This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 27 states. Many state Medicaid agencies elect to 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 27 states have released monthly Medicaid managed care enrollment data through the third quarter (Q3) of 2017. This report reflects the most recent data posted.
This week, our In Focus section highlights an article, Digitally Driven Integrated Primary Care and Behavioral Health: How Technology Can Expand Access to Effective Treatment, published in the Current Psychiatry Report, was co-authored by HMA Principals Lori Raney, MD and David Bergman, MPA, as well as John Torous, MD, and Michael Hasselberg, M.S., Ph.D. Together, they addressed how technology solutions can be utilized for more widespread implementation of effective integrated primary care and behavior health.
This week, our In Focus section reviews the Medicaid managed care procurement landscape for 2017, including those requests for proposals (RFPs) and other procurement vehicles that were awarded, are currently out to bid, or are expected to be released before the end of the calendar year. By year’s end, we anticipate there will have been at least 16 procurements awarded or issued this year across 13 states, covering more than 13 million Medicaid or CHIP members, and accounting for more than $76 billion in annual spending when fully implemented.
This week, our In Focus section reviews the bill put forward last week by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) to repeal and replace the Affordable Care Act (ACA). General consensus, the HMA Roundup included, viewed ACA repeal-and-replace efforts as largely defeated at the end of July, with the Senate’s failure to pass the Better Care Reconciliation Act. There is, however, an emerging view, which was shared by several speakers at last week’s HMA conference, that the Graham-Cassidy bill has a real chance of passing the Senate ahead of the September 30 deadline, at which point the reconciliation process expires and a bill would require 60 votes to pass the Senate. Below, we highlight key provisions of the Graham-Cassidy bill that impact federal funding to states, state Medicaid programs, and the Exchange and individual insurance markets, including both a block grant program targeted at higher-income and Medicaid expansion populations and a Medicaid per capita cap funding structure.
Last week, our In Focus section provided a recap of the second annual HMA Conference, The Future of Medicaid is Here: Implications for Payers, Providers, and States, held Monday, September 11, and Tuesday, September 12, in Chicago, Illinois. More than 300 leading executives from health plans, providers, state and federal government, community-based organizations, and others in the health care field gathered to address the challenges and opportunities for organizations serving Medicaid and other vulnerable populations given the priorities of the new Administration and Congress.
This week, our In Focus section reviews the request for proposals (RFP) released by the New Mexico Human Services Department (HSD) to reprocure contracts for the state’s Medicaid managed care program in its second phase, Centennial Care 2.0. Centennial Care provides integrated Medicaid managed care coverage, including long-term services and supports (LTSS) and behavioral health, to nearly 700,000 Medicaid beneficiaries in the state, with annual spending of roughly $4.5 billion.
Today, Health Management Associates (HMA) and Community Care of North Carolina, Inc. (CCNC) announced the formation of a strategic partnership that will leverage the complementary skills and expertise of both organizations to offer providers and payers innovative solutions for the challenges of today’s healthcare landscape.
This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the “May 2017 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report,” published on July 21, 2017. Additionally, we review 2017 Exchange enrollment data from the “Health Insurance Marketplaces 2017 Open Enrollment Period: Final State-Level Public Use File,” published by CMS on March 15, 2017. Combined, these reports present a picture of Medicaid and Exchange enrollment in the first half of 2017, representing nearly 75 million Medicaid and CHIP enrollees and more than 12 million Exchange enrollees.
This week, our In Focus section reviews “North Carolina’s Proposed Program Design for Medicaid Managed Care,” a draft proposal published this week for public comment, which provides a detailed overview of the planned statewide Medicaid managed care program to be launched in 2019. By 2023, North Carolina estimates it will have transitioned roughly 1.8 million Medicaid beneficiaries in the state to managed care. North Carolina’s Department of Health and Human Services (DHHS) is encouraging public comment on the program design proposal through September 8, 2017, ahead of a planned request for information (RFI) release later this year.
In deference to Miracle Max, after last week’s failed votes on “Repeal and Replace,” “Straight Repeal,” and “Skinny Repeal,” the GOP’s efforts to undo the Affordable Care Act (ACA) through budget reconciliation appear to be at least “mostly dead.” While it is possible strictly partisan discussions will reaccelerate at some point, it appears that Congress is, for the first time, considering bipartisan proposals for shoring up the underwriting challenges in the individual market. In light of this change in direction, we are using this week’s In Focus section to chronicle the events that transpired over the last five months leading to last week’s historic vote. Our objective here is to create a reference piece for our readers so that the next time Congress revisits major healthcare legislation we can look back on the strategies and approaches that led to last week’s result. Many times over the last eight months, we have reflected on the key dynamics surrounding the passage of the ACA in 2010 as a guide for what factors to watch in the efforts to repeal the ACA – budget reconciliation issues, Congressional Budget Office (CBO) scoring, key proposals to win over recalcitrant legislators, the President’s role in pushing the agenda – but our memories were not always up to the task. So in the spirit of having a reference document for future reflection, we record below the key events associated with this effort.