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- This week, our In Focus section reviews changes to Medicaid’s COVID-19 Public Health Emergency (PHE) unwinding. Read MoreRoundup:
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 MoreRoundup:
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 MoreRoundup:
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 MoreIn Focus:Roundup:
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 MoreRoundup:
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
- While the current federal COVID-19 Public Health Emergency (PHE) declaration could be in place through the winter months, HMA’s team of experts see many reasons to put the PHE’s Medicaid unwinding planning at the top of your list now. Read MoreRoundup:
Alabama Doubles Covered Physician Visits for Medicaid Enrollees Receiving Cancer Treatment
California Medi-Cal Procurement Protests Continue
California Releases Third-Party Monitoring RFI
Delaware Names First Director of Value-Based Healthcare Delivery
Illinois YouthCare Fails to Deliver Basic Medical Services to Foster Children, Investigation Finds
Medicaid Expansion News: Kansas, North Carolina
Elevance Files Appeal After Its Protest of Nebraska Medicaid Managed Care Awards is Denied
Maryland Declines to Pursue Higher Damages Against Medicaid Behavioral Health ASO
Ohio Delays Implementation of New Medicaid Managed Care Contracts to February 2023
Oklahoma Re-releases Medicaid Managed Care RFP
Wisconsin Releases External Quality Review, Quality Improvement Services RFP
CMS Targets Gaps in Health Equity Data, To Gradually Release Equity Scores
Sanford Health, Fairview Health Services Agree to Merge
- This week, our In Focus section reviews highlights and shares key takeaways from the 22nd annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 25, 2022, in Read MoreRoundup:
California Medi-Cal Members Can Now Fill Prescriptions at Costco
Florida Healthcare Groups File Challenge to $15 Minimum Wage Budget Provision
Hawaii Works With HMA to Develop Medicaid Social Determinants of Health Initiative
Massachusetts Home Health Care Workforce Decreases by 13 Percent from 2019 to 2022
Nebraska Says Protest of Medicaid Managed Care Contracts Will Not Delay Implementation
New Hampshire Executive Council Approves Medicaid Dental Contract
Pennsylvania Receives Federal Approval to Extend Postpartum Medicaid Coverage to 12 Months
South Dakota Voters Approve Medicaid Expansion
Virginia Projects ‘Tiny’ Increase in Fiscal 2024 State Medicaid Costs
Medicaid FFS More Likely to Cover Opioid Use Disorder Treatment than Medicaid Managed Care
Medicaid Plans Report Barriers to Telehealth Access
19 States Have Implemented Strategies to Increase Direct Care Worker Wages, Report Finds
CNSI, Kepro to Merge; Apax Partners to Exit
Walgreens’ VillageMD to Acquire Summit Health
Clover Health to Reduce Medicare ACO REACH Population by Two-Thirds in 2023
- This week, our In Focus section reviews the remaining Medicare payment and policy rules, finalized over the last several days by the Centers for Medicare & Medicaid Services (CMS), that will shape the landscape for the Medicare program in 2023 Read MoreRoundup:
Alabama Releases Medicaid Modernization Program System Integration Services RFP
Arkansas Receives Approval to Expand Community-Based Care for Certain High-Risk Individuals
District of Columbia Mayor Calls for Investigation Into Awarded Medicaid Managed Contracts
Michigan Medicaid Plan Meridian Appoints Patricia Graham as CEO
Mississippi Submits 1115 Waiver Extension Application for Aged, Blind, Disabled Individuals
New Hampshire to Award Adult Medicaid Dental Contract to Delta Dental
South Dakota Seeks Five-Year Extension of Former Foster Care Youth Medicaid 1115 Waiver
Tennessee Seeks to Extend Enhanced HCBS Supports
Vermont Releases Medicaid IV&V RFP
Wisconsin Receives Federal Approval to Use CHIP Funds For Housing Support
HHS Bolsters Medicare Behavioral, Dental, Cancer Care in Physician Fee Schedule Final Rule
HHS Focuses on Rural Health Equity in Hospital, Surgical Center Payment System Final Rule
Walgreens’ VillageMD Reportedly Explores Merger With Summit Health
- This week, our In Focus section highlights the Health Affairs article, Advancing Health Equity and Integrated Care for Rural Dual Eligibles, authored by Ellen Breslin , Samantha Di Paola , Susan McGeehan , Rebecca Kellenberg , Read MoreRoundup:
Georgia Children on Medicaid, CHIP Face Behavioral Health Access Barriers
Medicaid Dental News: Kentucky, New Hampshire, Nevada
North Carolina Says Hospitals Profited from Medicare, Despite Claims of Losses
PBM News: Ohio, Puerto Rico, Centene
OR Seeks $1.5 Billion Increase in Medicaid Funds for 2023-25 Biennial Budget
Pennsylvania Lawmakers Consider Prior Authorization Legislation
States Leverage Medicaid Managed Care to Improve Health Equity, KFF Finds
Community Medicare Advantage Plans Are Leaders in Quality, ACHP Finds
- This week, our In Focus section reviews the Mountain Health Promise request for proposals (RFP) released by the West Virginia Department of Health and Human Resources on September 30, 2022, for specialized Medicaid managed care for children and youth in Read MoreRoundup:
Arizona Receives Federal Approval of Waiver to Address Housing Needs
District of Columbia Council Approves Medicaid Managed Care Contracts Idaho Delays Behavioral Medicaid Awards to November 2022
Indiana Awards Medicaid FFS Prior Authorization, Utilization Management Contract to Kepro
Kansas, Gainwell Implement Modular Medicaid Technology Platform
Nevada Governor Tells SEIU He Will Push for Higher Payment Rates, Wages for Home Care Providers
New York Fails to Follow Up on Dual Eligible Cost Savings Opportunities, Comptroller Finds
Pennsylvania Senate Committee Passes Resolution to Study Medicaid Addiction Treatment Reimbursement Rates
HHS Offers States Certified Community Behavioral Health Clinic Planning Grants
CMS Agrees to Release Audits of 90 Medicare Advantage Plans
Acorn Health Acquires 7 Applied Behavior Analysis Centers in FL, VA For Children With Autism
Brave Health Secures $40 Million in Latest Funding Round to Expand Virtual Medicaid Behavioral Health Services
