This week, our In Focus section provides a high-level overview of the new Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) integration requirements in the Centers for Medicare & Medicaid Services (CMS) April 16, 2019, final rule for calendar year (CY) 2021. CMS recently released two publications providing guidance and technical assistance to assist with the implementation of these new opportunities: the November 14, 2019, CMCS Informational Bulletin and Integrated Care Resource Center technical assistance tool Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans. Both identify steps to ensure that states’ Medicaid agency contracts (SMACs) with D-SNPs comply with the new 2021 requirements, and further encourage states and D-SNPs to work together to address the often fragmented care provided to the Medicare-Medicaid dually eligible population.
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This week, our In Focus section reviews the annual Medicaid health plan ratings released in September by the National Committee for Quality Assurance (NCQA), which rated 171 Medicaid plans. For 2019-20, NCQA used a ratings methodology that scored each health plan from 0 to 5 in 0.5 increments – a system similar to the Five-Star Quality Rating System used by the Centers for Medicare and Medicaid Services. A plan is considered top-rated if it scores a 4.5 or 5 and low-rated if it scores a 1 or 2. For 2019-20, only 15 Medicaid plans across the country were awarded a 4.5 or 5.
In November 2019, the Centers for Medicare & Medicaid Services (CMS) officially proposed a comprehensive regulation on Medicaid fiscal accountability. To facilitate review of the rule, HMA staff have created an overview of key elements of the proposed regulation and summary. This document is designed to give a framework to analyze the proposal and provides analysis in most sections. The HMA team can provide in-depth policy support unique and local issues may require.
Working with the Kaiser Family Foundation (KFF), a team of HMA colleagues, Managing Principal Sharon Silow-Carroll, Consultant Carrie Rosenzweig, Senior Consultant Diana Rodin, and Principal Rebecca Kellenberg, completed the project.
Through state policy reviews, site visits, interviews with local stakeholders, and focus groups with low income women, the team examined how national, state, and local policies, as well as cultural factors, shape access to contraceptive care, sexually transmitted infection prevention and treatment, obstetrical care, and abortion services. The study focused on the on-the-ground experiences of women living in these communities and the reproductive health professionals caring for them.
The study identified themes that cut across all five “medically underserved” communities but play out in different ways depending on the local environment. The key factors influencing access include cultural and social determinants of health, healthcare coverage, provider supply and distribution, sex education, and abortion policies and environment.
This week, our In Focus section reviews the California Advancing and Innovating Medi-Cal (CalAIM) proposal, issued by the California Department of Health Care Services (DHCS) on October 28, 2019. CalAIM would implement broad delivery system, program, and payment reform for the state’s Medicaid program. The proposal includes efforts to address social determinants of health and other policy priorities such as homelessness, lack of access to behavioral health care, children with complex medical conditions, justice-involved populations, and aging individuals. According to DHCS, the three key goals of the proposal are to:
This week, our In Focus reviews the Medicare Advantage (MA) and Part D landscape files and quality performance data for the 2020 plan year from the Centers for Medicare & Medicaid Services (CMS). Data on MA and Part D offerings include premiums and benefit design, as well as Star Ratings for each MA contract. This year’s release signals continued growth for the MA program in 2020. The total number of MA plans increased by 403 offerings to 3,144, up from 2,741 in 2019, the highest number since inception of the program. Notably, growth appears to be occurring in parts of the country with existing market saturation, as many MA organizations are offering new plans in states with MA enrollment levels of 30 percent or higher. There is also significant growth in the number of Dual Eligible Special Needs Plans (D-SNPs) offered by MA organizations, particularly among top MA sponsors Humana and CVS (Aetna).
This week, our In Focus section reviews highlights and shares key takeaways from the 19th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 18, 2019, in two new reports: A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020 and Medicaid Enrollment & Spending Growth: FY 2019 & 2020. The report was prepared by Kathleen Gifford and Aimee Lashbrook from HMA; Eileen Ellis and Mike Nardone; and by Elizabeth Hinton, Robin Rudowitz, Maria Diaz, and Marina Tian from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
Results of the 19th annual Medicaid Budget Survey were released Oct. 18, 2019 and examine changes taking place in Medicaid in all 50 states and the District of Columbia. The Kaiser Family Foundation (KFF) and HMA conducted the annual survey in partnership with the National Association of Medicaid Directors.
Key findings of the survey include:
- Multiple states reported expansions or enhancements to provider rates and benefits.
- Several states implemented, adopted, or continued to debate the ACA Medicaid expansion.
- A growing number of states continued to pursue work requirements and other policies promoted by the Trump administration that could restrict eligibility.
- States are implementing Medicaid initiatives to address social determinants of health, control prescription drug spending, improve birth outcomes and reduce infant mortality, and address the opioid epidemic.
This week, our In Focus section reviews the Pennsylvania HealthChoices Physical Health Medicaid managed care request for applications (RFA), issued by the Pennsylvania Department of Human Services on October 15, 2019. Medicaid managed care organizations (MCOs) will serve the five HealthChoices zones covering all 67 counties: Southeast, Southwest, Lehigh-Capital, Northwest, and Northeast. Contracts are worth nearly $13 billion.
This week, our In Focus section reviews the Utah Medicaid Section 1115 Demonstration Waiver amendment Fallback Plan, released for public comment on September 27, 2019. The Fallback Plan would raise Utah’s Medicaid expansion income limit to 138 percent of the federal poverty level (FPL). Voters in the state passed full Medicaid expansion through a ballot initiative in 2018, however, the state only enacted partial expansion through a waiver. The Fallback Plan looks to fully expand Medicaid, while also implementing certain provisions, including work requirements and premiums.
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states. 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. All 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the second quarter (Q2) of 2019. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):