HMA Weekly Roundup

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  • This week, our In Focus section is the first in a summer series of analysis and insights from Health Management Associates (HMA) on recent Medicare payment and policy developments. Read More
    Roundup:

    Redeterminations News: Arkansas, Connecticut, Georgia, Iowa, Kentucky, North Carolina, North Dakota, Texas, Wyoming

    California Health Plan to Provide $46 Million in Grants for Housing, Other Services

    Colorado Medicaid, CHIP Are Among Payers Most Likely to Reimburse for Unnecessary Health Services, Study Finds

    Florida Is Ordered to Amend Medicaid Program to Prevent Institutionalization of Children with Complex Needs

    Hawaii to Seek Medicaid Services for Justice-involved Populations Prior to Release

    Illinois Provides $75 Million in Funding to Address Health Disparities, Housing

    Medicaid Disenrollments Top 3 Million Following Redeterminations

    MTM Acquires Medical Transportation Brokerage of Arizona

  • This week, our In Focus section reviews the Centers for Medicare & Medicaid Services (CMS) report to Congress on Non-emergency Medical Transportation (NEMT) in Medicaid, released June 20, 2023. Read More
    Roundup:

    Medicaid Eligibility Redeterminations News: Arizona, District of Columbia, Florida, Idaho, Maryland, Michigan, Mississippi, New Jersey, Tennessee, Wyoming

    Florida Extends Deadline for Medicaid Managed Care ITN Responses

    Georgia Launches Partial Medicaid Expansion Program With Work Requirements

    Idaho Medicaid Managed Care Task Force Holds Hearing on Structure of Program Funding

    New Jersey Will Allocate $5 Million to Improve Housing for Individuals with Disabilities, Acute Medical Needs

    New York Releases Third-Party Liability Match, Recovery Services RFP

    North Carolina Further Delays Implementation of Behavioral Health IDD Tailored Plans

    Ohio Releases RFP for Medicaid Enterprise System Alternate Payment Model Logic, Reporting Tool

    Pennsylvania Medicaid to Cover Care Delivered on Streets to Homeless

    ACA Risk Adjustment Pool to Redistribute $15.2 Billion to Individual Plans

    AmeriHealth Caritas CEO Paul Tufano to Step Down

  • This week, our In Focus section revisits three specific aspects and implications for regional and local managed care organizations of the proposed Medicaid and Children’s Health Insurance Program (CHIP) managed care access, finance, and quality rule published by the Centers Read More
    Roundup:

    Florida Disenrolls Some Children with Complex Medical Needs During Redeterminations

    Idaho Faces Lawsuits Over Medicaid Behavioral Plan Award

    Iowa Medicaid Managed Care Contracts Begin July 1

    UCare Names Former Kansas Medicaid Director Jon Hamdorf Market President

    Louisiana Governor Vetoes Part of Legislature’s Proposed Budget, Reinstates Health Spending Increase

    Maryland Extends Pregnancy, Postpartum Medicaid Benefits to Undocumented Individuals

    Massachusetts Made $85 Million in Capitation Payments on Beneficiaries Living Out of State, Audit Finds

    Minnesota Releases Medicaid, MinnesotaCare IHP RFP

    Minnesota Provides One Month Grace Period to Reenroll in Medicaid Following June Redeterminations

    Nevada Allows Medicaid to Cover Behavioral Health Services in Schools

    New Hampshire Medicaid Beneficiaries Struggle to Find Dental Care

    North Carolina Governor Urges Lawmakers to Separate Medicaid Expansion from Budget

    Oklahoma Disenrolls 54,000 Medicaid Enrollees During May Redeterminations

    South Dakota Implements Medicaid Expansion on July 1

    Washington Receives Federal Renewal of Medicaid Transformation Project Section 1115 Waiver

    Washington Disenrolls 116,000 Medicaid Beneficiaries During May Redeterminations

    Home Health Providers Face Proposed 2.2 Percent Medicare Rate Cut in Fiscal 2024

    Molina to Acquire Bright Health Medicare Advantage Subsidiaries

  • C-suite executives from AmeriHealth Caritas, Centene, Community Health Choice of California, Health Care Service Corp., Humana, UnitedHealthcare, and UMPC Health Plan are scheduled to speak on trends in publicly sponsored healthcare at HMA’s Sixth Annual Conference, October 30-31 in Chicago. Read More
    Roundup:

    Medicaid, CHIP Enrollment is Nearly 93.9 Million in March 2023

    Medicaid Disenrollment News: Connecticut, Michigan, North Carolina, Oregon, South Carolina

    California Renews Managed Care Tax, With Funds to Bolster Medicaid, Hospitals

    Georgia Directs $118 Million to Medicaid Expansion in Fiscal 2024

    Idaho Awards Centene/Magellan Healthcare Behavioral Health Plan Contract

    Illinois Governor Creates State-based Insurance Exchange

    Illinois Requests Extension for Behavioral Health Transformation Section 1115 Waiver

    New Hampshire Extends Postpartum Medicaid Coverage

    Washington Extends Family Planning Only Demonstration Waiver by One Year

    Wisconsin to Renew Family Care, Family Care Partnership Waivers

    Wisconsin Launches Independent Living Supports Pilot Program

    MACPAC Projects Medicaid Managed Care Directed Payment Spending to Be $69.3 Billion Annually

    Drug Makers File Federal Lawsuit to Block Medicare From Negotiating Drug Prices

    UnitedHealth Group Wins Bidding Showdown to Acquire Amedisys

    CareSource to Acquire Radiant Alliance

  • This week, our In Focus section reviews the projected healthcare expenditure and enrollment data from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary, published June 14, 2023. The Office of the Actuary provides annual updates to Read More
    Roundup:

    May Medicaid Redeterminations Update: Arizona, Illinois, Indiana, Iowa, West Virginia

    California Lawmakers Introduce Bills to Modernize State Mental Health Services Act

    Florida to Pilot Medicaid Managed Care for Individuals with Developmental Disabilities in 7 Counties

    Idaho Releases EQRO RFP

    Illinois Pauses Enrollment in Health Benefits for Immigrant Adults Program

    Indiana Names Cora Steinmetz as Medicaid Director

    Iowa Contracts With HMA to Study Service Delivery for New Health, Human Services Department

    Kentucky to Study Potential HCBS Waiver Program For Children with Severe Emotional, Intellectual Disabilities

    Montana Disenrolls 15,500 Medicaid Beneficiaries During April Redeterminations

    New Mexico Awards General Dynamics Information Technology $39 Million Contract to Update Medicaid Provider Enrollment System

    Oklahoma Closed Loop Electronic Referral System for SDOH RFP Responses Are Due June 19

    Tennessee Releases Medicaid, CHIP Eligibility Determination System RFI

    Enhanced Medicaid Funds to States for Pausing Disenrollment Top $117 Billion, KFF Finds

    Pennant Group Acquires Bluebird Home Health, Hospice, Home Care Provider

  • This week, our In Focus section highlights a Health Affairs Forefront post, “To Treat Residents With OUD, Nursing Facilities Must Improve Practices and Reduce Stigma, ” published June 8, 2023. Read More
    Roundup:

    Medicaid Disenrollment News: Arkansas, Georgia, Kansas, Maryland, Nebraska, New Hampshire, South Carolina

    Florida Raises KidCare Income Eligibility to 300 Percent of Poverty

    CareSource Files Protest Against Iowa Medicaid MCO Awards

    CareSource Forms Alliance with Three Organizations to Bid on Upcoming Kansas Procurement

    New York to Form Healthcare Commission to Improve Medicaid Quality, Reduce Costs

    North Carolina Enacts Law Allowing BCBS-NC, Delta Dental to Shift Assets to Holding Companies

    North Dakota Names Sarah Aker Medicaid Director

    Oklahoma Awards Medicaid Managed Care Contracts to Three Plans

    Pennsylvania Receives 67 Responses to Community HealthChoices RFI

    Texas Awards EVV System Management Services Contract to Accenture, HHAeXchange

    Health Plans Must Pay for Preventive Care Under Temporary Agreement

    CMS Announces New Primary Care Payment Model

    Center for Autism Files for Chapter 11, Assets To Be Acquired by Founder, Former CEO

    Walgreens Sells Remaining Shares of Option Care Health for $330 Million

  • This week our In Focus checks in on the Medicaid unwinding work and key issues HMA experts are watching as more states resume their normal policies and processes for determining eligibility. Read More
    Roundup:

    Medicaid Redeterminations New: Arizona, California, Colorado, Idaho, Indiana, Iowa, Kentucky, Louisiana, Michigan, Nevada, North Carolina, North Dakota. Texas, West Virginia, Wyoming

    Arkansas Submits Request for Medicaid Expansion Work Requirements

    Georgia Cancels RFQC for Medicaid Managed Care Plans

    Iowa Enacts Legislation Tightening Medicaid Eligibility Verification

    Nevada Medicaid Drug Spending Rose 126 Percent from 2017 to 2022

    New Mexico to Extend Medicaid Managed Care Contracts Additional 6 Months

    New Mexico to Expand Access to Medicaid Payments for Medical, Behavioral Health Services in Schools

    Pennsylvania Seeks to Implement Selective Contracting for IDD Residential, Supports Coordination Services

    South Dakota Receives Federal Approval to Implement Medicaid Expansion in July

    Elevance Health Names Natalie Cooper President of Amerigroup Tennessee

    Texas Names Emily Zalkovsky as State Medicaid Director

    Merck Seeks Injunction to Block Medicare Drug Negotiation Program

    UnitedHealth/Optum Makes Unsolicited $3.26 Billion Bid for Amedisys

  • This week, our In Focus section describes a new collaboration between Health Management Associates and the California Department of Health Care Services (DHCS). Read More
    Roundup:

    Arizona Delays Implementation of Housing, Health Opportunities Waiver to October 2024

    California Individual Mandate Generates $1.1 Billion in Fines Since 2020

    Georgia Disenrolls 2,200 Medicaid Beneficiaries During April Redeterminations

    Indiana Disenrolls 53,000 Medicaid Beneficiaries During First Month of Redeterminations

    Kentucky Subcommittee Again Finds Deficiencies in Rules Extending Dental, Vision, Hearing Benefits to Medicaid Beneficiaries

    Minnesota Enacts Legislation to Provide Comprehensive Dental Benefits to All Medicaid Beneficiaries

    Missouri Uses Ex Parte Renewal Process for 47 Percent of April Medicaid Eligibility Redeterminations

    Oregon to Disenroll 8,000 Medicaid Beneficiaries Following April Redeterminations

    Rhode Island Releases Medicaid Managed Care RFI; New Procurement Expected Fall 2023

    Wisconsin Could Disenroll Up to 300,000 Medicaid Beneficiaries During Redeterminations, Report Finds

    Medicaid Disenrollments to Date Are Largely for Administrative Reasons, CMS Says

    Medicaid Enrollment to Decrease by More Than 12 Million by 2025, CBO Projects

    CVS/Oak Street Health to Expand Into Arkansas, Iowa, Kansas, Virginia

    AHIP President, CEO to Step Down in October

    Medicaid Directors to Discuss Challenges, Opportunities at HMA Conference in Chicago

  • Health Management Associates has announced the preliminary lineup of speakers for its sixth annual conference, Innovations in Publicly Sponsored Healthcare: How Medicaid, Medicare, and Marketplaces Are Driving Value, Equity, and Growth. Read More
    Roundup:

    California Proposes Increasing Medicaid Reimbursement Rates for Providers

    Florida Disenrolls 250,000 Medicaid Beneficiaries Since Redeterminations Began

    Iowa Releases Dental RFP for Iowa Dental Wellness Plan, Hawki

    Iowa Expects 3,000 Individuals to Lose Medicaid Coverage by June 1

    Massachusetts Considers Increasing Medicaid Reimbursement Rates for Substance Use Disorder Treatment Providers

    Minnesota Legislature Passes Bill to Set Minimum Wages, Benefits for Nursing Home Staff

    Nebraska Passes Certified Community Behavioral Health Clinic Act

    Nevada to Transition to Medicaid Managed Care in Rural Areas

    Nevada Senate Considers Bill to Reimburse Rural Hospitals at Cost for Outpatient Services

    New Hampshire House Committee Subdivision Votes to Hold Medicaid Reauthorization Bill for a Year

    Texas Senate Passes Bill to Extend Postpartum Medicaid Coverage

    Vermont Lawmakers Approve 50 Percent Increase in Fiscal 2024 Medicaid Reimbursement Rates for Dental Services

    Washington Legislature to Increase Medicaid Reimbursement Rates for Nursing Homes by 14 Percent for Two Years

    CMS Releases Regulatory Requirements for State MES Modules

    HCA Healthcare Acquires TX Urgent Care Centers from FastMed

  • This week our In Focus section reviews the Illinois Healthcare Transformation 1115 Waiver Extension request, posted for review on May 12, 2023. Read More
    Roundup:

    Arkansas Is Urged by Healthcare Groups to Pause Medicaid Redeterminations

    Delaware Medicaid Expenses Are Projected to Increase Despite Redeterminations

    Florida Releases Medicaid Prepaid Dental Program RFI, To Release RFP Summer 2023

    Florida Releases D-SNP RFI, Considers Moving 300,000 Medicaid Members from D-SNPs to SMMC

    Illinois to Address Social Determinants of Health in 1115 Behavioral Health Waiver Amendments

    Indiana Enacts Legislation to Reform Long-term Care

    North Dakota Releases Medicaid Enterprise Technical Systems Integrator RFP

    Ohio Releases PACE Expansion RFP

    Virginia to Release Medicaid NEMT RFP in September 2023

    Virginia Disenrolls 20,000 Medicaid Beneficiaries During Redeterminations

    Federal Appeals Court Temporarily Blocks Overturning of ACA Preventive Services Requirement

    Wisconsin Approves Humana’s Proposed Purchase of Inclusa

    Sentara to Consolidate Medicaid Plans in Virginia