In this week’s In Focus section, Health Management Associates (HMA) Managing Director MMS Matt Powers, Senior Consultant Kaitlyn Feiock, and Regional Vice President Kathleen Nolan look at the future of the Patient Protection and Affordable Care Act (ACA). On November 10, 2020, the Supreme Court of the United States (SCOTUS) heard oral arguments for California v. Texas, challenging the constitutionality and severability of the ACA. This challenge became possible after the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty for not purchasing health insurance. While most experts agree that an entire invalidation of the ACA is the least likely outcome based on the oral arguments, some uncertainty remains and more than $100 billion federal funds are at risk. The ACA standardized insurance rules offset premium costs for many individual market consumers and provided authority and funding for Medicaid Expansions in the overwhelming majority of states. The ACA also included other provisions that may be at risk but are not the subject of this note, such as the creation of Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office, as well as demonstration authority that has led to the creation of numerous coverage models. As states, Congress, and the federal executive branch face the possibility that the ACA may not survive in its present form, what mitigation strategies are available at the state and federal levels to stabilize uncertainties and protect against abrupt coverage changes?
Oklahoma, North Dakota Release Medicaid Managed Care RFPs
This week, our In Focus section reviews the statewide Oklahoma Medicaid managed care request for proposals (RFP) released by the Oklahoma Health Care Authority on October 15, 2020, and the North Dakota Medicaid expansion managed care RFP released by the North Dakota Department of Human Services, Medical Services Division on October 20, 2020.
Evidence-Based Programs Paper Authored by HMA Colleagues
Health Management Associates (HMA), in contract with The National Council on Aging (NCOA), and with support from the Administration for Community Living (ACL), recently provided research and strategy services to support the goal to increase the adoption of evidence-based health promotion and disease prevention programs, known as evidence-based programs (EBPs) by Medicaid, Medicare, and other health insurance markets.
Highlights from Kaiser/HMA 50-State Medicaid Director Survey
This week, our In Focus section shares highlights and key takeaways from the 20th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 14, 2020, in two new reports: State Medicaid Programs Respond to Meet COVID-19 Challenges: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2020 and 2021 and Medicaid Enrollment & Spending Growth: FY 2020 & 2021. The reports were prepared by Kathleen Gifford, Aimee Lashbrook, and Sarah Barth from HMA and by Elizabeth Hinton, Robin Rudowitz, Madeline Guth, and Lina Stolyar from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.
HMA Summary of UnitedHealth Group’s ‘The Path Forward’
This week, our In Focus section reviews UnitedHealth Group’s The Path Forward to a Next-Generation Health System, an outline of policy recommendations to achieve a high-quality, affordable health care system. The paper focuses on four goals: 1) achieve universal coverage; 2) improve health care affordability; 3) enhance the health care experience; and 4) drive better health outcomes. UnitedHealth Group (United) advocates for expanding Medicaid in the remaining states, passively enrolling individuals into Medicaid and the Exchanges, implementing a Medicaid Buy-In program, transitioning Medicaid fee-for-service (FFS) programs to managed care, strengthening Medicare Advantage, eliminating surprise billing, expanding access to telehealth, in addition to other policies.
Ohio Releases Medicaid Managed Care RFA
This week, our In Focus section reviews the Ohio Medicaid Managed Care request for applications (RFA) released by the Ohio Department of Medicaid (ODM) on September 30, 2020. The RFA follows the release of two requests for information (RFIs) in June 2019 and February 2020, soliciting feedback from individuals, providers, and interested bidders to help design a new Medicaid managed care program. Ohio will award contracts, worth over $11 billion annually, to no more than five managed care organizations (MCOs) in each of the state’s three regions (Central/Southeast Region, Northeast Region, and West Region), with implementation beginning January 5, 2022. The procurement will not include the MyCare Ohio dual demonstration.
Health Management Associates Names Douglas Elwell CEO; Charles (Chuck) Milligan Joins Firm as COO
Health Management Associates (HMA) announced today that Chief Operating Officer Douglas (Doug) L. Elwell will assume the role of Chief Executive Officer, effective Nov. 1.
HMA Analysis of 2021 Medicare Advantage Landscape and Mandatory Medicare Radiation Oncology and ESRD Treatment Choices Innovation Models
This week, our In Focus section reviews two recent Medicare developments from the Centers for Medicare & Medicaid Services (CMS). On September 24, 2020, CMS released the Medicare Advantage (MA) and Part D landscape files for the 2021 plan year. These files include information on MA and Part D offerings, including plan types and premiums. Earlier this month, CMS also released a final rule implementing two new mandatory payment models addressing radiation oncology and end-stage renal disease (ESRD).
Leaders in Justice and Child Welfare Systems Explain How HMA-Developed MAT Training Can Keep Families Together
Focused on ongoing support and solutions for those living with opioid use disorder (OUD), Health Management Associates (HMA) has developed a robust web-based training program about addiction and its treatment in the criminal justice and child welfare systems, including access to, and continued use of, medications for addiction treatment (MAT).
CMS Eyes Medicaid Alternative Payment Models (APM) Expansion to Control Growth in Spending
On September 15, 2020, the Centers for Medicare & Medicaid Services (CMS) released State Medicaid Director (SMD) letter #20-004 regarding value-based care (VBC) opportunities in Medicaid. [1] In the letter, CMS lays out a road map for state Medicaid agencies to adopt value-based payment (VBP). The SMD describes how states can use existing – or obtain new – authorities to adopt VBP. It lists examples of successful VBP designs in other states and identifies key enabling factors from its examination of lessons learned over the last ten years of investments in VBC activities.