HMA Weekly Roundup

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  • This week, our In Focus section highlights a white paper that Wakely, a Health Management Associates company, released in October 2023, “Cut to the Point: A Summary of 2024 Star Rating Cut Point Changes”. Read More

    Arizona to Release Medicaid PBM RFP ‘in the Coming Weeks’

    Medicaid Eligibility Redeterminations News: Arizona, Florida, Georgia, Mississippi, North Carolina, Texas, Wyoming

    Florida Launches Dental Provider Incentive Program

    Minnesota Eliminates Parental Fees for Medicaid Coverage of Children With Disabilities

    Nevada Governor Proposes Exchange Reinsurance in ‘Revision’ to Public Option Law

    New York Medicaid Spending Exceed Expectations, Report Finds

    North Carolina Receives Final Federal Approval for Medicaid Expansion

    Oregon Announces 3.4 Percent Increase in 2024 Capitation Rates for Medicaid Coordinated Care Organizations

    Oregon Releases RFP to Expand PACE Services

    Long-term Services, Supports Spending Falls as Percentage of Total Medicaid Expenditures, CMS Reports

    State Medicaid Programs Disenroll 8.8 Million Beneficiaries During First 6 Months of Redeterminations, KFF Finds

    Alignment Health, Walgreens to Jointly Market Medicare Advantage Plans in 2024

  • This week, our In Focus section reviews the Florida Statewide Medicaid Prepaid Dental Program invitation to negotiate (ITN) released October 6, 2023, by the Florida Agency for Health Care Administration (AHCA). Read More

    Medicaid Eligibility Redeterminations News: Alabama, Alaska, Arizona, Arkansas, Florida, Maine, Missouri, New Mexico, Oregon, Texas, Wyoming

    Arizona Receives Five Bids for Medicaid Managed Long-term Care Contracts

    California Enacts Law Advancing State Toward Universal Healthcare System Such as Single-payer

    Idaho Medicaid Value-based Care Organizations Ask State to Stick with Current Model

    Kentucky Reports Savings Following Removal of PBMs from Medicaid Program

    Nevada Extends Deadline for Medicaid Managed Care RFI

    New York to Launch Medicaid Social Care Networks to Address Health-related Social Needs

    Dual Demos in New York, Ohio, Washington Show Mixed Results, CMS Reports

    Cigna Purchases Digital Health Company

  • This week, our In Focus section reviews the KanCare Medicaid capitated managed care request for proposals (RFP), released October 2, 2023, by the Kansas Department of Health and Environment and Department for Aging and Disability Services. Our second In Focus Read More

    Alaska Pauses Procedural Medicaid Disenrollments

    Florida Agencies to Report on Medicaid Redeterminations to State Senate

    CareSource to Partner with Pediatric Care Provider to Bid on Florida Medicaid Contract for Children, Teens with Special Needs

    Illinois Head of Healthcare, Family Services to Step Down

    Indiana Drops Molina from Medicaid MLTSS Contract

    Indiana Medicaid MLTSS Contracts to Begin July 2024

    Indiana Awards Hoosier Rx Program Contracts to Three Companies

    Iowa to Develop HCBS for Children With Severe Behavioral Health Needs in Lawsuit Settlement

    Elevance, Blue Cross Louisiana Withdraw Merger Application

    Louisiana Lawmakers Push to Reexamine Medicaid Technology Contract

    Michigan Releases State Action Plan to Improve Birth Outcomes

    North Carolina Medicaid Expansion to Launch on December 1

    Ohio Estate Recovery Program Recovers Less Than One Percent of Fiscal 2023 Medicaid Costs

    Oklahoma Receives Federal Waiver Approval Enabling Transition to Medicaid Managed Care

    Texas Implements Vendor Contracts for Medicaid FFS Prior Authorization, Enrollment, Other Functions

    CMMI Value-based Models Result in $5.4 Billion Increase in Federal Spending, Report Finds

    Carlyle Group in Talks to Acquire Majority of 2 Medtronic Medical Device Businesses

  • This week, our In Focus section reviews the new States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, which the Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and Medicare Innovation (the Innovation Center) announced on Read More

    Help at Home to Cease Operations in Alabama

    Arkansas Working Group Makes Recommendations Aimed at Improving Foster Care System

    Florida Delays Bidding for Medicaid Managed Care Contract

    AmeriHealth Caritas Names Melody Bonomo as Florida Market President

    Medicaid Eligibility Redeterminations News: Florida, Kansas, Louisiana, Mississippi, Nevada, North Carolina, Texas, Virginia

    Nebraska Launches Program to Enroll Inmates Nearing Release in Medicaid

    Nevada Medicaid Plan Aims to Improve Maternal Health-related HEDIS Scores

    New Mexico Seeks Public Comments on Section 1115 Waiver Renewal Application Addendum

    North Dakota Seeks Public Comments on IDD HCBS Waiver Renewal Application

    Utah Considers Carve Out of Medicaid ACO Pharmacy Benefits to Fee-for-Service

    Vermont Releases HCBS Business Supports RFP

    NCQA Includes Equity Measure in 2023 Health Plan Quality Ratings

    CVS Health/Aetna Promotes Mark Santos to Head of Medicaid

  • 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