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- This week our In Focus section reviews guidance from the Centers for Medicare & Medicaid Services (CMS), released on April 17, 2023, encouraging states to apply for the new Medicaid Reentry Section 1115 Demonstration Opportunity. Read MoreRoundup:
Arizona Requests Additional $3.3 Billion in Fiscal 2023 for Medicaid Managed Care Payments
Redeterminations News: California, Georgia, Indiana, Missouri, Nebraska, Pennsylvania
Colorado Enacts Legislation Eliminating Medicaid Co-pays for Pharmacy, Outpatient Services
Illinois Health Benefits Program for Immigrant Seniors, Adults Is Expected to Enroll 98,500
Maryland Releases Medicaid Managed Care External Quality Review RFP
Washington Requests Medicaid Coverage for Former Foster Youth, Continuous CHIP Enrollment for Children Up to Age Six
U.S. Senators Introduce Legislation to Ban PBM Spread Pricing
Kaiser Permanente to Acquire Geisinger Health
- This week, our In Focus reviews the policy changes proposed by the Centers for Medicare & Medicaid Services’ (CMS) on April 10, 2023 for the Fiscal Year (FY) 2024 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Read MoreRoundup:
Arkansas Legislature May Hold Special Session on Medicaid Spending
Florida House Passes Bill to Increase Income Threshold for KidCare Coverage
Georgia to Recommend Rate Increase for Providers Caring for Individuals with Disabilities
Illinois Receives Federal Approval for Additional Medicaid Funding in Schools
Iowa House Passes Bill to Create Medicaid Eligibility Verification System
Nevada to Review Medicaid HCBS Rate Setting Methodology
Pennsylvania Releases RFP for a Medicaid, CHIP EQRO
South Dakota to Implement Medicaid Expansion on July 1
Wisconsin Releases RFI for Eligibility Determination System
HHS Projects 6.8 Million Eligible Medicaid Beneficiaries Will Be Disenrolled During Redeterminations
Biden Administration Encourages States to Apply for Medicaid Reentry 1115 Demonstration for Individuals in Carceral Settings
Humana to Invest Another $40 Million in Affordable Housing
- This week our In Focus section reviews the Florida Statewide Medicaid Managed Care Program (SMMC) Invitation to Negotiate (ITN), released on April 11, 2023, by the Florida Agency for Health Care Administration (AHCA). Read MoreRoundup:
Alabama House Committee Holds Meeting on Medicaid Expansion
California to Seek Approval for Voluntary Medicaid Capitated Payment Model for FQHCs
California Medi-Cal To Comply With Federal Law, Continue Business with Walgreens
Delaware Struggles to Investigate Complaints Against Assisted Living, Nursing Facilities
Georgia Proposes Using Directed Payments to Make Up for Financial Losses at Rural Hospitals
Michigan to Release Medicaid Managed Care RFP in Fall 2023
New Jersey Receives Approval for Medicaid Waiver on Coordinating Behavioral Health, Covering Social Needs
New York Medicaid Audit Finds $184 Million in Uncollected Drug Rebates
Oregon Medicaid Beneficiaries Struggle to Access Mental Health Care Despite Relatively High Medicaid Rates, Study Finds
Pennsylvania Lawmakers Debate Medicaid Dental Benefits During Budget Hearing
Texas Files Federal Lawsuit Over Medicaid Provider Tax Policy Change
CMS Proposes 2.8 Percent Medicare Rate Increase for Hospitals that Meet Quality Reporting, Meaningful Use Standards
Medicaid Enrollment to Settle At Higher Than Pre-Pandemic Levels in Many States, Analysis Finds
Froedtert Health, ThedaCare to Merge
- This week, our In Focus section reviews the recently announced major policy updates from the Centers for Medicare and Medicaid Services (CMS) that affect the Medicare Advantage (MA) and Part D programs. Read MoreRoundup:
Arizona to Award $40 Million to HCBS Providers
California, Michigan Consider Legislation to Ensure Preventive Care Coverage at No Cost to Individuals
Colorado Legislature Debates Fiscal 2024 Budget Bill with $80 Million to Replace Enhanced FMAP
Connecticut House Committee Advances 2 Bills to Increase Income, Asset Limits for HUSKY C
Indiana Legislature Extends Medicaid Reimbursement Rate Hike for Out-of-state Children’s Hospitals
Iowa House Committee Holds Hearing on Bill to Create Eligibility Verification System for Medicaid
Michigan Launches Enhanced Medicaid Dental Benefits, Increased Dental Provider Reimbursement Rates
Montana House Passes Bill to Increase Medicaid Reimbursement Rates to Ambulance Providers
New York Implements Medicaid FFS Pharmacy Benefit Program
Redeterminations News: Oregon, Pennsylvania, Texas, Virginia
CMS to Increase Medicare Advantage Payments by 3.3 Percent in 2024
CMS Proposes Increasing Medicare Reimbursement Rates for Skilled Nursing Facilities by 3.7 Percent in 2024
HouseWorks Acquires Associated Home Care
UnitedHealth Group to Reduce Use of Prior Authorizations
- This week, our In Focus highlights a HMA Community Strategies program evaluation of the City of Los Angeles FamilySource System (FSS). Read MoreIn Focus:Roundup:
Alabama Releases RFP for Medicaid Enterprise Data Services Solution
Arizona Releases Strategic Roadmap to Modernize Medicaid Enterprise System
Florida Medicaid Disenrollment Could Impact Up to 1.8 Million Households
Florida Senate Committee Approves Bill to Place Restrictions on PBMs
Georgia Senate Committee Misses Deadline, Imperiling Mental Health Bill
Kentucky Governor Vetoes Bill that Would Block Expanded Dental, Vision, Hearing Benefits for Medicaid Beneficiaries
Louisiana Governor Proposes $196 Million for Medicaid Redeterminations Process
New York Providers File Lawsuit to Delay Transition of Medicaid Pharmacy Benefits from Managed Care to FFS
North Carolina Enacts Medicaid Expansion
Tennessee Legislature Considers Bill to Block State from Contracting with Medicaid Plans Covering Gender-affirming Treatment in Any State
Medicaid, CHIP Enrollment Tops 92.3 Million in December 2022
Mosaic Dental Collective Partners with Audax Private Equity
BCBS-NM Names Nancy Smith-Leslie as Vice President of Medicaid
- This week our In Focus section reviews the Centers for Medicare and Medicaid Services’ (CMS) announcement of initial guidance for the new Medicare Drug Price Negotiation Program for 2026. Read MoreRoundup:
Medicaid Expansion News: Alabama, Kansas, Mississippi, North Carolina
Arkansas Assisted Living Providers Struggle Financially After Medicaid Reimbursement Rate Increases are Delayed
California Expands Availability of Medi-Medi Plans for Dual Eligibles to Five More Counties
California Seeks Federal Approval of Program Covering 6 Months of Rent for Homeless Medi-Cal Beneficiaries
Redeterminations News: California, Illinois, Rhode Island
Idaho House Rejects $4.7 Billion Fiscal 2024 Medicaid Budget
Kentucky Governor Signs Legislation to Increase Medicaid Rates for Outpatient Procedures
New York Senate Advances Proposal to Repeal Medicaid Managed Care Pharmacy Carve-out
Most States Will Take 12-14 Months to Process Medicaid Redeterminations, KFF Survey Says
PurposeCare Acquires Home Sweet Home
- This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 32 states. Read MoreRoundup:
Alaska Submits Section 1115 Waiver Request to Extend Medicaid SUD, Behavioral Health Program
Redeterminations News: District of Columbia, Mississippi, Washington, Wyoming
Medicaid Expansion News: New Hampshire, North Carolina, South Dakota
New York Has Almost $10 Billion in Surplus Federal Funding for Basic Health Option
Oregon Medicaid CCO Purchases Hotel to Create Housing for Individuals with Behavioral Health Needs
Pennsylvania Governor Proposes $500 Million for Mental Health Services in Schools
Washington Pauses Apple Health Reprocurement Efforts to Focus on Medicaid Redeterminations
Biden’s Proposed Fiscal 2024 Budget Includes Mandatory Minimum Medicaid MLR
Help at Home Acquires Prosper Home Care
- This week, our In Focus highlights a Wakely, an HMA Company, summary and analysis of the 2024 Medicare Advantage Advance Notice, prepared for America’s Health Insurance Plans (AHIP). Read MoreRoundup:
Arizona House Committee Advances Bill to Reduce Medicaid Redetermination Period
Colorado Lawmakers Introduce Bill to Authorize Medicaid Reimbursement for Community Health Services
Redeterminations News: Delaware, Nebraska, Nevada, North Carolina, Rhode Island
Maryland Health Information Exchange to Expand Medicaid Eligibility Redetermination Notifications
Mississippi Releases Medicaid Utilization Management, Quality Improvement Organization IFB
New Jersey Senate Committee Advances Bill to Increase Medicaid Reimbursement Rates for Assisted Living Facilities
New Mexico House Passes Bill to Study Medicaid Buy-in Program
North Carolina Senate Committee Advances Medicaid Expansion Bill
Wisconsin Governor Proposes Tying Medicaid Expansion to Medicaid Reimbursement Rates
West Virginia House Passes Bill to Scrap Medicaid Managed Care RFP Process, Move to Applications
15 States Seek Section 1115 Waiver Amendments to Provide Medicaid Services to Incarcerated Individuals Prior to Release
VillageMD Acquires CT-based Multispecialty Group Starling Physicians
Presbyterian Healthcare Services, UnityPoint Health to Merge
- This week, our In Focus reviews a new Health Management Associates (HMA) report, highlighting hybrid (in-person & virtual visits) as the future of child welfare service delivery. Read MoreRoundup:
Eligibility Redeterminations: Arkansas, Alaska, Centene, Idaho, Illinois, Minnesota, Texas
California to Award Medicaid Bonus Payments to Nursing Homes
Illinois Releases Medicaid FFS Dental Program RFP
Indiana Awards Medicaid MLTSS Contracts to Four Managed Care Organizations
Iowa House, Senate Pass Separate Bills to Change Medicaid Eligibility Asset Limit
North Carolina Further Delays Implementation of Behavioral Health IDD Tailored Plans to October 2023
New Mexico Lawmakers Question Cancellation of Medicaid Managed Care RFP
Oregon Names Dana Hittle as Medicaid Director
Medicare Advantage Insurers Report Average Margins Per Enrollee Twice as High as Other Health Insurance Markets
Elevance Agrees to Acquire BCBS-LA for $2.5 Billion
- This week our In Focus section reviews the Centers for Medicare and Medicaid Services’ (CMS) announcement that the agency will explore three new prescription drug payment models in the Medicare and Medicaid programs: • Medicare High-Value Drug List Model Read MoreRoundup:
Arizona to Terminate Nearly 5,300 Medicaid Providers for Non-compliance
Medicaid Expansion News: Arkansas, Mississippi, New Mexico, North Carolina
Florida Representative Proposes Medicaid Managed Care Pilot Program for Individuals with Developmental Disabilities
Medicaid Dental News: Florida, Iowa, Michigan, Nebraska, Virginia,
Iowa Recommends Maximizing Access to HCBS for Individuals with LTSS Needs
Massachusetts to Release One Care, Senior Care Options RFR in Late 2023
Oklahoma to Phase In Medicaid Eligibility Redeterminations by Population
West Virginia House Committee Recommends Bill to Create Medicaid Buy-in Program
CMS Seeks Corrective Action Plans from Hospitals Falling Short on Price Transparency Requirements
Amazon Completes Acquisition of One Medical
