HMA Weekly Roundup

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  • This week our In Focus section summarizes the United States Government Accountability Office (GAO) Medicaid report, State Views on Program Administration Challenges, released earlier this year. GAO conducted interviews with Medicaid officials from 50 states and the District of Columbia Read More
    Roundup:

    Florida Governor Vetoes Disability Provider Rate Increase for Providers Serving Individuals with Disabilities

    Illinois Unit of Centene to Acquire NextLevel Members

    Kentucky Health Plans Formally Protest Medicaid Awards

    New York Medicaid Plan Sells Certain Assets to Molina

    North Carolina Medicaid Bill Awaits Governor’s Signature

    Oklahoma Voters Approve Medicaid Expansion Measure

    Virginia Governor Redirects $30 Million From Medicaid Plans

    House Votes to Increase Exchange Subsidies

  • This week, our In Focus section examines new guidance issued by the Centers for Medicare & Medicaid Services (CMS) regarding Medicare Advantage (MA) plan network adequacy requirements. On June 17, 2020, CMS released updated Medicare Advantage and 1876 Cost Plan Read More
    Roundup:

    California Budget Adopts Cuts to Medicaid Managed Care

    Delaware to Tap Magarik to Head Health and Social Services

    Kentucky Seeks to Bring Back State-Based Health Exchange

    North Carolina House Committee Advances Medicaid Managed Care Bill

    North Dakota Seeks Input on Re-Procurement of Medicaid Expansion Managed Care Plan

    Oklahoma to Release Medicaid Managed Care RFP This Fall

    Texas Names McCreary COO of Health and Human Services

    CMS Can Force Hospitals to Reveal Prices Negotiated with Insurers, Federal Judge Rules

  • This week, our In Focus section examines the operational impacts of federal Medicare Advantage policy changes in response to the COVID-19 pandemic. On January 31, 2020, the Secretary of Health and Human Services declared a public health emergency. This was Read More
    Roundup:

    California Names Lightbourne Health Care Services Director

    Kansas Names Christiane Swartz Interim Medicaid Director

    Missouri Chamber of Commerce Supports Medicaid Expansion

    North Carolina Senate Committee Clears Bill Delaying Transition to Medicaid Managed Care Until July 2021

    West Virginia Awards Medicaid Managed Care Contracts

    Medicare Would Permanently Cover Telemedicine at FQHCs, Rural Clinics Under House Bill

    MedPAC Calls for Accelerated Transition to Medicare Value-based Payments

  • This week, our In Focus section discusses an issue brief prepared by Health Management Associates (HMA), Optimizing Capacity for Prescribing Buprenorphine in Jails and Prisons, authored by HMA Principals Shannon Robinson, MD and Donna Strugar-Fritsch, BSN, MPA, CCHP. Read More
    Roundup:

    California Provides Updated Timeline for Medicaid Managed Care Procurement RFP

    District of Columbia Medicaid May Integrate Behavioral

    Florida Medicaid to Update Inpatient Payment Methodology

    Illinois Medicaid Plan NextLevel Health to Close Down

    Illinois Health System to Accept Molina Medicaid Members

    Kentucky Plan to Protest Medicaid Managed Care Awards

    Missouri Medicaid Expansion Ballot Measure Can Proceed

    New Jersey Falls Short in Medicaid LTSS Payment Audit

    New York Primary Care Practices Are Hard Hit By COVID-19

    CMS to Use ‘Glide Path’ to Phase Out Medicaid 1135 Waivers

    CMS Releases Medicaid, CHIP Plan MLR Guidance

  • This week, our In Focus section provides a model framework examining an option for care for individuals with behavioral health needs who often find themselves involved with law enforcement or in hospital emergency rooms during times of crisis. The framework Read More
    Roundup:

    California DHCS Director Bradley Gilbert Resigns

    California Governor Proposes Fiscal 2021 Medicaid Cuts

    Florida AHCA Secretary Mayhew Eyes Medicaid Changes

    Hawaii to Rescind Medicaid Managed Care Contracts Scheduled to Take Effect in July

    Illinois to Extend Medicaid to Undocumented Seniors

    Kentucky Awards Medicaid Managed Care Contracts

    Louisiana to Form Joint Medicaid Oversight Committee

    New Jersey Proposes Revisions to Telehealth Requirements

    New York Governor Holds Back On Budget Cuts

    Puerto Rico Medicaid Plan Is For Sale, Molina Says

  • Pre-Conference Workshop: October 25 Conference: October 26-27 Location: Fairmont Chicago, Millennium Park Dear Friends, The fifth annual HMA conference on trends in publicly sponsored health care is schedule for October 25-27 at the Fairmont Chicago, Millennium Park. It was well Read More
    Roundup:

    Illinois Lawmakers Pass Hospital Bill Without Funds to Support Merger of Troubled Safety-Net Hospitals

    Indiana Awards Medicaid Managed Care ABD Contracts

    Medicaid Expansion News: Kansas, Missouri, Oklahoma

    Kentucky Medicaid Managed Care Awards Expected In May

    CMS Releases Final Rule on Medicare Advantage Use of Telehealth, Coverage of ESRD Patients

  • This week, our In Focus section reviews recent announcements and actions by Congress and the Centers for Medicare & Medicaid Services (CMS) that have significant financial and operational implications for the hospital industry. This brief begins with the most recent Read More
    Roundup:

    State Budget News: California, Michigan

    Hawaii Medicaid Enrollment Hits 348,000 as Applications Spike

    Kansas Medicaid Director Adam Proffitt Resigns

    Nebraska Is on Track to Implement Medicaid Expansion

    Oklahoma Senate Confirms Kevin Corbett to Head OHCA

    1199SEIU, Home Care Providers Call On Congress for Support

    CMS Gives States Medicaid Managed Care Rate Flexibility

    States Expect Medicaid Spending Growth to Accelerate

    Medicaid Plan Profit Margin Dips to 0.1% In 2019

  • This week, our In Focus section reviews Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), we have received a draft Read More
    Roundup:

    California Faces $54 Billion Budget Deficit

    Colorado Eyes 25 Percent Cut to IDD Services

    Florida Projects $1 Billion in Additional State Medicaid Costs

    Illinois SEIU, Nursing Homes Continue to Negotiate

    New Mexico Medicaid Serves 40 Percent of State Population

    New York Requests Emergency Medicaid Waiver Extension

    Ohio to Cut Rates to Medicaid Managed Care Plans

    Pennsylvania Projects Financial Hit to CHIP

    Texas Awards STAR Kids Medicaid Contract to Aetna

    CMS Issues Final Rule, Backs Off Plan to Alter Auto Re-enrollment Process on Exchanges

  • This week, our In Focus section reviews key takeaways from the report, How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020, prepared by Kaiser Family Foundation Read More
    Roundup:

    Colorado Public Option Bill Is Tabled Until 2021

    Illinois Hospital Files Federal Lawsuit Claiming Inadequate State Oversight of Medicaid Plans

    Maine Experiences Surge in Medicaid Enrollment

    Missouri Advocates Gather Enough Signatures to Put Medicaid Expansion on November Ballot

    North Carolina Gets COVID-19 Relief Package, But Not Medicaid Expansion

    Texas Taps Stephanie Stephens as Medicaid Director

    Virginia Order to Make Medicaid Services More Accessible

    HHS Signals Approach to Distributing CARES Act Funds to Medicaid Providers

    Molina Healthcare to Acquire Magellan Complete Care

  • This week, our In Focus section reviews an issue brief written by HMA consultants examining Medicare-Medicaid integration. In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid Read More
    Roundup:

    Medicaid Expansion News: Florida, North Carolina

    New Jersey to Temporarily Increase Wages for Professionals Caring for Adults with IDD

    New Jersey Issues Behavioral Telehealth Guidelines

    New York Signals Additional Cuts to Health Care

    Rhode Island Names Benjamin Shaffer as Medicaid Director

    Tennessee Plan to Use Medicaid Funds to Care for Uninsured COVID-19 Patients Is In Doubt

    Washington Receives Federal Approval for Section 1115 Emergency Medicaid Waiver

    Exchange Plans Win $12 Billion Supreme Court Ruling