HMA Weekly Roundup

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  • 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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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 More
    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 More
    Roundup:

    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 More
    Roundup:

    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

  • This week, our In Focus section reviews the Michigan Medicaid Managed Care Comprehensive Health Care Program (CHCP) request for proposals (RFP), which the Michigan Department of Health and Human Services released on October 30, 2023. Read More
    Roundup:

    Alabama Releases Modular Electronic Visit Verification RFP

    California Submits Section 1115 Medicaid Waiver Amendment to Provide Rental Assistance

    Florida Legislators File Bills to Study Impact of Potential Medicaid Expansion on Individuals Aged 18 to 26

    Georgia Bidding Conference for Medicaid Managed Care Contracts Is Attended by Several Health Plans

    Georgia Democratic Leaders Call on Governor to Implement Full Medicaid Expansion

    Mississippi Medicaid Managed Care Procurement Stalls Following Protests from UnitedHealthcare, Elevance

    New Hampshire Providers to Receive Another Increase in Medicaid Payment Rates

    Pennsylvania Bill Would Reinstate Medicaid Coverage of Most Dental Services

    CMS Releases Final Rule to Increase Payments to ESRD Facilities by 2.1 Percent

    Bright Health Group, Friday Health Plans Owe $1.1 Billion in Exchange Risk-Adjustment Payments

  • This week, our In Focus section summarizes the Medicaid Long-Term Services and Supports (LTSS) Annual Expenditures Report, which the Centers for Medicare & Medicaid Services (CMS) released on October 17, 2023 Read More
    Roundup:

    Arizona Releases Fee-For-Service Pharmacy Benefits Management Services RFP

    Arkansas Releases Medicaid Enterprise Systems Independent Verification, Validation Services RFP

    Arkansas Releases Medicaid Dental Services RFP

    California Enacts Bills to Improve Treatment of Individuals with Mental, Behavioral Health Disorders

    Colorado Individual Plan Rates to Rise 9.7 Percent in 2024

    Florida Announces List of Bidders for Statewide Medicaid Managed Care ITN

    Florida Releases ITNs for 6 Behavioral Health Managing Entity Regions

    Georgia Pathways to Coverage Medicaid Expansion Enrollment is 1,343 Through September

    Medicaid Eligibility Redeterminations News: Iowa, Kentucky, Louisiana, Maryland, Michigan, Pennsylvania, South Dakota

    Maryland Cannot Document Receipt of Federal Funds, Shows $1.1 Billion Deficit in Medicaid Clearing Account, Audit Shows

    New Jersey Enacts Medicaid Rate Increase for Reproductive Health Care Providers

    New Mexico Releases Closed Loop Referral Service RFQ

    Pennsylvania Expands List of Medicaid Providers Eligible to Provide Street Medicine Services

    Previous Direct Contracting ACO Model Saved Medicare $371.5 Million in 2022

    UPMC, Washington Health System Sign Merger Agreement