Author Archives: Lauren Zuzelski

This week, our In Focus sections looks at the Medicaid redesign waiver, submitted by New Mexico to the Centers for Medicare & Medicaid Services (CMS) on April 25, 2012. New Mexico is proposing to consolidate the numerous federal waiver populations, as well as the fragmented managed care and fee-for-service structure that serves New Mexico’s roughly 512,000 Medicaid lives.

This week, our In Focus section reviews recent Medicaid MCO enrollment trends in 13 states. Many state Medicaid agencies elect to post to their website monthly enrollment figures by health plan for their Medicaid managed care population.

This week, our In Focus section briefly reviews the flurry of dual eligible integration proposals released for public comment in the past week. Arizona, South Carolina, Tennessee, Texas, and Virginia have all unveiled their plans to bring a combined 590,000 dual eligible lives into capitated managed care plans beginning in 2014.

This week, our In Focus section addresses Medicaid program integrity, highlighting two recent Federal commission recommendations on the topic. In the March 2012 report from the Medicaid and CHIP Payment and Access Commission (MACPAC), the Commission dedicated a chapter to Medicaid program integrity, or those initiatives designed to detect and deter fraud, waste, and abuse and improve program administration.

This week, our In Focus section looks at the updated guidance on dual eligible integra-tion, released March 29, 2012 by the Centers for Medicare & Medicaid Services (CMS). In January 2012, CMS released an initial round of guidance regarding dual eligible integra-tion demonstrations, providing information on payment principles, key dates, and net-work adequacy determinations.

This week, our In Focus section reviews New York’s dual eligible integration proposal. The New York State Department of Health has proposed a fully-integrated managed care program, which will be known as the Fully-Integrated Duals Advantage (FIDA) pro-gram.

This week, our In Focus section highlights key provisions of the federal final rule on Med-icaid eligibility and enrollment, released last Friday, March 16, by the Centers for Medi-care & Medicaid Services (CMS). The final rule provides the standards for determining Medicaid eligibility after January 1, 2014, when the Affordable Care Act (ACA) expands Medicaid coverage to all individuals under 133 percent of the federal poverty level (FPL).

This week, our In Focus section reviews the state of Washington’s proposal to integrate care for dual eligible individuals. Washington was one of fifteen states to receive dual el-igible demonstration grant funding from the Centers for Medicare and Medicaid Services (CMS) over an eighteen-month planning period.