan, an initial version would be operational on the federal platform by plan year 2025, with a final version on a state-based platform ready for the 2026 plan year. Read More

All Kids Misclassifies About 5 Percent of Undocumented Enrollees, Audit Finds. Health News Illinois reported on June 26, 2023, that the Illinois Children’s Health Insurance Program (CHIP) All Kids misclassified about five percent of undocumented enrollees, resulting in lost federal funds of at least $8.2 million between fiscal 2019 and 2022, according to a state Auditor General report. All Kids spent another $1.2 million on services for 1,328 ineligible individuals between 2018 and 2020. Read More

Kansas

Kansas Overpaid Medicaid MCOs $1.3 Million from 2019 to 2021, Audit Finds. The Kansas Reflector reported on June 21, 2023, that the Kansas Department of Health and Environment overpaid Medicaid managed care organizations (MCOs) more than $1.3 million, according to an audit from the state Office of the Medicaid Inspector General. The audit found that the state did not properly process beneficiaries who moved out of state, which led to the overpayments. The timeframe for the audit was January 1, 2019, through December 31, 2021. Read More

Maine

Maine Senate Rejects Bill to Extend Medicaid Coverage to Eligible Noncitizen Adults. The Sun Journal reported on June 27, 2023, that the Maine Senate rejected a bill, passed by the House, to extend Medicaid coverage to all eligible adults, regardless of immigration status. The bill, LD 199, was sponsored by House Speaker Rachel Talbot Ross (D-Portland). Maine previously provided public health benefits to noncitizens until 2011. Lawmakers recently extended Medicaid coverage to pregnant individuals and children under age 21 who are noncitizens. Read More

Michigan

Michigan Offers One Month Grace Period to Reenroll in Medicaid Following June Redeterminations Period. The Detroit Free Press reported on June 23, 2023, that Michigan will give Medicaid beneficiaries a one-month grace period until July 31 to re-enroll in the program following June redeterminations. The additional time will benefit nearly 218,000 beneficiaries who had a June 30 deadline. Read More

New Hampshire

New Hampshire Extends Postpartum Medicaid Coverage. New Hampshire Public Radio reported on June 26, 2023, that New Hampshire will extend postpartum Medicaid coverage from 60 days to 12 months through a provision in the enacted state budget. The budget also includes provisions requiring Medicaid to cover doulas, lactation services, and donor breastmilk; provide funding for family resource centers; and expand mental health services for young kids. Read More

New Jersey

New Jersey Legislature Considers Amended Bill Requiring Medicaid Reimbursement for Behavioral Health Services in Schools. The New Jersey Spotlight News reported on June 27, 2023, that the New Jersey legislature is considering an amended bill that would require Medicaid reimbursement for behavioral services offered to eligible students in schools, regardless of participation in individualized education plans (IEP) or if the services are free to the general student population. The bill, originally introduced last year in the Assembly Appropriations Committee and amended this month, is sponsored by Assembly members Louis Greenwald (D-Burlington), Angelica Jimenez (D-Bergen), and Reginald Atkins (D-Union). Read More

North Carolina

North Carolina Could Disenroll 300,000 Medicaid Members Following Redeterminations. Insurance Newsnet reported on June 26, 2023, North Carolina could disenroll 300,000 Medicaid beneficiaries following eligibility redeterminations. The state began the redeterminations process on April 1. Read More

Northern Mariana Islands

Northern Mariana Islands Remains Short of Medicaid Funding. Marianas Variety reported on June 22, 2023, that the Commonwealth of the Northern Mariana Islands (CNMI) needs to allocate $7.8 million to generate enough federal Medicaid matching funds to continue medical coverage through September. CNMI already suspended coverage of dental, outpatient physical therapy, and home health aides, effective June 1. Read More

Oregon

Oregon to Disenroll 24,000 Medicaid Beneficiaries During June Redeterminations. The Lund Report reported on June 26, 2023, that Oregon will disenroll about 24,000 Medicaid beneficiaries during June redeterminations, the first month the state is disenrolling beneficiaries. According to state officials, about 80 percent of beneficiaries are expected to remain enrolled at the end of the redeterminations process. Read More

South Carolina

South Carolina Awards $45.5 Million in Behavioral Health Crisis Stabilization Grants to 13 Hospitals. The South Carolina Department of Health and Human Services announced on June 27, 2023, the award of $45.5 million to 13 hospitals, with funds earmarked for building specialized hospital-based emergency department units dedicated to behavioral health. The funding comes from the state’s behavioral health crisis stabilization grant program, which was announced in March. Read More

South Carolina Disenrolls 118,313 Medicaid Members During May Redeterminations. The South Carolina Department of Human Services announced on June 9, 2023, that South Carolina disenrolled 118,313 Medicaid beneficiaries following May eligibility redeterminations. About 95 percent were disenrolled for procedural reasons. Read More

Washington

Washington Extends Family Planning Only Demonstration Waiver by One Year. The Washington State Health Authority announced on June 27, 2023, that federal regulators have extended the Washington Family Planning Only (FPO) 1115 demonstration waiver through June 30, 2024, pending review by the Centers for Medicare & Medicaid Services (CMS) of the state’s application for a five-year renewal. FPO covers a preventive family planning visits, cervical cancer screenings, and reproductive health services. Income eligibility is 260 percent of the federal poverty level. Read More

Vermont

Vermont Legislature Overrides Governor’s Veto of Budget. The Brattleboro Reformer reported on June 21, 2023, that the Vermont legislature overrode Governor Phil Scott’s vetoes of a budget bill, which includes Medicaid rate increases and investments in housing and childcare. Read More

Wisconsin

Wisconsin to Renew Family Care, Family Care Partnership Waivers. The Wisconsin Department of Health Services (DHS) announced on June 27, 2023, that it is seeking renewal for the state’s Family Care and Family Care Partnership Section 1915 waivers, which provide Medicaid managed long-term care and long-term services and supports for the aged and disabled. The waivers are expected to take effect in January 1, 2025, and last for five years. Current incumbents serving the Family Care program are Community Care, Inclusa, Lakeland Care, and My Choice Wisconsin, and serving Family Care Partnership are Community Care, Humana/iCare, and My Choice Wisconsin. DHS will gather stakeholder input this year and hold a 30-day public comment period in June 2024. The proposed waiver renewals are expected to be summitted to the Centers for Medicare & Medicaid Services in September 2024. Read More

Wisconsin State Assembly Considers Bill to Extend Postpartum Medicaid Coverage. WTMJ reported on June 24, 2023, that the Wisconsin State Assembly is considering bipartisan legislations attached to the state budget bill to extend postpartum Medicaid coverage from 60 days to 12 months. The State Assembly is expected to vote on the budget in July. Read More

Wisconsin Launches Independent Living Supports Pilot Program. The Wisconsin Department of Health Services announced on June 22, 2023, the launch of the Independent Living Supports Pilot program, which will use funding from the American Rescue Plan Act to provide eligible individuals with the resources they need to stay in their homes instead of a long-term care facility. Enrollees will have access to the benefits for up to 12 months. The program will be available in 16 counties. Read More

Wisconsin Legislature Rejects Extension of Medicaid Postpartum Coverage to One Year. The Milwaukee Journal Sentinel reported on June 22, 2023, that the Wisconsin Joint Committee on Finance voted against extending Medicaid postpartum coverage from two months to one year. The proposal would have expanded Medicaid postpartum coverage to approximately 5,000 women annually. Read More

National

Medicaid, CHIP Enrollment is Nearly 93.9 Million in March 2023. The Centers for Medicare & Medicaid Services (CMS) announced on June 27, 2023, that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) was nearly 93.9 million in March 2023, an increase of 494,664 from February 2023. Medicare enrollment was more than 65.7 million, up 99,194 from February 2023, including nearly 31.8 million in Medicare Advantage plans. More than 12 million Medicare-Medicaid dual eligibles are counted in both programs. Read More

U.S. Lawmakers Urge CMS to Expand Proposed Rule to Streamline Prior Authorizations in Medicaid, Medicare, Exchange Plans. HealthLeaders reported on June 23, 2023, that a bipartisan group of 294 lawmakers is urging federal regulators to expand a proposed rule to streamline prior authorization in Medicaid, Medicare Advantage, and Exchange plans. In a letter commenting on the proposed rule, lawmakers called for electronic prior authorizations for routine services, requiring plans to respond to prior authorization requests within 24 hours for urgent care, and requiring detailed transparency metrics. Read More

MACPAC Projects Medicaid Managed Care Directed Payment Spending to Be $69.3 Billion Annually. The Medicaid and CHIP Payment and Access Commission (MACPAC) projected in a June 2023 issue brief that annual directed payments in Medicaid managed care will be $69.3 billion for the 249 distinct arrangements approved as of February 2023. Directed payment arrangements are available in 40 states, District of Columbia, and Puerto Rico. Read More

Study Finds Geographic Disparities in Medicaid Access to Opioid Addiction Medication. A JAMA study published on June 23, 2023, found geographic disparities in Medicaid access to opioid addiction medication. For example, 75 percent to 80 percent of Medicaid patients in New England received opioid addiction medication, compared to less than 40 percent of patients in the Midwest and South. About 55 percent of Medicaid enrollees received opioid addiction medication nationally. Read More

Lawmakers Seek Approval of Rule Extending Medicaid, CHIP, Exchange Coverage to DACA Recipients. The Hill reported on June 23, 2023, that 80 Democratic lawmakers have asked federal regulators to approve and implement a proposed rule that would allow individuals in the Deferred Action for Childhood Arrivals (DACA) to access Medicaid, Children’s Health Insurance Program (CHIP), and Exchange coverage. The request, made in a letter as part of the rule’s public comment period, asks the Centers for Medicare & Medicaid Services (CMS) to implement the rule November 1, 2023. Read More

Biden Issues Executive Order to Strengthen Access to Contraception. On June 23, 2023, President Biden issued an executive order aimed at strengthening access to contraception, including the potential for new initiatives that cover family planning services and supplies through state Medicaid programs and through Medicaid managed care. The order also aims to improve access for women of reproductive age with disabilities on Medicare and for others in federal healthcare programs. Read More

Home Health Act of 2023 Would Reduce CMS Rate Setting Power. Home Health Care News reported on June 22, 2023, that Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) introduced the Preserving Access to Home Health Act of 2023, which would block cuts to home health payments beginning in 2024 and reduce the rate setting power of the Centers for Medicare & Medicaid Services (CMS). CMS has already reduced home health payments by 3.9 percent and is expected to propose the same percentage cut this summer. Read More

House Panel Holds Hearing Over Future of MIPS. CQ reported on June 22, 2023, that a House panel held an initial hearing on the future of the Medicare Merit-Based Incentive Payment System (MIPS). Members of the House Energy and Commerce Oversight and Investigations subcommittee questioned the efficacy of MIPS. Separately, the Medicare Payment Advisory Commission has already recommended that MIPS be eliminated. Read More

CMS Issues Guidance on Adults With IDD Supported by Aging Caregivers. Disability Scoop reported on June 22, 2023, that the Centers for Medicare & Medicaid Services (CMS) issued guidance aimed at helping states better serve adults with intellectual and developmental disabilities (IDD) who are supported by aging caregivers. Suggestions include outreach to caregivers, taking advantage of waiver opportunities, and utilizing the Social Security’s Disabled Adult Child program to forecast the need for home and community-based services. Of the 7.43 million individuals with IDD in the U.S., only 21 percent were receiving services as of 2018. Read More

CMS Proposes Program to Speed Medicare Coverage for Breakthrough Devices. STAT reported on June 22, 2023, that the Centers for Medicare and Medicaid Services (CMS) has proposed a voluntary program called Transitional Coverage for Emerging Technologies (TCET), which would accelerate approval of Medicare coverage for breakthrough medical devices to no more than six months following approval by the Food and Drug Administration (FDA). The public will have 60 days to comment on the proposal. Read More

Drug Makers File Federal Lawsuit to Block Medicare From Negotiating Drug Prices. Reuters reported on June 21, 2023, that the Pharmaceutical Research and Manufacturers of America joined two other pharmacy trade groups in filing a federal lawsuit to block Medicare from negotiating drug prices. The other groups are the National Infusion Center Association and the Global Colon Cancer Association. This is the fourth lawsuit challenging the law. Read More