This week, our In Focus section reviews Medicare-Medicaid integration opportunities through Dual Eligible Special Needs Plans (D-SNPs). States are motivated to expand their capacity to address the needs of dually eligible beneficiaries through integrated care. They are increasingly requiring health plans that operate Medicaid managed long-term services and supports (MLTSS) programs to become Medicare Advantage (MA) D-SNPs. A few states require D-SNPs to be Medicaid MLTSS health plans.
This week, our In Focus section reviews Texas’ biennial legislative appropriations request (LAR) for fiscal years 2020-21, submitted by the Texas Health and Human Services Commission (HHSC). The document, which totals 1358 pages, includes summary program data as well as budget breakouts by agency strategies, priorities, and source of funds.
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for beneficiaries dually eligible for Medicare and Medicaid (duals) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of duals into fully integrated plans providing both Medicaid and Medicare benefits (“Medicare-Medicaid Plans,” or “MMPs”) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of August 2018, nearly 369,000 duals were enrolled in an MMP. Enrollment dropped by 6.7 percent from August of the previous year after Virginia’s dual demonstration ended in December.
This week, our In Focus reviews North Carolina’s much-anticipated Prepaid Health Plan Services request for proposals (RFP), released by the Department of Health and Human Services, Division of Health Benefits on August 9, 2018, and District of Columbia’s Medicaid Managed Care RFP released on August 14, 2018. North Carolina is transitioning its Medicaid fee-for-service program to Medicaid managed care through its procurement. DC is reprocuring its managed care program, covering the District of Columbia Healthy Families Program (DCHFP), Alliance program, and the Immigrant Children’s Program (ICP).
This week, our In Focus section highlights HMA Medicaid Market Solutions’ (MMS) efforts to support state flexibility in designing and implementing Section 1115 Demonstration Waivers promoting member engagement and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing in-depth analyses of the many facets of these new Medicaid models. This week, we examine important issues and considerations for implementing Medicaid consumer empowerment, community engagement, and work requirements.
Jonathan (Jon) Blum will join HMA as a managing principal on Aug. 31 working out of the Washington, DC office.
He has more than 20 years of senior-level experience working in public and private healthcare financing organizations, including the Centers for Medicare and Medicaid Services (CMS).
This week, our In Focus reviews a New York State Health Foundation-commissioned report titled, “An Assessment of the New York Health Act: A Single-Payer Option for New York State.” The study, conducted by the RAND Corporation, analyzes a proposal that would establish a single-payer system in New York. The proposal, known as the New York Health Act (NYH Act), was developed by New York Assembly Health Committee Chair Richard Gottfried. It was passed by the Assembly several years in a row, but has never been brought to a vote in the Senate. The New York State Health Foundation commissioned the study to provide an independent, rigorous, and credible analysis of the proposal to understand the near-term and longer-term impact of the single-payer proposal. The study assesses how the plan would affect health care coverage and costs in the state.
This week, our In Focus reviews the New Hampshire Medicaid Care Management (MCM) Services Draft request for proposals (RFP), released by the state Department of Health and Human Services (DHHS) on July 9, 2018. The MCM program, worth $750 million in annualized spending, will provide full-risk, fully capitated Medicaid managed care services to approximately 181,000 beneficiaries from July 1, 2019 through June 30, 2024. The final RFP is expected August 10, 2018.
This week, our In Focus reviews a case study called, “Spotlight on Health Center Payment Reform: Washington State’s FQHC Alternative Payment Methodology,” authored and prepared for the National Association of Community Health Centers by Health Management Associates’ Principal Art Jones and Senior Consultant Liz Arjun. The study, published in May 2018, looks at Washington’s fourth federally qualified health center (FQHC) Alternative Payment Model (APM4), implemented in July 2017.
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 28 states. Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. Nearly all 28 states highlighted in this review have released monthly Medicaid managed care enrollment data into the second quarter (Q2) of 2018. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):