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High court's King decision could hit Medicaid programs
Politico (subscription required)
The heart of the latest challenge to Obamacare is whether private insurance subsidies are legal in the 34 states that don't run their own exchanges. But the 2010 law also says states can't reduce adults' Medicaid eligibility until "an exchange established by the state" is up and running. Legal experts say this so-called Medicaid maintenance-of-effort requirement could be revived if the Supreme Court finds that federal exchanges don't qualify as state-based exchanges. That would mean affected states couldn't reduce Medicaid eligibility — or could be forced to reinstate coverage for some — until they run their own insurance marketplaces.
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North Carolina House Republicans stick to Medicaid overhaul plan
The Associated Press via The Fayetteville Observer
House Republican leaders are sticking to their previous model for overhauling Medicaid, moving legislation through a committee Wednesday that places the responsibility of cost controls in the hands of doctor and hospital networks. The measure is nearly identical to the bill that passed the House by a wide margin last year. It remains dramatically different from what the Senate envisions Medicaid reform to be. Attempts to work out a compromise agreement could extend this year's General Assembly work session well into the summer.
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Medicaid debate will continue in North Carolina
Carolina Journal
For years now, legislators, policy analysts, medical providers and lobbyists for various interest groups have been arguing about North Carolina's Medicaid program. Whether you find this argument interesting, confusing or boring, the message is clear: It's far from over.
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Judge rejects mediation in Florida healthcare funding dispute
Orlando Sentinel
A federal judge Wednesday rejected a request by Florida Gov. Rick Scott for mediation in a legal battle between the state and federal government about healthcare funding. Chief U.S. District Judge M. Casey Rodgers issued an order that said she has already scheduled a hearing next week on a Scott motion for a preliminary injunction in the case.
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Arizona's Medicaid program cancels 5 percent provider cuts
The Associated Press via The Baltimore Sun
Arizona's Medicaid program has canceled a planned 5 percent cut in payments to hospitals, doctors and other medical professionals after they objected and lower than expected insurance costs gave the program leeway to avoid the cuts. The decision came just three months after Gov. Doug Ducey signed a plan for the budget year that begins July 1 that projected $37 million in savings from the cuts in the first year.
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Adult dental coverage expanding slowly in Medicaid
Kaiser Health News
Federal law requires state Medicaid programs to include dental care for children, and the Affordable Care Act extended that requirement to private insurers. But the federal health law did little for adults: While premium tax credits were made available to help low-income people purchase health insurance, the subsidies cannot be used to purchase dental coverage except as an add-on to health coverage.
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Did you miss Webinar Wednesday: 'Integrating High-Risk Member Care with Risk Adjusted Revenue for Medicaid Members and Dual Eligibles'?
MHPA
To request a copy of the presentation by PopHealthCare, or for additional information, please contact Eddie Gilmartin, or visit www.pophealthcare.com.

For copies of other past webinars, visit here.

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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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MHPA's Industry NewsBrief
Colby Horton, Vice President of Publishing, 469.420.2601
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Damon Sayles, Senior Editor, 469.420.2662   
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