Author Archives: Anh Pham
UnityPoint Health Terminates Network Contract with Molina in IL
The Journal Star reported on February 13, 2018, that UnityPoint Health terminated its provider network contract with Molina Healthcare in Illinois, effective January 1. The hospital will honor previously scheduled appointments in-network coverage through the end of February. Read More
IL Hospitals Threatened by Proposed Assessment Overhaul
The Chicago Tribune reported on February 13, 2018, that South Shore Hospital and Roseland Community Hospital would likely face closure or be forced to reduce services as a result of a proposed overhaul of the Illinois hospital assessment, hospital executives say. The Illinois House Appropriations-Human Services Committee held a hearing on February 13 to discuss the proposal, which seeks to better align assessment funding with hospitals serving the most patients.
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ID House Passes Legislation to Restore Medicaid Dental Benefits
AP News reported on February 13, 2018, that the Idaho House narrowly approved legislation to restore non-emergency dental benefits to more than 30,000 additional Medicaid recipients. Lawmakers restored benefits to children and individuals with major disabilities in 2013. Read More
PA Governor Releases 2018-19 Budget
Pennsylvania Governor Tom Wolf announced his 2018-19 budget, which totaled $32.9 billion. Twenty-one percent of that proposal is for medical assistance and long-term care. The budget focuses on four healthcare priorities: improving behavioral health treatment for opioid disorders, providing more services to more people with intellectual disabilities and autism, enhancing care for seniors and people with disabilities through Medicaid, and unifying the Department of Health and the Department of Human Services into a single streamlined entity.
- Draw down $26.5 million in federal funding from the second year of the 21st Century Cures Act. The Department of Drug and Alcohol Programs will use these funds to supplement existing efforts and focus primarily on expanding access to treatment services with a heavy emphasis on Medication Assisted Treatment (MAT).
- Include $4.5 million to provide training to service providers and serve families affected by opioid use disorder through evidence-based home visiting models.
- Provide a $74 million increase for services for individuals with intellectual disabilities and autism. Within this total, the budget targets $16 million to enroll 965 individuals with an intellectual disability or autism in waivers to provide supports and services so that they can remain in their home and community.
- Commit to consolidating the Department of Health and the Department of Human Services into one, unified department.
NJ Provides MLTSS Update
As of December 2017, the New Jersey Division of Medical Assistance and Health Services reported that 40,500 individuals were enrolled in MLTSS. The MLTSS enrollment is further broken down by service setting:
| Service Setting | Number of Enrollees |
| MLTSS HCBS | 21,604 |
| MLTSS Assisted Living | 3,094 |
| MLTSS Nursing Facility | 15,522 |
| MLTSS Specialty Care NF | 280 |
An additional 12,037 enrollees continue to receive long term care in nursing facilities under Medicaid fee for service and are exempt from managed care enrollment. There are 972 Medicaid enrollees in the PACE program.
Since the implementation of MLTSS in July 2014, the state has experienced a shift in the balance of long term care provided in institutional settings from 70.5% to 52% in December 2017. However, rebalancing to shift more long-term care into community-based settings has varied across counties; 13 out of 21 counties exceeded the statewide average in the use of Medicaid-related nursing facility admissions related to custodial care: Atlantic (53%), Burlington (56%), Cumberland (57%), Essex (60%), Hunterdon (64%), Mercer (53%), Monmouth (58%), Morris (59%), Ocean (63%), Salem (64%), Sussex (76%), Union (55%) and Warren (77%).
CA Assembly Passes Bill Allowing Regulators to Reject Certain Health Care Mergers
KPBS reported on February 5, 2018, that the California Assembly has passed a bill that would give state regulators the authority to reject health care mergers likely to lessen competition. The bill increases the authority of the state Department of Managed Health Care to approve or reject mergers based on whether the deals improve health care quality and reduce health disparities. Insurance companies say the bill is too broad and imposes an unreasonably high standard on proposed deals. Read More
FL Receives Bids from 8 Medicaid Dental Plans
The Florida Agency for Health Care Administration announced on February 9, 2018, that eight dental plans submitted bids in response to the state’s Prepaid Dental Health Plan request for proposals: Managed Care of North America, United Healthcare of Florida, Liberty Dental Plan of Florida, Delta Dental Insurance Company, Argus Dental & Vision, Evolve Dental of Florida, DentaQuest of Florida, and SKYGEN of Florida.
IA Considers Reducing Medicaid Managed Care Oversight
The Omaha World-Herald reported on February 12, 2018, that Iowa lawmakers in the House Human Resources Committee are considering legislation that would reduce oversight of the state’s privatized Medicaid program. The legislation, which has been pushed by the state Department of Human Services, would reduce the frequency of performance reporting, remove consumer protection metrics, and eliminate a requirement that the agency report expected savings from managed care. Read More
MI Mental Health Providers Say Medicaid Shortchanged Them
Crain’s Detroit Business reported on February 11, 2018, that Michigan mental health providers are claiming that the state Medicaid program shortchanged them by approximately $100 million over the past two years. The dispute centers on whether the state’s 10 regional prepaid inpatient health plans are receiving the correct payment rates for aged, blind and disabled members. Read More
PR Releases Medicaid Managed Care RFP
The Puerto Rico Health Insurance Administration (PRHIA) has issued a request for proposal (RFP) for its Medicaid managed care program. The RFP, which had been delayed mainly because of the recovery from Hurricane Maria, will implement changes under what the administration calls the “New Model of the P.R. Government Health Plan.” Proposals are due April 6, 2018.
