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NC Senate, House at odds over future of Medicaid
The Associated Press via Salisbury Post
Senate Republicans offered a Medicaid overhaul recently that's more sweeping than a House plan because it would recruit private managed-care companies to coordinate patient services and shift North Carolina's Medicaid agency to a new department. Jeff Myers, CEO of the Washington-based Medicaid Health Plans of America, called the North Carolina medical groups' complaints about the plan "more scaremongering than anything else." Myers continued, "Ultimately, I think the Senate’s on the right path."
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New NC Senate Medicaid plan rankles doctors, hospitals
WRAL-TV
When Senate leaders rolled out the latest in a series of long-term Medicaid reform efforts, they opted for a bill that would create a new agency to oversee the state health insurance system for the poor and disabled, snubbing a House-drafted plan that had been endorsed by Gov. Pat McCrory. Providers claim that the NC Senate Medicaid plan would deprive North Carolina of valuable input from the physician community. "It's disappointing that providers would say these kinds of things because it's simply not accurate," said Jeff Myers, chief executive of the Medicaid Health Plans of America, the nation's largest group of Medicaid managed care plans.
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NC Senate Medicaid plan relies on competition
Carolina Journal
The Senate recently rolled out an ambitious Medicaid reform plan with an aggressive timetable that health care provider organizations panned and other Medicaid experts applauded. "It's a typical kind of bogeyman argument [and] completely inaccurate" for providers to accuse managed care organizations of seeking profit over patient interests, and harboring a willingness to cut services and provider reimbursement rates in order to cut costs, said Jeff Myers, president and CEO of the Washington, D.C.-based Medicaid Health Plans of America. "It really does make sense to move to an MCO, fully capitated risk model," Myers said.
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mhpa2014 annual conference session on foster care
MHPA
Health plans must develop enhanced care coordination programs to address the unique needs of members in foster care, which are typically more intensive than their non-foster care peers. mhpa2014’s Helping MCOs Prepare to Serve Children in Foster Care will address these needs and offer solutions on how to provide better quality of care to this population. Sign up before Sept. 8 to save on registration for mhpa2014. For more annual conference details, please click here.
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State governments may spend $55 billion on hepatitis C medications
PRNewswire via MarketWatch
State legislatures will need to find billions in their budgets to purchase costly new hepatitis C therapy, according to a new state-by-state analysis released recently by Express Scripts. More than 750,000 Americans with chronic hepatitis C receive state-funded healthcare through Medicaid or the prison system. Given the pricing that drug manufacturers are currently offering to these public programs, Express Scripts projects states will spend more than $55.2 billion if they are to provide all of these patients the latest therapy regimen of Sovaldi and ribavirin.
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How do you pay for a drug that costs $84,000?
The Washington Post
There's a new $84,000 treatment for hepatitis C that's giving new hope to patients. But it's also giving a healthcare system strained by limited resources a strong reality check. Since Gilead Sciences unveiled Sovaldi more than six months ago, its $84,000 price tag has ignited a conversation in the health policy world about how to make lifesaving medicines more affordable without hurting drugmakers' incentives to develop the treatments in the first place.
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Costly Vertex drug is denied, and Medicaid patients sue
The Wall Street Journal (subscription required)
Vertex Pharmaceuticals' $300,000-a-year cystic fibrosis drug has sparked a battle in Arkansas, illustrating the dilemma faced by cash-strapped government insurance programs.
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Denti-Cal patients feel the pain as rates shrink
California Health Report
A few years ago, Kathleen Hamilton became a foster mom to 13- and 14-year-old boys, who also happened to be her nephews. Both needed extensive dental work, and the services were to be covered by the state's Medi-Cal program. But year after year, Hamilton ran into a snag.
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FEATURED ARTICLE
TRENDING ARTICLE
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NAMD director discusses Medicaid's future with Kip Piper
MediStrategy
In an episode of the podcast MediStrategy, National Association of Medicaid Directors Executive Director Matt Salo spoke about the significant changes underway in the $500 billion Medicaid program, payment and delivery reform priorities of state Medicaid directors and challenges faced by state Medicaid executives.

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Iowa Medicaid director leaving for university job
The Des Moines Register
Iowa's Medicaid director is leaving the job to take a position at the University of Iowa. Jennifer Vermeer has run the huge program since 2008. Vermeer will become assistant vice president of medical affairs at the University of Iowa Health Care, according to a Department of Human Services news release. Her resignation is effective Aug. 21.

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Report: Uninsured rate dropped after Obamacare exchanges opened
The Hill
The percentage of uninsured people in the U.S. dropped, from 20 percent to 15 percent, after the Obamacare marketplaces opened last year, according to a new study. The Commonwealth Fund polled between July and September of 2013, before the new exchanges went into effect, and then again between April and June this year, after the ObamaCare enrollment period ended.

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California releases proposal for clearing Medicaid backlog
Kaiser Health News
Responding to inquiries from federal officials, the California health department has released a plan it says will dramatically slash its backlog of Medi-Cal applications within six weeks. For months, the state has labored under the largest such pile up in the country, with 900,000 pending cases reported in May — the combined result of unexpectedly high application numbers and bug-ridden computer systems.
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TRENDING ARTICLES
Missed our previous issues? See which articles your colleagues read most.

    Florida shifts Medicaid mental health strategy (Kaiser Health News and USA Today)
NAMD director discusses Medicaid's future with Kip Piper (MediStrategy)
Medicaid agency has been perennial headache (News & Observer)
Florida: Medicaid funds repayment mark latest sign of
Washington-Tallahassee rift
(Miami Herald)
Senate Minority Leader: Obamacare plagued by 'almost-cartoonish inefficiency' (The Hill)

Don't be left behind. Click here to see what else you missed.


Aug. 6 Webinar Wednesday: 'Where am I? Finding and Impacting Members to Improve Quality Ratings, Reduce Administrative Costs, and Transform Processes'
LexisNexis
The changing landscape of healthcare has only increased our dependency on member and provider data to fuel administrative processes, quality initiatives and coordination of care. With more than half of Medicaid enrollees being assigned to managed care organizations, data provided by states and other entities on these members are critical to supporting your efforts to locate, enroll and manage their health and costs.

In this webinar, you will:
  • Get a better understanding of the seriousness of data quality issues across healthcare
  • Discover new ways to verify, augment and monitor provider and member data
  • Hear real-world case studies where data quality issues were identified and resolved to drive quality and performance ratings, efficiency and savings

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