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Two campaigns differ sharply on Medicaid, seeking vast growth or vast cuts
The New York Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The way Mitt Romney and U.S. Rep. Paul D. Ryan frame it, the debate over social programs that has become a dominant theme of the presidential race is all about the future of Medicare, the government health insurance program for retirees. But the outcome of the election will probably have a more immediate and profound effect on Medicaid, the joint state-federal program that provides health care to poor and disabled people. Few other issues present a starker difference between the Republican and Democratic tickets. President Barack Obama, through the healthcare law that was a centerpiece of his domestic agenda, seeks a vast expansion of Medicaid, which currently covers more than 60 million Americans — compared with 50 million in Medicare — and costs the states and the federal government more than $400 billion a year. More

Centene: Buckeye Community Health Plan to contract in 3 Ohio regions as part of Medicaid integrated care delivery system project
Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Centene Corp. has been notified by the Ohio Department of Job and Family Services that Buckeye Community Health Plan, Centene's Ohio subsidiary, has been selected to serve Medicaid members in a dual-eligible demonstration program in three of Ohio's pre-determined seven regions: Northeast (Cleveland), Northwest (Toledo) and West Central (Dayton). According to a release, this three-year program, which is part of the state of Ohio's Integrated Care Delivery System expansion, will serve those who have both Medicare and Medicaid eligibility. Enrollment is expected to begin in the second quarter of 2013. More

Massachusetts duals demo caps Medicare's risk corridor pay if plans underpaid    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The memorandum of understanding between CMS and Massachusetts for that state's Medicare-Medicaid financial alignment demonstration shows that there is a limit to the risk Medicare will bear if capitated payments to participating plans are not sufficient to cover the actual costs of dually eligible beneficiaries, sources say, adding that this approach is unlikely to be different in forthcoming demonstration MOUs for other states. More

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California pilot offers caveats for moving 'dual eligibles' to managed care
Kaiser Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As federal officials evaluate state proposals to move millions of the nation's poorest and sickest individuals into managed care plans, they might consider a recent report from the California HealthCare Foundation. The report analyzed California's year-long transition of 240,000 low-income seniors and people with disabilities from fee-for-service plans into managed care as part of a federally approved demonstration project. Beneficiaries had to pick a managed care plan, or the state assigned one to them. More

State of South Dakota awards 3rd-party liability contract to HMS
Business Wire via Insurance-Technology    Share    Share on FacebookTwitterShare on LinkedinE-mail article
HMS, a wholly owned subsidiary of HMS Holdings Corp., announced that it has been awarded a contract by the South Dakota Department of Social Services to provide third-party identification for cost avoidance services as well as billing of claims identified by the state as having third-party coverage The contract extends through May 31, 2013, with two one-year renewal options. HMS has performed third-party identification and billing services on behalf of South Dakota since 2006. More

Implementing the ACA's Medicaid-related health reform provisions after the Supreme Court's decision
Kaiser Family Foundation    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The Kaiser Commission on Medicaid and the Uninsured has prepared a brief that addresses questions that may arise for states in the wake of the Supreme Court's decision upholding the Affordable Care Act, including what parts of the ACA are affected by the decision, whether states can opt in and out of the Medicaid expansion over time, whether federal payments to hospitals for uncompensated care will still be reduced if a state does not expand its Medicaid program, and whether the court decision affects the ACA’s maintenance of effort provisions. More

Online map by Census Bureau shows rates of health insurance by county
Hartford Courant    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The U.S. Census Bureau has a new interactive online program that shows health insurance coverage as of 2010 for the nation's 3,140 counties. In general, an interactive map on the site, shows that the South and West have a greater percentage of uninsured residents than the Northeast and Midwest. The landscape of who is uninsured and who has coverage likely will change when an individual mandate becomes effective Jan. 1, 2014, meaning that anyone who doesn't have insurance will have to pay a penalty. More

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New Hampshire wins federal approval for Medicaid managed care plan    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Federal authorities have approved New Hampshire's plan to implement a managed care system for its Medicaid recipients. The change from the current fee-for-service plan is expected to save the state around $16 million this fiscal year, reports the New Hampshire Union Leader. More

Georgia Medicaid expansion: Room for compromise?
Georgia Health News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The door may not be closed on a Georgia Medicaid expansion after all. Gov. Nathan Deal had appeared to rule out expanding Medicaid while speaking to the media in Tampa at the Republican National Convention. “No, I do not have any intentions of expanding Medicaid,’’ Deal said, according to the AJC. “I think that is something our state cannot afford.’’ Deal spokesman Brian Robinson, though, told The Associated Press, ‘‘Today, the governor said if the state’s only options remain the ones that are available today, he would oppose taking part in the expanded Medicaid program.’’ More

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Maine faces debate over Medicaid expansion    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Maine's Republican Gov. Paul LePage has said he will wait until after the November election to decide whether the state will take part in the Medicaid expansion provision of the Affordable Care Act. The debate in Maine over Medicaid expansion also is heightened by a $20 million budget cut last year in state Medicaid funding that could cut health insurance benefits for 20,000 to 30,000 Maine residents. More

Medicaid cutbacks allowed, Arkansas told (Subscription required)    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The federal government officially notified Arkansas Gov. Mike Beebe that the states have "flexibility" regarding expanding Medicaid rolls by up to 250,000 of the state's poor residents as part of the new healthcare law. More

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GAO: States are lax verifying Medicaid eligibility for some applicants
Targeted News Service via Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
States have been behind in implementing a system that would help to independently verify whether applicants qualify for Medicaid, specifically those seeking long-term care, the Government Accountability Office revealed. In a report titled, "Medicaid Long-Term Care: Information Obtained by States about Applicants' Assets Varies and May Be Insufficient" (Report No. GAO-12-749) the GAO said states generally were good about verifying information through the Social Security system. However, Social Security only accounted for a portion of the assets or income an individual may have had access to. More

Insights webinar: Evolving Toward a New Model of Care | 11 a.m. EDT Sept. 10
Daiichi Sankyo Inc.    Share    Share on FacebookTwitterShare on LinkedinE-mail article
This presentation reviews the challenges that PCPs face, case studies where PCMH has been undertaken, and barriers/challenges associated with its implementation. More

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Free webinar from MHPA partner Verizon: Fraud Waste and Abuse — The Next Generation | 2 p.m. EDT Sept. 12
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Understanding the patterns of fraud, where to find it, how to detect, and when to act. The old pay-and-chase model of fraud management is inefficient and costly. Connie Schweyen, Debra Faulkner, MBA, MHA; and David Botsko, Ph.D., CFE, managing principals at Verizon Connected Healthcare, will show you how to catch crime before it happens and how a near real-time fraud management solution can ensure near-time results. More

Free webinar by MHPA partner Baxter: Importance of Coordinated Care in the Management of Members with Hemophilia | 11 a.m. EDT Sept. 18
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
This webinar is focused on coordinating care in hemophilia, improving outcomes and reducing costs. Best practice coordination of care includes the plan's relationship with the patient, specialty pharmacy, and hemophilia treatment centers. A managed Medicaid plan will discuss management of hemophilia patients through working with the state as well as outcomes associated with care through a specialty pharmacy. A hemophilia physician will discuss the uniqueness of coordinated care through the hemophilia treatment center and demonstrated outcomes. More

Reaching, Retaining, and Serving Dual Eligible Beneficiaries | Sept. 19-20 | Scottsdale, Ariz.
Healthcare Education Associates    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Explore effective marketing, outreach and engagement for Medicare/Medicaid dual eligibles. Healthcare Education Associates and the Risk Adjustment Initiative & Society for Education are pleased to present the Reaching, Retaining, and Serving Dual Eligible Beneficiaries Summit, slated for Sept. 19-20 in Scottsdale, Ariz. This groundbreaking two-day intensive event designed to tackle the unique challenges of marketing and outreach to the dual eligible population, will feature MHPA President and CEO Thomas Johnson as a guest speaker. MHPA members get 15 percent off registration by using Priority Code: HMP122. Call Theresa Powers at 704-341-2437 or register online here.

MHPA's 2012 Annual Meeting | Oct 24-26 | Washington, DC
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Register now for the MHPA 2012 Annual Meeting, "A Pivotal Time for Medicaid Health Plans," Oct. 25-26, and the Pre-Conference "Developments in the States," Oct. 24. More details on the agenda, speaker lineup, lodging info and travel discounts here. Register online now from your PC or PDA.

Free webinar by MHPA partner LexisNexis: Why Identity Management Matters to Medicaid | 1 p.m. EST Nov. 8
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
As a Medicaid Plan you should not just be addressing the "what" of identity management — the technical side — but, more important, the question of "who?" How do we know who the person on the other end is who they say they are and what risks they may pose for the environments and systems they are attempting to enter. More

Insights webinar: Reduce Outsourcing Risk | 11 a.m. EST Dec. 20
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Details here.

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