HMA Weekly Roundup

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  • This week, our In Focus section reviews the California amendment to the Section 1115 Waiver Demonstration titled, “California Advancing and Innovating Medi-Cal (CalAIM), ” approved by the Centers for Medicare & Medicaid Services (CMS) on January 26, 2023. Read More
    Roundup:

    California Awards $119 Million to 98 Organizations to Improve Medicaid Delivery System

    California Insurer to Offer Digital Health App to Medicaid Enrollees

    Iowa House Committee Advances Medicaid Work Requirements Bill

    Indiana Reaches $66.5 Million Settlement with Former PBM

    Michigan Releases Child, Adolescent Health Center Program RFP

    Minnesota Attorney General Asks for Delay of Sanford Health, Fairview Health Services Merger

    Mississippi Senator, Representative File Medicaid Expansion Bills

    North Carolina to Move Children Covered by CHIP to Medicaid

    New Mexico Cancels Medicaid Managed Care RFP

    South Dakota Legislators Propose Medicaid Expansion Fund

    Texas Awards STAR+PLUS Medicaid Managed Care Contracts to 7 Plans

    Utah Senate Passes Legislation to Extend Medicaid Dental Coverage

    CMS Proposes Updates to Medicare Advantage Risk Adjustment Model in 2024 Advance Notice

    CMS Will Not Impose Major Penalties on Medicare Advantage Plans for Overpayments

    CMS Outlines PHE Unwinding Requirements, Phase Out of FMAP Increase

    CVS Health Invests $32.7 Million in Affordable Housing in NC, TX

  • Lee Fleisher, MD, chief medical officer and director of CMS’ Center for Clinical Standards and Quality, will deliver the morning keynote address at HMA’s March 6 conference on “Healthcare Quality: A Deep Dive on What’s Next for Providers, Payers, Read More
    Roundup:

    Arkansas Legislature Faces Potential Hurdles for Funding Medicaid Expansion

    Arizona Governor Proposes $2.7 Million to Modernize Medicaid Enterprise System

    Georgia House Speaker Does Not Plan to Take Up Medicaid Expansion

    Massachusetts Governor Appoints Kate Walsh as Secretary of Health, Human Services

    Michigan Provides Pregnancy App for Eligible Medicaid Beneficiaries

    New Mexico Medicaid Director to Step Down

    New Mexico Has Yet to Announce Medicaid Managed Care Awards

    Oklahoma Awards Medicaid Dental Contracts to 2 Plans

    Rhode Island Legislators Introduce Medicaid Housing Supports Pilot Proposal

    Wisconsin Adds Medicaid Work Requirement Advisory Referendum to April Ballot

    Wyoming Appoints Lee Grossman as State Medicaid Agent, Senior Administrator

    Exchange Plan Enrollment Rises Nearly 13 Percent to 16.3 Million in 2023

    FCC Clears Medicaid Plans to Text, Robocall Beneficiaries for Eligibility Redeterminations

    Elevance Health to Acquire BCBS of LA

  • In 2022, HMA convened stakeholder roundtables in three states – including New Mexico, North Dakota, and New Mexico to identify the challenges facing dually eligible individuals living in rural areas and to propose solutions to these challenges. Informed by this Read More
    Roundup:

    Arkansas Releases RFI for Medicaid Managed Care Module of MMIS Replacement

    Florida Governor Announces Proposal to Regulate PBMs

    Medicaid Expansion News: Georgia, Kansas, Mississippi, North Carolina, South Dakota

    Georgia Releases RFI to Audit PBMs Contracted Through Medicaid Plans

    Louisiana Releases RFP for Permanent Supportive Housing Services Funded in Part by Medicaid

    Michigan Doulas Push for Higher Medicaid Reimbursement Rates

    Mississippi Seeks Bids for Medicaid FFS Non-emergency Transportation Services

    South Carolina to Continue Several Flexibilities After COVID-19 PHE Ends

    CMS Announces Medicare Accountable Care Partnerships Will Cover 13.2 Million Enrollees in 2023

    Health Network One Acquires Premier Eye Care

  • This week, our In Focus section reviews changes to Medicaid’s COVID-19 Public Health Emergency (PHE) unwinding. Read More
    Roundup:

    Arizona Medicare Plan Receives $60 Million Investment from Chicago Pacific Founder to Launch ESRD C-SNP

    California Revises List of Medicaid Managed Care Award Winners in Several Counties

    Connecticut Expands Medicaid Eligibility for Children Effective January 1

    Florida Appoints Jason Weida as Interim Secretary

    Georgia Releases RFQC for Medicaid Managed Care Plans

    Georgia Establishes State Exchange Directing Buyers to Brokers, Insurers

    Idaho Legislators to Review Medicaid Expansion

    Maine to Seek Renewal of Waivers for Adults in Need of Home and Community-based Services

    Maryland Releases Behavioral Health ASO RFP

    Maryland Implements Medicaid Comprehensive Dental Coverage

    Massachusetts Selects 20 Community Partners for ACO Behavioral Health, LTSS

    Nevada Receives Federal Approval for SUD Treatment Waiver

    New Hampshire Legislature to Vote on Reauthorization of Medicaid Expansion Funding

    New York Governor Announces $1 Billion Plan to Address Behavioral Health

    North Dakota Releases Medicaid Enterprise Technical Systems Integrator RFP

    Oklahoma Faces Lawsuit from Provider-led Entity Regarding Managed Care Procurement

    Oregon Approves Amazon Acquisition of One Medical

    Rhode Island Releases NEMT Program RFQ

    Wisconsin Names Jamie Kuhn as Medicaid Director

    HHS Extends Public Health Emergency Until April 11

    CMS Allows States, Medicaid Plans to Spend 5 Percent of Premiums on Social Determinants of Health

    CVS Health Considers Acquisition of Oak Street Health

  • This week, our In Focus section reviews a rule proposed by the Centers for Medicare & Medicaid Services (CMS) on December 14, 2022, that would revise regulations governing Medicare Advantage (MA or Part C), the Medicare Prescription Drug Benefit (Part Read More
    Roundup:

    California to Transition Dual Eligibles in 31 Counties to Medi-Cal Managed Care Plans in January 2023

    Georgia Receives Approval for 2 State-Directed Payment Programs

    Hawaii Governor Proposes Medicaid Provider Reimbursement Rate Increases

    Iowa Releases Medicaid Enterprise Systems RFI

    Idaho Looks to Expand Access to Crisis Services for Individuals with Developmental Disabilities

    Indiana Releases Medicaid NEMT RFP

    New Mexico Proposes 16 New Programs in Section 1115 Medicaid Waiver Renewal Application

    New York Medicaid Pharmacy Carve-Out Could Cost $400 Million More Annually, Wakely Report Finds

    Oregon Governor-Elect to Appoint James Schroeder as Interim Director of OHA

    Puerto Rico to Receive $17.6 Billion in Medicaid Funding Over 5 Years Under Omnibus Spending Bill

    Vermont Considers Punitive Cuts to 2023 All-Payer ACO Budget

    Washington Receives Federal Approval to Offer Exchange Plans to Non-Citizens

    Medicaid Eligibility Redeterminations to Begin April 2023 Under Omnibus Spending Bill

    Rise Health Secures Investments from Lorient Capital, Martis Capital

  • This week, our In Focus section reviews the State of Texas Access Reform (STAR), Children’s Health Insurance Program (CHIP), and Healthy Texas Women (HTW) Medicaid managed care request for proposals (RFP) released by the Texas Health and Human Services Commission Read More
    Roundup:

    California to Sanction 22 Medi-Cal Plans for Poor Quality Ratings

    California Governor Awards $480.5 Million in Grants for Youth Behavioral Health Infrastructure

    Connecticut Governor to Appoint Andrea Barton Reeves Commissioner of Social Services

    Massachusetts Medicaid Secretary To Step Down

    Minnesota Judge Blocks Managed Care Plan from Expanding Board of Directors

    Missouri, Mississippi, Montana, Wyoming Are Expected to Extend Medicaid Postpartum Eligibility in 2023

    Nevada Releases External Quality Review Organization RFP

    North Carolina Faces Lawsuit for Foster Children in Residential Psychiatric Treatment Facilities

    Wyoming Requests $22 Million to Increase Nursing Home Medicaid Reimbursement Rates in 2024

    CMS Rule Would Increase Availability of Standardized Exchange Plans

    MedPAC Draft Recommendations Call for Medicare Payment Increases for Hospitals, Physicians in 2024

    Exchange Enrollment Rises 18 Percent in First Five Weeks of Open Enrollment

    SCAN Group, CareOregon to Merge as HealthRight Group

    Centene Names New President, Chief Operating Officer, Other Leadership Changes

  • This week, our In Focus highlights a Leavitt Partners white paper, The Impact of the 340B Program on Drug Prices Charged by Manufacturers and Covered Entities, published in November 2022. Read More
    Roundup:

    North Carolina Appeals Ruling on Additional Community Services for Individuals with Disabilities

    New Mexico Health Plan Submits Bid for New Medicaid Managed Care Contract

    New York SMI Treatment Programs Face Over 1,000-Person Waiting List

    Oregon Reaches $17 Million Settlement with Former PBM

    Tennessee to Release Dental Benefit Management RFP in Late 2023

    Texas Releases STAR & CHIP Managed Care Services RFP

    Wisconsin Receives Approval to Continue Exchange Plan Reinsurance Program Through 2028

    HHS Releases Medicaid, CHIP FMAP for Fiscal 2024

    Defense Misses Deadline for Announcing Tricare Contract Awards

    Prime Therapeutics Completes Acquisition of Magellan Rx Management from Centene

  • This week, our In Focus reviews the Oklahoma Medicaid managed care SoonerSelect Program request for proposals (RFP) and the SoonerSelect Children’s Specialty Program RFP released by the Oklahoma Health Care Authority (OHCA) on November 10, 2022. Read More
    Roundup:

    Arkansas Medicaid Looks to Expand Access to Behavioral, Mental Health Services

    California Seeks Approval to Limit Medicaid Managed Care Choice in Metro, Urban Counties

    PHE News: Delaware, New Mexico, Tennessee

    Florida Medicaid Secretary Is Stepping Down

    Florida Releases Medicaid Managed Care Data Books Ahead of Procurement Process

    Georgia to Implement Medicaid Work Requirements After Public Health Emergency Ends

    Idaho Delays Medicaid Behavioral Health Plan Contract Award

    Michigan to Cover Doula Services for Medicaid Beneficiaries in 2023

    Mississippi Managed Care Enrollment Falls As State Shifts Members to FFS During Pandemic

    Montana Faces Lawsuit Concerning Hiring of Medicaid Director

    Oklahoma Releases SoonerSelect Children’s Specialty Program RFP Covering Foster Kids

    Oregon Proposes Continuous Medicaid Coverage for Beneficiaries Until Basic Health Program Launch

    Medicare Advantage Plans Overbilled Government by Over $1,000 Per Patient Yearly, Audits Find

    CMS Reports $70 Million in Medicare Savings Through Direct Contracting Model in 2021

    Centene Sells Magellan Specialty Health to Evolent Health

  • While the current federal COVID-19 Public Health Emergency (PHE) declaration could be in place through the winter months, HMA’s team of experts see many reasons to put the PHE’s Medicaid unwinding planning at the top of your list now. Read More
    Roundup:

    Alabama Doubles Covered Physician Visits for Medicaid Enrollees Receiving Cancer Treatment

    California Medi-Cal Procurement Protests Continue

    California Releases Third-Party Monitoring RFI

    Delaware Names First Director of Value-Based Healthcare Delivery

    Illinois YouthCare Fails to Deliver Basic Medical Services to Foster Children, Investigation Finds

    Medicaid Expansion News: Kansas, North Carolina

    Elevance Files Appeal After Its Protest of Nebraska Medicaid Managed Care Awards is Denied

    Maryland Declines to Pursue Higher Damages Against Medicaid Behavioral Health ASO

    Ohio Delays Implementation of New Medicaid Managed Care Contracts to February 2023

    Oklahoma Re-releases Medicaid Managed Care RFP

    Wisconsin Releases External Quality Review, Quality Improvement Services RFP

    CMS Targets Gaps in Health Equity Data, To Gradually Release Equity Scores

    Sanford Health, Fairview Health Services Agree to Merge

  • This week, our In Focus section reviews highlights and shares key takeaways from the 22nd annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 25, 2022, in Read More
    Roundup:

    California Medi-Cal Members Can Now Fill Prescriptions at Costco

    Florida Healthcare Groups File Challenge to $15 Minimum Wage Budget Provision

    Hawaii Works With HMA to Develop Medicaid Social Determinants of Health Initiative

    Massachusetts Home Health Care Workforce Decreases by 13 Percent from 2019 to 2022

    Nebraska Says Protest of Medicaid Managed Care Contracts Will Not Delay Implementation

    New Hampshire Executive Council Approves Medicaid Dental Contract

    Pennsylvania Receives Federal Approval to Extend Postpartum Medicaid Coverage to 12 Months

    South Dakota Voters Approve Medicaid Expansion

    Virginia Projects ‘Tiny’ Increase in Fiscal 2024 State Medicaid Costs

    Medicaid FFS More Likely to Cover Opioid Use Disorder Treatment than Medicaid Managed Care

    Medicaid Plans Report Barriers to Telehealth Access

    19 States Have Implemented Strategies to Increase Direct Care Worker Wages, Report Finds

    CNSI, Kepro to Merge; Apax Partners to Exit

    Walgreens’ VillageMD to Acquire Summit Health

    Clover Health to Reduce Medicare ACO REACH Population by Two-Thirds in 2023