HMA Weekly Roundup

Colorado

Colorado Submits Section 1115 SUD Demonstration Amendment to Add HRSN Services. The Centers for Medicare & Medicaid Services announced on August 28, 2024, that Colorado submitted a health-related social needs (HRSN) amendment for its Expanding the Substance Use Disorder (SUD) Continuum of Care Section 1115 demonstration. The amendment would offer housing support—including pre-tenancy navigation, tenancy sustaining services, six-month rent support, and one-time coverage of moving costs—as well as nutrition services to its beneficiaries. The state requested an effective date of July 1, 2025, and public comments will be accepted until September 27. Read more about the amendment

Georgia

Georgia Board Approves Medicaid Agency’s Fiscal 2026 Budget Proposal, Increasing Spending by $347 Million. Rome-news Tribune reported on August 22, 2024, that the Georgia Board of Community Health approved a $5.7 billion fiscal 2026 budget request for the Department of Community Health (DCH), the state’s Medicaid agency, an increase of $347 million from its current spending plan. Of this approximately $287 million is allocated for low-income Medicaid beneficiaries, primarily women and children, as DCH anticipates a rise in new enrollees. The budget request also includes increases for nursing home operations and prescription drugs. DCH will submit the proposed spending plan to the Governor’s Office of Planning and Budget later this year. Read the full article

Indiana

Indiana Explores Federal ARPA Relief Options for Beneficiaries on HCBS Waiver Waitlists. The Indiana Capital Chronicle reported on August 28, 2024, that the state’s Family and Social Services Administration (FSSA) is considering using federal funds to offer relief for the more than 13,000 Medicaid beneficiaries on waitlists for home and community-based services (HCBS) provided through the PathWays for Aging and Health and Wellness waivers. The agency is looking to use unobligated federal funds available through the American Rescue Plan Act (ARPA) to help bridge the gap in services for people while they wait, though it is unclear how much ARPA funding is available. Read the full article

Indiana Launches Waitlist Dashboard for PathWays for Aging, Health, Wellness Waivers. Louisville Public Media reported on August 24, 2024, that the Indiana Family and Social Services Administration (FSSA) has launched a dashboard that shows the number of waitlisted people who have received invitations to apply for home and community-based services (HCBS) available through the PathWays for Aging and Health and Wellness waivers, which were formerly combined as the Aged and Disabled waiver. More than 13,000 people are on the combined waitlists. FSSA expects to process 800 PathWays applications and 125 Health and Wellness applications per month. Read the full article

Anthem BCBS-IN Names Lynn Scott President of Medicaid Market. WBIW reported on August 22, 2024, that Lynn Scott was named president of Anthem Blue Cross and Blue Shield’s Medicaid Health Plan in Indiana. Anthem’s Indiana health plan covers more than 700,000 Medicaid beneficiaries. Read the full article

Michigan

Michigan Releases Proposed Policy Drafts to Support Children with Special Healthcare Needs. The Michigan Department of Health and Human Services released on August 20, 2024, two policy proposal drafts for the establishment of the Intensive Care Coordination with Wraparound (ICCW) as a new state plan service, and implementation of the MichiCANS tool for Medicaid-Funded Specialty Behavioral Health Services. The MichiCANS tool will be used to determine eligibility for the ICCW, which is an Early and Periodic Screening, Diagnosis and Treatment (EPSDT) state plan service for eligible individuals under 21 years of age. Under the proposal, Michigan will remove ICCW from its Serious Emotional Disturbances Waiver. Read the full notice

Mississippi

Mississippi Finalizes Medicaid Coordinated Care Contracts Following Protests. WLBT reported on August 21, 2024, that Mississippi has signed new Medicaid Coordinated Care contracts with incumbents Centene/Magnolia and Molina, and a new entrant TrueCare in partnership with CareSource. Contracts were stalled for two years due to protests from incumbent UnitedHealthcare and non-incumbent Anthem/Amerigroup filed in August 2022. The program consists of the Mississippi Coordinated Access Network (MississippiCAN) and the Children’s Health Insurance Program (CHIP), serving roughly 435,000 individuals. The new contracts are expected to be implemented in July 2025. Read the full article

Missouri

Missouri Planned Parenthood Affiliates Challenge Law Removing them from Medicaid Provider List. STLPR reported on August 27, 2024, that affiliates of Planned Parenthood in Missouri are requesting that the Missouri Administrative Hearing Commission, an independent regulatory panel of attorneys, block a new law that prohibits Medicaid from paying for any health care services from a provider that also performs abortions. Planned Parenthood claims the law, which goes into effect August 28, violates federal Medicaid law protecting patients’ right to choose their health care providers. Read the full article

New Mexico

New Mexico Justice-involved Reentry Demonstration Initiative to Launch July 2025. Source New Mexico reported on August 26, 2024, that New Mexico anticipates launching its reentry services for eligible incarcerated individuals up to 90 days immediately prior to release in July 2025 through the Turquoise Care Section 1115 demonstration. The state is currently in the process of determining provider rates and updating contracts with insurance companies to formalize eligibility. A full plan to implement services is due to the Centers for Medicare & Medicaid Services by January 1. Read the full article

New York

New York to Award $24 Million in Funding to Expand HealthySteps Program Sites. Crain’s New York Business reported on August 28, 2024, that New York is awarding more than $24 million in funding to expand its HealthySteps program, which supports mental health services for children up to 3 years old by placing childhood development specialists in participating practices. The funding will support up to 50 new HealthySteps sites as part of plans to grow the program to serve 350,000 children statewide by 2027. Notice of awards are anticipated on November 26, with contracts beginning April 1, 2025. Read the full article

Lawmakers Seek Federal Intervention to Prevent Single Statewide Fiscal Intermediary Contract for CDPAP. Spectrum News reported on August 21, 2024, that 31 New York lawmakers have signed a letter to the Centers for Medicare & Medicaid Services (CMS) asking the agency to prevent the state from moving forward with its single statewide fiscal intermediary (FI) vendor procurement for the Consumer Directed Personal Assistance Program (CDPAP). The legislators argue the state did not properly engage with stakeholders before moving forward with the change, and that a single FI will have negative effects on the economy, providers, and beneficiaries, especially those in rural and underserved populations. The state is set to award the FI contract on October 1. Read the full article

Public Partnerships Offers Subcontracts Ahead of New York CDPAP Fiscal Intermediary Awards. Crain’s New York Business reported on August 22, 2024, that Georgia-based Public Partnerships has offered potential subcontracts to existing fiscal intermediaries in the New York Consumer Directed Personal Assistance Program (CDPAP), should it win the single statewide procurement contract currently underway. PPL has sent teaming agreements which would allow fiscal intermediaries to stay in operation as a partner. The state is expected to award a contract by October 1. Read the full article

North Carolina

North Carolina Child Fatality Task Force Requests Medicaid Coverage for Doula Services. NC Newsline reported on August 23, 2024, that the North Carolina Child Fatality Task Force committee on Perinatal Health has recommended to the full committee that it continue requesting Medicaid coverage for doula services. Funding estimates include $1.5 million to implement Medicaid coverage of doula services and $550,000 for training, promotions, and doula engagement. The committee is also considering a request to support licensure for Certified Professional Midwives. Read the full article

Pennsylvania

Pennsylvania Awards MLTSS Contracts to Five Plans. The Pennsylvania Department of Human Services announced on August 22, 2024, that it has awarded five managed care organizations the Community HealthChoices (CHC) program contracts: Aetna Better Health of Pennsylvania, Health Partners Plans, Centene/PA Health and Wellness, UPMC For You, and Vista Health Plan (AmeriHealth Caritas Pennsylvania CHC and Keystone First CHC). These MCOs will go through a readiness review process before contracts are fully executed. CHC is the mandatory managed long-term services and supports (MLTSS) program, which serves five CHC zones that cover all 67 counties in the commonwealth. CHC serves individuals who are dually eligible for Medicare and Medicaid, and/or those who are enrolled in LTSS at either a nursing home or through a waiver at home. The new contracts, which go into effect January 2025, include increased emphasis on innovative approaches to address health equity and social determinates of health. Current incumbents are AmeriHealth Caritas Pennsylvania CHC, Keystone First CHC, Centene, and UPMC. Read the full announcement

Highmark Health to Form New I-SNP in Pennsylvania. Health Payer Specialist reported on August 21, 2024, that Highmark Health subsidiary’s Endorsed Health is partnering with senior living operators to establish American Health Advantage of Pennsylvania, an Institutional Special Needs Plan (I-SNP) providing specialty Medicare Advantage coverage tailored for dually eligible seniors who reside in long-term nursing care facilities. The partners include Lake Erie College of Osteopathic Medicine, HCF Management, and CHR Consulting Services, in collaboration with American Health Plans. This coverage will be available in 12 Pennsylvania counties starting in January, pending federal approval. Read the full article

Rhode Island

Rhode Island Extends Medicaid Contract Award Appeal Review Deadline by 30 Days. The Rhode Island Current reported on August 27, 2024, that the state’s Director of Administration and Chief Purchasing Officer is giving Rhode Island an additional 30 days to respond to protests over its Medicaid contract awards due to the complexity and scale of the program. The protests came from Tufts Health Plan and Blue Cross Blue Shield Rhode Island (BCBSRI), who both claim the bidding process was unfair, with BCBSRI raising concerns over the five-member review team that scored all four plans. Neighborhood Health Plan of Rhode Island and UnitedHealthcare of New England received awards for the $15 billion contract, which is slated to begin July 1, 2025. Read the full article

Rhode Island Receives Two Protests Over Medicaid Contract Awards. WPRI reported on August 22, 2024, that Blue Cross & Blue Shield Rhode Island (BCBSRI) and Tufts Health Plan have filed protests over the state’s July decision to award its $15 billion Medicaid contract to UnitedHealthcare of New England and Neighborhood Health Plan of Rhode Island. BCBSRI and Tufts both argue the state did not properly assess plans before choosing awardees, with BCBSRI alleging the assessment panel gave United and Neighborhood Health illogically high scores in multiple areas. Read the full article

Rhode Island Releases Medicaid Enterprise System Integrator, Operational Data Store RFP. The Rhode Island Executive Office of Health and Human Services released on August 27, 2024, a request for proposals (RFP) seeking a system integrator and operational data store (ODS) vendor to integrate technical components of the state’s Medicaid Enterprise System (MES). Rhode Island is currently in the process of transforming its Medicaid Management Information System (MMIS) to a modular but integrated MES. The vendor will be responsible for designing and implementing the technical components to efficiently share data and services between systems. The ODS will reduce duplication of data across systems and improve data quality. Proposals are due October 25, 2024, and the three-year contract will begin in March 2025. View the bidding opportunities

Tennessee

Tennessee Unlawfully Disenrolled Medicaid Coverage for Thousands of Children, Federal Judge Rules. The Tennessean reported on August 26, 2024, that a federal judge ruled that TennCare unlawfully terminated Medicaid coverage for thousands of Tennessee families and withheld information needed to have their coverage reinstated. The class-action lawsuit filed in 2020 alleged that flaws in the state’s eligibility policies and practices caused around 250,000 children to lose coverage. Tennessee claims to have revamped its eligibility verification system but denies that anyone had been improperly disenrolled. Read the full article

Texas

Texas Medicaid Plan Overstated Medical Expenses by $934,772 in Fiscal 2022, OIG Finds. The Texas Health and Human Services Commission’s (HHSC) Office of the Inspector General (OIG) reported on on August 13, 2024, that according to a July inspections report, Medicaid managed care organization Community Health Choice Texas misclassified 4,797 of 6,152 beneficiary encounters reviewed by OIG. The non-covered encounters were classified as covered visits, which resulted in a $934,772 overstatement of medical expenses in fiscal 2022. OIG made recommendations to Community Health Choice to resolve the errors, including implementing controls to ensure proper classification, coding non-covered services as case-by-case services, consulting with HHSC’s Financial Reporting and Audit Coordination to correct misreported medical expenses, and developing a documentation process to show why non-covered services are coded as case-by-case services. Read the full statement

Vermont

Vermont Governor Names DaShawn Groves as Medicaid Commissioner. Vermont Governor Phil Scott announced on August 22, 2024, that he has appointed DaShawn Groves as the new Department of Vermont Health Access (DVHA) commissioner, beginning September 3. Most recently, Groves worked as the Special Projects Officer to the Medicaid Director in Washington DC’s Department of Health Care Finance. DVHA is responsible for administering the Vermont Medicaid program and Vermont’s state-based exchange for health insurance. Read the full article

West Virginia

West Virginia Increases Medicaid HCBS Provider Reimbursement Rates by 15 Percent. The Parkersburg News and Sentinel reported on August 23, 2024, that West Virginia will increase reimbursement rates by 15 percent for Medicaid providers delivering services under the state’s home and community-based services (HCBS) Medicaid waivers. The waivers include the aged and disabled waiver, the children with serious emotional disorders waiver, the traumatic brain injury waiver, and the intellectual and developmental disability waiver. The new rates go into effect on October 1. Read the full article

National

CMS Awards $100 Million to Marketplace Navigators. The Centers for Medicare & Medicaid Services (CMS) announced on August 26, 2024, that it has awarded $100 million to 44 Navigators helping underserved communities enroll in healthcare coverage through the Affordable Care Act’s insurance marketplace. Navigators can also assist individuals in enrolling in Medicaid and CHIP. The funds are part of a five-year $500 million grant. Read the press release

CMS Resolves Thousands of No Surprises Act Cases, Issues $4.2 Million in Relief. Fierce Healthcare reported on August 21, 2024, that the Centers for Medicare & Medicaid Services (CMS) has resolved most of the 16,000 complaints involving the No Surprises Act and Affordable Care Act compliance received as of June 30. Patients and consumers mainly issued complaints against providers for surprise billing at in-network facilities for non-emergency services and surprise billing for emergency services, and payers faced complaints over non-compliance with qualifying payment amount requirements. CMS found no violation in 35 percent of closed cases, and issued a total of $4.2 million in relief to providers and consumers. Approximately 3,000 cases remain open. Read the full article

Hospitals Increasingly Invest in Affordable Housing to Reduce Preventable Visits. Modern Healthcare reported on August 21, 2024, that almost 25 hospital systems invested more than $550 million into affordable housing in fiscal 2023 in efforts to decrease emergency department visits from patients experiencing homelessness. Other hospital systems are using government funds made available through Medicaid section 1115 health-related social needs demonstrations approved in 10 states, giving hospitals the opportunity to cover their patients’ rent and other housing costs for up to six months. Some systems are also using their long-term financial reserves to invest in housing services and are leasing or buying land for affordable housing developers. Read the full article

Approaches to Analyzing Use, Spending in LTSS Vary, MACPAC Finds. The Medicaid and CHIP Payment and Access Commission (MACPAC) released in August 2024, an issue brief comparing and contrasting four approaches to analyzing Medicaid Long-term services and supports (LTSS) data, including the Centers for Medicare & Medicaid Services (CMS) LTSS expenditure and user reports; home and community-based services (HCBS) taxonomy work sponsored by the Assistant Secretary for Planning and Evaluation; DQ Atlas HCBS methodology brief; and KFF’s HCBS analyses. The reports varied in the timeframes analyzed, although both the CMS LTSS and KFF reports examine expenditures and user counts for HCBS and institutional LTSS, while the ASPE and DQ Atlas briefs provide a methodological approach for identifying HCBS but do not contain any statistics on use or spending. Read the issue brief