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Skyrocketing drug prices leave cures out of reach for some patients; MHPA's Myers comments
USA Today
Sophisticated drugs are opening the door, scientists say, to an era of "precision medicine." They're also ushering in an age of astronomical prices. New cancer drugs are routinely priced at more than $100,000 a year — nearly twice the average household income.

Even drugs outside the domain of precision medicine are getting pricier. Prices for insulin have skyrocketed in recent years, said Jeff Myers, president and CEO of Medicaid Health Plans of America.
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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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Poll: Most want Congress to save Obamacare subsidies
The Hill
More than 6 in 10 adults think Congress should restore Obamacare subsidies if the Supreme Court invalidates them, according to a new poll. The looming Supreme Court case of King v. Burwell could strike down subsidies that help 6.4 million people in at least 34 states afford insurance purchased through the law's federal exchange.
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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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New Nevada law opens door to privatizing Medicaid services for the
ABD population

Las Vegas Review-Journal
Nevada Gov. Brian Sandoval on Thursday signed a bill into law that includes provisions to privatize Medicaid services for the elderly, the blind and the disabled in Nevada. Section 37 of Senate Bill 514 enables the state to consider the possibility of providing long-term services and support to the blind, elderly and disabled through a managed care model. The governor would have to make a recommendation, which would then have to be approved by the state's Interim Finance Committee.
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Audit: Medi-Cal patients don't have adequate access to doctors
Los Angeles Times
An audit released Tuesday found California hasn't properly ensured that patients who are part of its Medicaid program have adequate access to doctors. The report from the California state auditor's office found that provider directories for Medi-Cal managed care plans were riddled with errors, including incorrect telephone numbers and listings for doctors who are no longer part of the plans, and that the state's Department of Health Care Services needs to improve its oversight of the plans.
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North Carolina TAs cut, Medicaid revamped under Senate proposal
WRAL-TV
Thousands of teaching assistants would be eliminated from classrooms throughout North Carolina over the next two years, the Medicaid program would be handled by a mix of managed care organizations and groups of health care providers and not all state employees would receive raises under the Senate's proposed budget.
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North Carolina: $9.7 million could be owed on delayed Medicaid payments
The Associated Press via The Baltimore Sun
North Carolina government owes up to nearly $10 million to Medicaid service providers whose payments were delayed — some dating back nearly two years to the start of a new computer billing system. The Department of Health and Human Services disclosed Wednesday night underpayments to about 2,500 providers could reach up to $9.7 million in state funds.
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Ad campaign starting for expanded Healthy Indiana Plan
The Associated Press via The Baltimore sun
A state agency is about to launch an advertising campaign to encourage enrollment in Indiana's expanded healthcare program for low-income residents. The $2 million campaign for the new Healthy Indiana Plan starts Monday with television, radio, online, newspaper and billboard ads. Its focus will include highlighting health services such as cancer screenings or preventive dental care that people without health insurance often don't receive.
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Indiana's poor get Medicaid — by paying
Chicago Tribune
Indiana, which has a conservative Republican governor and legislature, is pioneering an experiment that requires low-income patients to contribute monthly to a special health account. Charging poor people small premiums or fees for care — long favored by conservatives who argue that "skin in the game" engages patients in their health — has historically produced mixed results.
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Federal appeals court asked to throw out TennCare case
The Associated Press via Miami Herald
Tennessee is asking a federal appeals court to throw out a class-action lawsuit that claims the state left thousands of TennCare applicants in indefinite limbo, with their applications neither approved nor rejected.

With the rollout of the Affordable Care Act in October 2013, the government changed the method used to determine financial eligibility for Medicaid. But in Tennessee, a new computer system designed to accommodate the change was behind schedule. So the federal government agreed temporarily to accept applications for TennCare — Tennessee's version of Medicaid — on behalf of the state.

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Georgia commissioner of the Department of Community Health: 'Waiver' doesn't need new legislative OK
Georgia Health News
The head of a state health agency reiterated his position Thursday that Georgia already has the authority now to pursue a Medicaid "waiver" plan to cover uninsured people. That statement by Clyde Reese, commissioner of the Department of Community Health, runs counter to arguments made in a recent letter from Rep. Jason Spencer and other state legislators.
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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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Millennium Health unveils suite of tools to address the epidemic of unsafe opioid use
Millennium Health
Millennium Health, a leading health solutions company, and its population health management subsidiary, RxAnte, LLC., has announced a new suite of integrated services focused on addressing the growing epidemic of unsafe use of prescription pain medicines known as opioids. The company's risk-based opioid management program will be offered to health plans as a new approach to managing the growing epidemic of unsafe prescription opioid use. It features automated patient risk stratification, definitive lab monitoring for at-risk individuals and a platform for alerting potentially unsafe use.
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June 24 Webinar Wednesday: 'The New Frontier: Measuring Patient Engagement and Experience'
Avalere Health
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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