Insights

Report conducted by HMA addresses alarming youth suicide trends across Colorado

On January 3, 2019, Colorado Attorney General Cynthia H. Coffman released the study, Community Conversations to Inform Youth Suicide Prevention. The multi-layered study, conducted by HMA, focused on the four Colorado counties with the highest youth suicide rate.

HMA designed a multi-pronged strategy to the study with the goal of learning about opportunities and approaches to youth suicide prevention in each of the four counties, and across Colorado. The team conducted 42 stakeholder interviews and also facilitated 34 focus groups with adults and youth from various communities and sectors. For comparison, focus groups were also conducted with school staff and parents in two counties, where youth suicide rates were lower and/or there had not been recent suicide clusters.

HMA also reviewed information about current suicide prevention activities and resources, traditional and social media coverage related to suicide, and publicly available information on school policies and procedures related to suicide prevention and postvention in the aftermath of a student suicide or suicide attempt.

Key findings:

Risk factors attributing to youth suicide:

Pressure and anxiety about failing
Social media and cyber bullying
Lack of pro-social activities
Lack of connection to a caring adult
Judgement and lack of acceptance in the community.
Substance use, mental health disorders and trauma history
Adult suicides in the community

Barriers to suicide prevention:

Not enough resources to effectively implement youth suicide prevention, intervention and postvention activities
Each county faces lack of resources and funding for public health and social services programs
Lack of equitable distribution of resources across agencies
Lack of mental health providers in these communities who accept Medicaid
Communities with more mental health resources have few providers who are trained to work with youth or the providers only accept adults
Stigma associated with seeking help
Stigma against LGBTQ+ individuals limits the places and resources from which those individuals seek help

HMA Experts Contribute to Report on Health Disparities in Minnesota’s Medicaid Population

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Editors Note: This post was authored by HMA Principal Ellen Breslin, MPP.

The Minnesota Department of Human Services (DHS) recently submitted a report to the Minnesota Legislature, called Accounting for Social Risk Factors in Minnesota Health Care Program Payments. This report represents a multi-year effort on the part of DHS, and a real step forward in moving from social risk as a concept to a quantifiable methodology to explain its impact on health. The report delivers DHS recommendations to reduce health disparities among Medicaid and other DHS program participants.

Medicaid Expansion Considerations For Non-Expansion States

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This week, our In Focus section is led by Matt Powers, a Principal in our Chicago office, who worked with HMA colleagues to summarize the factors that non-expansion states weigh when considering whether or not to expand Medicaid under the Affordable Care Act. Including the states where Medicaid expansion ballot initiatives passed, 37 states have chosen Medicaid expansion or are moving toward Medicaid expansion. More than 12 million newly eligible individuals are insured by state Medicaid programs through the expansion. Comments on recent ACA Court Ruling:

Medicaid and Exchange Enrollment Update – September 2018

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This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “September 2018 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on November 30, 2018. Additionally, we review 2018 Exchange enrollment data from the “Health Insurance Marketplaces 2018 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on April 3, 2018. Combined, these reports present a picture of Medicaid and Exchange enrollment in 2018, representing 73 million Medicaid and CHIP enrollees and nearly 12 million Exchange enrollees.

Premium Assistance Programs for the Working Adult Population in Medicaid Expansion States

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This week, our In Focus section comes to us from HMA Senior Consultant Erin Mathies (Indianapolis), who reviews the premium assistance programs for the working adult population in Medicaid expansion states. Medicaid programs that pay for premiums in commercial insurance for individuals eligible for Medicaid have been part of state Medicaid programs since the 1990s. Under a premium assistance program, the employer or individual market coverage is the primary plan and Medicaid supports the cost of the premium, pays for cost sharing, and provides any wrapped benefits. These programs can save money for state Medicaid agencies by leveraging the employer contribution towards premiums and holding expenditures per member to the annual out of pocket maximum amounts. Existing Health Insurance Premium Payment (HIPP) programs traditionally cover children and populations with disabilities. Individuals eligible under the Medicaid Expansions may be more likely to have access to employer sponsored-insurance (ESI) and leveraging premium assistance options for these populations represents an unrealized opportunity for many state Medicaid agencies.

Navigating CMS’ Proposed Medicaid Managed Care Regulations

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This week’s HMA Weekly Roundup features an In Focus article from HMA Senior Consultants Amber Swartzell and Stephanie Baume (Indiana), who reviewed the Centers for Medicare & Medicaid Services (CMS) proposed Medicaid managed care regulations. On November 8, 2018, CMS released a proposed rule that would update several sections of the Medicaid and Children’s Health Insurance Program (CHIP) managed care rules, which were most recently amended in 2016. This much anticipated proposal, scheduled to appear in the Federal Register on November 14, 2018, focuses on “promoting flexibility, strengthening accountability, and maintaining and enhancing program integrity.” The key provisions of the proposed regulations are summarized below.

Florida Statewide Medicaid Managed Care (SMMC) Awards

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This week, our In Focus section comes to us from Principal Elaine Peters (HMA – Florida), who reviews the recent re-procurement by the Florida Agency for Health Care Administration (AHCA) of its Statewide Medicaid Managed Care (SMMC) health and dental plans. The SMMC program currently has two key program components: Long-Term Care (LTC) and Managed Medical Assistance (MMA). The new SMMC program changes the two components to: Integrated MMA and LTC and Dental. The 2016 Legislature “carved out” dental services from MMA plans and new dental plans will be responsible for providing dental services to eligible members.

A Deeper Look Into Highlights From the Kaiser/HMA 50-State Medicaid Director Survey

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This week, our In Focus section reviews highlights and shares key takeaways from the 18^th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 25, 2018, in two new reports: States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019 and Medicaid Enrollment & Spending Growth: FY 2018 & 2019. The reports were prepared by Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, and Aimee Lashbrook from HMA, and by Elizabeth Hinton, Larisa Antonisse, and Robin Rudowitz from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.

50-State Medicaid Director Survey Released: States Focus on Quality and Outcomes Amid Waiver Changes

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Results of the 18^th annual Medicaid Budget Survey were released Oct. 24, 2018 and examine changes taking place in Medicaid in all 50 states and the District of Columbia. The Kaiser Family Foundation (KFF) and HMA conduct the survey in partnership with the National Association of Medicaid Directors.

50-state Medicaid director survey released: states focus on quality and outcomes amid waiver changes

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Key findings of the study include:

A growing number of states are implementing or planning to implement Section 1115 waivers
Risk-based managed care continues to be the predominant deliver system for Medicaid services
States are working to address social determinants of health
Expansion of people served in in-home and community-based settings
States are planning provider rate increases, increase in benefits for mental health and substance use disorder treatment and efforts to address rising prescription drug costs and management strategies to address the opioid crisis.

The report was prepared by Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, and Aimee Lashbrook from HMA, and by Elizabeth Hinton, Larisa Antonisse, and Robin Rudowitz from the Kaiser Family Foundation.

CMS Section 1115 Medicaid Demonstration Evaluation Requirements: Implications for Designing Consumerism & Personal Responsibility Waivers

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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 the implications for designing consumerism and personal responsibility waivers.

MACPAC contracted with HMA to better understand how states develop their hospital payment policies

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Health Management Associates was contracted by MACPAC to better understand how states develop their hospital payment policies. State, hospital, and managed care representatives from five states that vary in their use of supplemental payments and financing approaches (Arizona, Louisiana, Michigan, Mississippi, and Virginia) were interviewed. The three key findings from the study include:

The availability of financing for the non-federal share of Medicaid payments has affected states’ use of base and supplemental payments;
The use of Medicaid managed care has not substantially affected Medicaid payments to hospitals; and,
The adoption of prospective payment systems and value-based payment models is slow.

MACPAC presented this information at its September 2018 Commission meeting.

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Report conducted by HMA addresses alarming youth suicide trends across Colorado

Key findings:

HMA Experts Contribute to Report on Health Disparities in Minnesota’s Medicaid Population

Medicaid Expansion Considerations For Non-Expansion States

Medicaid and Exchange Enrollment Update – September 2018

Premium Assistance Programs for the Working Adult Population in Medicaid Expansion States

Navigating CMS’ Proposed Medicaid Managed Care Regulations

Florida Statewide Medicaid Managed Care (SMMC) Awards

A Deeper Look Into Highlights From the Kaiser/HMA 50-State Medicaid Director Survey

50-State Medicaid Director Survey Released: States Focus on Quality and Outcomes Amid Waiver Changes

50-state Medicaid director survey released: states focus on quality and outcomes amid waiver changes

CMS Section 1115 Medicaid Demonstration Evaluation Requirements: Implications for Designing Consumerism & Personal Responsibility Waivers

MACPAC contracted with HMA to better understand how states develop their hospital payment policies

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Key findings: