HMA Weekly Roundup

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  • 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

    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

    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

    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

    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

    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

  • This week, our In Focus section reviews preliminary 2021 Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. Read More

    California Awards Medi-Cal Managed Care Contracts to Three Health Plans

    District of Columbia Medicaid Managed Care Contract Awards Await Mayor’s Recommendations

    Florida Medicaid Providers to Pay Long-Term Care Staff $15 Per Hour

    Illinois Enacts Legislation to Increase Nursing Home Pay

    Iowa Awards Medicaid Managed Care Contracts to Two Health Plans

    Louisiana Awards Single, Statewide PBM Contract to Magellan

    Louisiana Medicaid Begins Using State Directed Payment Model for Hospitals

    Mississippi Medicaid Managed Care Bidders File Protests

    Nebraska Delays Medicaid Managed Care Awards to September 23

    New Hampshire Releases Adult Medicaid Dental Managed Care RFP

    New York Removes Barrier to Home Care M&A Activity With New Licensure Process

    CMS Awards $98.9 Million to Navigators to Assist in 2023 Exchange Open Enrollment

    8.8 Million Medicaid Beneficiaries Received LTSS in 2019, CMS Report Finds

    Medicare Advantage Accounts for Nearly Half of All Medicare Beneficiaries, KFF Analysis Finds

    Walgreens Boots Alliance Completes Acquisition of 55 Percent Stake in CareCentrix

  • This week, our In Focus section highlights an HMA Issue Brief, Bolstering the Youth Behavioral Health System: Innovative State Policies to Address Access & Parity, published in August 2022. Read More

    California Releases Mobile Crisis Intervention Services RFI

    California Exchange Plans Must Resubmit 2023 Rates to Reflect Impact of Inflation Reduction Act

    Florida Medicaid Enrollment to Increase 5.5 Percent, Surplus to Top $1.25 Billion in Fiscal 2023

    Georgia Can Reinstate Medicaid Expansion Work Requirements, Federal Judge Rules

    Nebraska Awards Maxmius Contract for MMIS Provider Services Module

    New York Legislators Introduce Bill to Ease Burden of Medicaid Provider Audits, Recoveries

    North Carolina Healthy Opportunities Pilot Struggles to Gain Traction

    Ohio Counties Win $600 Million in Damages in Opioid Lawsuit

    Oregon Health Plan to Use Tech Platform to Connect Medicaid Members to Social Services

    Texas Dual Eligible Demonstration Shows Cost Reductions, Study Finds

    Utah Releases Medicaid Dental Managed Care RFP

    U.S. Senate Panel Investigates Medicare Advantage, Part D Marketing Tactics

    Sonas Home Health Care Acquires Focus Forward Skilled Care

    Wakely, An HMA Company, White Paper: 2021 Supplemental Claims Impact

  • This week, our In Focus section reviews the Inflation Reduction Act of 2022 (IRA), signed by President Biden on August 16, 2022. Read More

    Arizona Works on New Health Plan Contracts for ALTCS-EPD Program

    Delaware Judge Denies Motion to Quash Audit of Medicaid Program

    District of Columbia Accepts Bids from 2 Medicaid Managed Care Plans

    Florida Medicaid Plan Capitated Rates to Fall, Driven by Lower Utilization

    Illinois Announces PACE Program Awardees

    Massachusetts Seeks Input on Improving Medicaid MCO/ACO Risk Adjustment Model

    Minnesota Releases RFP for School-Linked SUD Services for Students

    Missouri Medicaid Software Vendor Wins $23 Million in Lawsuit Against State

    Nebraska Delays Medicaid Managed Care Awards to August 31

    North Carolina Legislators Fail to Reach an Agreement on Medicaid Expansion

    CMS Proposes Rule to Expand Medically Necessary Dental Services Covered by Medicare

    Medicare Rates Expected to Rise 2.5 Percent for Inpatient Psychiatric Facilities in Fiscal 2023

    Humana to Acquire Wisconsin-based MCO Inclusa

    LHC Group Agrees to Acquire Three Rivers Home Health

  • As the urgent needs of COVID-19 Public Health Emergency (PHE) continue to subside, state Medicaid agencies are exploring pathways and concepts to further address the historic inequities and health disparities laid bare by the pandemic. Read More

    California Delays Medi-Cal Managed Care Program Awards

    Connecticut HUSKY Health to Cover Additional Maternity Benefits in 2023

    Florida Medicaid Managed Care RFI Responses Stress Social Determinants, Providers, HCBS

    Georgia Proposal to Bypass Is Again Rejected by CMS

    Idaho Releases Quality Improvement Organization RFP

    Mississippi Awards MississippiCAN, CHIP Medicaid Managed Care Contracts to 3 Health Plans

    Missouri Commits to Trimming Medicaid Applications Backlog Under Federal Plan

    Ohio Pharmacists Express Concern Over Single PBM Program

    West Virginia Medicaid Must Cover Gender-Affirming Care, Federal Judge Rules

    U.S. Senate Passes Legislation Allowing Medicare to Negotiate Drug Prices, Extending Enhanced Exchange Subsidies

    CVS Is Reportedly Interested in Acquiring Signify Health

    UnitedHealth/Optum Acquires CareMount Medical

  • This week, our In Focus section reviews the request for information (RFI) on ways to strengthen the Medicare Advantage (MA) program, released by the Centers for Medicare & Medicaid Services (CMS) on July 28, 2022. Read More

    Alabama Releases SMI Independent Evaluator RFP

    Arkansas Withdraws Previously Released PBM RFP To ‘Start from Scratch’

    Georgia Receives Approval for 2 Percent Rate Increase for HCBS Waivers

    Michigan Seeks Another Year to Implement SPA for Community Support Services

    Mississippi Delays Medicaid Managed Care Awards to August

    Missouri Submits Substance Use Disorder 1115 Waiver Application

    New York Attorney General Files Antitrust Lawsuit Against CVS Over 340B Program

    Ohio Releases Medicaid IV&V Services RFP

    Oregon Seeks Medicaid Coverage for Individuals Up to 200 Percent of Poverty After PHE Ends

    South Carolina to Convene Working Group on Emergency Mental Health

    National Uninsured Rate Hits a Record Low of 8 Percent

    Biden Administration May Allow Medicaid Waivers to Cover Out-of-State Abortions

    Medical Transportation Management Finalizes Acquisition of Veyo