HMA Weekly Roundup

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  • This week’s In Focus is the second in a two-part look at the Centers for Medicare & Medicaid Services’ (CMS’s) recently proposed changes to the Medicaid program. Last week we covered CMS’s proposed changes to the federal Medicaid managed care Read More
    Roundup:

    Arizona Legislature Approves $3.4 Billion for Fiscal 2023 Medicaid Managed Care Payments

    Arkansas Disenrolls Almost 73,000 Medicaid Beneficiaries During April Redeterminations

    Georgia Community Health Commissioner to Step Down Summer 2023

    Idaho Finds 29,000 Ineligible Medicaid Beneficiaries During Redeterminations Healthy Blue

    Kansas Hires President Ahead of Bid on Medicaid Contract

    HAP, CareSource Form Partnership to Serve Michigan Medicaid Beneficiaries

    Rhode Island Senate Passes Bill to Use Medicaid Funds to Help Homeless Beneficiaries Find Housing

    Virginia Plan to Cut Medicaid Payments for Preventable ER Visits Is Vacated by Federal Judge

    1.7 Million Medicaid Beneficiaries Could Lose Coverage if Work Requirements are Implemented, KFF Projects

    Option Health Care To Acquire Amedisys

    Cano Health Looks to Sell Non-core Assets, Focus on Medicare Advantage

  • This week, our In Focus section reviews CMS’s proposed changes to the federal Medicaid managed care access, finance, and quality regulation (CMS-2439-P). Read More
    Roundup:

    Alabama Releases Integrated Care Network Program RFP

    Arkansas Proposes Medicaid Work Requirements for Expansion Program

    Florida Legislature Passes Bill to Regulate PBMs

    Florida House Passes Bill to Create Pilot Program Providing Medicaid Managed Care Coverage to Individuals with IDD

    Georgia Enacts Law to Create State-based Insurance Exchange

    Louisiana Candidates for Governor Promise to Keep Medicaid Expansion

    Mississippi Medicaid Beneficiaries Are No Longer Responsible for Copays

    Nevada Expands Dental Services for Medicaid Beneficiaries with IDD

    Nevada Releases Baseline Medicaid Enrollment Report Ahead of Redeterminations

    New York to Gradually Redirect Medicaid Funding from Counties

    Tennessee Medicaid to Cover Cost of Diapers for First Two Years

    Washington Publishes Plan to Remove Barriers to Access for Health, Human Services Benefits

    Medicare Advantage Enrollment Surpasses Traditional Medicare in January

    Centene to Sell Apixio to New Mountain Capital

    BCBS-MI, BCBS-VT to Pursue Affiliation

  • 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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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 More
    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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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