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AIS Health via HFI
Despite a recent federal court ruling creating some uncertainty about the future of Medicaid expansion, industry experts interviewed for AIS Health's annual Outlook Survey express optimism about several recent developments that they believe will give way to better patient care going forward.
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Inside Health Policy (Subscription required)
As 2019 opens with a divided Congress and a partially closed federal government, the debates about what Medicaid should cover and who it should be for show no signs of letting up. If anything, lobbyists and advocates expect these debates will only intensify this year in congressional committee rooms, federal courtrooms, the halls of CMS and statehouses around the country.
“There will be momentum around work requirements, around higher premiums and copays, lockout periods for those who don't comply," said Gerard Vitti, the CEO of Healthcare Financial, Inc., a company that helps enroll the uninsured into health programs. "Those red-state waivers will continue to fly out of Washington," he said.
"The administrator has no intent of slowing down on approving different waivers, especially 1115 waivers. They believe they have the authority," said Alex Shekhdar, the vice president of federal and state policy for Medicaid Health Plans of America.
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Managed Care
California Gov. Gavin Newsom wasted no time taking on one of the hot-button issues in healthcare, the skyrocketing costs of drugs. On Monday, the same day he was sworn in, Newson signed an executive order that makes the purchasing of drugs for Medicaid beneficiaries the purview of the state, and the state alone.
Sandeep Wadhwa, MD, former Colorado Medicaid director and current chief health officer and senior vice president of government programs at Solera Health, said the state appears to be carving pharmaceuticals out of the managed care contracts and making this a state administered service. "This is a bit like other state administered services such as long-term services or dental care which may not be part of managed care contract," says Wadhwa. "This will almost certainly require a state plan amendment to be approved by the feds."
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The Hill
Sen. Bernie Sanders (I-Vermont), joined by several Democratic colleagues, on Thursday unveiled three bills to lower prescription drug prices, part of a new push from progressives to act on the issue.
"The people of our country pay by far, not even close, the highest prices in the world for the prescription drugs that they need," Sanders said at a press conference. "That has got to end, and the legislation that we are supporting will do just that."
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HFI’s mission is to partner with healthcare clients to improve their fiscal health by advocating for their most vulnerable members. HFI helps members get necessary benefits and income affording them access to important social determinants of health.
We effectively identify and reclassify eligible super-utilizers from TANF/ACA to ABD.
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The Pew Charitable Trusts
Even as calls for "Medicare for All" grow louder among Democrats in Washington, D.C., at least 10 states are exploring whether to allow residents to pay premiums to "buy in" to Medicaid, the federal-state healthcare program for the poor.
Currently, Medicaid recipients pay for their coverage in only a handful of states, and the buy-in plans that states are considering might not offer the full range of benefits available to traditional beneficiaries. But advocates say the policies might be an appealing option for people hard-pressed to pay for plans on the healthcare exchanges, and spur competition that could lower prices for everybody.
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ZeOmega
Watch how Kern Health Systems, a large Medicaid organization in California, uses Jiva—the industry’s leading PHM platform—to achieve seamless integration and single sign-on while also streamlining workflows, lowering costs, and improving overall health outcomes for its members.
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The Times-Picayune
Louisiana Gov. John Bel Edwards said Monday that he still supports work requirements for some Medicaid recipients, though his administration doesn't appear to be actively pushing to implement them.
"It's still an approach that I support, but it wasn't something that we were able to get through the Legislature last year," said Edwards while speaking to the Baton Rouge Press Club.
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The Associated Press via Flathead Beacon
Neither Republicans nor Democrats want Montana to be the first state to end its Medicaid expansion program, but the parties have different opinions about how it should continue as the 2019 Legislature begins its session Monday.
Democrats are calling the state's first three years under Medicaid expansion a success that has benefited the state's economy and its healthcare system, while the Republicans who hold majorities in both the House and Senate say they have concerns the program is being misused and want to close some perceived loopholes.
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Idaho Press
Members of Close the Gap Idaho, a network of individuals and organizations that support Medicaid expansion, called on legislators to follow the lead of Gov. Brad Little, who emphasized during his State of the State Address Medicaid expansion as one of his top priorities for 2019.
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Richmond Times-Dispatch
Virginia Medicaid officials don't want another November surprise in the state's Medicaid budget to spoil Thanksgiving for state policymakers, who choked on a $462.5 million gap between revenue and reality in the two-year budget they now must balance.
The cost overrun emerged in early November from an annual forecasting process that state officials now want to overhaul. They want to ensure Virginia is getting its money's worth from a program that delivers critical healthcare services to more than 1.2 million Virginians, including the elderly and severely disabled.
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A key issue for our health plan clients is reducing opioid misuse while ensuring effective pain care for members. Last year we helped clients see a 25% decrease in multi-prescriber activity and dangerous co-prescribing, driving $1.75 PMPM cost savings.
Is opioid misuse a challenge for your organization? Let's connect.
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The Baltimore Sun
Several types of hearing devices will now be covered by Medicaid in Maryland for those over age 21, the Department of Health and the Governor's Office of Deaf and Hard of Hearing announced Wednesday. Previously, the federal-state health program for the poor only covered hearing devices for those under age 21.
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Kern Health Systems (Kern) is overcoming numerous care management challenges using Jiva, the industry’s leading PHM platform. Learn how the powerful end-to-end platform is helping Kern consolidate data, streamline workflow, manage compliance, create holistic assessments, improve overall health outcomes, and plan for future expansion into new lines of business.
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PRNewswire
Solera Health, a leading integrated community network, grew its national roster of Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention program (DPP) providers with the addition of Washington, D.C.-based Flexcare Pharmacy.
With 86 million American adults living with prediabetes, diabetes prevention programs recognized by the CDC are crucial in reducing the risk of developing type 2 diabetes and improving overall health through education focused on lifestyle changes.
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