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Medicare-Medicaid integration: integrated model enrollment rates show majority of Medicare-Medicaid dual eligible population not enrolled

Working in conjunction with Arnold Ventures, a team of HMA consultants has written an issue brief, Medicare-Medicaid Integration: Integrated Model Enrollment Rates Show Majority of Medicare-Medicaid Dual Eligible Population Not Enrolled. This brief presents key findings on their examination of the availability of integrated programs in states, the growth in enrollment rates, and differences in enrollment and programs across the country.

The HMA team cited several reasons why Medicare-Medicaid integrated program options are not equally available nationwide and why enrollment is limited in places where programs exist. The result is that millions of people are not enrolled in whole-person, integrated program options – a reality that is inefficient, and worse yet, inequitable.

The HMA team, led by Managing Principal Jon Blum and Principal Sarah Barth, includes Narda Ipakchi, Ellen Breslin, Mindy Cohen, Sharon Silow-Carroll and other HMA subject matter experts.

Medicare and Medicaid telehealth coverage in response to COVID-19

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Telehealth service expansions by Medicare and most Medicaid programs aim to rapidly increase access to care and reduce transmission, but also provide a natural experiment for policymakers.

This week, our In Focus section examines the extensive scope of flexibilities Federal and State governments have made to Medicare and Medicaid telehealth coverage in response to the COVID-19 national emergency. In March and April 2020, federal and state policymakers responded to the COVID-19 emergency by temporarily and aggressively expanding the definition of and reimbursement for telehealth services—moves intended to improve access to care and reduce virus transmission. Under the Medicare and Medicaid programs, these temporary expansions have been rapid and historic in scope, and will have substantial implications for patients, providers, payers, and federal/state financing. For policymakers, this temporary expansion may serve as a natural experiment for assessing which forms of telehealth services successfully expand access to care and should become permanent healthcare policy.

HMA model provides forecast of COVID-19 impact on Medicaid, Marketplace, and uninsured

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A model developed by Health Management Associates (HMA) assesses COVID-19’s potential impact on health insurance coverage for each state and forecasts Medicaid enrollment could increase by 11 to 23 million across all states over the next several months.

HMA review of state Appendix K waivers in response to COVID-19

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This week, our In Focus section comes from HMA Principals Ellen Breslin (MA) and Sharon Lewis (OR). In direct response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has encouraged states to maximize Medicaid flexibilities to protect people during the pandemic emergency. This includes state flexibilities for people receiving home and community-based services. States may temporarily amend their Home and Community-Based Services (HCBS) 1915(c) waivers through an expedited process by submitting an Appendix K request. As of March 31, 2020, CMS had approved Appendix K submissions for thirteen states with effective periods ranging from four months to one year.^[1] The thirteen states are: Alaska, Connecticut, Colorado, Hawaii, Iowa, Kentucky, Minnesota, New Mexico, Pennsylvania, Rhode Island, Washington, West Virginia and Wyoming.

D-SNP 2021 hospital and SNF admission data sharing: opportunity for states and health plans to support care transitions

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This week, our In Focus section provides an overview of new requirements and opportunities for states and Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs) to increase Medicare and Medicaid coordination in plan year 2021. Specifically, states and health plans will need to partner for compliance with calendar year (CY) 2021 Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) data sharing requirements for D-SNPs that are not designated as a fully integrated D-SNP (FIDE SNP) or a highly integrated D-SNP (HIDE SNP)^[1]. CY 2021 State Medicaid Agency Contracts (SMACs) with these D-SNPs must document the notification process for sharing hospital and skilled nursing facility (SNF) admissions for at least one group of high-risk enrollees.^[2]

Medicare and Medicaid flexibilities during public health emergencies

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This week, our In Focus comes from HMA Vice President Kathleen Nolan and Managing Principal Jon Blum. On March 13, 2020, President Trump declared a national emergency due to the rapid spread of COVID-19 virus. This declaration provides Health and Human Services (HHS) and the Centers of Medicare and Medicaid Services (CMS) new abilities to waive Medicare and Medicaid regulatory requirements to help health care providers, health plans and other stakeholders respond to immediate needs of their patients and communities. In the past, HHS and CMS have solicited requests for relief needs from states, local providers and trade associations, among other stakeholders. Health care providers, health plans and others should continue to monitor policy announcements from HHS and CMS and work with their states and trade associations to identify potential areas of need for requested regulatory relief.

Medicaid managed care enrollment update – Q4 2019

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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 fourth quarter (Q4) 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):

Former Illinois Medicaid director named COO of Health Management Associates

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Health Management Associates (HMA) announced today that Douglas (Doug) L. Elwell, who most recently served as Medicaid director for the State of Illinois in the Department of Healthcare and Family Services, has joined the firm as chief operating officer (COO).

Medicaid expansion in Missouri: economic implications and insights from Arkansas, Indiana, and Ohio

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This week, our In Focus section covers the report, Medicaid Expansion in Missouri – Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences, prepared by HMA Medicaid Market Solutions (MMS) Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Independent Health Policy Consultant Jack Meyer. Health Management Associates (HMA) conducted a targeted analysis of the likely economic impact of an ACA Medicaid Expansion in Missouri, with an emphasis on the effects on the state budget. The report was commissioned by the Missouri Hospital Association and Missouri Primary Care Association and released in partnership with stakeholders from the health care community in January 2020.

CMS Unveils Healthy Adult Opportunity

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This week, our In Focus section comes from HMA Medicaid Market Solutions (MMS) Managing Director Matt Powers and Senior Consultant Desmond Banks. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) convened an event titled, Transforming Medicaid: A New Opportunity for Better Health, in Washington, DC, during which CMS Administrator Seema Verma announced the Healthy Adult Opportunity (HAO), an optional Section 1115 Medicaid Demonstration initiative. Commonly referred to as, “block grant” or “spending cap” model, the HAO seeks to provide states with enhanced flexibility to design and administer parts of their Medicaid program. Administrator Verma articulated the HAO to be an important step to support the fiscal sustainability of Medicaid and invited state Medicaid directors to submit waiver applications.

Conservative states’ Medicaid expansion offers model for Missouri expansion

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A new analysis of conservative state Medicaid expansion in Arkansas, Indiana and Ohio clarifies many of the questions raised about state-level costs and budget savings of a potential Missouri expansion. Researchers at Health Management Associates interviewed leaders directly involved with expansion in these states to evaluate the policy and operational adjustments they undertook to design a budget-conscious program while maximizing state value.

HMA prepares report detailing economic implications of a Medicaid expansion in Missouri

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On January 30, 2020, the Missouri Hospital Association issued a press release outlining a report prepared by Health Management Associates. Read the official press release.

The report, Medicaid Expansion in Missouri – Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences, was prepared by HMA MMS Managing Director Matt Powers and Managing Principal Sharon Silow-Carroll, and Jack Meyer. They conducted interviews with leaders directly involved with expansion in Arkansas, Indiana, and Ohio to evaluate the policy and operational adjustments they undertook to design a budget-conscious program while maximizing state value. Those interviews allowed clarification of many of the questions raised about state-level costs and budget savings of a potential Missouri expansion.

The report was commissioned by the Missouri Hospital Association and Missouri Primary Care Association and released in partnership with stakeholders from the healthcare community.

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Medicare-Medicaid integration: integrated model enrollment rates show majority of Medicare-Medicaid dual eligible population not enrolled

Medicare and Medicaid telehealth coverage in response to COVID-19

HMA model provides forecast of COVID-19 impact on Medicaid, Marketplace, and uninsured

HMA review of state Appendix K waivers in response to COVID-19

D-SNP 2021 hospital and SNF admission data sharing: opportunity for states and health plans to support care transitions

Medicare and Medicaid flexibilities during public health emergencies

Medicaid managed care enrollment update – Q4 2019

Former Illinois Medicaid director named COO of Health Management Associates

Medicaid expansion in Missouri: economic implications and insights from Arkansas, Indiana, and Ohio

CMS Unveils Healthy Adult Opportunity

Conservative states’ Medicaid expansion offers model for Missouri expansion

HMA prepares report detailing economic implications of a Medicaid expansion in Missouri

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