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Avalere Health: 10 new drugs will cost Medicaid almost
$16 billion

The Hill
Ten new medications are expected to cost the government almost $50 billion in drug spending, according to a new report. The report from the consulting firm Avalere Health, commissioned by an insurance company trade group, falls into a long-running campaign by insurers against what they call exorbitant prices that they and the government must pay for drugs.

The new drugs are projected to cost the federal government $49.3 billion over the next 10 years, the analysis finds. That includes $31.3 billion in Medicare spending, $15.8 billion in state and federal Medicaid spending, and $2.1 billion in Obamacare subsidies.
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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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White House: Medicaid expansion would save billions, 5,200 lives
USA Today
Hospitals' non-reimbursed costs for treating patients would be $4.5 billion lower next year if Medicaid coverage was expanded to the poorest residents in states that haven't done so, according to a new White House report out Thursday. The 28 states that have already expanded Medicaid — the polarizing healthcare program for the poor and disabled — are on track to reduce these uncompensated care costs by almost the same amount, an estimated $4.4 billion in 2016, the White House Council of Economic Advisers said.
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Medicaid enrollment under Obamacare soars, raising cost concerns
Fox News
Several states that chose to expand Medicaid eligibility under Obamacare now are facing deadline pressure to pay for it, the result of more signups than anticipated — and a looming reduction in how much of the bill the federal government will cover. At least seven of the 29 states (and the District of Columbia) that expanded coverage have experienced significantly higher-than-expected enrollment. The expansion of Medicaid, the government healthcare program for low-income people, now allows most low-income adults making up to 138 percent of the federal poverty level to qualify.
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State budget gaps, Medicaid expansion force longer sessions in
some legislatures

The Associated Press via The Washington Post
With budget deadlines looming for nearly all states, disagreements over closing deficits or expanding Medicaid are forcing several legislatures to extend their sessions. The number of states in which lawmakers and governors are at odds over budget problems pales in comparison to those dealing with red ink during the Great Recession. But it serves as a cautionary note during a year in which the national economy is at its healthiest since the recovery began.
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Healthcare expansion is rejected in Florida
The New York Times
In another rebuke of the Obama administration's efforts to expand health care to the uninsured, Florida's Republican-led House of Representatives soundly rejected a plan on Friday that state officials said would have covered as many as 650,000 residents. It was the third time that legislators had considered and spurned some version of healthcare expansion since passage of the Affordable Care Act, and it represented a victory for Gov. Rick Scott, a Republican, who had changed his mind in the past on whether to support any such enlargement but was firmly opposed this time.
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Florida governor asks court to force mediation over Medicaid lawsuit
The Associated Press via The Baltimore Sun
A federal court judge gave the Obama administration until Tuesday to say whether it will accept Florida Gov. Rick Scott's request for mediation in a dispute over billions of dollars in federal healthcare funds. The Republican governor is suing the federal government for withholding hospital funds because Florida is not expanding Medicaid.
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US justices reject Maine challenge to Medicaid funding
Reuters
The U.S Supreme Court on Monday rejected the state of Maine's bid to revive its plan to trim some young people from its Medicaid rolls. By declining to hear the case, the court left intact an appeals court ruling that upheld the federal government's decision to reject the state's plan to cut 19- and 20-year-olds from Medicaid.
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Arkansas cancels cost-sharing for poorest in Medicaid expansion
Modern Healthcare
Arkansas will not, for the time being, impose cost-sharing for Medicaid expansion beneficiaries below the federal poverty level. The state won a federal waiver in 2013 to use new funding available under the Patient Protection and Affordable Care Act that helps residents earning up to 138 percent of the poverty level buy private plans on the new insurance exchange rather than enroll in traditional Medicaid coverage.
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Legal opinions say Alaska lawmakers' effort to stop Medicaid expansion likely unconstitutional
Alaska Dispatch News
Attempts by legislative leaders to use the budget to stop Alaska Gov. Bill Walker from accepting federal Medicaid expansion are likely unconstitutional and can't block unilateral action by Walker to bring the program to the state with or without the Legislature’s agreement, new legal opinions say. The Alaska Legislature has refused to consider an up-or-down vote on expansion bills unless it already has Republican-majority support. The Republican-led majorities stripped savings from the budget submitted by Walker that would come from expanding Medicaid.
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Hawaii to shutter state health insurance exchange
The Hill
Hawaii will abandon its state-based health insurance exchange and transition to the federal marketplace, known as HealthCare.gov, the state announced Friday. Gov. David Ige announced Hawaii Health Connector, a private nonprofit, would be shut down because it "has been unable to generate sufficient revenues to sustain operations."
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Could these new cholesterol drugs save many Americans from
heart attacks?

The Washington Post
A federal advisory committee this week will decide whether to recommend approval of the first in a new class of drugs many experts believe could significantly cut the risk of strokes and heart attacks, a leading cause of death for Americans. The highly-anticipated new drugs have been shown in clinical trials to sharply reduce levels of bad, or LDL cholesterol, representing the first major advance in the area since widely used statin drugs hit the market in the late 1980s.
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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: Vice president of marketing and sales | Chalfont, PA
Project Transition
Project Transition enables people with serious mental illness, co-occurring substance use disorder and/or a dual diagnoses of SMI and IDD live meaningful lives in the community on terms they define. This position is responsible for the planning, development, and implementation of marketing and sales strategies. View the complete job description.

To apply, please email your resume to Adorable Harper.

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Job opportunity: Senior Medicaid Strategist | Raleigh-Durham, NC
North Carolina Department 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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