HMA Weekly Roundup

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  • This week, our In Focus section reviews the New Hampshire Medicaid Care Management (MCM) request for proposals (RFP), which the state’s Department of Health and Human Services released on September 8, 2023. Read More

    California Medicaid Director Jacey Cooper Is Leaving to Join CMS

    District of Columbia Receives Approval for Community-Based Mobile Crisis Services SPA

    Florida Renews Medicaid Utilization Management Contract with Acentra Health

    Hawaii Receives $4 Million Project LAUNCH Federal Grant to Improve Children’s Behavioral Health

    Michigan Expects Medicaid Community Health Worker Benefit to Impact 50,000 Residents If Approved

    BCBS-NC Names Angela Boykin CEO of Medicaid Plan

    Oregon to Seek Federal Approval for Basic Health Plan

    Pennsylvania to Review Rates for Providers Serving Individuals with Intellectual Disabilities, Autism

    CMS to Lower Cost of 34 Prescription Drugs Beginning October 1

    Walmart May Buy Majority Stake in ChenMed

  • This week, our In Focus section reviews the request for proposals (RFP) for the Virginia Cardinal Care Medicaid managed care program, released by the Department of Medical Assistance Services (DMAS) on August 31, 2023. Read More

    California Medi-Cal Contracts Are Scheduled to Begin January 1

    PBMs Face Lawsuit from Los Angeles County Over Opioid Crisis

    Georgia Receives Approval of Waivers to Streamline Medicaid Unwinding Process

    Montana Medicaid Providers Face Further Delay in Receiving Increased Rates

    New York Managed Long-term Care Plan Is Closing Down

    Oregon to Step Up PBM Regulation After Audit Finds Lax Oversight

    Pennsylvania Senate Passes Bill to Raise Reimbursement Rate for Ambulance Services

    Tennessee Awards Findhelp Contract to Connect Medicaid Beneficiaries with Social Services

    West Virginia Receives CMS Approval for Medicaid Mobile Crisis State Plan Amendment

    CMS to Provide Funding to Help States Implement AHEAD Total Cost of Care Delivery System Model

    Molina Acquires My Choice Wisconsin

  • This week’s In Focus centers on the U.S. Department of Health and Human Services (HHS) August 29, 2023, announcement of the first 10 prescription medications that will be subject to price negotiation for Medicare coverage. Read More

    Medicaid Eligibility Redeterminations News: Alaska, Illinois, Maine, Massachusetts

    Georgia Looks to Increase Oversight of Medicaid Plans

    Idaho Gears Up for Transition to Single Behavioral Health Plan Covering Inpatient, Outpatient Services

    Indiana Medicaid Beneficiaries Struggle to Access Dental Care

    Iowa Increases Medicaid Reimbursements for Substance Abuse, Mental Health Counseling

    Michigan Governor to Call for Legislation Locking in ACA Protections

    Nevada Awards Magellan Contract for Complex Behavioral Care Management for Youths

    North Carolina Medicaid Expansion Will No Longer Launch on October 1

    Oklahoma Proposes 12 Months of Continuous Eligibility for Children on Medicaid, CHIP

    CMS Takes Additional Action to Halt Wrongful Medicaid Disenrollments

    Centene to Sell Circle Health Group to PureHealth

  • In this week’s In Focus, we continue our review of Medicare developments from this summer and look ahead at Centers for Medicare & Medicaid Services (CMS) activities to watch for this fall. Read More

    Florida Residents File Federal Lawsuit Challenging Their Disenrollment from Medicaid

    Georgia Medicaid Expansion Program Sees Slow Enrollment

    Hawaii Halts Medicaid Eligibility Redeterminations on Maui For Remainder of 2023

    Amerigroup Iowa Names Teresa Hursey President

    Louisiana Lawmakers Push to Delay Sale of BCBS Louisiana to Elevance Health

    Michigan New Medicaid Managed Care Contracts Will Take Effect October 2024

    CareSource, HAP Receive Approval to Form Medicaid Joint Venture

    New Mexico Releases $80 Million Rural Health Care Delivery Fund RFA

    Ohio Renews Contract with Medicaid EVV Company

    Oregon to Implement Mandatory Annual Audits of Medicaid PBMs

    Texas to Restore Medicaid Coverage of 90,000 Disenrolled Individuals

    Virginia Delays Release of Medicaid Managed Care RFP to September 1

    Washington Allocates Over $100 Million to Apple Health, Homes Program

    CMS Warns States That Call Center Wait Times, Dropped Calls Are Impeding Medicaid Coverage Renewals

    Centene to Challenge Tricare Contract Loss in Federal Claims Court

  • This week, our In Focus section reviews the Arizona Long Term Care System (ALTCS) Elderly and Physically Disabled (EPD) Program request for proposals (RFP), which the Arizona Health Care Cost Containment System (AHCCCS) released on August 1, 2023. Read More

    Colorado Hospitals Continue to Post Operating Losses

    Florida Projects $600 Million Medicaid Budget Deficit for Fiscal 2024

    Medicaid Eligibility Redeterminations News: Florida, Illinois, Massachusetts, Michigan, Nevada, Rhode Island, Wyoming

    Idaho Medicaid Managed Care Task Force Holds Second Hearing

    Illinois Governor Signs Law Increasing Oversight of Healthcare Mergers

    Indiana Parents, Advocates Call on Governor to Reconsider Funding Cut for Autism Therapy

    Massachusetts to Raise Income Eligibility Limits for ConnectorCare

    Nebraska to Lift $750 Cap on Medicaid Dental Benefits

    New Mexico to Award Previously Announced Medicaid Plan Contracts in Defeat for Governor

    New York City Cannot Switch Retirees to Aetna Medicare Advantage Plan, Judge Rules

    North Carolina Medicaid Behavioral Health Plans Sandhills Center, Eastpointe to Merge

    Vermont All-Payer ACO Model Lowers Medicare Spending, Hospitalizations, Analysis Finds

    CMS Launches Changes to Encourage Participation in Medicare ACO REACH

    4.8 Million Medicaid Beneficiaries Are Disenrolled from Medicaid Following Redeterminations, Analysis Finds

    5.6 Million Medicaid Enrollees Utilize Long-term Services, Supports in 2020, KFF Finds

    U.S. Appeals Panel Rules False Claims Lawsuit Against Walgreens Can Proceed

  • This week, our In Focus section continues analysis and insights from Health Management Associates (HMA) and its affiliate The Moran Company on recent Medicare payment and policy developments. Read More

    Arizona Releases Long Term Care System RFP

    Arkansas Releases Medicaid Enterprise Pharmacy System and Services RFP

    Medicaid Eligibility Redeterminations News: Arkansas, California, Idaho, Illinois, Kansas, Louisiana, Maine, Minnesota, Pennsylvania, West Virginia

    California Releases Medi-Cal Dental Managed Care RFP for Los Angeles, Sacramento Counties

    Massachusetts Releases Section 1115 Waiver Amendment for Public Comment

    New York To Continue Coverage of Extended Medicaid Telehealth Services Through 2024

    North Carolina State Budget May Stall Until September, Delay Medicaid Expansion Until At Least December

    Utah Requests Three 1115 Demonstration Amendments for Chronic Conditions, Dental Services, Family Planning

    Virginia to Release NEMT RFP September 1

    Washington Requests Section 1115 Medicaid Waiver Amendment To Cover Former Foster Care Youth, CHIP Children

    Wyoming Releases Draft Section 1115 Medicaid Waiver to Expand Income, Asset, Need Eligibility for Existing HCBS Waiver Services

    CMS Extends HCBS Flexibilities Granted During COVID-19 Until November 11

    OIG Finds High Rates of Prior Authorization Denials Among Medicaid MCOs

    Health Connect America Acquires Specialized Youth Services of Virginia

  • This week, our In Focus section reviews the new Guiding an Improved Dementia Experience (GUIDE) Model, announced by the Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and Medicare Innovation (the Innovation Center) on July 31, 2023. Read More

    Alabama Seeks Medicaid Waiver to Cover Opioid, SUD Services for Individuals in IMDs

    Alaska Medicaid to Cover Assisted Living Services in At-home Settings

    California Receives Approval to Lift the Medicaid Asset Test in 2024

    Florida Seeks Waiver to Pilot Managed Care Program for Individuals with IDD

    Medicaid Eligibility Redeterminations News: Louisiana, Michigan, Minnesota, Missouri, New Hampshire

    North Carolina Reaches Agreement with CMS in Hopes of Launching Medicaid Expansion by October

    Virginia Medicaid Managed Care RFP Release Delayed to Mid to Late August

    CMS Releases Final Medicare Inpatient, Long Term Care Prospective Payment System Rule

    CMS Increases Medicare Reimbursement Rates for Skilled Nursing Facilities by 4 Percent in Fiscal 2024

    CMS Projects 1.8 Percent Decrease in Medicare Part D Premiums in 2024

    CMS Increases Medicare Hospice Rates by 3.1 Percent in Fiscal 2024

    Medicaid, CHIP Enrollment Is Nearly 94.2 Million in April 2023

    Medicaid Disenrollments Near 4 Million Following Redeterminations

    The Ensign Group Acquires Skilled Nursing Facilities in Colorado, Washington

    Help at Home Acquires IN-based My Care at Home, OH-based Berkshire Homecare

  • This week’s In Focus section is the second in a summer series of analysis and insights from Health Management Associates (HMA) on recent Medicare payment and policy developments. Read More

    California Exchange Plan Premium Hikes Softened by State Financial Support

    Medicaid Eligibility Redeterminations News: Indiana, Massachusetts, Minnesota, Montana, Washington, West Virginia, Wisconsin

    Molina Healthcare Names Aaron Dunkel as President of Kansas Operations

    Michigan Ends Cost Sharing in Medicaid Expansion Program

    Nevada Releases Medicaid Managed Care RFI

    Oklahoma Health Care Authority CEO Kevin Corbett to Resign

    Medicaid Disenrollment Rates Vary Widely Among States, Report Finds

    Community Health Systems to Sell Three Hospitals to Tampa General Hospital in $290 Million Deal

    United’s Optum Health Names Amar Desai as CEO

  • This week, our In Focus section is the first in a summer series of analysis and insights from Health Management Associates (HMA) on recent Medicare payment and policy developments. Read More

    Redeterminations News: Arkansas, Connecticut, Georgia, Iowa, Kentucky, North Carolina, North Dakota, Texas, Wyoming

    California Health Plan to Provide $46 Million in Grants for Housing, Other Services

    Colorado Medicaid, CHIP Are Among Payers Most Likely to Reimburse for Unnecessary Health Services, Study Finds

    Florida Is Ordered to Amend Medicaid Program to Prevent Institutionalization of Children with Complex Needs

    Hawaii to Seek Medicaid Services for Justice-involved Populations Prior to Release

    Illinois Provides $75 Million in Funding to Address Health Disparities, Housing

    Medicaid Disenrollments Top 3 Million Following Redeterminations

    MTM Acquires Medical Transportation Brokerage of Arizona

  • This week, our In Focus section reviews the Centers for Medicare & Medicaid Services (CMS) report to Congress on Non-emergency Medical Transportation (NEMT) in Medicaid, released June 20, 2023. Read More

    Medicaid Eligibility Redeterminations News: Arizona, District of Columbia, Florida, Idaho, Maryland, Michigan, Mississippi, New Jersey, Tennessee, Wyoming

    Florida Extends Deadline for Medicaid Managed Care ITN Responses

    Georgia Launches Partial Medicaid Expansion Program With Work Requirements

    Idaho Medicaid Managed Care Task Force Holds Hearing on Structure of Program Funding

    New Jersey Will Allocate $5 Million to Improve Housing for Individuals with Disabilities, Acute Medical Needs

    New York Releases Third-Party Liability Match, Recovery Services RFP

    North Carolina Further Delays Implementation of Behavioral Health IDD Tailored Plans

    Ohio Releases RFP for Medicaid Enterprise System Alternate Payment Model Logic, Reporting Tool

    Pennsylvania Medicaid to Cover Care Delivered on Streets to Homeless

    ACA Risk Adjustment Pool to Redistribute $15.2 Billion to Individual Plans

    AmeriHealth Caritas CEO Paul Tufano to Step Down