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North Carolina Senate votes to overhaul Medicaid
The North Carolina Senate gave tentative approval to a proposal to overhaul the state's Medicaid system. The proposal, H.B. 1181, would remove Medicaid from the Department of Health and Human Services, setting it up as an independent agency called the Department of Medical Services governed by an independent — although politically appointed — board.
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MHPA commends North Carolina Senate on Medicaid reform plan
PRNewswire via
MHPA, the leading advocacy organization representing Medicaid managed care organizations, congratulates North Carolina's Senate for approving on second reading a real Medicaid reform plan that will deliver coordinated, high-quality care to the needy in The Tar Heel State while providing much needed budget predictability for state taxpayers.
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mhpa2014 annual conference session on advanced data analytics by Deloitte
Health analytic methodologies and tools are instrumental in a Medicaid managed care plan's ability to effectively find and engage their members, make their service experience more effective and improve the overall quality and cost of care delivered. In the new paradigm, health plans must capture meaningful data and leverage new methodologies and tools in order to meet their goals.

In "Achieving Improved Member Engagement and Care Through Advanced Data Analytics: Insights on Leveraging Information and Leading Edge Tools from the Field," Deloitte's Jason Wainstein and Megan Cormier will share insights into how an organization can:
  • Effectively engage members
  • Create an enhanced population health management framework through predictive modeling, targeting the needs of high-risk populations and performance monitoring
  • Identify and monitor a high-value provider network
  • Build and utilize effective executive and clinical management dashboards
Sign up before Sept. 8 to save on registration for mhpa2014. For more annual conference details, please click here.

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Missourians still face delays seeking Medicaid coverage
St. Louis Post-Dispatch
More than 12,000 applications transferred to Missouri's Medicaid program from the federal health insurance exchange are still being processed. In February, a deluge of applications as well as software compatibility issues between the federal exchange and the state's Medicaid computer systems created a huge backlog. The backlog had gotten so bad that federal officials last month asked Missouri and five other states to explain what steps they would take to fix the problem.
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South Carolina Medicaid backlog leaves thousands in insurance limbo
The Post and Courier
Thousands of South Carolina residents who filed for Medicaid between October and mid-July are still waiting to find out if they qualify for the government's low-income health insurance program. While most Medicaid applications are typically approved or denied within six days, the state agency responsible for processing the paperwork hasn't been able to keep pace with an influx from
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One Set of Data...Results Across All Service Lines

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Georgia hard at work on Medicaid backlog
Georgia Health News
A Georgia state health agency says it's working though the application backlog for Medicaid that recently provoked federal scrutiny. The Department of Community Health has made decisions on eligibility for up to 70 percent of the 88,854 "account transfers" from Georgia's insurance exchange, the agency said.
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Georgia governor makes a (very limited) exception to his stance against Medicaid expansion
The Atlanta Journal-Constitution
Georgia Gov. Nathan Deal has gone to great lengths to assure his supporters that he's against the expansion of Medicaid under the Affordable Care Act. But he carved out one exception this week. It has to do with the more than 1,100 unaccompanied immigrant children transferred by the feds this year to the care of sponsors living in Georgia. The influx comes amid a surge of Central American children fleeing instability and violence at home to illegally cross the southwest border.
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Florida Medical Association supports Medicaid expansion
The Florida Medical Association's House of Delegates overwhelmingly adopted a resolution supporting Medicaid expansion to cover uninsured low-income adults at FMA's annual meeting, according to doctors who were there.
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Official: Lack of Medicaid expansion hampers economic development in
rural Alabama

The Birmingham News
Alabama's unwillingness to expand Medicaid is adding to the economic distress of the state's rural communities and further impeding their economic development efforts, officials said. Danne Howard, senior vice president of government relations and emergency preparedness for the Alabama Hospital Association, was the lead speaker of a rural economic development session to kick off the Economic Development Association of Alabama's summer 2014 conference.
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States want more time on ACA funds
States running their own Obamacare exchanges were supposed to wean themselves off federal funding by the end of this year, but some of them want that Obama administration spigot open a bit longer. The states aren't asking for the feds to dole out more money on top of the $4.6 billion already dedicated to exchange planning and construction. But they do want to be able to spend their federal exchange grants into 2015 as they grapple with core components of the insurance portals that are balky, unfinished or in disrepair.
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Paul Ryan to unveil antipoverty plan; doesn't include Medicaid
The Washington Post
House Budget Committee Chairman Paul Ryan will shift from his years-long focus on cutting federal spending to an antipoverty proposal that seeks to overhaul the safety net but also leaves in place existing levels of funding. The proposal is part of an effort to reorient the Republican Party away from battles of recent years and toward addressing the economic anxieties of the most disadvantaged Americans.

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Will Gilead's hepatitis C drug bust state budgets?
The Wall Street Journal
Will the cost of new hepatitis C treatments bust state budgets? A new analysis suggests many states may, in fact, be overwhelmed as they attempt to pay for the Solvaldi medication sold by Gilead Sciences, which costs $84,000 for each patient, and several forthcoming treatments that may be priced at a similar level.

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CDC: Many children with Medicaid use ER as doctor's office
HealthDay via
The Philadelphia Inquirer

Children covered by Medicaid visit the emergency room for medical care far more often than uninsured or privately insured youngsters, a U.S. survey finds. And children with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention.

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'Health Care Behind Bars: A Key to Population Health?' on Aug. 1
Alliance for Health Reform
This briefing will explore innovations and challenges in delivering healthcare to a growing population of inmates. This is an expensive group because of the large number of people with mental illness, addiction disorders and conditions associated with aging and hepatitis C. Indeed, corrections spending is the second fastest-growing state expenditure, behind Medicaid, according to the Pew Charitable Trusts.
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Aug. 6 Webinar Wednesday: 'Where am I? Finding and Impacting Members to Improve Quality Ratings, Reduce Administrative Costs, and Transform Processes'
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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Missed our previous issues? See which articles your colleagues read most.

    Health officials crack down on Florida Medicaid marketing (The Associated Press via Miami Herald)
'Intervention: Will North Carolina clean up its Medicaid program?' (Telemachus)
Arkansas weighs plan to make some Medicaid enrollees fund savings accounts (Kaiser Health News)
Agency running Medi-Cal didn't know how many doctors took its insurance (California Health Report)
NC Senate to take up managed care Medicaid plan; MHPA's Myers makes the case for MCOs (

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

Aetna job opportunities
The following are job opportunities from Aetna. Visit here, and enter Req # for full description and details.
    MD/Psychiatrist; Newark, Delaware; Req# 19223BR
    This successful candidate will become the Delaware Physicians Care (DPCI) Medical Director for Behavioral Health and will serve as our expert physician resource in the areas of utilization management, quality management, case management and overall medical management. This critical role sits at the intersection of behavioral and physical health services in helping DPCI to develop holistic programs to improve the quality and outcomes of our constituent members.

    MD/Physical Health; Newark, Delaware Req# 19166BR
    The position entails duties and responsibilities of Medical Director for Delaware Physicians Care (DPCI). The successful candidate will serve as a critical contributor to the DPCI medical management team in the role of clinical expert to the various functional areas including utilization management, case management and quality management. A key component of this position is to use the clinical credentials, experience and judgment in rendering benefit determinations based on medical necessity.

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