Insights

Texas Medicaid and CHIP Managed Care Final Comprehensive Report

This week, our In Focus section comes to us from Senior Consultant Ryan Mooney, reviewing the Texas Medicaid and Children’s Health Insurance Program (CHIP) Evaluation report. The 85th Legislature of the State of Texas required the Texas Health and Human Services Commission (HHSC) to report on its findings for Rider 61, Evaluation of Medicaid Managed Care (the Report). HHSC recently published the Report, which includes the following:

Rider 61(a) – A review of the current Medicaid and Children’s Health Insurance Program (CHIP) managed care delivery system and an assessment of the performance of managed care;
Rider 61(b) – An assessment of Medicaid and CHIP managed care contract review and oversight;
Rider 61(c) – A study of Medicaid Managed Care rate setting processes and methodologies in other states; and
Rider 61(d) – An analysis of MCO administrative costs, including a survey of each MCO to determine the nature and scale of administrative resources devoted to the Texas Medicaid and CHIP programs and the identification of cost reduction opportunities.

HMA Report Examines Needs Assessment for Denver Residents with Intellectual and Developmental Disabilities

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The City and County of Denver’s Department of Human Services (DHS) contracted with HMA, between March and August 2018, to conduct a needs assessment of services and supports for individuals with intellectual and/or developmental disabilities (IDD). Denver will use findings from this assessment to inform decisions regarding the governance and distribution of a Denver property tax (mill levy) dedicated to funding services for residents with IDD.

The primary goals of the needs assessment were:

Inventory current services for Denver County residents with IDD and the existing capacity in and around Denver to provide these services.
Identify service gaps and potential ways to address these gaps by engaging stakeholders ‐ including clients, families, caregivers, service providers, city and state agencies, employers, and the public, with the intent to form the basis of how dedicated mill levy funding is programmed going forward.
Research possible governance models for determining/overseeing the disbursement of dedicated revenue, gathering stakeholder feedback on the governance models, and evaluating pros and cons of preferred models to form the basis of the process through which dedicated funding is allocated going forward.

The report summarizes the findings in the three areas identified above, including recommendations on the most pressing service gaps to address and features of the governance model.

Highlights From This Week’s HMA Conference On The Rapidly Changing World Of Medicaid

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This week, our In Focus section provides a recap of the third annual HMA Conference, The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States, held this Monday, October 1, and Tuesday, October 2, in Chicago, Illinois. More than 450 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 opportunities and challenges facing health plans, states, and providers as they strive to provide the best possible care to Medicaid beneficiaries and other vulnerable populations at a time of significant uncertainty and change. 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.

Companion Medicaid and Medicare Advantage Dual Eligible Special Needs Plans

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This week, our In Focus section reviews Medicare-Medicaid integration opportunities through Dual Eligible Special Needs Plans (D-SNPs). States are motivated to expand their capacity to address the needs of dually eligible beneficiaries through integrated care. They are increasingly requiring health plans that operate Medicaid managed long-term services and supports (MLTSS) programs to become Medicare Advantage (MA) D-SNPs. A few states require D-SNPs to be Medicaid MLTSS health plans.[1]

Dual Eligible Financial Alignment Demonstration Enrollment Update

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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 August 2018, nearly 369,000 duals were enrolled in an MMP. Enrollment dropped by 6.7 percent from August of the previous year after Virginia’s dual demonstration ended in December.

North Carolina and District of Columbia Medicaid Managed Care RFPs

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This week, our In Focus reviews North Carolina’s much-anticipated Prepaid Health Plan Services request for proposals (RFP), released by the Department of Health and Human Services, Division of Health Benefits on August 9, 2018, and District of Columbia’s Medicaid Managed Care RFP released on August 14, 2018. North Carolina is transitioning its Medicaid fee-for-service program to Medicaid managed care through its procurement. DC is reprocuring its managed care program, covering the District of Columbia Healthy Families Program (DCHFP), Alliance program, and the Immigrant Children’s Program (ICP).

Medicaid Community Engagement, Work Requirement and Consumer Empowerment Programs: Key Implementation and Operations Issues and Considerations

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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 important issues and considerations for implementing Medicaid consumer empowerment, community engagement, and work requirements.

New Hampshire Medicaid Care Management Draft RFP

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This week, our In Focus reviews the New Hampshire Medicaid Care Management (MCM) Services Draft request for proposals (RFP), released by the state Department of Health and Human Services (DHHS) on July 9, 2018. The MCM program, worth $750 million in annualized spending, will provide full-risk, fully capitated Medicaid managed care services to approximately 181,000 beneficiaries from July 1, 2019 through June 30, 2024. The final RFP is expected August 10, 2018.

Medicaid Managed Care Enrollment Update – Q2 2018

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This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 28 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. Nearly all 28 states highlighted in this review have released monthly Medicaid managed care enrollment data into the second quarter (Q2) of 2018. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):

Benefit Options for the Medicaid Expansion Population: Alternative Benefit Plans and the Medically Frail

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This week, our In Focus section highlights HMA Medicaid Market Solutions (MMS) which is supporting state flexibility in designing and implementing initiatives, including Section 1115 Demonstration Waivers, promoting member engagement, and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing an in-depth look at the facets of these new Medicaid models.

Registration Open for HMA Conference on the Rapidly Changing World of Medicaid

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HMA Conference on the Rapidly Changing World of Medicaid to Feature Insights from 30-Plus Speakers, Including Health Plan CEOs, State Medicaid Directors, Providers

Pre-Conference Workshop: Sept. 30
Conference: Oct. 1-2
Location: The Palmer House, Chicago

Health Management Associates is proud to announce its third annual conference on trends in publicly sponsored health care: The Rapidly Changing World of Medicaid: Opportunities and Pitfalls for Payers, Providers and States.

HHS Releases Blueprint to Address Prescription Drug Costs

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This week, our In Focus, written by HMA Principal Anne Winter and Senior Consultant Aimee Lashbrook, examines American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, released May 11, 2018. Over time, the pharmaceutical supply chain has become a complex ecosystem, responding to the ever-changing dynamics of new drug products, pricing strategies, health care reform, benefit design, and the regulatory environment making it, arguably, the most complicated in health care. Due to this complexity, solutions to equitably control drug pricing will take a multiprong approach that includes regulatory redesign.

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Texas Medicaid and CHIP Managed Care Final Comprehensive Report

HMA Report Examines Needs Assessment for Denver Residents with Intellectual and Developmental Disabilities

Highlights From This Week’s HMA Conference On The Rapidly Changing World Of Medicaid

Companion Medicaid and Medicare Advantage Dual Eligible Special Needs Plans

Dual Eligible Financial Alignment Demonstration Enrollment Update

North Carolina and District of Columbia Medicaid Managed Care RFPs

Medicaid Community Engagement, Work Requirement and Consumer Empowerment Programs: Key Implementation and Operations Issues and Considerations

New Hampshire Medicaid Care Management Draft RFP

Medicaid Managed Care Enrollment Update – Q2 2018

Benefit Options for the Medicaid Expansion Population: Alternative Benefit Plans and the Medically Frail

Registration Open for HMA Conference on the Rapidly Changing World of Medicaid

HHS Releases Blueprint to Address Prescription Drug Costs

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