Author Archives: Gabby Palmieri
KS KanCare Program External Quality Review Reports, 2020-24
1. Kansas KanCare Program External Quality Review Annual Technical Report, 2024, Published April 25, 2024
2. Kansas KanCare Program External Quality Review Annual Technical Report, 2023, Published April 26, 2023
3. Kansas KanCare Program External Quality Review Annual Technical Report, 2022, Published April 27, 2022
4. Kansas KanCare Program External Quality Review Annual Technical Report, 2021, Published April 28, 2021
5. Kansas KanCare Program External Quality Review Annual Technical Report, 2020, Published May 29, 2020
Section 1115 Medicaid Demonstration Inventory
HMAIS expanded its inventory of tracking documents to include a new resource focused on a subset of Medicaid Section 1115 demonstration programs. The calendar currently reflects 45 states with approved and pending 1115 demonstrations in five major categories.
MI Medicaid Managed Care Enrollment is Down 13.6%, Jul-24 Data
Medicaid managed care enrollment in Michigan was down 13.6% in July 2024, compared to year-end 2023 after a 10.1% increase in 2023, 4.3% in 2022, 7.0% in 2021, and 16.4% in 2020.
MN DHS Expenditure Forecast, 2023-24
1. Minnesota Department of Human Services (DHS) Bi-annual Expenditure Forecast, February 2024
2. Minnesota DHS Bi-annual Expenditure Forecast, November 2023
3. Minnesota DHS Bi-annual Expenditure Forecast, February 2023
NY School-based Providers to Transition Medicaid Payments to Managed Care in April 2025
Crain’s New York reported on October 8, 2024, that more than 250 New York school-based health clinics will shift Medicaid payments to managed care by April 1, 2025. School health centers, which are satellite clinics linked to hospitals and other health care facilities, will be required to contract with private health insurers. The clinics claim the transition could cause payment delays, denials, and rate decreases jeopardizing operations, affecting the 250,000 students they serve. Providers will need to get certified, negotiate contracts, and hire administrative staff within a six month transition period.
WA Waitlists 8,000 Undocumented Immigrants for Apple Health Coverage
KOUW reported on October 7, 2024, that nearly 8,000 eligible undocumented individuals in Washington are on a waitlist for the state’s Medicaid managed care coverage Apple Health. The state expanded coverage for undocumented adults with incomes below 138 percent of the poverty line; however, the program has a budget cap of $76.8 million, with only the first 12,000 eligible applicants receiving coverage.
CMS Issues Final Rule to Address SAHS Billing Activity with ACOs
The Centers for Medicare & Medicaid Services (CMS) released on September 24, 2024, a final rule on mitigating the impact of significant, anomalous, and highly suspect (SAHS) billing activity on Medicare Shared Savings Program financial calculations in calendar year 2023. The rule is part of a larger strategy to address SAHS billing activity within Accountable Care Organizations’ (ACOs) reconciliation. The final rule outlines benchmarks for ACOs beginning new agreement periods in 2024, 2025, and 2026, and factors for ACOs applying for a new agreement period starting January 1, 2025. The rule also addresses billing activity concerns for intermittent urinary catheters on Medicare Durable Medical Equipment claims.
CMS Announces $1.4 Million Minority Research Grant Program Awards to Address Health Care Disparities
The Centers for Medicare & Medicaid Services (CMS) Office of Minority Health announced on September 24, 2024, that six recipients have received the 2024 Minority Research Grant Program (MRGP) awards, which supports researchers at minority-serving institutions to address health care disparities. Each recipient will receive awards of up to $237,500, totaling $1.4 million, to examine critical public health disparities and increase health equity research capacities at those institutions. Awardees include Palo Alto College; Research Foundation CUNY on behalf of Lehman College; San Diego State University Foundation; North Carolina Agricultural and Technical State University; Research Foundation of the State University of New York; and Fayetteville State University.
NY Receives Federal Approval for New Essential Plan Subsidies in 2025
The Centers for Medicare & Medicaid Services (CMS) announced on September 25, 2024, that it has approved New York’s amendment to the Section 1332 State Innovation Demonstration, which will expand the Essential Plan to include new cost-sharing subsidies for certain Marketplace enrollees. The amended waiver will include three new state cost-sharing subsidies beginning in 2025 for only Marketplace silver plan enrollees with estimated household incomes up to 400 percent of the federal poverty level; certain diabetes-related services for all Marketplace enrollees; and for certain pregnancy and postpartum outpatient care, inclusive of mental health services, for all Marketplace enrollees. The demonstration will be effective from January 1, 2025, through December 31, 2028.
NY Section 1332 State Innovation Waiver Documents, 2023-24
1. New York Section 1332 State Innovation Waiver Approval, September 25, 2024
2. New York Section 1332 State Innovation Waiver Application, the Essential Plan Expansion, May 12, 2023
3. Fact Sheet, Issued March 1, 2024
4. Amendment Request, Submitted December 18, 2023
5. Amendment Request, Submitted November 14, 2023
6. Amendment Request, Submitted July 23, 2023
