HMA Weekly Roundup

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  • 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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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 More
    Roundup:

    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

  • This week, our In Focus explores a new trend to watch in Medicaid Section 1115 waiver demonstration programs. Read More
    Roundup:

    California Faces Lawsuit from Health Plan Over Alleged Public Records Act Violation

    Kansas to Hold Public Meetings on KanCare With Beneficiaries, Stakeholders

    Massachusetts to Transition Dual Eligibles from MMP Demo to D-SNP

    Mississippi Submits Amendment to Increase Reimbursement Rates for Private Duty Nurses by 15 Percent

    Oklahoma Gubernatorial Candidates Clash on Medicaid Managed Care Implementation

    Texas Releases STAR, CHIP Draft RFP

    Utah to Transition to New MMIS in 2023

    West Virginia Releases RFP for Foster Children, Youth in Medicaid Managed Care

    Treasury Announces Rules Aimed at Fixing Exchange Plan ‘Family Glitch’

    Walgreens Boots Alliance to Acquire Remaining 45 Percent Stake in CareCentrix

    Cimarron Healthcare Capital, Tacoma Holdings Invest in Frontpoint Health

  • This week, our In Focus reviews the New Mexico Medicaid managed care request for proposals (RFP), released on September 30, 2022, by the New Mexico Human Services Department (HSD). Read More
    Roundup:

    Colorado Releases Medicaid, CHIP Enrollment Broker Services RFP

    Louisiana to Begin Auto Assignment of Medicaid Beneficiaries into Managed Care Plans

    Maine Looks to Renew NEMT Waiver, Release RFP

    Minnesota Awards Medicaid Managed Care Contracts Covering Individuals Outside Twin Cities, Elderly, Disabled

    Nebraska Seeks Funds to Cover Aduhelm, Reduce Waiting List for Individuals With Development Disabilities

    New York Medicaid Fraud, Waste Reduction Efforts Yield Results

    North Carolina Delays Implementation of Behavioral Health IDD Tailored Plans to April 2023

    North Dakota Leads Country in Rate of Physicians Accepting New Medicaid Patients, Analysis Finds

    Ohio Governor Looks to Expand Medicaid Eligibility for Pregnant Women to 300 Percent of Poverty

    Oklahoma Implements 25 Percent Rate Increase for Developmental Disability, HCBS Providers

    HCSC Names Anne Rote President of Medicaid Division

    Federal Grants Topping $346 Million Awarded to Address Healthcare Staffing Shortages

    Ensign Group May Soon Become Largest Nursing Home Provider in U.S.

  • This week, our In Focus section looks at the current federal policy landscape and trends and the legislative outlook for the remainder of 2022 and beyond. Read More
    Roundup:

    Arizona Medicaid Director to Step Down at the End of 2022

    Colorado Appoints Adela Flores-Brennan as Medicaid Director

    Centene Names Bill Wilson CEO of Delaware Medicaid Plan

    Kansas Begins Distributing $51 Million in Bonuses for Direct Care Workers at Medicaid HCBS Providers

    Massachusetts Receives Federal Approval to Extend MassHealth 1115 Waiver Through 2027

    Nebraska Awards Medicaid Managed Care Contracts to 3 Health Plans

    Nevada Releases Electronic Visit Verification System RFP

    Oregon 1115 Waiver Renewal Is Approved by Federal Regulators

    Texas Report Recommends Transitioning Medicaid-Only Services into Managed Care for Dual Eligibles

    Virginia Medicaid Provider Sets Up Neighborhood Clinics to Expand Access to Preventive Health Care

    OIG Calls For Increased Oversight of Medicaid Plan MLR Reporting

    DentaQuest Commits $275,000 to Initiative Connecting Children to Dental Care

  • This week, our In Focus section highlights an issue brief from Wakely, an HMA Company, The Basics of Evaluating PBM Contracts, published September 2022. Read More
    Roundup:

    Cityblock to Serve About 10,000 MDWise Members in Indiana

    Kentucky Appeals Panel Upholds 2020 Medicaid Managed Care Contracts With 5 Plans, Excluding Elevance Health

    Missouri Meets Federal Requirement of 45 Days for Processing Medicaid Expansion Applications

    New York PACE Could Expand Dramatically Under Bill Awaiting Governor’s Signature

    Ohio Releases Medicaid Electronic Visit Verification Services RFP

    AbsoluteCare Expands Into Pittsburgh Through Collaboration With Highmark Wholecare

    Tennessee Is Hit With Lawsuit Over Medicaid Managed Care Procurement

    Texas to Receive $165.6 Million in Settlement Over Medicaid Drug Pricing

    Medicaid Eligibility Redeterminations Could Take 12 Months Following PHE, State Regulators Say

    NCQA, CHCF Release Framework to Measure Health Equity in Medicaid Managed Care

    UnitedHealth Group Is Cleared to Acquire Change Healthcare

    Humana to Fully Acquire 20 Senior Primary Care Clinics After Buying Out Welsh, Carson’s Stake

  • This week, our In Focus highlights a Health Management Associates Institute on Addiction (HMA IOA) report, Delaware Substance Use Disorder Treatment System Needs Assessment, published in June 2022. Read More
    Roundup:

    Kentucky Seeks to Expand Number of PACE Providers, Counties Served

    Montana Medicaid Reimbursement Rates Are 22 Percent Below Benchmarks, Study Finds

    New York Proposes 1115 Waiver Amendment to Address Equity, Housing, Workforce Shortages

    Oregon Medicaid Mobile Crisis Intervention Services Program Receives CMS Approval

    Texas Awards STAR Health Contract to Centene/Superior HealthPlan

    CareSource, Legacy Community Health Form Joint Venture to Bid on Texas STAR, CHIP RFP

    CMS to Phase Out D-SNP Look-Alikes Within Medicare Advantage in 2023

    Illinois Review Board to Reconsider Merger of Advocate Aurora, Atrium Health

  • This week, our In Focus section identifies steps that Medicare and Medicaid plans and providers can undertake to effectively return to normal operations after the end of the COVID-19 public health emergency (PHE) declaration. Read More
    Roundup:

    Arkansas Seeks Federal Approval to Offer Full Medicaid Coverage to Pregnant Women

    California Awards $340 Million Population Health Management Contract to Gainwell Technologies

    California Medi-Cal Contract Awards Face Appeals

    Iowa Awards NEMT Contract to MTM

    Maryland Releases Dental Benefits Administrator RFP

    Maryland Releases Medicaid NEMT Broker RFP

    New Mexico Delays Medicaid Managed Care RFP Release to Third Quarter of 2022

    Oklahoma Releases Medicaid Dental Managed Care RFP

    Tennessee Proposes PMPM Medicaid Spending Cap to Replace Proposed Aggregate Cap

    Texas Delays Releases of STAR/CHIP, STAR Kids RFPs

    MedPAC Eyes Potential Standardized Benefit Options for Medicare Advantage

    CMS Proposes Rule to Standardize Medicaid, CHIP Eligibility and Enrollment

    CVS to Acquire Signify Health

    Maximus Retains Contract to Support CMS Contact Center Operations