Public Health

Medicaid Managed Care Provides Opportunities for States to Address Social Determinants of Health and Health Equity

This week, our In Focus highlights a new report prepared by Health Management Associates (HMA) on the potential for Medicaid Managed Care to enable states to address social determinants of health (SDOH) and health equity above and beyond what’s possible with traditional fee-for-service models. The report was released by Together for Better Medicaid, a coalition committed to building a better Medicaid system across the country.

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Dual Eligible Financial Alignment Demonstration Enrollment Updated

This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for individuals dually eligible for Medicare and Medicaid (dual eligibles) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of dual eligibles 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 February 2021, approximately 392,000 dual eligibles were enrolled in an MMP. Enrollment rose 5.7 percent from February of the previous year.

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Modest Skilled Nursing Facility Payment Update and Policy Updates in 2022 Proposed Rule

This week, our In Focus reviews the fiscal year (FY) 2022 skilled nursing facility (SNF) proposed payment rule, released by the Centers for Medicare & Medicaid Services (CMS) on April 8, 2021. If the proposals contained in the rule are foreshadowing, SNFs will continue to face financial pressures coming out of the public health emergency. This payment update, combined with other policy proposals, is likely to lead to the smallest payment update since the Medicare Access and CHIP Reauthorization Act of 2015 set a 1 percent increase in FY 2018. The rule proposes a net payment update of 1.3 percent after accounting for forecast error and the multifactor productivity adjustment. In addition to the payment update, CMS proposes changes to the SNF Quality Reporting Program (QRP), and the SNF Value-Based Program (VBP) for FY 2022. Notably, CMS proposes an eventual payment correction to achieve a budget neutral implementation of the Patient-Driven Payment Model (PDPM) that could result in a 5 percent rate reduction.

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Federal Funding for Home and Community-based Services (HCBS): Enacted and Proposed Investments

This week, our In Focus reviews federal enacted and proposed investments in home and community-based services (HCBS). HCBS are critically important for millions of Americans with disabilities and older adults, assisting them to remain in their homes and participate in their communities. People with disabilities and older adults have also been disproportionately affected by COVID-19, yet little federal funding has been directed to HCBS during the public health emergency. This changed on March 11, 2021, when the American Rescue Plan Act (ARPA) was signed into law, with both Medicaid and non-Medicaid HCBS funding included. Additionally, the Administration has recently proposed further HCBS investments in both The American Jobs Plan and the President’s 2022 Discretionary Request.

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CMS Interoperability and Patient Access Final Rule – Part 2

This blog was written by Laura Zaremba, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC

Making the Economics Work for You

Most health care organizations impacted by the Interoperability Rule have very logically focused their attention and resources on interpreting what the new rule requires them to do within their own systems, in what timeframe, and at what cost. And to be sure, scoping the work and deploying the resources required to meet the compliance deadlines is a significant investment of time and money, but the compliance focus should be only the first action step for to the Interoperability Rule.

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Nursing Home Report Highlights Benefits of Single Resident Rooms

The COVID-19 pandemic highlighted nursing home safety and infection control as critical public health issues. A new report authored by HMA colleagues found compelling evidence that single rooms in nursing homes have numerous benefits for both public health and residents’ experience. The authors conclude that transitioning from multi-resident rooms to single rooms should be a component of person-centered nursing home reform. The report calls on stakeholders to come to the table to discuss options and strategies for long-term care redesign and transformation. 

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Highlights from Kaiser/HMA 50-State Medicaid Director Survey COVID-19 Update for FY 2021 and FY 2022

This week, our In Focus section shares key takeaways from the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) mini-survey of Medicaid directors in all 50 states and the District of Columbia titled, Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022. The survey, released on March 12, 2021, is an update to the 20th annual Medicaid Budget Survey conducted by KFF and HMA. The brief is authored by Elizabeth Hinton , Lina Stolyar , and Robin Rudowitz from KFF with survey assistance and dissemination from HMA Principal Kathy Gifford and Consultant Anh Pham.

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California Releases Revised CalAIM Proposal

This week, our In Focus section summarizes the revised California Advancing and Innovating Medi-Cal (CalAIM) proposal, released on February 17, 2021. Medi-Cal, the state’s Medicaid program, covers over 12 million individuals, with over 11 million in managed care. CalAIM seeks to standardize and streamline the Medi-Cal program and address health disparities and social determinants of health for high-risk, high-cost Medi-Cal members through broad-based delivery system, program, and payment reform. CalAIM was originally scheduled to begin its tiered implementation in January 2021, but due to COVID-19 has been delayed until January 2022. The revised proposal incorporates additional stakeholder input, learnings from the workgroup meetings, and ongoing policy development.

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New Report Supports State Medicaid Programs to Advance Health Justice

Rates of illness and death due to the COVID-19 pandemic have disproportionally impacted Americans who are Black, African American, Latinx, Native American, Asian, and other people of color as well as people with disabilities and those subsisting on poverty-level income. In response to this, AcademyHealth, in partnership with the Disability Policy Consortium (DPC), a Massachusetts-based cross-disability advocacy and action research organization, released a new report: Advancing Health Justice Using Medicaid Data: Key Lessons from Minnesota for the Nation. This report provides information on the importance of investing in data analysis to advance health justice in Medicaid populations. It further highlights the importance of partnering with communities most impacted by injustices that cause inequities in health outcomes.

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