This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 27 states.[1] Many state Medicaid agencies elect to 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 27 states have released monthly Medicaid managed care enrollment data through the third quarter (Q3) of 2017. This report reflects the most recent data posted.
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New Mexico Issues Centennial Care 2.0 Medicaid Managed Care RFP
This week, our In Focus section reviews the request for proposals (RFP) released by the New Mexico Human Services Department (HSD) to reprocure contracts for the state’s Medicaid managed care program in its second phase, Centennial Care 2.0. Centennial Care provides integrated Medicaid managed care coverage, including long-term services and supports (LTSS) and behavioral health, to nearly 700,000 Medicaid beneficiaries in the state, with annual spending of roughly $4.5 billion.
Health Management Associates, Community Care of North Carolina Form Strategic Partnership
Today, Health Management Associates (HMA) and Community Care of North Carolina, Inc. (CCNC) announced the formation of a strategic partnership that will leverage the complementary skills and expertise of both organizations to offer providers and payers innovative solutions for the challenges of today’s healthcare landscape.
Medicaid and Exchange Enrollment Update – May 2017
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 “May 2017 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on July 21, 2017. Additionally, we review 2017 Exchange enrollment data from the “Health Insurance Marketplaces 2017 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on March 15, 2017. Combined, these reports present a picture of Medicaid and Exchange enrollment in the first half of 2017, representing nearly 75 million Medicaid and CHIP enrollees and more than 12 million Exchange enrollees.
Report Provides Analysis and Technical Assistance on Oklahoma’s Section 1332 Waiver
This report was prepared by HMA and Leavitt Partners for the Oklahoma State Department of Health.
During the 2016 session, Oklahoma’s legislature enacted Senate Bill (SB) 1386, which authorized the development of a Section 1332 State Innovation Waiver. The goals of the legislation were to improve healthcare quality and access in the state while reducing costs, and to meet the needs of Oklahomans by developing a system that provides more affordable health care options. A Section 1332 Waiver, which allows states to obtain flexibility within selected requirements of the Affordable Care Act (ACA), represents an opportunity for Oklahoma to develop its own unique program that is responsive to the needs of the state’s residents.
Virginia Releases Medallion 4.0 Medicaid Managed Care RFP
This week, our In Focus section reviews the request for proposals (RFP) issued by the Virginia Department of Medical Assistance Services (DMAS) for the Medallion 4.0 Medicaid managed care program. Medallion 4.0 will serve roughly 740,000 children, including those with special health care needs, families, and individuals in foster care and adoption assistance programs, with annual Medicaid managed care spending of more than $3 billion when fully implemented by the end of 2018. Proposals are due to DMAS on September 8, 2017.
Quarterly Medicaid Managed Care Enrollment Update – Q2 2017
This In Focus article was originally published in the July 12, 2017 HMA Weekly Roundup.
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 27 states.[1] Many state Medicaid agencies elect to 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 27 states have released monthly Medicaid managed care enrollment data through the second quarter (Q2) of 2017. This report reflects the most recent data posted.
Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Health Outcomes
With the support of State Health and Value Strategies, Ellen Breslin and Anissa Lambertino of Health Management Associates, in partnership with Dennis Heaphy of the Disability Policy Consortium and Tony Dreyfus, prepared a recently released issue brief “Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Health Outcomes.”
This brief answers two key questions for state policy makers:
- Why should Medicaid programs account for social determinants of health (SDOH) in setting payments and in measuring quality?
- What methods can Medicaid programs use to examine SDOH and account for them in their payment and/or quality improvement policies?
Case studies from Medicaid agency efforts in both Massachusetts and Minnesota will be used to answer these questions.
This brief was prepared to accompany the recent State Health and Value Strategies webinar “Using Social Determinants of Health Data in Medicaid Managed Care.”
Report Examines State Medicaid Coverage of Perinatal and Maternal Benefits
Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey
This report, authored by the Kaiser Family Foundation and Health Management Associates (HMA), analyzes the status of Medicaid benefit policies for perinatal and family planning services in 40 states and the District of Columbia.
While inpatient and outpatient hospital care must be covered for pregnant women under the federal scope of Medicaid, it is up to the discretion of states to define which other maternal benefits are included. Most states cover a broad range of perinatal services such as ultrasounds and prenatal vitamins. Other services are less likely to be covered by the states, including parenting classes and breastfeeding education.
Key findings in the report are presented in the areas of:
- Perinatal services
- Counseling and support services
- Delivery and postpartum care
- Breastfeeding services
HMA’s Kathleen Gifford co-authored the report along with Usha Ranji, Alina Salganicoff and Ivette Gomez of the Kaiser Family Foundation and Jenna Walls. This report serves as a companion report to Medicaid Coverage of Family Planning Benefits: Results from a State Survey, released in September 2016 by the same authors.
Quarterly Medicaid Managed Care Enrollment Update – Q1 2017
This week, we reviewed recent Medicaid enrollment trends in capitated, risk-based managed care in 25 states.[1] Many state Medicaid agencies elect to 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 25 states have released monthly Medicaid managed care enrollment data through the first quarter (Q1) of 2017. This report reflects the most recent data posted.
Alabama, Ohio Provide Details on Medicaid MLTSS Program Designs
This week, we reviewed two proposed statewide Medicaid managed long-term services and supports (MLTSS) program designs. Alabama is currently accepting public comments on a plan to implement provider-driven Integrated Care Networks (ICNs) to provide MLTSS statewide to roughly 25,000 beneficiaries who are residing in nursing facilities or receiving home and community based services (HCBS) through three of the state’s Medicaid HCBS waiver programs. Meanwhile, Ohio Governor John Kasich proposed in his upcoming state budget to implement a statewide MLTSS program for more than 100,000 beneficiaries in the state. We review both states’ plans for MLTSS, including market sizes, implementation timing, and existing Medicaid managed care plans in the states.
Medicaid and Health Policy Highlights from Governors’ Proposed Budgets
Governor’s Proposed Budgets for FY 2018: Focus on Medicaid and Other Health Priorities
This issue brief, authored by the Kaiser Family Foundation and Health Management Associates (HMA), analyzes governors’ proposed budgets for state fiscal year (FY) 2018.
Despite nearly half of the states facing budget challenges for FY 2018, many governors are recommending enhancements to Medicaid and increasing the use of managed care and community-based long-term services and supports. With ongoing debate of the Affordable Care Act at the federal level, several governors still view Medicaid expansion as a solution to addressing top health priorities, including the opioid epidemic and healthcare for those involved with the criminal justice system.
This issue brief reviews 48 proposed state budgets. Key findings are presented in the areas of:
• Provider payment rates and taxes
• Eligibility changes
• Benefits, premiums and cost-sharing
• Delivery system and managed care reforms
• Community-based long-term services and supports
• Medicaid administration
• Initiatives to fight the opioid epidemic
• Initiatives to enhance behavioral health services
• Health-related corrections and criminal justice initiatives
HMA’s Kathleen Gifford and Nicole McMahon co-authored the issue brief along with Larisa Antonisse, Elizabeth Hinton and Robin Rudowitz of the Kaiser Family Foundation.