Medicaid

HIP 2.0 Waiver Renewal Summary

This week’s review comes to us from HMA Principal Sarah Jagger, of our Indianapolis, Indiana office. Sarah provides an overview of the Healthy Indiana Plan (HIP) and the proposed changes under the HIP 2.0 waiver renewal request, submitted to the Centers for Medicare & Medicaid Services (CMS) for approval on January 31, 2017.

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Medicaid Managed Care Spending in 2016

This week, Andrew Fairgrieve and Greg Nersessian reviewed Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. In federal fiscal year (FFY) 2016, Medicaid expenditures across all 50 states and 6 territories exceeded $548 billion, with nearly half of all spending now flowing through Medicaid managed care programs.

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Reviewing Oregon’s Medicaid Expenditure Cap Waiver

This week, our In Focus article provides an overview of Oregon’s Medicaid waiver program, under which the state implemented integrated managed care entities and committed to a per capita reduction on the rate of Medicaid cost growth. The model, viewed widely as a success, may be of interest to states as discussions at the federal level around restraining spending growth in Medicaid develop under the incoming administration.

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Medicaid Managed Care Procurement Updates in DC, Massachusetts, and Texas

This week we reviewed two active Medicaid managed care procurements – in the District of Columbia and Massachusetts – and a Medicaid managed care request for information issued by Texas. On December 22, 2016, the District of Columbia issued a request for proposals (RFP) to rebid Medicaid managed care organization (MCO) contracts for the DC Healthy Families and Alliance programs. One day prior, on December 21, 2016, Massachusetts issued a request for responses (RFR) from MCOs interested in participating in the MassHealth managed care program, with a focus on preparing for Medicaid ACO implementation, as well as the planned carve-in of managed long-term services and supports (MLTSS). Finally, also on December 22, 2016, Texas issued a request for information (RFI) ahead of an upcoming statewide reprocurement of the STAR+PLUS Medicaid managed care program.

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Medicaid and Exchange Enrollment Update

This week, we reviewed updated reports issued by the Department of Health & Human Services (HHS) on Medicaid expansion enrollment from the “September 2016 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on December 1, 2016. Additionally, we review 2016 Exchange enrollment data from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief, “Health Insurance Marketplace 2016 Open Enrollment Period: February 2016 Enrollment Report,” and 2017 enrollment snapshot data through December 19, 2016, from the Centers for Medicare & Medicaid Services (CMS). Combined, these reports present a picture of Medicaid and Exchange enrollment at the end of 2016, with a look at progress towards 2017 Exchange enrollment.

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Virginia JLARC Issues Report on Medicaid Spending Management

This week, our In Focus section comes to us from HMA Principal Barbara Markham Smith, JD, of our Washington, DC office. On December 12, 2016, Virginia’s Joint Legislative Audit and Review Commission (JLARC), the audit arm of the General Assembly, issued findings from its two-year review of the Department of Medical Assistance Service’s (DMAS’s) management of the Medicaid program. In a review of DMAS’s performance that largely foreshadows Medicaid reforms to be implemented in 2017-2018, JLARC notes that inflation-adjusted Medicaid spending in Virginia, per enrollee, remained essentially flat from FY2011 to FY2015. Program spending increases came from growing enrollment due to expanded outreach activities and the addition of new waiver slots for people with intellectual and developmental disabilities.  The growth in total spending (as opposed to per capita spending), amounted to average annual cost increases of 8.9 percent over the past 10 years. Services for individuals with disabilities accounted for the lion’s share of cost increases, according to a budget report released earlier this year. Medicaid spending accounted for 22 percent of Virginia’s general fund budget in FY2016. 

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Revisiting Republican Governors’ 2011 Medicaid Reform Proposals

This week, we revisited a 2011 report from the Republican Governors Public Policy Committee Health Care Task Force. The report, titled “A New Medicaid: A Flexible, Innovative and Accountable Future,” was prepared with input from governors, secretaries of health and human services, Medicaid directors, and other senior policy staff in the 31 states (including two territories) with Republican governors at the time. Across these 31 states, 20 of the governors in office at the time of the report are still in office. Only three of the 31 states (Louisiana, Pennsylvania, and Virginia) now have Democratic governors in office, although Alaska’s new governor is an Independent who expanded Medicaid this year. The report provides more than 30 recommended solutions across seven broad principles that would “increase Medicaid’s efficiency and effectiveness as a part of the overall health care delivery system regardless of whether or not [the Affordable Care Act (ACA)] is repealed.”

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Quarterly Medicaid Managed Care Enrollment Update – Q3 2016

This week, we reviewed recent Medicaid enrollment trends in capitated, risk-based managed care in 24 states.[1] Many state Medicaid agencies elect to 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 24 states have released monthly Medicaid managed care enrollment data through the third quarter (Q3) of 2016. This report reflects the most recent data posted.

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HMA Conference on Integrated Delivery Is Just a Month Away, More than 200 Already Registered to Attend

This week, we are providing an update on HMA’s inaugural conference on The Future of Publicly Sponsored Healthcare: Building Integrated Delivery Systems for Vulnerable Populations, October 10-12, 2016, at The Palmer House in Chicago. More than 200 industry leaders have already registered to attend, including top executives from hospitals, health systems, clinics, provider practices, community-based organizations, and Medicaid managed care plans. Featuring 37 high-level industry speakers, conference panels and breakout sessions are designed to inspire discussion about real-world approaches to helping provider organizations improve the health status of patient populations, lower costs, and ensure a more satisfactory patient experience. Visit the conference website at https://fpsh.healthmanagement.com/ for complete details.

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Texas Submits Uncompensated Care Evaluation to CMS

This week, we reviewed the independent evaluation of Texas’ Uncompensated Care Pool submitted to the Centers for Medicare and Medicaid Services (CMS) by the Texas Health and Human Services Commission (HHSC). The evaluation, which was required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, was completed by Health Management Associates (HMA).

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