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- This week, our In Focus section highlights a new report released on January 25, 2024, Analyzing the Expanded Landscape of Value-Based Entities: Implications and Opportunities of Enablers for the CMS Innovation Center and the Broader Value Movement. The second In Read MoreRoundup:
HMA Press Release: Nine States to Participate in Children’s Behavioral Health Policy Lab
California Plan Offers Medi-Cal Enrollees GED Services
Colorado Legislative Committee Approves Increase in Medicaid Reimbursement for Pediatric Behavioral Care
Indiana Intellectual, Developmental Disabilities Task Force Calls for Pause to Proposed Aged, Disabled Waiver Cuts
Kentucky House Passes Bill Requiring Medicaid to Cover At-home Blood Test Kits
Minnesota Releases Medicaid Dental Administrator RFI
New Jersey Enacts Law to Expand Hospital at Home Services to Medicaid Beneficiaries
New York Legislature Considers Bill to Transition Home Care Services From Managed Medicaid to Fee-For-Service
Federal Government Issues Lawsuit to Block Novant Health’s Acquisition of North Carolina Hospitals
South Dakota to Include Doula Services in New Medicaid Pregnancy Health Home
Vermont Releases MMIS Procurement Assistance Vendor RFP
Wisconsin Releases IRIS Self-Directed Personal Care Services RFP
Medicaid Redetermination Updates: Louisiana, Ohio
Medicare ACO Shared Savings Program Participation Increases in 2024
CMS Cell and Gene Therapy Access Model to Focus on Sickle Cell Disease
MACPAC Releases Medicaid Payment Policies Report for Home and Community-based Services
Health Care Services Corporation to Acquire Cigna Medicare, CareAllies Businesses
- This week, our In Focus section highlights the Innovation in Behavioral Health (IBH) model, which the Centers for Medicare & Medicaid Services (CMS) announced January 18, 2023. Read MoreRoundup:
Connecticut Proposes to Extend Medicaid Services to Incarcerated Individuals Prior to Release
Florida to Submit Section 1115 Waiver Request to Expand CHIP Eligibility
Florida Senate Passes Bill to Expand Healthcare Access, Resources
Idaho House Committee Proposes Bill Setting Requirements on Medicaid Expansion
Indiana Alters Waivers, Enhances Budget Monitoring to Address Medicaid Budget Shortfall
Kansas Governor’s Proposed Fiscal 2025 Budget Includes Medicaid Expansion Funds
Kentucky Senate Advances Bill to Limit Number of Managed Care Organizations
Michigan Extends Due Date for Medicaid Managed Care Proposals
New Hampshire Awards Medicaid Managed Care Contracts to Incumbents
New York MCOs Oppose Proposed Competitive Medicaid Managed Care Procurement Process
North Carolina Medicaid Expansion Enrollment Surpasses 314,000
Rhode Island Medicaid State-directed Payments Approved by CMS
Texas Extends Medicaid Postpartum Coverage to 12 Months
Washington Updates State Action Plan to Remove Barriers to Health Services
Medicaid Redetermination Updates: Florida, Georgia, Indiana, Mississippi, New Hampshire, Oklahoma, Vermont
More Than 21.3 Million Have Selected ACA Marketplace Plans Since Enrollment Period Began
Combined Medicaid, Medicare Spending on Dual Eligibles was $493.4 Billion in 2021, MACPAC, MedPAC Report Finds
Centene Names Michael Carson as President, CEO of Medicare Business
- This week, our In Focus section describes New York State’s Medicaid Section 1115 waiver amendment authorizing at least $6.7 billion in funding for new programs and initiatives in the state’s Medicaid program. Read MoreRoundup:
Driving Change in Healthcare Delivery: HMA Spring Workshop Provides Deep Dive into Metrics, Coordination, and Partnerships for Value-based Care
Health Management Associates Successfully Completes SOC 2 Type 2 Examination
Medicaid Redetermination Updates: Arizona, Minnesota, Missouri
California Proposes CalAIM Amendment to Provide Continuous Medicaid, CHIP Coverage for Children
Florida Proposed Bills Would Boost Physician Workforce, Develop Advanced Birth Centers
Iowa Legislature Considers Bill to Create Tiered Medicaid Reimbursement System for Children’s Mental Health
Kentucky Submits Medicaid Section 1115 Amendment to Improve Care for Individuals Leaving Public Institutions
Kentucky State Bill Would Reduce Maximum Number of Medicaid Managed Care Contracts
Mississippi Hospital Directed Payments Bring in Additional $658.2 Million Under New Program
New Mexico Governor’s Fiscal 2025 Budget Proposes Additional Medicaid Funding For Rural Hospitals, Provider Reimbursement
New York Grants More Than $950 Million to Fund Healthcare Facility Upgrades, Technological Modernization
West Virginia Selects Highmark as Fourth Medicaid Managed Care Organization
Wisconsin Releases Medicaid Managed LTC RFP
CMS Releases Final Rule Aimed At Improving Electronic Exchange of Health Information, Prior Authorization Processes
MedPAC Meeting Highlights Overpayments in Medicare Advantage
Health Plans Seek Increased Medicaid Rates Amid Rising Costs
Elevance Launches Program to Provide Smartphones to Medicaid Beneficiaries in 21 States
- This week our In Focus section reviews the Rhode Island statewide, capitated risk-bearing Medicaid managed care program request for proposals (RFP), which the Rhode Island Executive Office of Health and Human Services (EOHHS) released December 15, 2023. Read MoreRoundup:
Elizabeth Mitchell to Keynote HMA’s Spring Workshop on Value-based Care March 5-6 in Chicago
Alabama Releases Medicaid Enterprise System Provider Management Services RFP
Arizona Receives 3 Protests Against Medicaid ALTCS Awards
California Medi-Cal MCO Tax Receives Federal Approval
Florida Announces List of Bidders for Statewide Medicaid Prepaid Dental Program ITN
Illinois to Release Medicaid Managed Care RFP in Spring 2024
Iowa Lawmaker Files Bill to Extend Postpartum Medicaid Coverage to 12 Months
Kansas Announces List of Bidders for Medicaid Managed Care RFP
Missouri Lawmakers to Consider Medicaid Provider Tax Renewal
Nebraska Lawmakers File Bill to Increase Medicaid Hospital Payment Rates
New York Receives Federal Approval for Medicaid Section 1115 Waiver Amendment to Support Health Equity, Health-related Social Needs
Oregon Medicaid CCOs to Invest $25 Million to Support Youth Behavioral Health Projects
Washington Behavioral Health-related Outcomes Remain Similar Between Integrated, Carve-out Models, Study Finds
West Virginia Medicaid Beneficiaries Face Barriers to Dental Care Access, Stakeholder Analysis Finds
CMS Releases ARPA State Spending Plan Summaries
Health Insurance Marketplace Enrollment Exceeds 20 Million for 2024
CVS Invests in WellBe Senior Medical
Elevance Sues CMS Over Medicare Advantage Star Ratings System
CMS to Terminate Medicare Advantage Plans in Arizona, North Carolina
- Policymakers have been working to move the U.S. healthcare system away from the costly and inefficient framework of fee-for-service to patient-centered structures focused on value and quality. Read MoreRoundup:
Alabama Releases Coordinated Health Network RFP
Arkansas Releases Medicaid Third Party Liability RFP
California Expands Medicaid Coverage to 700,000 Undocumented Immigrants
CA Medi-Cal Looks to Improve Doula Benefit Utilization
Florida Legislators Propose Medicaid Buy-in Program for Individuals with Disabilities
Illinois Approves Applications to Expand Access to Dementia Care Through the Supportive Living Program
Montana Medicaid Seeks to Provide Housing Support Services
Nebraska Medicaid Proposes Dental Coverage, Reimbursement Changes
Medicaid Redetermination Updates: Oklahoma, Utah
Utah CHIP to Cover Non-citizen Children
Medicaid, CHIP Enrollment Drops 1.6 Million in September 2023, CMS Reports
Cigna to Sell Medicare Advantage Business to Health Care Services Corporation
Molina Healthcare Acquires Bright Healthcare’s CA Medicare Business
The Ensign Group Acquires Two Skilled Nursing Facilities
- This week, our In Focus section reviews the new Transforming Maternal Health (TMaH) Model, which the Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and Medicare Innovation (the Innovation Center) announced on December 15, 2023. Read MoreRoundup:
Medicaid Business Transformation DC: Recommendations for Technical Assistance
Connecticut Appropriations, Human Services Committees Authorize New Paid Family Caregiver Waiver Requirement
Kansas Lawmakers Reject Governor’s Medicaid Expansion Proposal
Medicaid 12 Month Postpartum Coverage Extensions: Mississippi, Nebraska
Medicaid Redetermination Updates: Georgia, Mississippi, New Hampshire, Texas
Mississippi Extends Medicaid Postpartum Coverage to 12 Months
Mississippi Receives Federal Approval for Hospital Provider Assessment
Missouri Receives Federal Approval for SUD, SMI Section 1115 Demonstration
New Hampshire Disputes Federal Reporting of Medicaid Disenrollment Numbers for Children
North Carolina Auto-enrolls 273,000 Individuals on First Day of Medicaid Expansion
North Carolina DHHS Secretary Approves Consolidation of Trillium, Eastpointe, In Effort to Decrease Regional LME-MCO’s From Six to Four
Pennsylvania House Passes Bill to Expand Medicaid Dental Services
Rhode Island Releases Medicaid Managed Care Program RFP
DOJ Files Motion to Transfer or Dismiss Humana’s Lawsuit Over Medicare Advantage Clawback Rule
Health Insurance Marketplace Enrollment Exceeds 15 Million for 2024
HouseWorks Enters Definitive Agreement to Acquire NY-Based Elite Home Health Care
Elevance Health’s Proposed Acquisition of BCBS-LA Resumes Following Delay
- This week, our In Focus section highlights the efforts of Health Management Associates (HMA) and partner organizations to better coordinate services for children in foster care and for children with behavioral health needs. Read MoreRoundup:
Early Bird Registration Now Available for HMA’s Spring Workshop on Implementing Value Based Care
Medicaid Redetermination Update: Arizona, Iowa, Utah
Arkansas Assisted Living Facilities Face Financial Crisis, Possibility of Closures
California Los Angeles County Implements Free Behavioral Health Programs for K-12 Students
Florida Senate President Proposes Initiative to Increase Healthcare Access, Workforce
Idaho Moves Forward with Magellan Health’s Behavioral Health Plan Contract
Kansas Rural Hospitals at Risk of Closing, Report Finds
Massachusetts Medicaid to Cover Doula Services by Spring 2024
Michigan Expands Medicaid Coverage to Include Community Health Worker Services
New Hampshire Releases Technical Scoring for Contract Bids on Medicaid Procurement
New Hampshire Experiences Strong Demand in Adult Medicaid Dental Program
North Carolina Provides 12-Month Continuous Medicaid, CHIP Coverage for Children
Oregon Medicaid Committee Recommends Against SCAN Acquisition of CareOregon
West Virginia Medicaid Program Faces $114 Million Budget Deficit in Fiscal 2025
CMS Guidance Promotes Tool to Improve Medicaid Access to HCBS Direct Support Workers
Medicare Advantage Market Grows More Competitive
House Passes Bill Requiring Greater PBM Transparency, Hospital Site Neutrality Policies
Federal Government to Crack Down on Anticompetitive Health Insurer Transactions
Cigna, Humana Scrap Merger Discussions
- After more than two decades, SAMHSA and its Center for Substance Abuse Treatment (CSAT) is revisiting regulations governing opioid treatment programs (OTPs), as required by the 2023 Consolidated Appropriations Act passed by Congress. Read MoreIn Focus:Roundup:
Save the Date: HMA Spring Workshop on Implementing Value-Based Care
Alabama Receives Approval for Community-Based Mobile Crisis Services SPA
Arizona Requests Section 1115 Waiver Amendment to Raise CHIP Eligibility Threshold
California Governor Signs Bill to Simplify Billing, Increase Access for Medicaid School-based Health Programs
Florida Bills Would Remove Step Therapy Requirement for Medicaid Beneficiaries with Mental Illness
Georgia Legislators Discuss Coupling Full Medicaid Expansion, Relaxation of Certificate-of-Need Requirements
Idaho Releases MMIS System Integrator Technical Advisory Services RFP
Nevada Submits Section 1332 State Innovation Waiver Application For Market Stabilization, Public Option Program.
New York Essential Plan Expansion Implementation Delayed to April 2024
North Carolina Hospitals Will Receive $2.6 Billion As State Prepares to Start Medicaid Expansion
Tennessee to Renew Existing TennCare Medicaid Managed Care Contracts for Now
Wisconsin Insurers Fail to Meet Federal Access Standards for Exchange Program, Report Finds
Average Time Spent on Medicaid HCBS Waiting Lists Has Decreased Since 2021
ACA Exchange Enrollment Approaches 4.6 Million Through Three Weeks of Open Enrollment
Medicare, Medicaid Improper Payment Rates Driven by Documentation Errors in Fiscal 2023, CMS Finds
CMS Launches Medicare GUIDE Model Application
CMS Issues Proposed Rule to Ensure Network Adequacy Standards For State-run Exchange Plans
Humana, Cigna in Talks to Merge by End of Year
- This week, our In Focus section reviews a wide-ranging proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) on November 6, 2023. Read MoreRoundup:
HMA Report Shows First-of-Its-Kind Actual Comparisons of State-by-State Medicaid Disenrollments vs. Projections
Medicaid Eligibility Redeterminations News: Arkansas, Idaho, Florida, Iowa, Kentucky, Maine, Maryland, Mississippi, Nevada, Texas, Washington
Idaho Legislative Task Force Agrees State Should Stick with Medicaid Value Care Organizations
Indiana Submits 1915c Waiver Request to Transition Medicaid LTSS to Managed Care
Iowa to Award Medicaid Dental Services Contracts to Delta Dental of Iowa, DentaQuest USA
CareSource Names Chad Moore Kansas Market President
Missouri Extends Medicaid Postpartum Coverage to 12 Months
South Dakota Enrolls Less than 20 Percent of Eligible Medicaid Expansion Population
Tennessee Releases RFP for TennCare Select Prepaid Inpatient Health Plan for Children
States Expect Medicaid Enrollment Decrease, Spending Increase in Fiscal 2024, KFF Medicaid Director Survey Finds
Fourteen Insurers to Exit Medicare Advantage Markets in 2024, KFF Data Show
Centene Names Susan Smith as Chief Operating Officer
- This week, our In Focus section reviews several calendar year (CY) 2024 Medicare payment final rules that the Centers for Medicare & Medicaid Services (CMS) issued in recent weeks. Read MoreRoundup:
HMA Information Services Names Andrea Maresca as Managing Director
Arizona to Award $47.5 Million to HCBS Providers in Second Round of ARP Grant Funding
California Minimum Wage Increase for Healthcare Workers Estimated to Cost $4 Billion in Fiscal 2025
Florida Releases Comprehensive IDD Managed Care Pilot Program ITN
Idaho Health Data Exchange Lacked Accountability Measures, Report Finds
Iowa Releases Medicaid Quality Improvement Organization Services RFP
Missouri Disenrolls 52,000 Children From Medicaid During First Four Months of Redeterminations
Nebraska Medicaid Director Resigns
North Carolina Order Dissolves Sandhills Behavioral Management Entity, Consolidates Two Others
GuideWell Names Thurman Justice President, CEO of Triple-S Management
Medicare Advantage Plans Enjoy Higher Payments than FFS, MedPAC Reports
Medicaid Disenrollments Top 10 Million Following Redeterminations
Cigna Explores Sale of Medicare Advantage Business
