HMA Weekly Roundup

Alabama

Alabama Disenrolls 22,313 Medicaid Beneficiaries in July. The Anniston Star reported on October 4, 2023, that Alabama disenrolled 22,313 Medicaid enrollees during July eligibility redeterminations. Read More

Alaska

Alaska Pauses Medicaid Eligibility Redeterminations, Looks to Reinstate Coverage to Families Disenrolled for Procedural Reasons. Alaska Public Media reported on October 9, 2023, that the Alaska Health Department has announced it will again pause Medicaid eligibility redeterminations and review paperwork for families previously disenrolled for procedural reasons. Going forward, Alaska will conduct redeterminations by individual instead of by family to reduce the number of procedural disenrollments. Read More

Arizona

Arizona Receives Five Bids for Medicaid Managed Long-term Care Contracts. Health Payer Specialist reported on October 9, 2023, Arizona received bids from five health plans for state Medicaid managed long-term care contracts, which are valued at about $1.6 billion and cover about 26,000 members. Bidders included incumbents UnitedHealthcare Community Plan, Banner University Family Care, and Mercy Care Plan. New entrants include Centene/Arizona Complete Health and Blue Cross Blue Shield of Arizona. Awards will be announced on December 13, with contracts effective by October 1, 2024. Read More

Arizona Disenrolls 36,042 Medicaid Beneficiaries During September Redeterminations. The Arizona Health Care Cost Containment System announced on October 11, 2023, that the state has disenrolled 36,042 Medicaid beneficiaries during September redeterminations. More than 178,000 beneficiaries had their coverage renewed, and 52,863 had coverage reinstated after being previously disenrolled for procedural reasons. Read More

Arkansas

Arkansas Disenrolls More Than 427,000 Medicaid Beneficiaries, Completes Redetermination Process. The Associated Press reported on October 10, 2023, that Arkansas has completed its eligibility redeterminations process, disenrolling more than 427,000 Medicaid beneficiaries over six months. Another 298,000 beneficiaries had coverage renewed. Of those disenrolled, 151,000 were children. As of October 1, Arkansas had 868,000 Medicaid members, down three percent from 898,000 on January 1, 2020. Read More

California

California Enacts Law Advancing State Toward Universal Healthcare System Such as Single-payer. Los Angeles Times reported on October 8, 2023, that California enacted a law aimed at advancing the state toward a universal healthcare system such as single-payer. Under the law, California will seek a federal waiver allocating state and federal Medicaid and Medicare funds toward a universal system, which could eventually cover all residents. California’s health secretary will have to offer recommendations for the waiver by June 1, 2024. The incremental approach follows multiple failed attempts at enacting sweeping universal healthcare legislation. Read More

California to Apply for BH-CONNECT Section 1115 Waiver to Improve Behavioral Health Community Services. The California Department of Health Care Services will submit a Section 1115 waiver this year for approval to implement its Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration, which is intended to strengthen the state’s Medicaid behavioral health continuum and improve care and outcomes for enrollees with serious mental health and addiction treatment needs. The waiver contains approaches specifically designed for high-need children and youth. The demonstration is scheduled to take effect on January 1, 2025. Read More

District of Columbia

Ounce Offers Health Care Wraparound Services Alongside AmeriHealth Caritas, National Housing Trust. Fierce Healthcare reported on October 5, 2023, that startup Ounce will provide care coordination and wraparound services to 2,000 Washington, DC, residents in nine affordable housing properties. The services, offered in partnership with AmeriHealth Caritas and National Housing Trust, include onsite health clinics, screenings, and help connecting with Medicaid, healthcare, and social services. Read More

Florida

Florida Attempts to Block Class Action Lawsuit Seeking Pause in Medicaid Eligibility Redeterminations. Health News Florida reported on October 10, 2023, that Florida has asked a state judge to block a class-action lawsuit and a request for an injunction pausing Medicaid eligibility redeterminations. The lawsuit also seeks reinstatement of coverage for disenrolled beneficiaries, arguing that the state failed to provide adequate prior notice. A hearing has been scheduled for October 30. The lawsuit was filed in August on behalf of four Medicaid beneficiaries and seeks class action status. Read More

Florida Advocacy Groups Push Governor to Pause Medicaid Eligibility Redeterminations. Florida Politics reported on October 10, 2023, that several health care advocacy groups sent a letter asking Florida Governor Ron DeSantis to pause the state’s Medicaid eligibility redeterminations process and reinstate coverage to children disenrolled for procedural reasons. Florida ranked 45th in both call center wait times and abandonment rates and has disenrolled more than 250,000 beneficiaries since redeterminations began in April. Read More

Georgia

Georgia Nursing Homes Participating in Medicare, Medicaid Fail to Meet Federal Requirements, Audit Finds. The Augusta Chronicle reported on October 9, 2023, that 19 Georgia nursing homes participating in Medicare or Medicaid programs failed to meet federal requirements for safety, emergency preparedness, and infection control, according to an audit by the Office of the Inspector General of the U.S Department of Health and Human Services. A total of 155 deficiencies across 20 audited nursing homes included blocked fire sprinkler heads, improperly stored oxygen tanks, out of date emergency plans, gaps in infectious disease plans, doors that would not lock, and issues with COVID vaccination policies. The report did not release the names of the audited nursing homes. Read More

Idaho

Idaho Medicaid Value-based Care Organizations Ask State to Stick with Current Model Before Transitioning to MCOs. Idaho Press reported on October 10, 2023, that representatives of four Idaho Medicaid value-based care organizations (VCOs) defended their progress in controlling Medicaid costs and urged members of a state task force to stick with the year-old program, rather than recommend a transition to Medicaid managed care. The task force, which is studying a potential shift to managed care, is expected to release its recommendations on October 16. Read More

Kentucky

Kentucky Reports Savings Following Removal of PBMs from Medicaid Program. The Commonwealth Journal reported on October 5, 2023, that Kentucky’s decision to remove pharmacy benefit managers from the state’s Medicaid prescription drug program in 2020 has resulted in about $283 million in savings over two years, according to state Medicaid officials during a Senate Health Services Committee hearing. Kentucky has used the savings to increase funding for adult Medicaid dental, vision, and hearing benefits. Read More

Maine

Maine Disenrolls 7,586 Medicaid Beneficiaries Following Redeterminations From May Through August. The Maine Department of Health and Human Services (DHHS) announced on October 6, 2023, that the state has disenrolled 7,586 Medicaid beneficiaries during redeterminations from May through August, including 1,494 for procedural reasons. More than 53,000 beneficiaries had coverage renewed. Read More

Massachusetts

Mass General, Concert Health Launch Integrated Behavioral Health Initiative. Fierce Healthcare reported on October 9, 2023, that behavioral health medical group Concert Health will offer access to integrated behavioral health services through Mass General Brigham’s 400 primary care, pediatric and OB-GYN providers. The initiative, which will involve nearly 200 Concert clinicians, will accept all types of insurance, including Medicaid and Medicare. Read More

Michigan

Michigan Legislature Passes Bills Codifying ACA Protections in State Law. Detroit Free Press reported on October 10, 2023, that the Michigan legislature voted to pass bills codifying certain Affordable Care Act (ACA) protections into state law, including allowing dependents to remain on a parent’s insurance until age 26; restricting insurers from imposing annual or lifetime caps on essential services; requiring insurers to cover certain services; and baring insurers from denying insurance to individuals based on gender identity. The bills now head to Governor Gretchen Whitmer for signature. Another bill, prohibiting providers from denying coverage based on preexisting conditions, will return to the House for consideration after the Senate passed a modified version. Read More

Missouri

Missouri Disenrolls More Than 82,000 Beneficiaries Since Redeterminations Began in June. The Springfield News-Leader reported on October 9, 2023, that Missouri has disenrolled over 82,000 Medicaid beneficiaries eligibility redeterminations from June through August. Approximately 77 percent lost coverage for procedural reasons. Read More

Nevada

Nevada Extends Deadline for Medicaid Managed Care RFI. The Nevada Department of Health and Human Services announced on October 11, 2023, that it has extended the deadline for responses to the state’s Medicaid managed care request for information (RFI) from October 10 to October 17. The new procurement will expand coverage to all counties in the statewide, resulting in a projected 10 percent increase in Medicaid managed care enrollment. Incumbents are Centene, Elevance/Anthem, Molina, and United. The next contract period will begin January 1, 2026. Read More

New Mexico

New Mexico Extends Deadline for Submitting Medicaid Renewal Applications. KRQE reported on October 10, 2023, that the New Mexico Human Services Department has extended the deadline for Medicaid beneficiaries to submit Medicaid renewal applications to 75 days from 45. The state has more than 900,000 Medicaid members. Read More

New York

New York to Launch Medicaid Social Care Networks to Address Health-related Social Needs. Fierce Healthcare reported on October 11, 2023, that New York plans to introduce social care networks for addressing Medicaid health-related social needs (HRSN). The networks would conduct screenings, verify eligibility, and creating a social care plan for Medicaid beneficiaries in need of HRSN services. The state is expected to release a request for applications for a platform to facilitate the networks, connecting the state, managed care organizations, and community-based organizations (CBO). A designated Medicaid provider would oversee each network’s administration, contracting, data collection, referral management, and CBO capacity building. Read More

New York Reinforces Certificate of Need Law Through Health Equity Impact Assessments. Modern Healthcare reported on October 11, 2023, that New York has begun requiring healthcare providers to submit third-party health equity impact assessments as part of the certificate-of-need process to gauge the impact that expansions may have on health disparities and communities. Read More

Medicaid Value-based Payments Increase Behavioral Health Visits, Study Finds. Revcycle Intelligence reported on October 10, 2023, that New York’s Medicaid value-based payment reform was associated with an average increase of 0.91 behavioral health visits per patient with depression and 1.01 visits per patient with bipolar disorder, according to a JAMA Health Forum study from July 2013 through July 2019. The study also found value-based payments led to a slight decrease in mental health hospitalizations for patients with depression and a reduction in mental health emergency department visits for patients with depression, bipolar disorder, and schizophrenia. Read More

New York Awards Recovery Audit Contractor Contract to Performant. Performant Financial Corporation announced on October 4, 2023, that it was awarded the New York Medicaid recovery audit contractor contract. The contract, which is awarded by the New York Office of the Medicaid Inspector General, will run for three years with two one-year renewals. Read More

New York Lacks Adequate Oversight of Medicaid Third-party Liability Process, Audit Finds. New York State Comptroller Thomas DiNapoli said in an audit released on September 27, 2023, that the state Medicaid program lacked adequate oversight of the third-party liability (TPL) recovery process from January 2017 through August 2021. Separately, DiNapoli reported in another audit that state officials have made minimal progress in addressing previously identified issues concerning improper Medicaid claims payments.

North Carolina

North Carolina Launches Medicaid Expansion Informational Website. Spectrum Local News reported on October 9, 2023, that the North Carolina Department of Health and Human Services has launched a website that provides information and resources on the state’s newly approved Medicaid expansion program. The program, with an expected 600,000 eligible residents, will begin coverage December 1. Read More

Oklahoma

Oklahoma Faces Lawsuit Over Health Information Exchange. KOSU reported on October 9, 2023, that Oklahoma faces a lawsuit over the state’s two-year-old Health Information Exchange, which requires Medicaid providers to report patient information. The Oklahoma Fraternal Order of the Police filed the lawsuit in state court against the Oklahoma Health Care Authority, alleging the requirement violates state law. A hearing is set for November 30. Read More

Oregon

Oregon Disenrolls 99,239 Medicaid Beneficiaries During Redeterminations. The Oregon Department of Health and Human Services disenrolled 99,239 Medicaid beneficiaries from April through October 6, according to the state’s eligibility redeterminations dashboard. OHA has renewed coverage for 574,952 beneficiaries. More than 24,500 beneficiaries had benefits reduced. Read More

Medicaid Recipients Receive Improper Behavioral Health Care; Audit Highlights Lack of State Oversight. The Lund Report reported on October 9, 2023, that Oregon Medicaid beneficiaries with chronic mental illness are receiving improper behavioral healthcare, with an internal audit highlighting the lack of state oversight of needs assessment vendor Comagine Health. The audit highlighted how a lack of oversight had allowed mental health patients to be placed in overly restrictive care, a lack of transparency in claims appeals processes, and inadequate outreach. Read More

Texas

Texas Will Extend Medicaid Eligibility Renewal Deadline for Some Enrollees. The Texas Health and Human Services Commission announced on October 11, 2023, that it will offer some Medicaid beneficiaries an additional 30 days to submit eligibility renewal applications, including elderly adults, individuals with disabilities, and others most likely to still be eligible for Medicaid. To date, Texas has completed eligibility redeterminations for 59 percent of Medicaid beneficiaries in the state. Read More

Virginia

Virginia Gains Federal Approval of Plan to Expand School-based Medicaid Services. The Centers for Medicare & Medicaid Services announced on September 25, 2023, that it has approved a Virginia state plan amendment allowing the state to expand school-based Medicaid services, including nursing, testing by a licensed psychologist, and transportation. Read More

Wyoming

Wyoming Disenrolls 7,000 Medicaid Members for Procedural Reasons in July. The Cowboy State Daily reported on October 4, 2023, that the Wyoming Department of Health disenrolled 7,000 Medicaid members for procedural reasons in July. Earlier reports put the number at 10,100; however, some children were incorrectly included. Coverage was renewed for more than 9,000 beneficiaries. Read More

National

Medicare Advantage Plans Offer Tailored Benefit Packages. Modern Healthcare reported on October 11, 2023, that Medicare Advantage (MA) plans are offering tailored benefit packages. For example, SCAN Health Plan will offer SCAN Inspired for women in 2024. The plan, to be offered in partnership with Los Angeles-based Cedars Sinai, will include benefits like $0 estrogen therapy, weight management programs, and fitness programs. SCAN also offers an MA plan for the LGBTQ+ community in partnership with Included Health. Another organization, Alignment Health, offers MA plans for the Asian American and Hispanic communities. Clever Care Health Plan offers MA plans incorporating Western and Eastern medicine. Read More

Dual Demos in New York, Ohio, Washington Show Mixed Results, CMS Reports. The Centers for Medicare & Medicaid Services (CMS) reported on October 5, 2023, that the Ohio Financial Alignment Initiative demonstration for Medicare-Medicaid dual eligibles had a favorable impact on hospital and nursing home outcomes over six years, but increased overall Medicare costs. New York’s Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities demonstration had no significant impact on Medicaid or Medicare costs, but enrollees valued the program’s care management and improved access to durable medical equipment. Washington’s Managed Fee-for-Service Financial Alignment Initiative demonstration showed lower levels of savings in 2021 in comparison to prior demonstration years. Read More