This week, we revisited a 2011 report from the Republican Governors Public Policy Committee Health Care Task Force. The report, titled “A New Medicaid: A Flexible, Innovative and Accountable Future,” was prepared with input from governors, secretaries of health and human services, Medicaid directors, and other senior policy staff in the 31 states (including two territories) with Republican governors at the time. Across these 31 states, 20 of the governors in office at the time of the report are still in office. Only three of the 31 states (Louisiana, Pennsylvania, and Virginia) now have Democratic governors in office, although Alaska’s new governor is an Independent who expanded Medicaid this year. The report provides more than 30 recommended solutions across seven broad principles that would “increase Medicaid’s efficiency and effectiveness as a part of the overall health care delivery system regardless of whether or not [the Affordable Care Act (ACA)] is repealed.”
365 Results found.
This week, we reviewed recent Medicaid enrollment trends in capitated, risk-based managed care in 24 states. 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 24 states have released monthly Medicaid managed care enrollment data through the third quarter (Q3) of 2016. This report reflects the most recent data posted.
Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017
Growth in Medicaid enrollment and total Medicaid spending nationally slowed significantly in fiscal year 2016, and it looks like a continued slowdown will occur in fiscal year 2017. This is just one finding in the 16th annual 50-state Medicaid Budget Survey conducted by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured and in collaboration with Health Management Associates (HMA) and the National Association of Medicaid Directors.
This report highlights policy changes implemented in state Medicaid programs in FY 2016 and those implemented or planned for FY 2017 based on information provided by the nation’s state Medicaid directors. Key findings are presented in the areas of:
- Eligibility and enrollment
- Managed care and delivery system reforms
- Long-term services and supports
- Provider payment rates and taxes
- Benefits (including prescription drug policies)
- Projections for 2017
HMA’s Vernon K. Smith, Kathleen Gifford, Eileen Ellis and Barbara Edwards authored the report along with Robin Rudowitz, Elizabeth Hinton, Larisa Antonisse and Allison Valentine of the Kaiser Family Foundation.
Two additional issue briefs were developed as well:
Medicaid Enrollment & Spending Growth: FY 2016 &2017, which provides an analysis of national trends in Medicaid enrollment and spending.
Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2016 and FY 2017, a collection of four case studies of Medicaid programs in Maryland, Montana, New York and Oklahoma.
This week, we are providing an update on HMA’s inaugural conference on The Future of Publicly Sponsored Healthcare: Building Integrated Delivery Systems for Vulnerable Populations, October 10-12, 2016, at The Palmer House in Chicago. More than 200 industry leaders have already registered to attend, including top executives from hospitals, health systems, clinics, provider practices, community-based organizations, and Medicaid managed care plans. Featuring 37 high-level industry speakers, conference panels and breakout sessions are designed to inspire discussion about real-world approaches to helping provider organizations improve the health status of patient populations, lower costs, and ensure a more satisfactory patient experience. Visit the conference website at https://fpsh.healthmanagement.com/ for complete details.
This week, we reviewed the independent evaluation of Texas’ Uncompensated Care Pool submitted to the Centers for Medicare and Medicaid Services (CMS) by the Texas Health and Human Services Commission (HHSC). The evaluation, which was required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, was completed by Health Management Associates (HMA).
HMA was engaged by the Texas Health and Human Services Commission to perform an independent evaluation of Texas’ Uncompensated Care Pool, as required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, to submit to the Centers for Medicare and Medicaid Services (CMS). The report was submitted to CMS on August 31st.
Consistent with the approach it has taken in other states that operate uncompensated care pools, CMS required Texas to commission a detailed analysis of the state’s uncompensated care costs, payments and the impact of environmental factors and potential policy changes. Pursuant to the waiver Special Terms and Conditions (STCs), the report includes the following:
- A detailed description of the composition of current Medicaid hospital payments.
- Analysis of Medicaid financing and how the non-federal match is funded.
- Estimated cost incurred by hospitals to provide services to Medicaid beneficiaries compared to the cost to the corresponding payments received.
- Estimated cost of uncompensated care provided by hospitals and the portion of uncompensated care attributed to charity care.
- Analysis of the adequacy of Medicaid payments in relation to cost incurred by hospitals.
- Analysis of Texas Medicaid payment adequacy relative to other states.
- Assessment of recent economic and environmental trends within Texas that may impact future reimbursement levels and the cost of caring for low-income populations.
- Estimated financial impact of: 1) implementing a Medicaid expansion for low-income adults; 2) Medicaid DSH reductions required by the Affordable Care Act (ACA); 3) reestablishing supplemental upper payment limit (UPL) payments; and 4) fully funding Medicaid hospital costs through payment rates.
 Note that this portion of the analysis and report were completed by Deloitte Consulting.
On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the final Medicaid managed care rules to modernize federal Medicaid managed care regulations. Many of the new rules go into effect July 2017. The hard work of implementing the new Medicaid managed care regulations will fall squarely on the shoulders of states and Medicaid managed care health plans. For managed care plans, they must step up their operational, administrative, and reporting capabilities to accommodate new state oversight requirements across all aspects of the contract performance.
HMA’s inaugural conference “The Future of Publicly Sponsored Healthcare: Building Integrated Delivery Systems for Vulnerable Populations” is slated for October 10-12 in Chicago. This premier event, presented by HMA and HMA’s Accountable Care Institute, will address key issues facing health systems, hospitals, clinics and provider practices seeking to integrate care in an environment of rising quality and cost expectations. More than 30 speakers have been confirmed to date. Early Bird registration is now open. Click here for complete conference details.
This webinar was held on May 24, 2016.
How to Drive Compliance and Delivery System Performance for States and Health Plans
The hard work of implementing the new Medicaid managed care regulations will fall squarely on the shoulders of states and health plans. For states, the changes come at a time when Medicaid staff are already stretched thin by budgetary constraints and the impact of the continual state and federal regulatory and innovation projects. Now states must drive and oversee new requirements, including a variety of tighter rules around encounter data quality and submission, provider network adequacy, quality rating systems, provider screenings, and program integrity. Medicaid managed care plans, meanwhile, must step up their operational, administrative, and reporting capabilities to accommodate new state oversight requirements across all aspects of the contract performance.
During this webinar, experts from HMA and CNSI will demonstrate the value of using automated dashboard technology and data analytics to establish a single electronic data and reporting portal between states and Medicaid managed care plans for the submission of data and tracking of performance – creating an efficient and centralized compliance audit trail in real time.
- Explore the requirements of the new Medicaid managed care regulations and methods for monitoring for compliance.
- View compliance solutions like MCTrack, which effectively monitors performance and creates an audit trail to meet expectations of both internal and external stakeholders and auditors.
- Learn about data analysis and an automated dashboard for tracking key performance criteria, including access to care, quality, enrollment, member and provider satisfaction, accurate encounter data and network adequacy.
- Find out about dashboards that allow regular monitoring of Medicaid pay for performance requirements, providing health plan with the ability to maximize incentives payments and withholds.
- Track and drive to completion all Medicaid managed care corrective action and quality improvement plans.
- Capture health plan readiness metrics during new contract cycles.
Heidi Robbins Brown, HMA Principal, Seattle
Diana Criss, HMA Senior Consultant, Lansing, MI
Kathleen Nolan, HMA Managing Principal, Washington, DC
Arvinder Singh, Chief Health Innovation Officer, CNSI
Who Should Attend
Medicaid directors, managed care contract managers, quality oversight directors, program integrity officials and staff; federal and state regulators and auditors; executives of Medicaid managed care plans, including compliance officers.
On February 3, 2016, HMA Information Services hosted the webinar, “California Medi-Cal 2020: What the State’s 1115 Waiver Renewal Means for Medicaid Providers, Health Plans and Patients.”
California has received federal approval for a five-year, $6.2 billion 1115 waiver renewal, which can best be described as a mix of old and new. The waiver reauthorizes Medi-Cal managed care and other existing state Medicaid programs – as well as initiating important reforms and innovations. Though scaled down from the state’s original proposal, the new waiver moves California closer to value-based purchasing in Medicaid in several ways.
During this webinar, business and policy experts from HMA’s California offices provide a comprehensive overview of the waiver’s various components, with an emphasis on the type of organizational structures, systems, and performance measurement capabilities providers and health plans will need to successfully compete in the state’s emerging value-based environment. Listen to the replay and:
- Find out what public and district/municipal hospitals need to do to get their share of up to $3.27 billion in performance incentives through PRIME – successor to the state’s DSRIP initiative.
- Understand the types of reporting requirements, outcome measures and delivery system models needed to successfully implement waiver programs and comply with new rules and regulations.
- Evaluate various integrated care models, an essential component of the state’s Whole Person Care pilot, which will divvy up $1.5 billion in incentive payments to foster integrated behavioral and physical healthcare.
- Learn how to organize case management, care management and training to align with the waiver’s quality and performance requirements.
- Assess the state’s Global Payment Pilot Program, which seeks to move patients out of the emergency room and into primary care with $1.4 billion in incentive payments – funds previously earmarked for Safety Net Care Pool and Medicaid Disproportionate Share Hospital programs.
The slide deck for this webinar can be retrieved by clicking the “DOWNLOAD” button below.
Change is the new normal for healthcare today. The industry is in constant flux. Healthcare reform is prompting us to reimagine what we do and how we deliver healthcare. It seems many public, private and nonprofit stakeholders are taking different approaches, sparking a daily stream of research, studies and trends to inform your next move.
But who has time to sift through all that data? Keeping current with the latest developments alone is a full-time job. That’s where HMA can help.
You’ve counted on us for decades to provide clear insights into policy, programs and financing to get the job done. We provide counsel, research, whitepapers, webinars and weekly updates.
And now, we’re writing a blog.
Medicaid Managed Care is the subject of a recently released HMA white paper.
In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.
The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:
- Planning and implementation
- Stakeholder engagement
- Procurement approaches
- Outreach and enrollment
- Contract management and monitoring