HMA Weekly Roundup

Arizona

Arizona Receives Federal Approval to Increase CHIP Income Limit. The Arizona Health Care Cost Containment System announced on February 20, 2024, that it has received federal approval to increase the upper income limit of KidsCare, the state’s Children’s Health Insurance Program (CHIP), to 225 percent of the federal poverty level, beginning April 1. The state has also received approval to pay parents as caregivers of their minor children with disabilities enrolled in Arizona’s Long Term Care System, which will now be a permanent feature of the program. Read More

Colorado

Colorado Disenrolls 67,967 Medicaid Beneficiaries During January Redeterminations. The Colorado Department of Health Care Policy & Financing disenrolled approximately 67,967 Medicaid beneficiaries during January eligibility redeterminations, including 45,566 due to procedural reasons and 22,401 due to ineligibility. Read More

Connecticut

Connecticut Medicaid Reimbursement Rates Generally Lower Compared to Peer States, Medicare. CT Mirror reported on February 19, 2024, that Connecticut’s Medicaid reimbursement rates were generally lower when benchmarked against five peer state averages and Medicare, according to a phase-one rate study report released by the Connecticut Department of Social Services. The peer states included Maine, Massachusetts, New Jersey, New York, and Oregon. Overall, Connecticut paid less than a peer state benchmark for 85 percent of services analyzed and less than a Medicare-based benchmark for 94 percent of services analyzed. The rate study phase two report is due January 1, 2025. Read More

Florida

Florida Delays Awards for Medicaid Managed Care ITN. The Florida Agency for Health Care Administration released on February 15, 2024, an addendum extending the anticipated award date for the Statewide Medicaid Managed Care procurement from February 23 to March 25. The bidders are AmeriHealth Caritas, CareSource/ImagineCare, Centene/Sunshine State Health Plan, CVS/Aetna, Elevance/Simply Healthcare Plans, Florida Community Care, Humana, Molina, Sentara Care Alliance, South Florida Community Care Network/Community Care Plan, and UnitedHealthcare. Contracts are expected to take effect October 1. Read More

Florida House Committee Advances Bill to Boost Physician Workforce. Health News Florida reported on February 16, 2024, that the Florida House Health & Human Services Committee advanced a bill, sponsored by House Majority Leader Michael Grant (R-Port Charlotte), that would offer $717 million to expand medical residency programs, increase the number of doctors in the state, and provide increased access to student loan programs. A similar bill, sponsored by Senate Health Policy Chairwoman Colleen Burton (R-Lakeland), passed in the Senate. The bill will next head to the House floor for review. These bills comprise Senate President Kathleen Passidomo’s “Live Healthy” legislation package aimed at improving healthcare access. Read More

Georgia

Georgia Bill Would Establish Study Committee to Examine Private Option Medicaid Expansion Waiver. The Atlanta Journal Constitution reported on February 20, 2024, that Georgia House Speaker Jon Burns (R-Newington) introduced a bill that would establish a study committee to examine a waiver to enroll additional Medicaid beneficiaries through a private option. The Comprehensive Health Coverage Commission would include nine members who would examine a similar waiver program implemented in Arkansas that allowed the state to utilize expansion dollars to purchase private insurance for uninsured individuals. The push for a study committee indicates that state lawmakers are unlikely to advance Medicaid expansion legislation this year. Read More

Iowa

Iowa Senate Advances Bills Altering Postpartum Medicaid Coverage, MOMS Program. The Iowa Capital Dispatch reported on February 19, 2024, that the Iowa Senate has advanced two bills, one of which would extend postpartum Medicaid coverage to 12 months for families. The bill would limit eligibility for Medicaid coverage of birth and postpartum care from 380 percent of the federal poverty level under current law to 215 percent. It is estimated that 1,300 women and 400 infants would lose Medicaid coverage per month under the new income restrictions. The second bill would allow the Iowa Department of Health and Human Services to directly oversee the More Options for Maternal Support (MOMS) program and contract with providers, removing the previous requirement to hire a third-party administrator. Read More

Kentucky

Kentucky Senate Advances Bill to Cover Midwife Services Under Medicaid. News From The States reported on February 16, 2024, that the Kentucky Senate passed a bill that would allow Medicaid to cover licensed certified professional midwife services for women with low-risk pregnancy. Licensed midwives may offer prenatal, postpartum, and labor and delivery services. The bill now moves to the House. Read More

Maryland

Maryland Awards Behavioral Health ASO Contract to Elevance. The Maryland Department of General Services announced on February 14, 2024, that Maryland has awarded Carelon, an Elevance subsidiary, the state’s administrative services organization (ASO) contract for the Public Behavioral Health System (PBHS). The PBHS provides mental health and substance use disorder services to Medicaid members. The five-year contract is valued at a total of $339.6 million. The incumbent is United/Optum. Read More

Missouri

Missouri Supreme Court Rules Against Blocking Medicaid Payments to Planned Parenthood. The Missouri Independent reported on February 14, 2024, that the Missouri Supreme Court has ruled that a 2022 budget bill, which prohibits Medicaid from paying for any health care services from a provider that also performs abortion, was unconstitutional. In 2020, the Missouri Supreme Court ruled in favor of Planned Parenthood in a similar dispute. Read More

Nebraska

Nebraska Legislature Advances Bill to Increase Medicaid Hospital Payment Rates. Nebraska Public Media reported on February 15, 2024, that the Nebraska Legislature advanced a provider tax bill, sponsored by Senator Mike Jacobson (R-North Platte) and 19 co-sponsors, that could garner $1 billion in additional funding, raise Medicaid payment rates for hospitals, and reduce cuts in services. The bill would require hospitals to pay an assessment of up to 6 percent of net patient revenue, which would serve as the match for federal funding. The bill will next receive the second of three reviews from the legislature. Read More

Legislature Considers Bill to Expand Medicaid Coverage of Anti-obesity Medications. The Nebraska Examiner reported on February 15, 2024, that the Nebraska legislature is considering a bill, sponsored by Senator Mark Riepe (R-Ralston), that would expand Medicaid coverage of anti-obesity medications. The bill is expected to cost $3.6 million annually and is aimed at improving health outcomes for the more than 30 percent of residents affected by obesity. The bill is currently in the Health and Human Services Committee. Read More

Legislature Advances Bill to Expand Medicaid Prenatal Care Reimbursement. The Omaha World-Herald reported on February 14, 2024, that the Nebraska legislature advanced a bill to establish the Nebraska Prenatal Plus Program. The program, aimed at at-risk mothers who are Medicaid recipients, would expand Medicaid reimbursements for prenatal care to include nutrition counseling and targeted case management beginning six months prior to birth. Legislators adopted an amendment to end the program in June 2028. The bill will next undergo the second of three reviews by the Legislature. Read More

New York

New York Proposed Budget Amendment to Increase Consumer Directed Personal Assistance Program Oversight. The New York Post reported on February 16, 2024, that New York Governor Kathy Hochul submitted a fiscal 2025 proposed budget amendment which makes changes to the Consumer Directed Personal Assistance Program (CDPAP), aimed at minimizing fraud. The amendment includes limiting the number of financial intermediaries that can operate in the state, limiting the number of hours those employed can work, and allowing the state Department of Health expanded oversight and regulatory powers. The administration estimates the proposed changes to the CDPAP will save the state around $100 million per year. Read More

Pennsylvania

Pennsylvania Submits Section 1115 Waiver Application Addressing Health-related Social Needs. The Centers for Medicare & Medicaid Services announced on February 15, 2024, that Pennsylvania submitted a new Section 1115 waiver application, titled “Bridges to Success: Keystones of Health For Pennsylvania.” The waiver is intended to address health-related social needs and specifically aims to reduce healthcare costs and expand services to individuals in the following focus areas: individuals reentering the community from correctional facilities; recipients in need of stable housing, food and nutrition services; and continuous Medicaid coverage for children under age six. If approved, the state would administer the waiver from January 1, 2025, through January 1, 2030. The federal comment period will be open through March 16. Read More

Utah

Utah Senate Considers Bill Allowing Medicaid Coverage for Native Healing Services. The Salt Lake Tribune reported on February 19, 2024, that the Utah Senate is considering a bill that would allow Medicaid to cover traditional Native healing services. Utah would be the fourth state to request federal approval to reimburse for Native healing practices, following New Mexico which is currently approved, and California and Arizona, which have pending requests. It is estimated that about 1,100 Medicaid eligible Native Americans will use the traditional healing services. Read More

Virginia

Virginia Senate Passes Medicaid Initiative Bill for Undocumented Children. The Post Millennial reported on February 14, 2024, that the Virginia Senate passed the “Cover All Kids” Medicaid initiative which would expand a Medicaid style program to about 88,000 children who are undocumented in the state. The plan will now move to the House of Delegates for consideration. Read More

National

CMS Issues Final Rule Imposing Restrictions on DSH Payments. Modern Healthcare reported on February 20, 2024, that the Centers for Medicare & Medicaid Services (CMS) has issued a final rule setting new restrictions on how Medicaid disproportionate share hospital (DSH) payments are calculated and distributed. Under the rule, hospitals will only be able to account for patients with Medicaid as their primary payer, although safety-net hospitals with the highest concentrations of low-income patients are exempt. Read More

Surprise Billing Negotiations Surpass Federal Estimates, CMS Finds. Fierce Healthcare reported on February 16, 2024, that the number of surprise billing negotiations that reached the independent dispute resolution phase of the No Surprises Act protocols surpassed federal estimates in the first six months of 2023, according to a report from the Centers for Medicare & Medicaid Services (CMS). The number of cases totaled 288,810 during this period, which was 13 times higher than projections for the entire year. CMS also reported that a small number of entities drove the majority of the cases, with the top 10 parties representing 78 percent of all cases that went to dispute resolution, including large practice management companies, revenue cycle management firms, and medical practices. In the first half of 2023, three entities were responsible for starting 58 percent of the disputes, SCP Health, Team Health, and Radiology Partners. Providers won in 77 percent of cases, while health insurers won in 23 percent of cases. Read More

CMS Issue Brief Finds Doulas, Community Health Workers Improve Postpartum Outcomes. The Centers for Medicare & Medicaid Services (CMS) released on February 16, 2024, a brief highlighting findings from the Improving Postpartum Care Affinity Group from 2021 through 2023. Several states found that doulas, community health workers, and home visits reduced postpartum complications and improved maternal and infant outcomes. Maternity case management services also ensured beneficiaries received the services and supports they needed. States that participated include Kentucky, Georgia, Oklahoma, South Carolina, Texas, Kansas, Missouri, Montana, and Wyoming. Read More

HHS, FTC Release RFI to Investigate Generic Drug Shortages. CQ reported on February 14, 2024, that the U.S. Department of Health and Human Services (HHS) and the Federal Trade Commission (FTC) have released a joint request for information (RFI) to seek feedback on how group purchasing organizations and drug wholesalers affect generic drug shortages. The RFI mainly focuses on how market concentration and contracting terms affect drug supply and whether violations of antitrust and price discrimination laws are present. Read More

CMS Releases Preliminary CMS-64 2023 Medicaid, CHIP Expenditure Report. The Centers for Medicare & Medicaid Services (CMS) released the Medicaid Budget and Expenditure System/State Children’s Health Insurance Budget and Expenditure System expenditure report for 2023. The report contains preliminary data from state Form CMS-64 filings, with breakdowns of expenditures for Medicaid, Medicaid administration, and CHIP. If you’re interested in becoming an HMAIS subscriber to gain access, contact Andrea Maresca at [email protected].