This week’s In Focus section, written by HMA Principal Juan Montanez, reviews the request for proposals (RFP) issued by Puerto Rico earlier this month to deliver managed care services to the territory’s Government Health Plan (GHP) members. The government of Puerto Rico is seeking to contract with between three and six MCOs to provide services to the approximately 1.3 million members of the GHP, the territory’s medical assistance and insurance affordability program. Proposals in response to the recently issued RFP are due in early April.
Medicaid
Washington Releases 2019/2020 Integrated Managed Care RFP
This week’s In Focus section reviews Washington’s 2019/2020 Integrated Managed Care (IMC) request for proposals (RFP) issued by the Washington State Health Care Authority (HCA) on February 15, 2018 to provide 1.6 million Medicaid enrollees with both physical and behavioral health services. The procurement will expand Washington’s Apple Health – IMC program (formerly known as Fully Integrated Managed Care (FIMC)) to eight additional Regional Service Areas (RSAs) and add an additional managed care organization to the Southwest RSA. It will also add one county to the Southwest RSA and one county to the North Central RSA.
CMS Renews Healthy Indiana Plan Through 2021
HMA Medicaid Market Solutions helped the State of Indiana secure approval for an extension of its Medicaid Section 1115 Waiver, the Healthy Indiana Plan. Below is a summary of what the renewal entails.
On February 1, 2018, Indiana received approval from the Centers for Medicare and Medicaid Services (CMS) to continue its long-standing Healthy Indiana Plan (HIP) with a three-year renewal. This CMS approval maintains the core of the HIP program and incorporates additional features, including expansion of the current Gateway to Work initiative to add required community engagement for non-exempt HIP members beginning in 2019. Also new is a substance use disorder component that will be available to all Indiana Medicaid members, including those enrolled in HIP.
Texas Receives 1115 Waiver Renewal
This week, our In Focus section reviews Texas’ 1115 Medicaid waiver renewal. After more than a year of negotiations, on December 21st the Texas Health and Human Services Commission (HHSC) received CMS approval to extend the state’s 1115 waiver.[1] The Texas Healthcare Transformation and Quality Improvement Program waiver was initially approved by CMS as a five-year demonstration waiver that began December 2011 and ended September 2016 and included $29 billion in funding. The waiver authorized the expansion of Medicaid managed care while preserving federal hospital funding historically received as supplemental payments. The waiver created two new funding pools: the Uncompensated Care (UC) payment pool and the Delivery System Reform Incentive Payment (DSRIP) pool.
Kentucky Becomes First State to Enact Community Engagement & Employment Requirements for Medicaid Members
This article was written by Senior Consultants Amanda Schipp and Lora Saunders of HMA Medicaid Market Solutions (HMA MMS). HMA MMS helped the Commonwealth of Kentucky secure a groundbreaking Medicaid Section 1115 Waiver. Below is a summary of what the waiver entails.
On January 12, 2018, Kentucky’s section 1115 Medicaid Demonstration Waiver was approved by the Centers for Medicare and Medicaid Services (CMS). The demonstration includes two significant components: an expansion of substance use disorder (SUD) services, including a waiver of the Institution for Mental Disease (IMD) exclusion, and the creation of a new Medicaid program for able-bodied adults, known as Kentucky HEALTH (Helping to Engage and Achieve Long Term Health). The demonstration contains several groundbreaking policies never previously approved by CMS, most notably, a requirement for non-exempt Medicaid enrollees to work or participate in approved work-related activities, such as education, training, or volunteering as a condition of Medicaid eligibility. This approval paves the way for the nine other states that also have pending waivers requesting similar work requirements.[1]
CMS approves Kentucky Medicaid Waiver
The Centers for Medicare & Medicaid Services (CMS) has approved the “Kentucky Helping to Engage and Achieve Long Term Health” 1115 Medicaid Waiver, a five-year waiver that includes a “community engagement” or work requirement as a condition of eligibility for non-disabled adult Medicaid beneficiaries ages 19-64.
The decision from CMS represents the first approval of a Medicaid waiver that includes a work requirement as a condition of eligibility. Kentucky developed the waiver in collaboration with HMA Medicaid Market Solutions (HMA MMS).
Kentucky defines “community engagement activities” as 80 hours per month of employment, education, job skills training, and community service. Exempted groups include pregnant women, the medically frail, and full-time students. The waiver also includes “consumer-driven tools” that provide incentives for healthy behavior.
Come back to the HMA blog Monday to read more about Kentucky HEALTH.
Read the full text of the press release issued by the Kentucky Governor’s Office here.
Read the Kentucky HEALTH Demonstration Approval here.
Medicaid Managed Care Enrollment Update – Q4 2017
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 27 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. Nearly all 27 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2017. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
Dual Eligible Financial Alignment Demonstration Enrollment Update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for beneficiaries dually eligible for Medicare and Medicaid (duals) in 10 states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, Texas, and Virginia. Each of these states has begun either voluntary or passive enrollment of duals into fully integrated plans providing both Medicaid and Medicare benefits (“Medicare-Medicaid Plans,” or “MMPs”) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of November 2017, more than 400,000 duals are enrolled in an MMP, the second-highest monthly enrollment since the demonstrations began, according to state and CMS enrollment reports.
Texas Issues STAR+PLUS Request for Proposals
This week, our In Focus section reviews the Texas STAR+PLUS request for proposals (RFP) issued on December 4, 2017. The STAR+PLUS Medicaid managed care program covers approximately 519,000 individuals who have disabilities or are aged 65 or older. The program will integrate Acute Care services and Long-Term Services and Supports (LTSS), and cover members including those with intellectual or developmental disabilities (IDD) and dual eligibles. Managed care organizations (MCOs) will also provide access to behavioral health services, such as mental health and substance use disorder counseling and treatment. When fully implemented, Texas expects enrollment to be over 530,000 and annualized spending over $7.5 billion, based on FY 2018 data.
Ballot Initiative Requirements in Non-Medicaid Expansion States
This week, our In Focus section examines the 10 states that have not expanded Medicaid under the Affordable Care Act but where citizens can initiate a public vote on the issue. In November, nearly 60 percent of Maine voters approved a ballot initiative expanding Medicaid. Advocates in Idaho, Missouri, and Utah have filed paperwork to begin collecting signatures to place Medicaid expansion on the ballot in November 2018.