HMA Weekly Roundup

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  • This week our In Focus section reviews President Joseph R. Biden’s 2023 State of the Union Address (SOTU) to Congress. Read More

    Alabama Legislative Committee Puts Hold on Inmate Health Contract

    Florida CHIP Enrollment Likely to Increase as Medicaid Redeterminations Begin

    Indiana House Passes Bill to Continue Medicaid Coverage of Children’s Out-of-State Hospital Care

    Michigan Governor Proposes $210 Million to Increase Wages for Direct Care Workers in Fiscal 2024 Budget

    Minnesota Lawmakers Develop Proposal for MinnesotaCare Public Option

    Missouri Representative Proposes Higher Income Limit for Ticket to Work Medicaid Program

    Montana Lawmakers Consider Bill to Allow Physician Assistants to Practice Unsupervised

    New Mexico Awards MMIS Contract to Conduent

    New York Awards $658 Million in Grants to Expand Healthcare Access

    North Carolina House Committees Advance Bill to Expand Medicaid, Increase Hospital Reimbursements

    Tennessee Governor Proposes Expanding Medicaid Eligibility Limits for Pregnant Women, Caretakers

    Virginia to Release Medicaid Managed Care RFP in June 2023

    Virginia to Release Medicaid NEMT RFP in April 2023

    West Virginia Awards Medicaid Managed Care for Foster Care Youth Contract

    CMS Approves Programs to Provide Nutritional Supports for Medicaid Enrollees

    Consonance Capital Partners Acquires Embark Behavioral Health

    Wakely Summary of 2024 MA Advance Notice

  • This week, our In Focus section reviews recently announced major policy updates from the Centers for Medicare & Medicaid Services (CMS) that affect the Medicare Advantage (MA) and Part D programs. Read More

    Alaska Releases MMIS RFP California Awards $18 Million in Grants for Student Behavioral Health Center Training

    California Awards $18 Million in Grants for Student Behavioral Health Center Training

    Florida Appoints Ken Kniepmann as Assistant Deputy Secretary for Medicaid Policy and Quality

    Medicaid Expansion News: Florida, Kansas, Mississippi

    Idaho Senate Panel Recommends Focus on Prevention Through Managed Care for Medicaid Expansion Population

    Idaho Delays Award of Behavioral Health Plan Contract Pending Appeals Process

    New York Governor Prioritizes Medicaid Reimbursement Increases, Behavioral Health in Fiscal 2024 Budget

    North Carolina Seeks Waiver Amendment to Extend Medicaid Eligibility to Parents, Caretakers of Children in Foster Care

    North Carolina Announces Retirement of Medicaid Director Dave Richard

    Oklahoma to Apply for Medicaid Managed Care Waiver

    Vermont Releases Technical Assistance for Medicaid Supportive Housing Program RFP

    Federal Judge Rules Against Disenrollment of Medicaid Members Who Are Eligible for Medicare Savings Program

    CMS Officials Aim to Establish Universal Quality Measures Across Programs

    CVS Health to Acquire Oak Street Health

    Carlyle Group Looks to Acquire of Cotiviti from Veritas Capital

  • This week, our In Focus section reviews the California amendment to the Section 1115 Waiver Demonstration titled, “California Advancing and Innovating Medi-Cal (CalAIM), ” approved by the Centers for Medicare & Medicaid Services (CMS) on January 26, 2023. Read More

    California Awards $119 Million to 98 Organizations to Improve Medicaid Delivery System

    California Insurer to Offer Digital Health App to Medicaid Enrollees

    Iowa House Committee Advances Medicaid Work Requirements Bill

    Indiana Reaches $66.5 Million Settlement with Former PBM

    Michigan Releases Child, Adolescent Health Center Program RFP

    Minnesota Attorney General Asks for Delay of Sanford Health, Fairview Health Services Merger

    Mississippi Senator, Representative File Medicaid Expansion Bills

    North Carolina to Move Children Covered by CHIP to Medicaid

    New Mexico Cancels Medicaid Managed Care RFP

    South Dakota Legislators Propose Medicaid Expansion Fund

    Texas Awards STAR+PLUS Medicaid Managed Care Contracts to 7 Plans

    Utah Senate Passes Legislation to Extend Medicaid Dental Coverage

    CMS Proposes Updates to Medicare Advantage Risk Adjustment Model in 2024 Advance Notice

    CMS Will Not Impose Major Penalties on Medicare Advantage Plans for Overpayments

    CMS Outlines PHE Unwinding Requirements, Phase Out of FMAP Increase

    CVS Health Invests $32.7 Million in Affordable Housing in NC, TX

  • Lee Fleisher, MD, chief medical officer and director of CMS’ Center for Clinical Standards and Quality, will deliver the morning keynote address at HMA’s March 6 conference on “Healthcare Quality: A Deep Dive on What’s Next for Providers, Payers, Read More

    Arkansas Legislature Faces Potential Hurdles for Funding Medicaid Expansion

    Arizona Governor Proposes $2.7 Million to Modernize Medicaid Enterprise System

    Georgia House Speaker Does Not Plan to Take Up Medicaid Expansion

    Massachusetts Governor Appoints Kate Walsh as Secretary of Health, Human Services

    Michigan Provides Pregnancy App for Eligible Medicaid Beneficiaries

    New Mexico Medicaid Director to Step Down

    New Mexico Has Yet to Announce Medicaid Managed Care Awards

    Oklahoma Awards Medicaid Dental Contracts to 2 Plans

    Rhode Island Legislators Introduce Medicaid Housing Supports Pilot Proposal

    Wisconsin Adds Medicaid Work Requirement Advisory Referendum to April Ballot

    Wyoming Appoints Lee Grossman as State Medicaid Agent, Senior Administrator

    Exchange Plan Enrollment Rises Nearly 13 Percent to 16.3 Million in 2023

    FCC Clears Medicaid Plans to Text, Robocall Beneficiaries for Eligibility Redeterminations

    Elevance Health to Acquire BCBS of LA

  • In 2022, HMA convened stakeholder roundtables in three states – including New Mexico, North Dakota, and New Mexico to identify the challenges facing dually eligible individuals living in rural areas and to propose solutions to these challenges. Informed by this Read More

    Arkansas Releases RFI for Medicaid Managed Care Module of MMIS Replacement

    Florida Governor Announces Proposal to Regulate PBMs

    Medicaid Expansion News: Georgia, Kansas, Mississippi, North Carolina, South Dakota

    Georgia Releases RFI to Audit PBMs Contracted Through Medicaid Plans

    Louisiana Releases RFP for Permanent Supportive Housing Services Funded in Part by Medicaid

    Michigan Doulas Push for Higher Medicaid Reimbursement Rates

    Mississippi Seeks Bids for Medicaid FFS Non-emergency Transportation Services

    South Carolina to Continue Several Flexibilities After COVID-19 PHE Ends

    CMS Announces Medicare Accountable Care Partnerships Will Cover 13.2 Million Enrollees in 2023

    Health Network One Acquires Premier Eye Care

  • This week, our In Focus section reviews changes to Medicaid’s COVID-19 Public Health Emergency (PHE) unwinding. Read More

    Arizona Medicare Plan Receives $60 Million Investment from Chicago Pacific Founder to Launch ESRD C-SNP

    California Revises List of Medicaid Managed Care Award Winners in Several Counties

    Connecticut Expands Medicaid Eligibility for Children Effective January 1

    Florida Appoints Jason Weida as Interim Secretary

    Georgia Releases RFQC for Medicaid Managed Care Plans

    Georgia Establishes State Exchange Directing Buyers to Brokers, Insurers

    Idaho Legislators to Review Medicaid Expansion

    Maine to Seek Renewal of Waivers for Adults in Need of Home and Community-based Services

    Maryland Releases Behavioral Health ASO RFP

    Maryland Implements Medicaid Comprehensive Dental Coverage

    Massachusetts Selects 20 Community Partners for ACO Behavioral Health, LTSS

    Nevada Receives Federal Approval for SUD Treatment Waiver

    New Hampshire Legislature to Vote on Reauthorization of Medicaid Expansion Funding

    New York Governor Announces $1 Billion Plan to Address Behavioral Health

    North Dakota Releases Medicaid Enterprise Technical Systems Integrator RFP

    Oklahoma Faces Lawsuit from Provider-led Entity Regarding Managed Care Procurement

    Oregon Approves Amazon Acquisition of One Medical

    Rhode Island Releases NEMT Program RFQ

    Wisconsin Names Jamie Kuhn as Medicaid Director

    HHS Extends Public Health Emergency Until April 11

    CMS Allows States, Medicaid Plans to Spend 5 Percent of Premiums on Social Determinants of Health

    CVS Health Considers Acquisition of Oak Street Health

  • This week, our In Focus section reviews a rule proposed by the Centers for Medicare & Medicaid Services (CMS) on December 14, 2022, that would revise regulations governing Medicare Advantage (MA or Part C), the Medicare Prescription Drug Benefit (Part Read More

    California to Transition Dual Eligibles in 31 Counties to Medi-Cal Managed Care Plans in January 2023

    Georgia Receives Approval for 2 State-Directed Payment Programs

    Hawaii Governor Proposes Medicaid Provider Reimbursement Rate Increases

    Iowa Releases Medicaid Enterprise Systems RFI

    Idaho Looks to Expand Access to Crisis Services for Individuals with Developmental Disabilities

    Indiana Releases Medicaid NEMT RFP

    New Mexico Proposes 16 New Programs in Section 1115 Medicaid Waiver Renewal Application

    New York Medicaid Pharmacy Carve-Out Could Cost $400 Million More Annually, Wakely Report Finds

    Oregon Governor-Elect to Appoint James Schroeder as Interim Director of OHA

    Puerto Rico to Receive $17.6 Billion in Medicaid Funding Over 5 Years Under Omnibus Spending Bill

    Vermont Considers Punitive Cuts to 2023 All-Payer ACO Budget

    Washington Receives Federal Approval to Offer Exchange Plans to Non-Citizens

    Medicaid Eligibility Redeterminations to Begin April 2023 Under Omnibus Spending Bill

    Rise Health Secures Investments from Lorient Capital, Martis Capital

  • This week, our In Focus section reviews the State of Texas Access Reform (STAR), Children’s Health Insurance Program (CHIP), and Healthy Texas Women (HTW) Medicaid managed care request for proposals (RFP) released by the Texas Health and Human Services Commission Read More

    California to Sanction 22 Medi-Cal Plans for Poor Quality Ratings

    California Governor Awards $480.5 Million in Grants for Youth Behavioral Health Infrastructure

    Connecticut Governor to Appoint Andrea Barton Reeves Commissioner of Social Services

    Massachusetts Medicaid Secretary To Step Down

    Minnesota Judge Blocks Managed Care Plan from Expanding Board of Directors

    Missouri, Mississippi, Montana, Wyoming Are Expected to Extend Medicaid Postpartum Eligibility in 2023

    Nevada Releases External Quality Review Organization RFP

    North Carolina Faces Lawsuit for Foster Children in Residential Psychiatric Treatment Facilities

    Wyoming Requests $22 Million to Increase Nursing Home Medicaid Reimbursement Rates in 2024

    CMS Rule Would Increase Availability of Standardized Exchange Plans

    MedPAC Draft Recommendations Call for Medicare Payment Increases for Hospitals, Physicians in 2024

    Exchange Enrollment Rises 18 Percent in First Five Weeks of Open Enrollment

    SCAN Group, CareOregon to Merge as HealthRight Group

    Centene Names New President, Chief Operating Officer, Other Leadership Changes

  • This week, our In Focus highlights a Leavitt Partners white paper, The Impact of the 340B Program on Drug Prices Charged by Manufacturers and Covered Entities, published in November 2022. Read More

    North Carolina Appeals Ruling on Additional Community Services for Individuals with Disabilities

    New Mexico Health Plan Submits Bid for New Medicaid Managed Care Contract

    New York SMI Treatment Programs Face Over 1,000-Person Waiting List

    Oregon Reaches $17 Million Settlement with Former PBM

    Tennessee to Release Dental Benefit Management RFP in Late 2023

    Texas Releases STAR & CHIP Managed Care Services RFP

    Wisconsin Receives Approval to Continue Exchange Plan Reinsurance Program Through 2028

    HHS Releases Medicaid, CHIP FMAP for Fiscal 2024

    Defense Misses Deadline for Announcing Tricare Contract Awards

    Prime Therapeutics Completes Acquisition of Magellan Rx Management from Centene

  • This week, our In Focus reviews the Oklahoma Medicaid managed care SoonerSelect Program request for proposals (RFP) and the SoonerSelect Children’s Specialty Program RFP released by the Oklahoma Health Care Authority (OHCA) on November 10, 2022. Read More

    Arkansas Medicaid Looks to Expand Access to Behavioral, Mental Health Services

    California Seeks Approval to Limit Medicaid Managed Care Choice in Metro, Urban Counties

    PHE News: Delaware, New Mexico, Tennessee

    Florida Medicaid Secretary Is Stepping Down

    Florida Releases Medicaid Managed Care Data Books Ahead of Procurement Process

    Georgia to Implement Medicaid Work Requirements After Public Health Emergency Ends

    Idaho Delays Medicaid Behavioral Health Plan Contract Award

    Michigan to Cover Doula Services for Medicaid Beneficiaries in 2023

    Mississippi Managed Care Enrollment Falls As State Shifts Members to FFS During Pandemic

    Montana Faces Lawsuit Concerning Hiring of Medicaid Director

    Oklahoma Releases SoonerSelect Children’s Specialty Program RFP Covering Foster Kids

    Oregon Proposes Continuous Medicaid Coverage for Beneficiaries Until Basic Health Program Launch

    Medicare Advantage Plans Overbilled Government by Over $1,000 Per Patient Yearly, Audits Find

    CMS Reports $70 Million in Medicare Savings Through Direct Contracting Model in 2021

    Centene Sells Magellan Specialty Health to Evolent Health