Public Health

Public Health

Texas Medicaid and CHIP Managed Care Final Comprehensive Report

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This week, our In Focus section comes to us from Senior Consultant Ryan Mooney, reviewing the Texas Medicaid and Children’s Health Insurance Program (CHIP) Evaluation report. The 85th Legislature of the State of Texas required the Texas Health and Human Services Commission (HHSC) to report on its findings for Rider 61, Evaluation of Medicaid Managed Care (the Report). HHSC recently published the Report, which includes the following:

  1. Rider 61(a) – A review of the current Medicaid and Children’s Health Insurance Program (CHIP) managed care delivery system and an assessment of the performance of managed care;
  2. Rider 61(b) – An assessment of Medicaid and CHIP managed care contract review and oversight;
  3. Rider 61(c) – A study of Medicaid Managed Care rate setting processes and methodologies in other states; and
  4. Rider 61(d) – An analysis of MCO administrative costs, including a survey of each MCO to determine the nature and scale of administrative resources devoted to the Texas Medicaid and CHIP programs and the identification of cost reduction opportunities.

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Highlights From This Week’s HMA Conference On The Rapidly Changing World Of Medicaid

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This week, our In Focus section provides a recap of the third annual HMA Conference, The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States, held this Monday, October 1, and Tuesday, October 2, in Chicago, Illinois. More than 450 leading executives representing managed care organizations, providers, state and federal government, community-based organizations, and other stakeholders in the health care field gathered to address the opportunities and challenges facing health plans, states, and providers as they strive to provide the best possible care to Medicaid beneficiaries and other vulnerable populations at a time of significant uncertainty and change. Conference participants heard from keynote speakers, engaged in panel discussions and connected during informal networking opportunities. Below is a summary of highlights from this year’s conference.

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Companion Medicaid and Medicare Advantage Dual Eligible Special Needs Plans

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This week, our In Focus section reviews Medicare-Medicaid integration opportunities through Dual Eligible Special Needs Plans (D-SNPs). States are motivated to expand their capacity to address the needs of dually eligible beneficiaries through integrated care. They are increasingly requiring health plans that operate Medicaid managed long-term services and supports (MLTSS) programs to become Medicare Advantage (MA) D-SNPs. A few states require D-SNPs to be Medicaid MLTSS health plans.[1]

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North Carolina and District of Columbia Medicaid Managed Care RFPs

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This week, our In Focus reviews North Carolina’s much-anticipated Prepaid Health Plan Services request for proposals (RFP), released by the Department of Health and Human Services, Division of Health Benefits on August 9, 2018, and District of Columbia’s Medicaid Managed Care RFP released on August 14, 2018. North Carolina is transitioning its Medicaid fee-for-service program to Medicaid managed care through its procurement. DC is reprocuring its managed care program, covering the District of Columbia Healthy Families Program (DCHFP), Alliance program, and the Immigrant Children’s Program (ICP).

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Medicaid Community Engagement, Work Requirement and Consumer Empowerment Programs: Key Implementation and Operations Issues and Considerations

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This week, our In Focus section highlights HMA Medicaid Market Solutions’ (MMS) efforts to support state flexibility in designing and implementing Section 1115 Demonstration Waivers promoting member engagement and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing in-depth analyses of the many facets of these new Medicaid models. This week, we examine important issues and considerations for implementing Medicaid consumer empowerment, community engagement, and work requirements.

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New Report Assesses Effects of a Single-Payer Model for New York

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This week, our In Focus reviews a New York State Health Foundation-commissioned report titled, “An Assessment of the New York Health Act: A Single-Payer Option for New York State.” The study, conducted by the RAND Corporation, analyzes a proposal that would establish a single-payer system in New York. The proposal, known as the New York Health Act (NYH Act), was developed by New York Assembly Health Committee Chair Richard Gottfried. It was passed by the Assembly several years in a row, but has never been brought to a vote in the Senate. The New York State Health Foundation commissioned the study to provide an independent, rigorous, and credible analysis of the proposal to understand the near-term and longer-term impact of the single-payer proposal. The study assesses how the plan would affect health care coverage and costs in the state.

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New Hampshire Medicaid Care Management Draft RFP

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This week, our In Focus reviews the New Hampshire Medicaid Care Management (MCM) Services Draft request for proposals (RFP), released by the state Department of Health and Human Services (DHHS) on July 9, 2018. The MCM program, worth $750 million in annualized spending, will provide full-risk, fully capitated Medicaid managed care services to approximately 181,000 beneficiaries from July 1, 2019 through June 30, 2024. The final RFP is expected August 10, 2018.

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Washington FQHC Alternative Payment Methodology

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This week, our In Focus reviews a case study called, “Spotlight on Health Center Payment Reform: Washington State’s FQHC Alternative Payment Methodology,” authored and prepared for the National Association of Community Health Centers by Health Management Associates’ Principal Art Jones and Senior Consultant Liz Arjun. The study, published in May 2018, looks at Washington’s fourth federally qualified health center (FQHC) Alternative Payment Model (APM4), implemented in July 2017.

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MACPAC June Report to Congress Addresses Role of Managed Care in LTSS

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This week, our In Focus comes from Senior Consultant Rachel Patterson, who provides an overview of Chapter 3 of the Medicaid and CHIP Payment and Access Commission (MACPAC) June 2018 Report to Congress on Medicaid and CHIP, which examines the growing role of managed care in long-term services and supports (LTSS).  Chapter 3 includes research conducted by teams including HMA Principals Sarah Barth and Karen Brodsky regarding network adequacy for home and community-based service (HCBS) and Principals Sarah Barth, and Sharon Lewis and Senior Consultant Rachel Patterson regarding enrollment of people with intellectual and developmental disabilities (ID/DD) into MLTSS.

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