This week we are providing a brief recap of our January 8th webinar Evolving Integrated Managed Care Models for Medicare-Medicaid Dual Eligible Beneficiaries: Key Considerations for Health Plans presented by Principals Sarah Barth, JD and Ellen Breslin, MPP.
Medicaid
HMA Colleagues Played Pivotal Role in Launching Forum for the Brooklyn Perinatal Network
HMA New York colleagues Heidi Arthur and Annalisa Baker played a pivotal role in launching a forum for the Brooklyn Perinatal Network on Jan. 11.
The forum, entitled, “A Community Response to Addressing Maternal Morbidity and Mortality,” was a collaboration between a network of community-based organizations (CBOs) making up the Brooklyn Coalition for the Health Equity for Women and Families Coalition Leadership Team.
Oregon Releases Medicaid Coordinated Care Organizations 2.0 RFA
This week, our In Focus reviews the Oregon Health Plan’s Coordinated Care Organizations (CCO) 2.0 request for applications (RFA), released by the Oregon Health Authority (OHA) on January 25, 2019. Under CCO 2.0, the CCOs will provide full-risk coordinated care for approximately 840,000 Medicaid members.
Medicaid Managed Care Enrollment Update – Q4 2018
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2018. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
HMA Experts Contribute to Report on Health Disparities in Minnesota’s Medicaid Population
Editors Note: This post was authored by HMA Principal Ellen Breslin, MPP.
The Minnesota Department of Human Services (DHS) recently submitted a report to the Minnesota Legislature, called Accounting for Social Risk Factors in Minnesota Health Care Program Payments. This report represents a multi-year effort on the part of DHS, and a real step forward in moving from social risk as a concept to a quantifiable methodology to explain its impact on health. The report delivers DHS recommendations to reduce health disparities among Medicaid and other DHS program participants.
Medicaid Expansion Considerations For Non-Expansion States
This week, our In Focus section is led by Matt Powers, a Principal in our Chicago office, who worked with HMA colleagues to summarize the factors that non-expansion states weigh when considering whether or not to expand Medicaid under the Affordable Care Act. Including the states where Medicaid expansion ballot initiatives passed, 37 states have chosen Medicaid expansion or are moving toward Medicaid expansion. More than 12 million newly eligible individuals are insured by state Medicaid programs through the expansion. Comments on recent ACA Court Ruling:
Medicaid and Exchange Enrollment Update – September 2018
This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “September 2018 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on November 30, 2018. Additionally, we review 2018 Exchange enrollment data from the “Health Insurance Marketplaces 2018 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on April 3, 2018. Combined, these reports present a picture of Medicaid and Exchange enrollment in 2018, representing 73 million Medicaid and CHIP enrollees and nearly 12 million Exchange enrollees.
Premium Assistance Programs for the Working Adult Population in Medicaid Expansion States
This week, our In Focus section comes to us from HMA Senior Consultant Erin Mathies (Indianapolis), who reviews the premium assistance programs for the working adult population in Medicaid expansion states. Medicaid programs that pay for premiums in commercial insurance for individuals eligible for Medicaid have been part of state Medicaid programs since the 1990s. Under a premium assistance program, the employer or individual market coverage is the primary plan and Medicaid supports the cost of the premium, pays for cost sharing, and provides any wrapped benefits. These programs can save money for state Medicaid agencies by leveraging the employer contribution towards premiums and holding expenditures per member to the annual out of pocket maximum amounts. Existing Health Insurance Premium Payment (HIPP) programs traditionally cover children and populations with disabilities. Individuals eligible under the Medicaid Expansions may be more likely to have access to employer sponsored-insurance (ESI) and leveraging premium assistance options for these populations represents an unrealized opportunity for many state Medicaid agencies.
Navigating CMS’ Proposed Medicaid Managed Care Regulations
This week’s HMA Weekly Roundup features an In Focus article from HMA Senior Consultants Amber Swartzell and Stephanie Baume (Indiana), who reviewed the Centers for Medicare & Medicaid Services (CMS) proposed Medicaid managed care regulations. On November 8, 2018, CMS released a proposed rule that would update several sections of the Medicaid and Children’s Health Insurance Program (CHIP) managed care rules, which were most recently amended in 2016. This much anticipated proposal, scheduled to appear in the Federal Register on November 14, 2018, focuses on “promoting flexibility, strengthening accountability, and maintaining and enhancing program integrity.” The key provisions of the proposed regulations are summarized below.
Florida Statewide Medicaid Managed Care (SMMC) Awards
This week, our In Focus section comes to us from Principal Elaine Peters (HMA – Florida), who reviews the recent re-procurement by the Florida Agency for Health Care Administration (AHCA) of its Statewide Medicaid Managed Care (SMMC) health and dental plans. The SMMC program currently has two key program components: Long-Term Care (LTC) and Managed Medical Assistance (MMA). The new SMMC program changes the two components to: Integrated MMA and LTC and Dental. The 2016 Legislature “carved out” dental services from MMA plans and new dental plans will be responsible for providing dental services to eligible members.