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Medicaid insurers prodding Massachusetts on funds
The Boston Globe
Buckling from more than $140 million in losses since the start of the year, companies that insure Medicaid patients are pressing the Patrick administration to increase payments they receive from the state of Massachusetts for serving low-income residents. The health insurers say the deficits are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members — many with serious medical issues — assigned to the companies by MassHealth, the state Medicaid program.
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The risky business of limiting Medicaid access to Sovaldi
Governing
Partially because of its high cost, nearly half the states are restricting Medicaid patients' access to an effective new hepatitis C drug. Experts say there's no question lawsuits will come.
Brand drug makers push trade deal that restricts US ability to
curb spending
Inside Health Policy
Just as the country is on the verge of a significant increase in drug spending, brand-drug makers are lobbying for a trade deal that could severely constrain the ability of Medicare to curb drug prices, consumer groups warn.
mhpa2014 ENGAGEMENT session on behavioral changes and ROI
MHPA
Join Matt Onstott, Ph.D, Deputy Medicaid Director, New Mexico Human Services Department/Medical Assistance Division; Catherine McCarron, RN, BSN, CPHQ, Director, Accreditation and Clinical Programs, Health Partners Plans; Deborah Stewart, President and CEO, Finity, Inc.; and Medagate's Suzanne O'Hara as they show how to structure member engagement and incentive programs to produce behavioral changes and ROI. Attendees will find value in learning from the results of two Medicaid incentive programs — new HCIA ROI results for a Medicaid incentive program and one of the first portable, closed-loop Medicaid incentive programs for the state of New Mexico. The panel will share program results to date, incentive and engagement plan design strategies and closed-loop platform tracking and program plan design methodologies.
For details on other sessions at the signature event for the Medicaid managed care industry, please click here for our latest agenda. Don't forget: Sign up before Sept. 8 to grab the early-bird discount.
SHOWCASE
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Contact HMS today.
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Reform Update: Arkansas may make Medicaid enrollees fund HSAs
Modern Healthcare (Subscription required)
Arkansas, the first state to establish the conservative private-plan model for expanding Medicaid under the Patient Protection and Affordable Care Act, now is looking to join several other conservative-leaning states in requiring low-income beneficiaries to make monthly contributions to their health coverage in the form of a health savings account.
Wisconsin governor on Medicaid: Democrats 'living in alternate universe'
Green Bay Press-Gazette
 Wisconsin Gov. Scott Walker countered attacks against his Medicaid policy saying Wisconsin has a "very unique" approach that provides health coverage for all poor people without taking on additional financial risk. Walker came under fire by Democrats who solicited a report from the nonpartisan Legislative Fiscal Bureau that found the state could have saved $206 million in its current biennial budget and another $315 million in its 2015-17 budget if Walker accepted federal money to expand Medicaid.
Auditor says $93 million in Medi-Cal payments could be fraudulent
Los Angeles Times
A California state audit has found that more than $93 million in Medi-Cal payments made to substance abuse clinics across California were potentially fraudulent. The audit reviewed billing data from July 2008 to December 2013 for Medi-Cal's Drug Treatment program, which reimburses rehabilitation clinics. The audit found the state's Department of Health Care Services and the Department of Alcohol and Drug Programs failed to administer the program "and created opportunities for fraud."
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HHS figures: Missouri led nation in Medicaid roll reductions
The Associated Press via Springfield News-Leader
Missouri's Medicaid program is leading the nation in the number of people dropped from its rolls. New figures from the U.S. Department of Health and Human Services show that Missouri's Medicaid enrollment dropped by 37,260 people in June, compared with its average enrollment from July through September of last year.
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More than 7.2 million added Americans covered under Medicaid, CHIP
U.S. Department of Health & Human Services
Over the last year, we've seen the Affordable Care Act deliver on a number of important milestones as we work toward more accessible, affordable, quality healthcare. New options have meant that 10.3 million previously uninsured Americans can now rest a little easier knowing that they are covered.
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National Hemophilia Foundation Annual Meeting Pre-Conference Symposium on Hemophilia Pharmacy Management: Sept. 18 in Washington, DC
National Hemophilia Foundation
The National Hemophilia Foundation Annual Meeting Pre-Conference Symposium on Hemophilia Pharmacy Management: "Steps for Success With Managed Care and Specialty Pharmacy" will take place Sept. 18 in Washington, D.C.
Specifically designed for specialty pharmacists, home health pharmacists, health plan pharmacists, managed Medicaid pharmacists, medical directors and other health care professionals with an interest in the management of patients with hemophilia, this free event is also a CME/CPE-certified activity.
For more details including program overview, educational objectives, the full agenda, and free registration, click here.
Did you miss Webinar Wednesday: 'The Promise of Aggregated Data: Trends, Pitfalls, and Tips for Commercial Payers' by HMS?
MHPA
View and download the Aug. 20 Webinar Wednesday by HMS, "The Promise of Aggregated Data: Trends, Pitfalls, and Tips for Commercial Payers," here. Other webinars are available to download, as well.
Missed our previous issues? See which articles your colleagues read most.
Upcoming Webinar Wednesdays
MHPA
Here are some upcoming Webinar Wednesday events to mark on your calendars:
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Aetna job opportunities
Aetna
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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