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BREAKING: CMS releases Medicaid managed care regs
MHPA
CMS has released the long-awaited Medicaid managed care regs. Read the full text of the rule here.

For pre-release comments from Jeff Myers on the rule and long-term care in Modern Healthcare, click here.
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Medicaid expansion helps cut rate of older, uninsured
adults from 12 to 8 percent

Kaiser Health News
The health law's expansion of Medicaid coverage to adults with incomes over the poverty line was key to reducing the uninsured rate among 50- to 64-year-olds from nearly 12 to 8 percent in 2014, according to a new analysis.
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Rhode Island homecare program predicts Medicaid cost savings
exceeding $2.7 million

Providence Journal
With an eye toward slowing the soaring cost of health care, experts are focusing more and more on the relatively small number of people who are responsible for a disproportionate share of medical spending. So with Rhode Island Gov. Gina Raimondo pushing her cost-cutting Reinventing Medicaid initiative, Neighborhood Health Plan of Rhode Island is eagerly touting what it says is the early success of a program begun just five months ago to address Medicaid subscribers with frequent and hefty medical bills.
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North Carolina hospital execs make their case to lawmakers
North Carolina Health News
After years of cuts to their Medicaid reimbursements, increased assessments by the state government and shrinking clout at the General Assembly, executives from the state of North Carolina's hospitals came to Raleigh to promote their plan for Medicaid and talk to legislators.
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Amendment incites Massachusetts Medicaid fight
The Boston Globe
A proposal aimed at promoting new ways to pay for the healthcare of low-income patients has spurred a fierce political fight between insurers, consumer advocates and one of the state of Massachusetts' largest hospital systems.
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Medi-Cal director talks California shortages and modernization
Los Angeles Times
Since California's health insurance program for the poor was expanded under the Affordable Care Act last year, enrollment has exploded, with more than 3.5 million people signing up for the first time. Almost 1 in 3 Californians — a total of 12.2 million people — now receive coverage through Medi-Cal.
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Obama administration proposes big cuts in Florida Medicaid fight
National Journal
The Obama administration is keeping the pressure on Florida to expand Medicaid under the Affordable Care Act. On Thursday, it proposed cutting more than $1.6 billion over two years in funding for Medicaid's Low-Income Pool in Florida. The offer, made in a letter from the Centers for Medicare and Medicaid Services to state officials, signals public progress in the negotiations that have been ongoing for months in that there actually is something on paper.
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Florida Speaker Crisafulli: Federal money 'should not be tied to' Medicaid expansion debate
Tampa Bay Times
House Speaker Steve Crisafulli said in a statement Friday that the announcement that Florida could see up to $1 billion in federal LIP money would "greatly" help the legislature finalize a budget during the special session set to begin June 1. However, Crisafulli said the federal money does not completely relieve the pressure on budget talks.
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Florida governor's draft of session agenda banned Medicaid expansion talk
Tampa Bay Times
While the Senate and House scrambled last week to agree on terms of a proclamation for a special session, Florida Gov. Rick Scott had followed through on a threat to draft his own proclamation — and on his terms.
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Bill would create opening for vote on Kansas Medicaid expansion
Kansas Health Institute
A Senate committee on Thursday learned that a bill proposing that the state of Kansas collect a 3.5 percent fee on health insurance policies sold to Kansans on the federal government's online marketplace could be used to force a vote on Medicaid expansion.
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More pay for Texas Medicaid doctors lost in budget deal
The Texas Tribune
As final details of the state of Texas' next budget for health and human services emerged Wednesday, Republicans hailed a fiscally conservative approach to serving the state’s neediest populations, while doctors' groups and advocates for the poor saw little to celebrate.
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Budget panel OKs seeking to raise Wisconsin Medicaid premiums for some
The Associated Press via The Baltimore Sun
Low-income childless adults on Wisconsin's BadgerCare Plus Medicaid program may have to pay higher premiums if they engage in risky behavior. The legislature's Joint Finance Committee approved Wisconsin Gov. Scott Walker's proposal that could lead to the change as part of a wide-ranging Medicaid motion Thursday.
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Representative proposes putting Arkansas Medicaid expansion
money into highways

Times Record via Arkansas News
An Arkansas congressman has set his sights on the Affordable Care Act's Medicaid expansion to shore up an insolvent federal Highway Trust Fund that has required nearly 30 short-term extensions since 2009. U.S. Rep. Bruce Westerman filed his Prioritizing American Roads and Jobs Act of 2015 on Thursday as a long-term solution to help fund a nearly $16 billion annual shortfall with the Highway Trust Fund and pay down some of the national debt.
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June 10 Webinar Wednesday: 'Integrating High-Risk Member Care with Risk Adjusted Revenue for Medicaid Members and Dual Eligibles'
PopHealthCare
Taking a holistic approach to integrated programs in high-risk population management can provide true value to members, the plans and the providers serving them. Please join Eddie Gilmartin, vice president, product and business development for PopHealthCare, who will offer groundbreaking programs in high-risk population management that drive rapid, large and demonstrable improvements in member quality of life and satisfaction, while helping its partnering health organizations realize appropriately enhanced revenues, enhanced quality scores and reduced medical costs.
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June 17 Webinar Wednesday: 'The Latest Trends in OHI Discovery and Cost Avoidance for Payers of Last Resort'
Syrtis Solution
Why "pay and chase" when you can cost avoid? It's not easy to discover if a Medicaid enrollee has primary commercial coverage at the point of sale — costing time and money, chasing reimbursements for claims that others should have paid. On average less than 17 percent of the dollars billed to primary insurers are paid back to Medicaid plans that paid claims in error. This webinar will focus on a very unique and powerful data source that has the potential to revolutionize the way Pharmacy & Medical OHI (Other Health Information) is discovered. Cost avoidance is more attainable than ever before. Capture savings by having the latest active insurance coverage information available to you, in real time.
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Philadelphia Asthma Summit set for June 26
U.S. Housing and Urban Development
The Philadelphia Asthma Summit will take place from 8 a.m. to 4 p.m. on Friday, Jun 26, at the Children's Hospital of Philadelphia. This is the fifth asthma summit that the U.S. Housing and Urban Development has hosted in collaboration with federal, state and local partners.

While each meeting is unique, the overall intent is to advance the conversation locally (state or region) around securing sustainable financing for in-home services targeting children disproportionately impacted by asthma. This Philadelphia Asthma Summit is designed to meet this intent with a specific focus on promoting the value of home-based interventions for children with poorly controlled asthma and reimbursement mechanisms for these services by healthcare insurers for children in low-income households.

Health plans participating in the meeting will hear perspectives and experiences from other health plans serving Medicaid populations. The meeting agenda includes a "Payers' Perspectives Panel" featuring Family Health Network (Barbara Hay, Retired COO), Keystone First (Dr. Lily Higgins, Medical Director) and Aetna Better Health (Dr. Guerra-Garcia, Chief Medical Officer).

RSVP here.

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Job opportunity: Senior Medicaid Strategist | Raleigh-Durham, NC
North Carolina Dept of Health and Human Services
The Senior Medicaid Strategist has responsibility for the execution of the day to day activities in all efforts related to implementing Medicaid Reform for DMA. This position acts a project manager by directing internal and external resources to successfully operationalize reform policy. This individual will report directly to the DHHS Deputy Secretary for DMA.

For more details and to apply: click here.

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Job opportunity: RN, manager, Clinical Health Services,
pre-authorization | Detroit

Aetna
Aetna seeks an experienced RN with managed care, leadership and prior authorization expertise. Reinforces clinical philosophy, programs, policies and procedures. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.

Visit here and search for requisition #24937BR to learn more and apply.

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Colby Horton, Vice President of Publishing, 469.420.2601
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