HMA Weekly Roundup

Alabama

Alabama Receives Approval for Community-Based Mobile Crisis Services SPA. The Centers for Medicare & Medicaid Services announced on November 20, 2023, that it has approved the Alabama community-based mobile crisis state plan amendment (SPA). The state can now utilize federal Medicaid funding to create mobile intervention teams to provide Medicaid crisis services 24/7 to eligible youth and adults experiencing a mental health or substance use crisis. Read More

Alabama Awards General Dynamics Contract for Medicaid Enterprise System Redesign. HIT Consultant reported on November 17, 2023, that the Alabama Medicaid Agency has awarded General Dynamics Information Technology (GDIT) a $63 million contract to help the state transition to a modular Medicaid Enterprise System (MES), including technology designed to streamline processes, enhance data interoperability, and improve overall service delivery. The contract is for two years, with three additional two-year renewal options. Read More

Arizona

Arizona Requests Section 1115 Waiver Amendment to Raise CHIP Eligibility Threshold. The Centers for Medicare & Medicaid Services announced on November 20, 2023, that Arizona submitted a request to amend its Health Care Cost Containment System Section 1115 demonstration program to raise the Children’s Health Insurance Program (CHIP) eligibility thresholds from 200 percent of the federal poverty level (FPL) to 225 percent FPL. Public comments will be accepted through December 20, 2023. Read More

California

California Governor Signs Bill to Simplify Billing, Increase Access for Medicaid School-based Health Programs. The Sierra Sun Times reported on November 18, 2023, that California Governor Gavin Newsom signed a bill (AB 483) that will streamline the Local Education Agency Billing Option Program (LEA BOP), which reimburses LEAs for the federal share of services provided to Medi-Cal eligible students. State officials expect that easing the administrative burdens for schools to participate in LEA BOP will expand access to several student health and mental health services. Currently, about one-half of all California LEAs participate in the LEA BOP program and receive less in Medicaid reimbursement than other states, in part due to administrative requirements. Read More

California Revises Prior Authorization Policies for Diabetes Medications, Supplies. KFF Health News reported on November 17, 2023, that the California Medicaid program (Medi-Cal) has revised its prior authorization policy for diabetes medications and supplies, making approvals valid for one year and allowing patients to obtain a 90-day supply. Medi-Cal will also now permit prior authorization approvals by phone or video. Read More

Delaware

Delaware Fiscal 2025 Budget Requests Include Additional Medicaid Funding, Workforce Support. Delaware Public Media reported on November 19, 2023, that the Delaware Department of Health and Social Services (DHSS) has requested about $79.5 million to support the state Medicaid program after the loss of additional federal funding during the COVID-19 public health emergency. DHSS also requested $1.3 million to provide additional personal attendant services for those with disabilities or above age 60. Read More

Florida

Florida Agency Sent $145 Million in Unspent Funds Intended for Disability Services Back to State Coffers. The Orlando Sentinel reported on November 17, 2023, that Florida’s Agency for Persons with Disabilities (APD) had $287 million in unspent state funds for disability services over the past two years, according to a budget analysis conducted by The ARC of Florida. The APD reported that it returned $145 million of the unspent funds to the state coffers. Read More

Florida Bills Would Remove Step Therapy Requirement for Medicaid Beneficiaries with Mental Illness. Health News Florida reported on November 17, 2023, that Florida Representative Karen Gonzalez Pittman (R-Tampa) filed a bill for the 2024 legislative session that would permit Medicaid beneficiaries with serious mental illness to avoid step therapy. Senator Gayle Harrell (R-Stuart) filed a similar bill in the Senate, which was subsequently referred to the Health Policy and Fiscal Policy Committees last month. If passed, the legislation would require the Florida Agency for Health Care Administration to adjust rates paid to managed care plans accordingly. Read More

Medicaid Redeterminations Lawsuit Is Scheduled for Arguments in December. Health News Florida reported on November 16, 2023, that a federal judge will hear arguments on December 5 in a lawsuit seeking to pause Florida Medicaid eligibility redeterminations and to reinstate coverage for disenrolled beneficiaries. The plaintiffs are also seeking class-action status. The lawsuit, which was filed in August 2023, argues that the state failed to provide enough clear information to beneficiaries about the redetermination process. Read More

Florida Disenrolls 56,010 Medicaid Beneficiaries During October Redeterminations. Health News Florida reported on November 16, 2023, that Florida disenrolled 56,010 Medicaid beneficiaries in October. The state has disenrolled a total of more than 670,000 enrollees since redeterminations began in April. Read More

Georgia

Georgia Legislators Discuss Coupling Full Medicaid Expansion, Relaxation of Certificate-of-Need Requirements. The Atlanta Journal-Constitution reported on November 17, 2023, that Georgia legislators held a hearing to discuss a proposal to couple full Medicaid expansion with easing certificate-of-need (CON) rules. Topics at the hearing included potential financial impacts of Medicaid expansion and CON rules, particularly for the stability of rural hospitals. Read More

Idaho

Idaho Releases MMIS System Integrator Technical Advisory Services RFP. The Idaho Division of Purchasing for the Department of Health and Welfare released on November 16, 2023, a request for proposals (RFP) seeking a vendor to provide System Integrator Technical Advisory professional services to support the state’s new modular solution Medicaid Management Information System (MMIS) procurement. The contractor is expected to develop a framework for MMIS modernization and ensure implementation and integration of the new system. Responses are due January 5, 2024. The contract will last for four years, with a maximum term length of eight years. Read More

Idaho Department of Health and Welfare Director Dave Jeppesen to Retire. The Idaho Capital Sun reported on November 15, 2023, that Idaho Department of Health and Welfare (DHW) director Dave Jeppesen will retire at the end of 2023. Idaho Department of Insurance (DOI) director Dean Cameron will serve as interim director of DHW, while the state searches for a permanent replacement. Cameron will also maintain his role as DOI director. Read More

Indiana

Indiana Medicaid Oversight Committee Defers Making Recommendations Ahead of 2024 Legislative Session. WBAA News reported on November 15, 2023, that the Indiana legislature’s Medicaid Oversight Committee, chaired by Senator Ryan Mishler (R-Mishawaka), did not include recommendations in its final report after hearing testimony on several aspects of the program. The chair signaled that its findings may be used to inform recommendations for the 2025 state budget. Read More

Louisiana

Louisiana Department of Health Met More Than 90 Percent of FY 2023 Goals and Deliverables, Report Finds. The Louisiana Department of Health (LDH) released on November 27, 2023, its annual Outcomes Report, which found that LDH successfully completed 91.1 percent of the 45 goals and 92.5 percent of the 235 deliverables detailed in the fiscal 2023 LDH Business Plan. The goals include efforts to address chronic disease, improve maternal health and services for those with developmental disabilities, and expand behavioral health care. Read More

Massachusetts

Massachusetts Disenrolls 87,914 Medicaid Beneficiaries During October Redeterminations. WBUR reported on November 29, 2023, that Massachusetts disenrolled 87,914 Medicaid beneficiaries following October redeterminations. The state has renewed coverage for 90,600 beneficiaries. Massachusetts combined Medicaid and Children’s Health Insurance Program rolls have dropped by a total of 112,000, since redeterminations began in April while enrollment through the state’s Exchange program has increased by 38,000 during that time. Read More

Minnesota

Minnesota Disenrolls 119,942 Million Medicaid Beneficiaries Following Redeterminations from July Through September. State of Reform reported on November 27, 2023, that Minnesota has disenrolled a total of 119,942 Medicaid beneficiaries, with 42 percent of those disenrolled being children, following eligibility redeterminations from July through September 2023. Of those disenrolled, about 97,324 were due to procedural reasons. The state has renewed Medicaid coverage for 377,227 individuals since July and identified more than 23,100 eligible for exchange coverage. Read More

Montana

Montana Medicaid Disenrolls 104,097 Beneficiaries. KTVH reported on November 28, 2023, that Montana has disenrolled 104,097 Medicaid beneficiaries during redeterminations from April through October. Of those disenrolled, 65,897 were due to procedural reasons. Read More

Nebraska

Nebraska Total Care/Centene Appoints Adam Proctor as Plan President, CEO. Nebraska Total Care, a subsidiary of Centene, announced on November 16, 2023, that it has appointed Adam Proctor as plan president and chief executive officer, effective November 19, 2023. Proctor most recently served as Nebraska Total Care’s chief operations officer. Read More

Nevada

Nevada Submits Section 1332 State Innovation Waiver Application For Market Stabilization, Public Option Program. The Nevada Department of Health and Human Services released on November 20, 2023, a Section 1332 State Innovation Waiver application to establish a Market Stabilization program and a new Public Option program with coverage options referred to as the Battle Born State Plans (BBSPs), which will be certified as Qualified Health Plans (QHPs). The Market Stabilization Program aims to mitigate any unexpected risks or impacts to carriers through a state-based reinsurance program; an annual bonus payment program for health insurance carriers that improve health outcomes and quality of care; and a loan repayment program to support health care providers committed to practicing in Nevada for at least four years. Public comments will be accepted through December 20, 2023. Read More

New Hampshire

New Hampshire Seeks Feedback on Medicaid Long-term Services and Supports Programs. New Hampshire Bulletin reported on November 28, 2023, that the New Hampshire Department of Health and Human Services is seeking feedback to improve its Medicaid long-term services and supports programs for older individuals and people with disabilities. Among the programs under review is the Medicaid-funded Choices for Independence, which received a 42 percent reimbursement rate increase in 2023. Public comment sessions will be held in December and a report with recommendations for improvement is expected in June 2024. Read More

New Hampshire Extends Postpartum Coverage to 12 Months. The Centers for Medicare & Medicaid Services approved on November 3, 2023, New Hampshire’s state plan amendment to extend postpartum Medicaid and Children’s Health Insurance Program coverage to 12 months. The amendment has an effective date of October 1, 2023. Read More

New Jersey

New Jersey Governor Requests More Time to Implement Community-based Palliative Care Services in Medicaid Program. The Office of New Jersey Governor Phil Murphy announced on November 20, 2023, that the governor requested the General Assembly modify a bill (AB 5225) that would provide Medicaid beneficiaries with community-based palliative care services. While supportive of the addition of services, the governor recommended providing the Department of Health Services with two years to design a comprehensive, high quality, and equitable benefit and to secure necessary federal approvals. Read More

New York

New York Essential Plan Expansion Implementation Delayed to April 2024. Politico Pro reported on November 11, 2023, that New York State submitted to the Centers for Medicare & Medicaid Services an updated application for a Section 1332 Innovation Waiver for the state’s Essential Plan to provide coverage to residents with income between 200 and 250 percent of the federal poverty level. The state proposes to revise the Essential Plan start date to April 1, 2024, at the earliest. The updated application also would eliminate the earlier proposal for a $15 monthly member premium for the Essential Plan expansion group. Read More

New York City Selects TalkSpace to Provide Mental Health Services to Teens. Becker’s Behavioral Health reported on November 22, 2023, that New York City will pay online therapy provider TalkSpace $26 million over three years to provide virtual mental health services at no cost to residents aged 13 to 17. The platform, which facilitates messaging and video visits, is expected to expand access to behavioral health care to between 400,000 and 500,000 residents. Read More

North Carolina

North Carolina Seeks Five-year Extension of Medicaid Reform Section 1115 Waiver. The Centers for Medicare & Medicaid Services (CMS) announced on November 20, 2023, that North Carolina submitted an application seeking a five-year extension of the North Carolina Medicaid Reform Section 1115 demonstration program, which aims to create a system of care that broadens health access and reduces disparities for historically marginalized populations. Specifically, the request extends managed care authorities, expands the Healthy Opportunities Pilot program, and establishes four new initiatives intended to streamline Medicaid enrollment for youth, improve care for justice-involved individuals, and invest in behavioral health. The federal comment period will be open through December 20, 2023. Read More

Hospitals Will Receive $2.6 Billion As State Prepares to Start Medicaid Expansion. The North Carolina Department of Health and Human Services announced on November 27, 2023, that 102 hospitals are eligible to receive payments from the $2.6 billion Healthcare Access and Stabilization Program (HASP). The state is launching HASP in conjunction with the start of its Medicaid expansion program. The programs are financed through new assessments on North Carolina hospitals, making the state eligible for $8 billion in federal funding annually. HASP payments will be distributed to hospitals based on in-network Medicaid managed care payments. Read More

North Carolina to Raise Medicaid Behavioral Health Reimbursement Rates in January. North Carolina Health News reported on November 17, 2023, that the North Carolina Department of Health and Human Services (DHHS) will raise minimum reimbursement rates for Medicaid behavioral health providers for the first time since 2012 ahead of the state’s upcoming launch of Medicaid expansion in December. The new rates will take effect on January 1, 2024, and raise payments to behavioral health facilities from less than $500 to nearly $900 a day, double psychological assessment reimbursement, and increase inpatient psychiatric care reimbursement by 30 percent. The increase would impact fee-for-service and managed care rates. Read More

North Dakota

North Dakota to End Medicaid Primary Care Case Management Program in 2024. The North Dakota Department of Health and Human Services announced on November 16, 2023, that it will officially end its Medicaid Primary Care Case Management (PCCM) program as early as January 1, 2024. The state enacted legislation earlier this year to end the program. PCCM members will be transitioned to fee-for-service Medicaid. Read More

Rhode Island

Rhode Island Releases RFP for Vendor to Improve Awareness of Medicaid Renewals, Mobile App. The Rhode Island Executive Office of Health and Human Services released on November 15, 2023, a request for proposals (RFP) for a vendor to develop and manage various media buys for two public awareness campaigns to (1) promote awareness that Medicaid renewals have returned and encouraging beneficiaries to update their contact information; and (2) raise awareness of the Healthy Rhode mobile app to aid beneficiaries in managing benefits. Responses are due December 14. The release of the RFP coincides with WJAR’s coverage on November 15, 2023, that Medicaid renewals for more than 75,000 households with children under age 19 will restart in December and last until April 2024. Read More

Tennessee

Tennessee to Renew Existing TennCare Medicaid Managed Care Contracts for Now. Tennessee Lookout reported on November 15, 2023, that Tennessee will renew existing TennCare Medicaid managed care contracts with three incumbent plans, rather than initiate new contracts awarded in 2021, pending the outcome of a lawsuit filed by Centene. Incumbents Blue Cross Blue Shield of Tennessee, UnitedHealthcare, and Elevance/Amerigroup were awarded the new contracts. Centene, which was the only other bidder, did not win a contract. Read More

Tennessee Requests Section 1115 Waiver Amendment to Expand Caretaker Coverage, HCBS Services. The Centers for Medicare & Medicaid Services announced on November 24, 2023, that Tennessee submitted for federal approval a request to amend its Medicaid Section 1115 demonstration entitled “TennCare III,” which would expand coverage of parents and caretaker relatives of dependent children, cover a supply of diapers for infants and children enrolled in TennCare, and enhance the home and community-based services (HCBS) available to individuals with disabilities. The federal comment period will be open from through December 23, 2023. Read More

Tennessee Crisis Wellness Center Receives Additional Funds. Becker’s Behavioral Health reported on November 22, 2023, that the Memphis City Council granted Alliance Healthcare Services $1 million to support construction of a Crisis Wellness Center, which will allow Memphis first responders to immediately connect individuals with behavioral health services beginning in January 2025. The center has also received $24.5 million from the state and philanthropies. Read More

Texas

Texas Medicaid Disenrolled 1.4 Million, Including Over 812,000 Children. The Dallas Morning News reported on November 27, 2023, that Texas has disenrolled 1.4 million Medicaid beneficiaries, including at least 812,000 children since Medicaid eligibility redeterminations began in April. Nearly 70 percent of those disenrolled lost coverage for procedural reasons. The state has renewed coverage for almost 760,000 beneficiaries, and renewal decisions are pending for almost one quarter of individuals. Read More

Texas to Build Three Hospitals Aimed At Boosting Rural Mental Healthcare Access. The Texas Tribune reported on November 27, 2023, that Texas will build hospitals in Lubbock, the Permian Basin, and Amarillo as part of a plan to boost mental health care access, including in rural areas of the state. The Amarillo hospital alone is expected increase mental health care access to nearly 436,000 people living in northern rural areas of the state. Read More

Texas Suit Alleges Pfizer, Tris Pharma Inappropriately Provided Adulterated Drug to Children Enrolled in Medicaid. The Office of Texas Attorney General Ken Paxton announced on November 20, 2023, that its Civil Medicaid Fraud Division is suing Pfizer and Tris Pharma for violating the Texas Health Care Program Fraud Prevention Act. The state claims that Pfizer and Tris knowingly provided Texas children enrolled in Medicaid with the ADHD drug Quillivant, which failed quality control tests due to flawed manufacturing. Between 2012 and 2018, Tris allegedly altered testing methods to circumvent regulatory measures and Pfizer concealed lack of compliance with federal and state law, while both companies continued to receive Medicaid reimbursement for Quillivant. Read More

Utah

Utah Medicaid Disenrollments Top 130,000, With 30 Percent Remaining Uninsured. The Standard-Examiner reported on November 26, 2023, that Utah has disenrolled more than 130,000 Medicaid beneficiaries since redeterminations began in April. A Utah Medicaid agency survey of more than 1,000 of those disenrolled found that about two-thirds found other insurance, while about 30 percent were left uninsured. Read More

West Virginia

West Virginia Selects Acentra Health to Provide Medicaid UM Services. WashingtonExec reported on November 15, 2023, that the West Virginia Department of Health and Human Resources awarded Acentra Health a five-year contract to continue to deliver assessment and utilization management services for children and adults enrolled in the state’s Medicaid fee-for-service and waiver programs. Specifically, Acentra will aid in development and management of programs offered via the Bureaus for Social Services, Behavioral Health, and Medical Services, and the West Virginia Children’s Health Insurance Program. Read More

Wisconsin

Wisconsin Insurers Fail to Meet Federal Access Standards for Exchange Program, Report Finds. The Wisconsin Office of the Commissioner of Insurance released on November 27, 2023, a report that found that Exchange health plans in 52 Wisconsin counties (73 percent), on average, do not meet the pediatric primary care access standards for exchange programs set by the Centers for Medicare & Medicaid Services (CMS) and networks in 34 counties do not meet the federal exchange program standards for access to obstetrics and gynecology providers. The report also found that nine plans do not meet the federal access standards for outpatient behavioral health services. Read More

National

Average Time Spent on Medicaid HCBS Waiting Lists Has Decreased Since 2021. KFF reported on November 29, 2023, that the average time spent on waiting lists for Medicaid home and community-based services (HCBS) programs decreased from 45 months in 2021 to 36 months in 2023. Over 80 percent of people on HCBS waiting lists are eligible for personal care or other state plan services. Most individuals on waiting lists for Medicaid HCBS have intellectual or developmental disabilities and reside in states that do not screen for program eligibility prior to addition to the waitlist. Waiting list numbers grew in 18 states between 2021 and 2023 and decreased in 16. Read More

Medicaid Enrollees Report Relatively Worse Health Status, But Positive Experience with Medicaid, KFF Survey Finds. KFF on November 27, 2023, released results from its 2023 Consumer Experiences with Health Insurance survey, which found that Medicaid enrollees are more likely to rate their health status as fair or poor compared to adults with Medicare or Exchange coverage. The vast majority of Medicaid enrollees (83 percent), however, rated their overall experience with Medicaid positively. Medicaid enrollees were more likely to report problems with access and quality for mental health providers, finding available providers, and prior authorization. Read More

Non-profit Hospitals Provided Less Charity Care Amid COVID-Related Increases in Operating Costs. Modern Healthcare reported on November 27, 2023, that non-profit hospitals provided less charity care during the COVID-19 pandemic amid rising costs. Between 2020 and 2022, the percentage of operating expenses regarding free or discounted care within non-profit hospitals decreased from 1.21 percent to 0.99 percent, while median operating costs increased approximately 20 percent. In 2023, hospitals are beginning to report an increase in charity care expenses that corresponds with the restart of Medicaid disenrollments. Read More

ACA Exchange Enrollment Approaches 4.6 Million Through Three Weeks of Open Enrollment. The Centers for Medicare & Medicaid Services announced on November 21, 2023, that nearly 4.6 million people selected an Affordable Care Act (ACA) Exchange plan during the first three weeks of 2024 open enrollment. About 920,000 consumers are new to the Exchange, and about 3.7 million are return customers. Overall, data show significant Exchange enrollment increases in 2023. Read More

Medicaid Disenrollments Near 11 Million Following Redeterminations. KFF reported on November 21, 2023, that approximately 10.9 million Medicaid enrollees have been disenrolled since eligibility redeterminations resumed earlier this year. Disenrollment rates varied widely between states, ranging from 64 percent in Texas to 10 percent in Illinois and Maine. Approximately 71 percent of people have been disenrolled for procedural reasons across all states with available data. Read More

Medicare, Medicaid Improper Payment Rates Driven by Documentation Errors in Fiscal 2023, CMS Finds. Fierce Healthcare reported on November 20, 2023, that the fee-for-service (FFS) Medicare improper payment rate was 7.38 percent, or $31.2 billion, in fiscal year 2023, which represents potential fraud, overpayments, underpayments, or improper reimbursement due to the provider not submitting the correct documentation, according to the Centers for Medicare & Medicaid Services (CMS). The national Medicaid improper payment rate was 8.53 percent, or $50.3 billion, in FY 2023. Lack of sufficient documentation accounted for 66.5 percent of FFS Medicare improper payments and 82 percent of the national Medicaid improper payments. Read More

Congress Approves Second Short-Term Funding Measure. Modern Healthcare reported on November 16, 2023, that Congress agreed to another short-term federal spending deal that will continue funding healthcare programs, including federally qualified health centers, until January 19. Congress is considering separate legislation to set higher mandatory, multi-year funding for health centers. Read More

CMS Launches Medicare GUIDE Model Application. The Centers for Medicare & Medicaid Services (CMS) released on November 15, 2023, a request for applications (RFA) for the Guiding an Improved Dementia Experience (GUIDE) Model, which will test an alternative payment for participants to deliver supportive services to Medicare beneficiaries with dementia. The GUIDE model, which will run for eight years, includes care management and coordination plans, caregiver education and support, and GUIDE Respite Services. Applications are due January 30, 2024, awards are anticipated in spring 2024, and the model will launch on July 1, 2024. Read More

CMS Issues Draft 2025 Actuarial Value Calculator Methodology for Individual, Small Group Plans. The Centers for Medicare & Medicaid Services released on November 15, 2023, the draft 2025 actuarial value (AV) calculator for individual and small group plans both on and off-Exchange, which includes changes to the annual limitation on cost sharing, updates to the set of codes used to identify the preventive care category, and updates to the demographic weights used in constructing the AV calculator’s continuance tables for the individual market. For 2025, the calculator applies a one-year projection factor of 6.40 percent for medical costs and 9.90 percent for drugs costs. Comments will be accepted through January 2, 2024. Read More

CMS Issues Proposed Rule to Ensure Network Adequacy Standards For State-run Exchange Plans. The Centers for Medicare & Medicaid Services (CMS) announced on November 15, 2023, a proposed rule aimed at raising network adequacy standards for state-based Exchange plans among other changes for health plans, agents and brokers. Along with requiring state-based Exchanges to have the same network time and distance standards as the federal Exchanges, the proposals provide states with greater flexibility to determine financial eligibility policies which could allow for targeted expansions of Medicaid coverage; allow state-run exchanges to require insurers to cover adult dental care as an essential health benefit; and require a transition period before states can establish a state-based marketplace. The changes are included in the Department of Health & Human Services (HHS) Notice of Benefit and Payment Parameters (Payment Notice) proposed rule for 2025. Read More