HMA Weekly Roundup

Florida

Florida Faces Lawsuit from Transgender Rights Groups over Medicaid Coverage Determination. Politico reported on September 7, 2022, that a coalition of transgender rights activists has filed a state lawsuit against the Florida Agency for Health Care Administration, alleging that the state’s determination that Medicaid will not cover gender-affirming care violates the U.S. Constitution’s equal protection clause. The complaint also alleges that the state would be denying critical care to 9,000 individuals. Read More

Kentucky

Kentucky Seeks to Expand Number of PACE Providers, Counties Served. The Kentucky Cabinet for Health and Family Services announced on September 13, 2022, that the state has certified two Programs of All-Inclusive Services for the Elderly (PACE) and is looking to expand the number of PACE providers and counties served. The two current PACE organizations are Horizon PACE and Bluegrass Care Navigators, which cover 19 counties. Read More

Montana

Medicaid Reimbursement Rates Are 22 Percent Below Benchmarks, Study Finds. The Montana Free Press reported on September 7, 2022, that Montana’s Medicaid reimbursement rates were 22 percent below benchmarks for comparable providers in other states who care for seniors in assisted-living facilities, individuals with disabilities, and children and adults with mental illnesses and addiction, according to a study commissioned by the state legislature and performed by Guidehouse. The study also found that it would cost $82 million annually in state and federal funding to bring the state up to par. Read More

New Jersey

Health Partners Plans to Offer Medicare Advantage Options in New Jersey. The Philadelphia Inquirer reported on September 12, 2022, that Pennsylvania insurer Health Partners Plans will expand into Burlington, Camden, and Gloucester counties in New Jersey, with a Medicare Advantage (MA) offering. Open enrollment for the 2023 coverage year will begin on October 15, 2022. Health Partners Plans, which offers MA and Medicaid plans in Pennsylvania, is now fully owned by Thomas Jefferson University. Read More

New York

Lawmakers Urge U.S. Senate to Pass Legislation to Provide Continuity of Medicaid Coverage for Foster Care Youth. Spectrum News reported on September 9, 2022, that a group of New York state lawmakers sent a letter to U.S. Senators Chuck Schumer (D-NY) and Kirsten Gillibrand (D-NY) urging the Senate to pass the Ensuring Medicaid Continuity for Children in Foster Care Act of 2021, which would ensure Medicaid eligibility for children and youth in foster care. Currently, not all foster children are able to obtain Medicaid coverage. Read More

New York Proposes 1115 Waiver Amendment to Address Equity, Housing, Workforce Shortages. The New York Department of Health proposed on September 2, 2022, a Medicaid Redesign Team 1115 Waiver amendment aimed at addressing health equity, developing transitional housing for individuals at risk of institutionalization, redesigning state systems addressing quality and workforce shortages, and creating digital health and telemedicine infrastructure statewide. The state submitted the proposal to the Centers for Medicare & Medicaid Services for approval.

North Carolina

North Carolina Medicaid Official Urges Lawmakers to Expand Medicaid This Year to Maximize Federal Funding. WGHP reported on September 7, 2022, that North Carolina secretary for Health and Human Services Kody Kinsley urged state lawmakers to expand Medicaid and establish the Healthcare Access and Stabilization Program this year or lose more than $1 billion in federal funds, more than half of which would go toward mental health, rural health and other initiatives. Kinsley noted that thousands of individuals will lose coverage when the public health emergency ends if the state does not expand Medicaid. Read More

Oklahoma

Task Force Recommends Raising Income Eligibility Limit for Pregnant Women, Extending Postpartum Coverage to 12 Months. The Tulsa World reported on September 13, 2022, that a task force created by Oklahoma Governor Kevin Stitt recommended that the state extend Medicaid postpartum coverage to 12 months from 60 days and increase the Medicaid eligibility income limit for pregnant woman to 205 percent of poverty. The current limit is 138 percent. The recommendations would extend coverage to 2,500 women in the state. Read More

Oregon

Oregon Medicaid Mobile Crisis Intervention Services Program Receives CMS Approval. The Centers for Medicare & Medicaid Services (CMS) announced on September 12, 2022, approval of the Oregon Health Authority’s state plan amendment (SPA) to offer Medicaid community-based mobile crisis intervention services for individuals experiencing mental health and substance use crises. The SPA was made possible through the American Rescue Plan Act. Read More

Texas

Texas Awards STAR Health Contract to Centene/Superior HealthPlan. The Texas Health and Human Services Commission announced on September 13, 2022, its intent to award incumbent Centene/Superior HealthPlan a contract for Texas STAR Health, the state’s Medicaid managed care program for children and youth in foster care. Implementation is scheduled between September 2023 and November 2023. Read More

CareSource, Legacy Community Health Form Joint Venture to Bid on Texas STAR, CHIP RFP. The Dayton Daily News reported on September 13, 2022, that CareSource and Legacy Community Health have formed a joint venture called CareSource Bayou Health to bid on the Texas STAR Program and Children’s Health Insurance Program (CHIP). Legacy is a Federally Qualified Health Center serving Texas. The request for proposals (RFP) is expected to be released between December 2022 and February 2023. Read More

West Virginia

West Virginia Allocates Funding to Increase Medicaid HCBS Payments. Becker’s Hospital Review reported on September 12, 2022, that the West Virginia Department of Health and Human Services has allocated $240 million to increase Medicaid reimbursement rates for home and community-based services (HCBS) providers. The funds, which will be available October 2022 pending federal regulatory approval, will run through the state’s Aged and Disabled Waiver, Intellectual/Developmental Disabilities Waiver, and Children with Serious Emotional Disorders Waiver. At least of 85 percent of the increased funds must go toward increased wages and benefits for direct-care workers. Read More

Wisconsin

Joint Finance Committee Allocates $1 Million to Address SUD Among Medicaid Beneficiaries. Wisconsin Health News reported on September 8, 2022, that the Wisconsin Joint Finance Committee unanimously approved the allocation of $1 million to expand the state’s pilot program to address substance use disorders (SUDs) for Medicaid beneficiaries. The allocation is part of a broader state Department of Health Services spending plan for $31 million in opioid settlement funds. The plan also provides $2 million for SUD medication-assisted treatment. Read More

National

CMS Approves Extension of Postpartum Coverage to 12 Months in Indiana, West Virginia. The Centers for Medicare & Medicaid Services (CMS) announced on September 8, 2022, that it has approved the extension of postpartum Medicaid and Children’s Health Insurance Program (CHIP) coverage to 12 months in Indiana and West Virginia. The extensions will provide coverage for 15,000 individuals in the two states. Read More

CMS to Phase Out D-SNP Look-Alikes Within Medicare Advantage in 2023. Hospice News reported on September 12, 2022, that the Centers for Medicare & Medicaid Services (CMS) will phase out dual-eligible special needs plan (D-SNP) look-alikes within Medicare Advantage (MA) in 2023. MA plans began offering D-SNP look-alikes in recent years, which are not subject to the same regulations as actual D-SNPs. There are about 12 million individuals who are dually eligible, with about 3.8 million enrolled in D-SNPs. Read More

CMS to Resume Standard Process for Calculating Medicare Advantage Star Ratings. Modern Healthcare reported on September 12, 2022, that the Centers for Medicare & Medicaid Services (CMS) will resume the standard process for calculating Medicare Advantage (MA) star ratings, which was relaxed in 2021 and 2022 due to COVID-19. The relaxed process resulted in a record number of insurers receiving higher scores and an increase in federal spending on bonuses. MA plans received $9.2 billion in bonuses in 2021 and will receive an estimated $10 billion in 2022, which is more than triple what they received in 2015. Read More

Medicaid Drug Rebate Case to Be Heard by Full 4th Circuit Court of Appeals. Reuters reported on September 12, 2022, that the full 4th U.S. Circuit Court of Appeals will hear arguments in a Medicaid False Claims Act lawsuit alleging that Allergan’s Forest Laboratories defrauded the Medicaid program by reporting inaccurate drug pricing data to the Centers for Medicare & Medicaid Services. Previously, a panel of judges ruled in Forest Laboratories’ favor in a split decision. Read More

Lack of Medicaid Expansion Correlates to Rural Hospital Closures, Report Finds. Becker’s Hospital Review reported on September 9, 2022, that 74 percent of the 136 rural hospitals that closed between 2010 and 2021 occurred in states where Medicaid expansion was not implemented or had been in place for less than a year, according to report from the American Hospital Association. The report also found that rural hospitals require increased state and federal resources to address barriers and called on Congress to extend the Medicare-dependent Hospital program and the Low-Volume Hospital program, which are set to expire October 1. Read More

Medicare Telehealth Usage Rises, Largely in Urban Areas, OIG Reports Find. Modern Healthcare reported on September 8, 2022, that telehealth service usage rose dramatically in the first year of the pandemic versus the previous year, according to a report by the U.S. Office of Inspector General (OIG). However, Medicare telehealth fraud remained low. The report found that two in five Medicare beneficiaries utilized telehealth during the first year of the pandemic, with overall usage up 88 times the prior year. Another OIG Report found that Medicare beneficiaries in urban areas were more likely to use telehealth services than those in rural areas during the first year of the pandemic, with 20 percent of beneficiaries using audio-only telehealth services. Read More