Weekly Roundup

HMA Weekly Roundup

Trends in Health Policy

In Focus

Discover the Challenges and Opportunities Associated with Implementing Value-Based Care at the HMA Spring 2024 Workshop

Policymakers have been working to move the U.S. healthcare system away from the costly and inefficient framework of fee-for-service to patient-centered structures focused on value and quality. Financial pressures, government regulation, and improvements in managed care all contribute to the drive toward value-based care, and that creates challenges for providers, payers, manufacturers, government, and others supporting the industry. Though some stakeholders are hanging on to the old ways of doing things, others are rightly moving toward putting their emphasis on value, changing their payment and workforce structures, and improving quality.  

Health Management Associates will host the spring workshop, Getting Real About Transforming Healthcare Quality and Value, March 5−6, 2024, at the Fairmont Chicago Millennium Park Hotel in Chicago. The workshop starts with a kickoff event the evening of March 5 designed to foster meaningful connections for attendees, regardless of their role as a government official, provider, health system representative, payer, or vendor in public or private healthcare markets.  

The full-day program on March 6 will feature a compelling keynote speaker and include multiple interactive workshop sessions focused on four key pillars of value-based care: Policy & Strategy Frameworks, Payment & Risk Management, Data & Technology, and Care Delivery Measures. HMA has expertise in working with commercial payers; primary, specialty, and behavioral healthcare providers; and publicly sponsored health plans at the local, state, and federal levels. Session discussions will help participants adapt to the new value-based market and are designed to provide a comprehensive exploration of the intricacies involved in healthcare transformation. Attendees will discuss what to expect during the early phases of transformation, as well as strategies, collaborations, and actions that have moved them closer to adding value on the ground.  

Participants will be challenged to think critically about their organization’s cultural and operational readiness to create additional value for patients within the healthcare ecosystem. Drivers of policy, innovation, population health, risk management, IT, and data, as well as enablers and other stakeholders working in public and commercial markets, will meet in smaller groups to discuss and analyze scenarios, pose challenging questions, and identify tactical steps and solutions to thorny issues.  

Other groups focusing on value will address multi-sector issues and perspectives that affect value-based care, including behavioral health, primary, and specialty care. From navigating the complexities of employee insurance plans for businesses to advocating for the needs of individual consumers, this workshop will address the formidable challenge of reshaping the healthcare landscape.  

Don’t miss this opportunity to gain valuable insights and contribute to genuine and productive discussions that will shape the future of healthcare.  

Whether you attend on behalf of your organization or with a team of colleagues whose roles touch upon different links in the value-based chain, you will bring back ideas and strategies that can be implemented upon your return. Click here to register today! 

HMA Roundup


Alabama Releases Coordinated Health Network RFP. The Alabama Medicaid Agency released on December 27, 2023, a request for proposals (RFP) for the Alabama Coordinated Health Network (ACHN) program, the state’s primary care case management (PCCM) entity. Eligible beneficiaries served through the ACHN program include medically complex recipients, maternity care recipients, children under age 19, parents or other caretaker relatives, foster children, individuals with breast and cervical cancer, and American Indians. Proposals are due March 4, 2024, with intent to award on April 19, 2024. The contracts will run for one year beginning October 1, 2024, with four one-year renewal options. The incumbents are MyCare Alabama Northwest, North Alabama Community Care, Gulf Coast Total Care, Alabama Care Network Southeast, Alabama Care Network MidState, MyCare East, and MyCare Central. Read More


Arkansas Releases Medicaid Third Party Liability RFP. The Arkansas Department of Human Services released on December 22, 2023, a request for proposals (RFP) for a Medicaid third-party liability identification, cost avoidance, and recovery system vendor. The state will award one contract for a one year term with up to six one-year renewal options. Proposals are due February 19, 2024, with intent to award on March 22, 2024. The anticipated contract start date is July 1, 2024. Read More


California Expands Medicaid Coverage to 700,000 Undocumented Immigrants. The Associated Press reported on December 30, 2023, that California expanded Medicaid coverage to more than 700,000 undocumented individuals ages 26 to 49, effective January 1, 2024. The expansion is expected to cost $1.2 billion during the first six months and $3.1 billion annually thereafter. Read More

Medi-Cal Looks to Improve Doula Benefit Utilization. LAist reported on December 21, 2023, that preliminary data show that 50 Medi-Cal beneficiaries have received doula services since July. There have been 180 individual doulas and about 70 doula organizations that completed the Medi-Cal provider enrollment process as of mid-November. Medi-Cal requires that beneficiaries receive a recommendation for doula services from their provider, which can be difficult due to barriers to maternity care. In the next month, California will begin convening a workgroup of doulas, health advocates, and other stakeholders to discuss how to improve the Medi-Cal benefit. Read More


Florida Legislators Propose Medicaid Buy-in Program for Individuals with Disabilities. Axios Tampa Bay reported on January 2, 2024, that Florida lawmakers filed bills in both the state House and Senate that would establish a Medicaid buy-in program to provide Medicaid coverage options for employed individuals with disabilities. The House version of the bill, sponsored by Representative Dotie Joseph (D-Miami-Dade), has been referred to the House Select Committee on Health Innovation. The Senate version, sponsored by Senator Joe Gruters (R-Sarasota), has been referred to the Health Policy Committee, Fiscal Policy Committee, and Appropriations Committee on Health and Human Services. Read More

Florida Files Lawsuit Against Federal Government Over Withheld Medicaid Records. The Sun Sentinel reported on December 20, 2023, that Florida Governor Ron DeSantis filed a Freedom of Information Act lawsuit alleging that the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services have withheld records that the state requested in August. The records requested are relevant to a class-action lawsuit against the state, which argues that the state failed to provide enough clear information to beneficiaries about the redetermination process. HHS denied the request to the Florida Agency for Health Care Administration, citing an exemption in the Freedom of Information Act. Read More


Illinois Approves Applications to Expand Access to Dementia Care Through the Supportive Living Program. The Illinois Department of Healthcare and Family Services announced on December 28, 2023, approval for 11 entities to pursue certification to participate in the Medicaid Supportive Living Program for Dementia Care Settings, which operates through a home and community-based services waiver. The program allows Medicaid to pay for assisted living services for Medicaid participants with Alzheimer’s disease or related dementia. Selected applicants are required to become operational within 180 days and apartments will be located in Cook, DuPage, Lake, St. Clair and Winnebago counties. Read More


Louisiana Governor-elect Plans to Consider Medicaid Work Requirement. The Louisiana Illuminator reported on December 20, 2023, that Louisiana Governor-elect Jeff Landry is considering work requirements and copayments for Medicaid beneficiaries. The state briefly considered implementing work requirements for Medicaid in 2018 but ended up abandoning the proposal. Read More


Montana Medicaid Seeks to Provide Housing Support Services. NBC Montana reported on December 20, 2023, that Montana is seeking to include housing support services as a Medicaid benefit for beneficiaries with behavioral health and housing needs, not including rent payments. The new benefit will be requested through the state’s Medicaid Section 1115 Waiver, the Healing and Ending Addiction through Recovery and Treatment Initiative. Read More


Nebraska Medicaid Proposes Dental Coverage, Reimbursement Changes. The North Platte Post reported on December 28, 2023, that Nebraska Medicaid proposed expansions to dental services, including removing the annual dental benefit maximum and implementing coverage of asymptomatic wisdom tooth extraction. The changes would additionally reimburse dentists for each step of the denture treatment process and reimburse public health dental hygienists for select services. Read More


Nevada Extends Medicaid Postpartum Coverage to 12 Months, Covers Autism Care for Adults Up to Age 27. The Nevada Independent reported on January 1, 2024, that Nevada Medicaid extended postpartum Medicaid coverage to 12 months and will cover applied behavioral analysis for adults with autism up to age 27, effective January 1, 2024. Read More

North Carolina

North Carolina Launches Medicaid Expansion Data Dashboard. The Rhino Times reported on December 20, 2023, that North Carolina has launched a Medicaid expansion enrollment dashboard, which shows enrollment changes and trends for newly eligible adults who can now apply for Medicaid expansion coverage. Information on the percentage of eligible adults newly enrolled in Medicaid by county and type of health plan is also included, as well as information specific to rural areas of the state. Read More

North Dakota

North Dakota Announces 2024 Medicaid Plan Changes, Including Inflationary Rate Increases. The North Dakota Department of Health and Human Services announced on December 29, 2023, several state Medicaid plan changes effective for January 1, 2024, including a 3.2 percent inflationary increase for nursing facility services, a 3.0 percent inflationary increase for psychiatric residential treatment facility services, and a state plan amendment to update the rate limits for nursing facility services. The capitated monthly rate for Medicaid expansion, effective January 1, 2024, is still unknown due to uncertainties stemming from the end of the public health emergency and unwinding efforts. As required by state statute, North Dakota Medicaid ended the Primary Care Case Management program in December 2023. Read More


Oklahoma Disenrolls More Than 307,000 Medicaid Beneficiaries During Redeterminations. High Plans Public Radio reported on December 29, 2023, that Oklahoma disenrolled more than 307,000 Medicaid beneficiaries between April and November. Of those disenrolled, approximately 173,183 individuals lost coverage due to procedural reasons. Read More


Utah CHIP to Cover Non-citizen Children. The Salt Lake Tribune reported on January 3, 2024, that Utah Children’s Health Insurance Program (CHIP) launched a new benefit to cover non-citizen children. The cost of the program is capped at $4.5 million a year, limiting enrollment to about 2,000 children. Utah is one of an increasing number of states that offer fully state-funded health coverage for individuals, regardless of citizenship status. Read More

Utah Survey Finds More Than Half of Medicaid Beneficiaries Disenrolled During Redeterminations Did Not Seek Renewal. KFF reported on January 3, 2023, that 57 percent of Utahans who were disenrolled during the Medicaid redetermination process did not attempt to renew their coverage, according to a survey conducted from October 11-17, 2023. Of those, 39 percent are now insured through an employer, 30 percent became uninsured, and 15 percent enrolled in a Marketplace health plan. Thirteen percent of the now uninsured said the process was too difficult and nine percent said they never received renewal documents. Read More


Medicaid, CHIP Enrollment Drops 1.6 Million in September 2023, CMS Reports. The Centers for Medicare & Medicaid Services (CMS) reported on December 28, 2023, that enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) was approximately 88.4 million in September 2023, a decrease of 1.6 million from August 2023. Medicare enrollment was 66.5 million, up 134,147 from August 2023, including 32.5 million in Medicare Advantage plans. More than 12 million Medicare-Medicaid dual eligibles are counted in both programs. Read More

Industry News

Cigna to Sell Medicare Advantage Business to Health Care Services Corporation. The Wall Street Journal reported on January 3, 2024, that Cigna is in exclusive talks to sell its Medicare Advantage (MA) business to Health Care Service Corporation for an estimated value between $3 and $4 billion. The MA business had approximately 599,000 members at the end of September 2023 and operates in 29 states. Read More

BrightSpring Health Services Files for IPO. Modern Healthcare reported on January 3, 2024, that Kentucky-based BrightSpring Health Services, an independent provider of home and community-based services, filed plans for an initial public offering (IPO) with the Securities and Exchange Commission. Read More

Molina Healthcare Acquires Bright Healthcare’s CA Medicare Business. Molina Healthcare announced on January 2, 2024, that it finalized its acquisition of Bright Healthcare’s California Medicare business, effective January 1, 2024. The Bright Healthcare business served more than 109,000 individuals at closing. Read More

The Ensign Group Acquires Two Skilled Nursing Facilities. Modern Healthcare reported on January 2, 2024, that the Ensign Group, a senior living and skilled nursing home operator, acquired TriState Health, a 116-bed Tennessee-based skilled nursing facility, and Hearthstone Health and Rehabilitation, a 125-bed Nevada-based skilled nursing facility, for undisclosed amounts. Ensign now possesses 299 skilled nursing and senior living operations across 14 states. Read More

RFP Calendar

HMA News & Events


Medicaid Data
Medicaid Enrollment:

  • California Medicaid Managed Care Plans Generate $52.6 Billion in Premiums Across 27 Plans, 2022 Data
  • Louisiana Medicaid Managed Care Enrollment is Down 9.4%, Nov-23 Data
  • Mississippi Medicaid Managed Care Enrollment is Up 3.7%, Nov-23 Data
  • Missouri Medicaid Managed Care Enrollment is Flat, Sep-23 Data
  • MLRs Average 83.8% at Missouri Medicaid MCOs, 2022 Data
  • North Carolina Medicaid Managed Care Enrollment is Up 10.6%, 2023 Data
  • Pennsylvania Medicaid Managed Care Enrollment is Down 9.3%, Nov-23 Data

Public Documents: 

Medicaid RFPs, RFIs, and Contracts:

  • Alabama Coordinated Health Network RFP, Dec-23
  • Alabama Modular Electronic Visit Verification RFP, 2023
  • Arizona Long Term Care System RFP, Proposals, Scoring, Protests, and Related Documents, 2023
  • Arkansas Medicaid Third-Party Liability RFP, Dec-23
  • Texas STAR Health Foster Care RFP, Scoring, Response, and Oral Presentation, 2021-22

Medicaid Program Reports, Data, and Updates:

  • Hawaii Medicaid Managed Care Rate Certifications, FY 2019-24
  • Pennsylvania HealthChoices CAHPS Quality Measures, 2020-22
  • Utah Former Medicaid Member Online Survey Report, Dec-23

A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services. An HMAIS subscription includes:

  • State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
  • Downloadable ready-to-use charts and graphs
  • Excel data packages
  • RFP calendar

If you’re interested in becoming an HMAIS subscriber, contact Andrea Maresca at [email protected].

Get the free HMA
Weekly Roundup