This week, our In Focus section reviews Texas’ 1115 Medicaid waiver renewal. After more than a year of negotiations, on December 21st the Texas Health and Human Services Commission (HHSC) received CMS approval to extend the state’s 1115 waiver.[1] The Texas Healthcare Transformation and Quality Improvement Program waiver was initially approved by CMS as a five-year demonstration waiver that began December 2011 and ended September 2016 and included $29 billion in funding. The waiver authorized the expansion of Medicaid managed care while preserving federal hospital funding historically received as supplemental payments. The waiver created two new funding pools: the Uncompensated Care (UC) payment pool and the Delivery System Reform Incentive Payment (DSRIP) pool.
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Kentucky Becomes First State to Enact Community Engagement & Employment Requirements for Medicaid Members
This article was written by Senior Consultants Amanda Schipp and Lora Saunders of HMA Medicaid Market Solutions (HMA MMS). HMA MMS helped the Commonwealth of Kentucky secure a groundbreaking Medicaid Section 1115 Waiver. Below is a summary of what the waiver entails.
On January 12, 2018, Kentucky’s section 1115 Medicaid Demonstration Waiver was approved by the Centers for Medicare and Medicaid Services (CMS). The demonstration includes two significant components: an expansion of substance use disorder (SUD) services, including a waiver of the Institution for Mental Disease (IMD) exclusion, and the creation of a new Medicaid program for able-bodied adults, known as Kentucky HEALTH (Helping to Engage and Achieve Long Term Health). The demonstration contains several groundbreaking policies never previously approved by CMS, most notably, a requirement for non-exempt Medicaid enrollees to work or participate in approved work-related activities, such as education, training, or volunteering as a condition of Medicaid eligibility. This approval paves the way for the nine other states that also have pending waivers requesting similar work requirements.[1]
CMS approves Kentucky Medicaid Waiver
The Centers for Medicare & Medicaid Services (CMS) has approved the “Kentucky Helping to Engage and Achieve Long Term Health” 1115 Medicaid Waiver, a five-year waiver that includes a “community engagement” or work requirement as a condition of eligibility for non-disabled adult Medicaid beneficiaries ages 19-64.
The decision from CMS represents the first approval of a Medicaid waiver that includes a work requirement as a condition of eligibility. Kentucky developed the waiver in collaboration with HMA Medicaid Market Solutions (HMA MMS).
Kentucky defines “community engagement activities” as 80 hours per month of employment, education, job skills training, and community service. Exempted groups include pregnant women, the medically frail, and full-time students. The waiver also includes “consumer-driven tools” that provide incentives for healthy behavior.
Come back to the HMA blog Monday to read more about Kentucky HEALTH.
Read the full text of the press release issued by the Kentucky Governor’s Office here.
Read the Kentucky HEALTH Demonstration Approval here.
Medicaid Managed Care Enrollment Update – Q4 2017
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 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 highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2017. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
Highlights from NASBO Fall 2017 Fiscal Survey of States
This week, our In Focus section highlights some of the key findings of the Fiscal Survey of the States Fall 2017, released this month by the National Association of State Budget Officers (NASBO). The association conducted surveys of state budget officers in all 50 states from August through November 2017. The findings in the report focus on the key determinants of state fiscal health, highlighting data and state-by-state budget actions by area of spending. Below we summarize the major takeaway points from the report, as well as highlight key findings on Medicaid-specific and other health care budget items.
Dual Eligible Financial Alignment Demonstration Enrollment Update
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 10 states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, Texas, and Virginia. 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 November 2017, more than 400,000 duals are enrolled in an MMP, the second-highest monthly enrollment since the demonstrations began, according to state and CMS enrollment reports.
HMA Principal Designs Workshop to Enhance Delivery of Patient-Centered Care
This blog post was written by HMA Principal Jeffrey M. Ring, Ph.D.
There are many great things to do up in California’s majestic Sierras. The air is fresh and crisp, the water runs clear and the trees stretch up to dizzying heights.
The health care practitioners of Avenal/Aria Community Health in Central California decided to head to the Sierras for a weekend retreat coordinated with Health Net, and an opportunity to learn together about enhancing the delivery of patient-centered care. I designed an interactive, experiential workshop that aimed to facilitate team-building, an exploration of the foundations of communication (including empathy, trust and non-verbal communication), and the skills of Motivational Interviewing which has been empirically demonstrated to be more successful in generating patient behavior change than giving advice.
Texas Issues STAR+PLUS Request for Proposals
This week, our In Focus section reviews the Texas STAR+PLUS request for proposals (RFP) issued on December 4, 2017. The STAR+PLUS Medicaid managed care program covers approximately 519,000 individuals who have disabilities or are aged 65 or older. The program will integrate Acute Care services and Long-Term Services and Supports (LTSS), and cover members including those with intellectual or developmental disabilities (IDD) and dual eligibles. Managed care organizations (MCOs) will also provide access to behavioral health services, such as mental health and substance use disorder counseling and treatment. When fully implemented, Texas expects enrollment to be over 530,000 and annualized spending over $7.5 billion, based on FY 2018 data.
Ballot Initiative Requirements in Non-Medicaid Expansion States
This week, our In Focus section examines the 10 states that have not expanded Medicaid under the Affordable Care Act but where citizens can initiate a public vote on the issue. In November, nearly 60 percent of Maine voters approved a ballot initiative expanding Medicaid. Advocates in Idaho, Missouri, and Utah have filed paperwork to begin collecting signatures to place Medicaid expansion on the ballot in November 2018.
HMA PCMH Experts Create 2017 Readiness Assessment Tool
This blog post was written by HMA Senior Consultant Meghan Kirkpatrick Manilla.
HMA’s Healthcare Transformation Institute (HTI) provides a venue to develop and share new innovations, experiences, and best practices across the country related to the development of community-specific integrated delivery systems, new financial strategies to incentivize value, and innovative partnerships between providers and payers to ensure quality care for its populations. Through the HTI, HMA has invested in the continued development of new approaches, tools, and resources to enhance the provision of healthcare services, with a focus on publicly-supported populations.
New CMS Guidelines to Expedite Approval of 1115 Waivers and State Plan Amendments
This week, our In Focus section reviews the new guidelines issued by the Centers for Medicare & Medicaid Services (CMS) on expediting the approval process for Medicaid waivers and state plan amendments (SPAs) and improving quality, accessibility, outcomes, and transparency. The guidelines, titled Section 1115 Demonstration Process Improvements and State Plan Amendment and 1915 Waiver Process Improvements to Improve Transparency and Efficiency and Reduce Burden were released on November 6, 2017.
Arizona, Kansas Medicaid Managed Care RFPs Reviewed
This article was authored by HMA Senior Consultant Annie Melia and Consultant Alona Nenko.
This week, our In Focus section reviews two Medicaid managed care requests for proposals (RFPs) released on November 2, 2017. The Arizona Health Care Cost Containment System (AHCCCS) issued an RFP for the “Complete Care” program, which will integrate Medicaid managed care for physical and behavioral health as well as replace the state’s long-standing Acute Care Medicaid managed care program. It will cover approximately 1.5 million Medicaid members. Meanwhile, the Kansas Department of Health and Environment and Department for Aging and Disability Services issued an RFP for KanCare 2.0 Medicaid and Children’s Health Insurance Program (CHIP) Capitated Managed Care, which will serve approximately 403,000 members.