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)[1]. 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.
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Medicaid Managed Care Enrollment Update – Q2 2019
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states.[1] 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):
Highlights from this Week’s HMA Conference on The Next Wave of Medicaid Growth and Opportunity
This week, our In Focus section provides a recap of the fourth annual HMA Conference, The Next Wave of Medicaid Growth and Opportunity: How Payers, Providers, and States are Positioning Themselves for Success, held this Monday, September 9, and Tuesday, September 10, in Chicago, Illinois. Nearly 500 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 challenges and opportunities for organizations serving Medicaid and other vulnerable populations. 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.
Hawaii Releases Quest Integration Medicaid Managed Care RFP
This week, our In Focus section reviews the Hawaii QUEST Integration (QI) Medicaid Managed Care request for proposals (RFP), issued by the Hawaii Department of Human Services (DHS) on August 26, 2019. DHS intends to contract with four health plans. All four will serve Medicaid and Children’s Health Insurance Program (CHIP) members in Oahu, while two will also operate statewide. The two plans with the highest scoring technical proposals will serve beneficiaries statewide. The Quest Integration program is worth $2.2 billion annually.
Strategies to Support Postpartum Visits for Women in Medicaid
This week, our In Focus section comes from HMA Community Strategies (HMACS) Senior Associate Diana Rodin and HMA Managing Principal Sharon Silow-Carroll who authored a recent article in the Journal of Women’s Health drawing on data from the recently completed five-year evaluation of the Strong Start for Mothers and Newborns II Initiative to identify promising approaches to support women in Medicaid to attend postpartum visits. Nationally, less than 60 percent of women enrolled in Medicaid or the State Children’s Health Insurance Program attend a scheduled postpartum medical visit, and some states have much lower rates.[1],[2]
HMA Colleagues Author Journal Article on Strategies to Support Postpartum Visits for Women in Medicaid
HMA Community Strategies (HMACS) Senior Associate Diana Rodin and HMA Managing Principal Sharon Silow-Carroll have authored an article drawing on data from the recently completed five-year evaluation of the Strong Start for Mothers and Newborns II Initiative to identify promising approaches to support women in Medicaid to attend postpartum visits.
Jonathan Blum to Join HMA as Managing Principal
Jonathan (Jon) Blum will join HMA as a managing principal on Aug. 31 working out of the Washington, DC office.
He has more than 20 years of senior-level experience working in public and private healthcare financing organizations, including the Centers for Medicare and Medicaid Services (CMS).
CMS Medicare Fee-For-Service FY2020 Proposed Rules: Hospital Outpatient Department and End-Stage Renal Disease
This week, our In Focus section reviews the new Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service FY 2020 proposed rules. On July 29, 2019, CMS issued the Calendar Year (CY) 2020 proposed rules for the Physician Fee Schedule (PFS), the hospital outpatient department (HOPD) and ambulatory surgical center (ASC) prospective payment systems (PPS), and the End-Stage Renal Disease (ESRD) PPS. These proposed regulations include payment rate and policy changes for the upcoming calendar year. The comment deadline for all three of these proposed rules is September 27, 2019.
CMS Releases Section 1332 Waiver Application Resource Tools
This week, our In Focus section reviews the new 1332 State Relief and Empowerment Waiver resources released by the Centers for Medicare & Medicaid Services (CMS) on July 15, 2019. The new resources, intended to help states better understand regulations and reduce burdens associated with waiver application, include four waiver concept papers on how states can take advantage of the flexibility to wave certain Affordable Care Act (ACA) requirements, as well as their respective application templates. CMS has also released an updated application checklist of required elements.
California 2019-20 Budget Overview
This week, our In Focus section reviews the California fiscal 2019-20 budget. California Governor Gavin Newsom signed his first budget, and much of its related legislation on June 27, 2019. The budget appropriates $214.8 billion ($147.8 billion General Fund) in total spending with $19.2 billion in reserves. The total reserves includes $16.5 billion in the Rainy Day Fund, $1.4 billion in the Special Fund for Economic Uncertainties, $900 million in the Safety Net Reserve, and nearly $400 million in the Public School System Stabilization Account.
Dual Eligible Financial Alignment Demonstration Enrollment Update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for beneficiaries dually eligible for Medicare and Medicaid (duals) 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 duals 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 May 2019, approximately 372,600 duals were enrolled in an MMP. Enrollment was flat from May of the previous year.
HMA, CMCS Launch Resource for Medicaid Innovation Program
A team of HMA consultants, led by Izanne Leonard-Haak and Matt Roan, have collaborated with organizations under a Centers for Medicaid and CHIP Services (CMCS) contract to provide support to CMCS on the Medicaid Innovation Accelerator Program.