This week’s review comes to us from HMA Principal Karen Brodsky and Research Assistant Anh Pham, both of our New York City office. Anh and Karen provide a review of the “Medicaid 2.0 Blueprint for the Future” issued by the New Jersey Health Care Quality Institute (Quality Institute). Funded by The Nicholson Foundation, the Quality Institute embarked on a year-long project convening a wide variety of stakeholders in New Jersey with the goal of redesigning and modernizing the State’s Medicaid program. The report is a culmination of 24 recommendations to promote the efficient delivery of quality healthcare services to New Jersey’s most vulnerable populations.
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Illinois Issues RFP to Rebid Medicaid Managed Care Programs, Expand Statewide
This week, we reviewed the request for proposals (RFP) issued on February 27, 2017, by the Illinois Department of Healthcare and Family Services (HFS) to rebid the majority of the state’s existing Medicaid managed care program contracts, consolidate multiple programs into a single streamlined program, and expand managed care statewide. The RFP will consolidate the current Family Health Plans/ACA Adults (FHP/ACA) program, the Integrated Care Program (ICP), and the Managed Long Term Services and Supports (MLTSS) program into a single contracting approach, while reducing the number of contracted managed care organizations (MCOs) from 11 to between four and seven. The RFP does not impact the Medicare-Medicaid Alignment Initiative (MMAI) duals demonstration at this time. When fully implemented by the end of 2018, the new managed care program will cover roughly 2.7 million Medicaid beneficiaries in all 102 counties in Illinois.
Washington Releases Apple Health Fully Integrated Managed Care RFP for North Central RSA
This week, we reviewed the Washington Health Care Authority’s (HCA’s) request for proposals (RFP) for the North Central Regional Service Area (RSA) transition to Fully Integrated Managed Care (FIMC) under the Apple Health Medicaid program. Under the RFP, HCA will contract with fully integrated Medicaid managed care organizations (MCOs) – integrating physical and behavioral health – for the North Central RSA, which consists of Chelan, Douglas, and Grant counties. HCA previously issued a FIMC RFP for Clark and Skamania counties in the second half of 2015. The state eventually intends to transition all counties to the Apple Health FIMC model. Awarded MCOs will begin serving the North Central RSA on January 1, 2018. There are more than 66,200 Apple Health members in the North Central RSA as of February 2017.
Mississippi Division of Medicaid Issues RFP to Rebid MississippiCAN Program
This week, we reviewed the request for proposals (RFP) issued by the Mississippi Division of Medicaid (DOM) for the reprocurement of Mississippi Coordinated Access Network (MississippiCAN) Medicaid managed care plans. Under the RFP, the DOM is adding 1915(i) Intellectual/Developmental Disabilities Community Support Program (IDD CSP) and Mississippi Youth Programs Around the Clock (MYPAC) services to the MississippiCAN benefit package. As of February 2017, MississippiCAN enrolls roughly 490,000 Medicaid members across all 82 counties in the state, with annual spending of more than $2.7 billion.
HIP 2.0 Waiver Renewal Summary
This week’s review comes to us from HMA Principal Sarah Jagger, of our Indianapolis, Indiana office. Sarah provides an overview of the Healthy Indiana Plan (HIP) and the proposed changes under the HIP 2.0 waiver renewal request, submitted to the Centers for Medicare & Medicaid Services (CMS) for approval on January 31, 2017.
Medicaid Managed Care Spending in 2016
This week, Andrew Fairgrieve and Greg Nersessian reviewed Medicaid spending data collected in the annual CMS-64 Medicaid expenditure report. In federal fiscal year (FFY) 2016, Medicaid expenditures across all 50 states and 6 territories exceeded $548 billion, with nearly half of all spending now flowing through Medicaid managed care programs.
Save the Date for HMA’s 2017 Conference on Trends in Publicly Sponsored Healthcare
The Future of Medicaid is Here: Implications for Payers, Providers and States
Sept. 11-12, 2017
Health Management Associates (HMA) is proud to announce its 2nd conference on Trends in Publicly Sponsored Healthcare, Sept. 11-12, 2017, in Chicago. The theme of this year’s event is The Future of Medicaid is Here: Implications for Payers, Providers and States and features as keynote speakers some of the nation’s most innovative healthcare leaders.
Reviewing Oregon’s Medicaid Expenditure Cap Waiver
This week, our In Focus article provides an overview of Oregon’s Medicaid waiver program, under which the state implemented integrated managed care entities and committed to a per capita reduction on the rate of Medicaid cost growth. The model, viewed widely as a success, may be of interest to states as discussions at the federal level around restraining spending growth in Medicaid develop under the incoming administration.
HHS Selects Eight States to Participate in CCBHC Demonstration
This week’s article comes to from HMA Principals Meggan Schilkie, Joshua Rubin, and Heidi Arthur in our New York City office and the HMA national behavioral health team. On December 21, 2016, the U.S. Department of Health and Human Services (HHS) announced the selection of eight states for participation in a two-year Certified Community Behavioral Health Clinic (CCBHC) demonstration program “designed to improve behavioral health services in their communities.” The eight states are Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, Oregon, and Pennsylvania. The demonstration projects are slated to begin on July 1, 2017. They build on a total of 24 state planning grants issued by HHS in 2015 to support states in designing their certification process. Nineteen of the 24 states submitted applications to participate in the demonstration program, and the eight awardees were selected from this pool of 19 applicants.
Medicaid Managed Care Procurement Updates in DC, Massachusetts, and Texas
This week we reviewed two active Medicaid managed care procurements – in the District of Columbia and Massachusetts – and a Medicaid managed care request for information issued by Texas. On December 22, 2016, the District of Columbia issued a request for proposals (RFP) to rebid Medicaid managed care organization (MCO) contracts for the DC Healthy Families and Alliance programs. One day prior, on December 21, 2016, Massachusetts issued a request for responses (RFR) from MCOs interested in participating in the MassHealth managed care program, with a focus on preparing for Medicaid ACO implementation, as well as the planned carve-in of managed long-term services and supports (MLTSS). Finally, also on December 22, 2016, Texas issued a request for information (RFI) ahead of an upcoming statewide reprocurement of the STAR+PLUS Medicaid managed care program.
Is your organization ready to become an integrated delivery system?
For providers, transitioning from volume- to value-based care is no easy task. You are likely facing a growing number of pressures that are becoming increasingly difficult to manage. These could include community/political pressures, primary care shortages, medical staff competition, and incentives to measure and manage care quality and total costs and address non-clinical aspects of health. Additional demands include risk sharing arrangements, audits, and pitches from vendors. Aligning your facilities, programs and services into a fully integrated delivery system can seem like a daunting task. But HMA can help.
Medicaid and Exchange Enrollment Update
This week, we reviewed updated reports issued by the Department of Health & Human Services (HHS) on Medicaid expansion enrollment from the “September 2016 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on December 1, 2016. Additionally, we review 2016 Exchange enrollment data from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief, “Health Insurance Marketplace 2016 Open Enrollment Period: February 2016 Enrollment Report,” and 2017 enrollment snapshot data through December 19, 2016, from the Centers for Medicare & Medicaid Services (CMS). Combined, these reports present a picture of Medicaid and Exchange enrollment at the end of 2016, with a look at progress towards 2017 Exchange enrollment.