HMA Insights: Your source for healthcare news, ideas and analysis.
HMA Insights – including our new podcast – puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.
Organizations are facing extensive challenges to improve health outcomes and healthcare quality through broad delivery, payment, and program reforms in CalAIM. With proven expertise in CalAIM policy, operations, and implementation, Health Management Associates (HMA) can help you with identifying needs, developing a strategy, and implementing those plans. We actively support clients across California implementing the CalAIM Section 1115 Waiver Demonstration Justice-Involved Initiative. Our team of Medi-Cal, managed care, and correctional healthcare experts – including physical and behavioral health clinicians, healthcare administrators, and former correctional leaders – are uniquely positioned to help clients navigate this deliverysystem transformation.
California is the first state in the nation to receive approval from the Centers for Medicare and Medicaid Services (CMS) to provide detained and sentenced individuals with 90-day pre-release healthcare services and behavioral health linkages. Through PATH JI grant funding, HMA is helping clients build administrative capacity, information technology, pre-release services, care management models, and Medi-Cal claiming infrastructure to meet their unique needs and leverage this significant opportunity. Our planning and implementation support spans the breadth of the CalAIM Justice-Involved Initiative including: the pre-release Medi-Cal application process, 90-day pre-release services, behavioral health links, Enhanced Care Management (ECM), and Community Supports services.
That’s why sheriffs’ departments, probation authorities, correctional health services agencies, behavioral health agencies, managed care plans, healthcare providers and community-based organizations see HMA as a trusted partner in helping to develop and implement 1115 waiver healthcare programs.
We provide:
Project management
State policy monitoring and compliance tracking
Current and future state process mapping
Partner and stakeholder collaboration and meeting facilitation
Process and quality improvement recommendations
Protocol development
Implementation plan and readiness assessment drafting
With more than 25 years of experience in comprehensive healthcare and justice-related service delivery, Julie White has developed policy, strategic … Read more
Health Management Associates (HMA), a leading independent, national healthcare consulting firm today announced that it is establishing offices in North Carolina and New Orleans.
In North Carolina, HMA will have a presence in Raleigh and Charlotte with plans to continue building out the North Carolina team in the coming months.
The Focus Group, based in New Orleans, joined HMA in 2022, and HMA continues to expand its footprint there adding new colleagues from the area to its roster of experts. They will share office space at The Focus Group’s current Poydras Street location.
“Our firm’s continued growth is designed to support the current and future needs of our clients across the country,” said Doug Elwell, HMA’s chief executive officer. “We are excited to plant roots in North Carolina and expand our talented team in New Orleans as we help clients successfully navigate the toughest challenges facing healthcare and human services.”
About HMA
Founded in 1985, HMA is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. Clients include government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. With offices in more than 30 locations across the country and over 700 multidisciplinary consultants coast to coast, HMA’s expertise, services, and team are always within client reach. Learn more about HMA at healthmanagement.com, or on LinkedIn and X.
Health Management Associates (HMA) has partnered with the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition to produce a series of briefs that characterize the opportunities to improve coordination of services for children.
In this brief, “State Policy and Practice Recommendations to Advance Improvements in Children’s Behavioral Health,” the HMA team of Caitlin Thomas-Henkel, Uma Ahluwalia, Heidi Arthur and Annalisa Baker, and Devon Schechinger address key issues and highlighted practice recommendations that are designed to bring forth systems change and raise awareness at the state level. This brief provides state policymakers and behavioral health leaders with a vision for coordinating and optimizing services to promote mental health well-being, prevent behavioral health conditions, and ensure access to a coordinated continuum of behavioral healthcare.
Health Management Associates (HMA) has partnered with the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition to produce a series of briefs that characterize the opportunities to improve coordination of services for children with behavioral health needs.
“The Role of Specialized Manage Care,” written by HMA experts, Heidi Arthur, Angela Bergefurd, Caitlin Thomas-Henkel and Uma Ahluwalia, focuses on addressing the intersection of child welfare reform and health transformation. This issue brief explains how specialized Medicaid managed care plans can ensure better alignment between child welfare and behavioral healthcare services. The role of special needs plans for the delivery of coordinated care is emphasized and the opportunities to leverage specialty managed care plans by states are highlighted.
Health Management Associates (HMA) has partnered with the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition to produce a series of briefs that characterize the opportunities to improve coordination of services for children.
In this brief, “Improving Outcomes for Children in Crisis with Evidence-Based Tools,” the HMA team of experts which include Rachel Bembas, Lauren Niles, Caitlin Thomas-Henkel and Uma Ahluwalia, outline limitations of current pediatric quality measures and several approaches to measure and track goals and objectives while offering a call to action at both the state and local levels. The brief calls on federal, state, and local entities, payers, provider organizations, and community-based organizations to collectively take steps to bolster and improve existing standardized monitoring, evaluation, and quality measurement efforts for youth mental health.
Health Management Associates (HMA) has partnered with the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition to produce a series of briefs that characterize the opportunities to improve coordination of services for children.
The significance of caregiver support for healthy early childhood outcomes is highlighted in this brief “Early Childhood Mental Health: The Importance of Caregiver Support in Promoting Healthy Child Development and Clinical Interventions for Children written by HMA experts Christina Altmayer, Caitlin Thomas-Henkel and Uma Ahluwalia. This brief explores the role of Medicaid in advancing early childhood child mental health outcomes, the importance of caregiver support in promoting healthy child development, and innovative practices aimed at increasing access to supports.
Health Management Associates (HMA) has partnered with the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition to produce a series of briefs that characterize the opportunities to improve coordination of services for children.
Connecting Schools to the Larger Youth Behavioral Health System: Early Innovations from California focuses on the role schools can play in ensuring that children and youth get the behavioral healthcare they need. Written by HMA experts, Michael Butler, Ilia Rolon, Caitlin Thomas-Henkel and Uma Ahluwalia, this brief outlines California’s innovative approach to expanding access while describing the lessons learned and potential implications for other states.
Health Management Associates (HMA) offered a 3-part series of webinars looking at the effect of proposed regulations on delivery of opioid treatment services to the population facing addiction issues. In this third and final webinar, HMA consultants highlighted opportunities for state regulators to shape policy and regulation of substance use disorder (SUD) treatment.
New federal regulations encourage significant changes to how opioid treatment is provided, with the goal of expanding access and improving patient-centered care. State regulators will need to adapt their regulatory practices and work closely with Medicaid agencies and treatment providers so the new regulations can achieve their intended goals. This webinar discussed how State Opioid Treatment Authorities (SOTAs), licensing entities, and state Medicaid agencies will need to work together to craft updated regulations, facility licensing, and reimbursement practices that advance person-centered care.
HMA experts were joined by Allegra Schorr, VP, West Midtown Medical Group and President of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA). COMPA represents New York State’s Opioid Treatment Programs (OTPs), as well as providers offering office-based medication-assisted treatment, currently providing addiction treatment to over 43,000 New Yorkers.
Learning Objectives:
New Regulatory Requirements – Overview of state rules around opioid treatment vs the new requirements.
How to Improve SUD Treatment Access – Specific recommendations on statutory and regulatory changes that could lead to more patient centered treatment options.
States Leading the Way – Examples from states that are leading the way to expand access and reduce stigma.
This week, our In Focus section reviews the Michigan Medicaid Managed Care Comprehensive Health Care Program (CHCP) request for proposals (RFP), which the Michigan Department of Health and Human Services released on October 30, 2023. CHCP covers 2.2 million Medicaid members and is worth approximately $15 billion.
MIHealthyLife
The rebid is part of MIHealthyLife, an initiative that the department launched in 2022 to strengthen Medicaid services through new Medicaid health plan contracts. At that time, Michigan Medicaid sought input from nearly 10,000 stakeholders in an effort to strengthen Medicaid managed care contracts and create a more equitable, coordinated, and person-centered system of care. Based on the feedback, the department designed the RFP with a focus on five strategic pillars:
• Serve the Whole Person, Coordinating Health and Health-Related Needs • Give All Kids a Healthy Start • Promote Health Equity and Reduce Racial and Ethnic Disparities • Drive Innovation and Operational Excellence • Engage Members, Families and Communities
RFP
Medicaid managed care organizations (MCOs) serve 10 regions, each consisting of multiple counties. MCOs will bid on one or more of the regions throughout the state. Each region requires at least two plans, with the exception of Region 1, a rural area that includes Michigan’s Upper Peninsula, where members are enrolled in a single plan.
As part of the MIHealthyLife initiative, the RFP will include the following changes:
• Prioritizing health equity by requiring Medicaid health plans to achieve National Committee for Quality Assurance Health Equity Accreditation • Addressing social determinants of health through investment in and engagement with community-based organizations • Increasing childhood immunization rates, including greater provider participation in the Vaccines for Children program • Adopting a more person-centered approach to mental health coverage • Ensuring access to health care providers by strengthening network requirements • Increasing Medicaid Health Plan accountability and clarifying expectations to advance state priorities
Timeline
Proposals are due January 16, 2024, and implementation is anticipated to begin October 1, 2024. Contracts will run through September 30, 2029, with three one-year optional periods.
Current Market
Michigan currently has nine plans, which serve more than 2.2 million Medicaid and expansion members. The table below provides a breakdown of the plan market share by enrollment.
This week, our In Focus section summarizes the Medicaid Long-Term Services and Supports (LTSS) Annual Expenditures Report, which the Centers for Medicare & Medicaid Services (CMS) released on October 17, 2023. The report includes detailed information about Medicaid LTSS expenditures for federal fiscal year (FY) 2020, which runs from October 1, 2019, through September 30, 2020. During this time, LTSS spending grew 20 percent to $199.4 billion from the previous year.
Medicaid LTSS Expenditures
Medicaid LTSS expenditures cover home and community-based services (HCBS), which includes personal care and home health, as well as institutional care, which includes services provided in nursing facilities, intermediate care facilities (ICF) for individuals with intellectual or developmental disabilities (IDD), and mental health facilities. HCBS accounted for 62.5 percent ($124.6 billion) of LTSS expenditures. The remaining 37.5 percent, or $74.8 billion, was directed toward institutional care (see Figure 1).
Figure 1. Medicaid LTSS Expenditures by Type
In addition, Section 1915c waiver program spending accounted for 43.1 percent of HCBS expenditures, followed by personal care at 20.5 percent. See Figure 2 for additional breakouts.
Figure 2. Percentage of Medicaid HCBS Expenditures by Service Category
Nursing facilities accounted for the largest percentage (78.2 percent) of institutional care spending. See Figure 3 for additional breakouts.
Figure 3. Percentage of Medicaid Institutional Expenditures by Service Category
Medicaid LTSS spending accounted for 33.5 percent of total Medicaid spending in FY 2020. States with the highest LTSS as a percentage of total Medicaid spending were North Dakota at 54.9 percent, Wyoming at 54 percent, Kansas at 51.2 percent, Minnesota at 49.6 percent, and Nebraska at 45.2 percent. Texas and Virginia did not report spending for Medicaid LTSS programs, which comprise a substantial share of total LTSS expenditures in those two states (see Table 1).
Table 1. Medicaid LTSS Expenditures by State
LTSS spending per resident also varied from state to state. On average, states spent $679 Medicaid LTSS dollars per state resident in FY 2020. Utah had the lowest Medicaid LTSS expenditures per state resident at $284, whereas the District of Columbia had the highest at $1,554 per resident.
Medicaid MLTSS Expenditures
Medicaid managed long-term services and supports (MLTSS) spending totaled $57 billion in FY 2020. HCBS accounted for $35.7 billion and institutional care accounted for $21.3 billion. As more states adopted and extended their Medicaid managed care programs, MLTSS spending grew 750 percent from FY 2008.
In FY 2020, 25 states had operational MLTSS programs. Of these, nine were Financial Alignment Initiative (FAI) capitated model demonstrations for dual eligible members. New York, Pennsylvania, Florida, and California accounted for 58 percent of total MLTSS spending nationally, with New York representing 23 percent of total national MLTSS expenditures. Three states—Idaho, Texas, and Virginia—did not report MLTSS spending (see Figure 4).
Figure 4. States with MLTSS programs, FY 2020
Source: Mathematica
Iowa had the highest share of MLTSS expenditures as a percentage of total Medicaid LTSS expenses in FY 2020 at 95 percent. Arizona and Kansas followed at 94 percent and Hawaii at 74 percent. The national average was 29 percent. At the lowest end were South Carolina at 4 percent and Rhode Island at 12 percent, both of which are fee-for-service states. Michigan followed at 14 percent.
Contributing Factors to LTSS Expenditures
The COVID-19 public health emergency, which includes the first six months of the pandemic that started in March 2020, had a major effect on LTSS expenditures in FY 2020. Many residents in long term care facilities are covered by Medicaid and disproportionately experienced the most COVID-19 deaths. States began to implement various policies to address the impact of COVID-19 among Medicaid LTSS users. This includes modifying utilization limits for covered services and increasing payment rates for certain institutional services and HCBS.
As mentioned earlier, Texas and Virginia did not report Medicaid LTSS expenditures, which undercut the national total. Other factors that affect the reliability of Medicaid LTSS data include changes in state MLTSS expenditure reporting methods, and changes in state Medicaid LTSS policies and programs.
Note: CMS hired Mathematica to conduct the research, which used CMS-64 Medicaid expenditure report data, state-reported MLTSS data, Money Follows the Person (MFP) worksheets for proposed budgets, CMS 372 data on section 1915(c) waiver program population groups, and U.S. Census data to compile the report
