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As pricey hepatitis pill Harvoni joins Sovaldi, states erect Medicaid hurdles; MHPA's Myers comments
Forbes
As Gilead Sciences launches its next generation Hepatitis C pill, Harvoni, Medicaid programs are bracing for another extraordinary wave of costs, with 70 percent of states implementing coverage restrictions. Already, the cost of Gilead's first generation hepatitis C drug Sovaldi, which costs $1,000 a pill and more than $84,000 for a course of treatment, has triggered 35 states to require prior authorization before Medicaid patients can get the drug, according to a report from Washington, D.C.-based consulting firm Viohl & Associates. Gilead has said Harvoni's price will be $94,500 for a 12-week course of treatment.
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Will 'son of Sovaldi' cause state Medicaid programs to erect high hurdles? MHPA weighs in
The Wall Street Journal
How might state Medicaid programs cope with a new and equally expensive hepatitis C treatment from Gilead Sciences? A new report released just as the FDA approved Harvoni, which will cost $94,500 for a 12-week regimen, may offer some insights, at least according to a trade group for the state programs.
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Read 'The Sovaldi Squeeze: High Costs Force Tough State Decisions'
MHPA
MHPA released a report by Viohl & Associates on Friday, Oct. 10, to coincide with Gilead's launch of Harvoni, the all-oral indication for hepatitis C. The survey project referenced in the two stories above examines how state Medicaid programs are dealing with Sovaldi and its costs. The findings — the cost of Sovaldi being so huge that all states have established some form of prior authorization — are a window to what will likely happen with future drugs, especially Harvoni.
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Many on Medicaid see boost in benefits as economy improves
Kaiser Health News
With an improving fiscal climate, many states are increasing benefits for Medicaid recipients and paying their providers more. The trend is continuing into fiscal year 2015 for those who rely on Medicaid, the state and federal health insurance program for the poor, according to a survey of 50 state Medicaid programs released by the Kaiser Family Foundation and the National Association of Medicaid Directors.
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Medicaid backlogs could worsen as health-law signups resume
The Wall Street Journal (Subscription required)
Hundreds of thousands of people who signed up for Medicaid months ago still don't have coverage, a problem that could worsen when insurance signups under the Affordable Care Act restart in November. California and Tennessee are facing lawsuits from residents who say they have seen long delays for coverage after signing up for Medicaid, the federal-state health program for the low income and disabled. Some say they have been waiting since late 2013. The delays stem from various technical problems and the sheer volume of Medicaid applications states must process.
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Oct. 15 Webinar Wednesday: 'Strategies for Developing a Successful Member Conversion Strategy' by Human Arc
Human Arc
In many states, Medicaid managed care plans are capitated at higher rates for members with disabilities due to typically higher medical costs. Identifying plan members who are potentially disabled, conducting outreach and providing SSI/SSDI enrollment assistance can be challenging.

Please join Linda Roman, associate vice president of business development at Human Arc, to learn how to design a successful member conversion strategy and secure capitation payments that more appropriately reflect actual health utilization.

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C-level rising at mhpa2014
MHPA
Executive attendees of mhpa2014 are able to take advantage of a reserved lounge space so they can connect with colleagues, prepare for various sessions, or just take a load off. Thanks to Centene® Corporation and the Centene® Corporation Specialty Companies for making this space available for use throughout the conference. The lounge is open throughout the conference in Room 201 of the Convention Center.

And to hear some insights from the top, join us and Forbes columnist Bruce Japsen for a frank and informal CEO "fireside chat" with Thomas Duncan, CEO of Trusted Health Plan, Bill George, CEO of Health Partners Plans, and Karen Clark, president of Horizon NJ Health, for their take on various industry issues and trends.

For more info and registration, please visit bit.ly/mhpa2014.

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Fate of Indiana's Medicaid expansion proposal still uncertain
Post-Tribune
Indiana Gov. Mike Pence and federal officials have struggled to come to agreement on the state’s Medicaid expansion proposal — HIP 2.0 — since it was submitted in July. Advocates and stakeholders are worried that drawn-out negotiations could negatively impact 350,000 uninsured Hoosiers.
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Feds work with Indiana on Medicaid alternative
The Indianapolis Star
Health and Human Services Secretary Sylvia Burwell said she will continue to work with Indiana on its alternative Medicaid proposal, although the plan will have to maintain protections for Medicaid beneficiaries. After Gov. Mike Pence met with Burwell, he likewise said the two sides have not reached an agreement on getting federal funding to expand Medicaid in Indiana.
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Florida gubernatorial candidates agree on taking Medicaid expansion money, but not on how to do it
Miami Herald
As he gains momentum in the race for Florida governor, Charlie Crist is driving a conversation on Medicaid expansion. The Republican-turned-Democrat has become such a fervent supporter of the policy that he said he would consider using an executive order to get it done. Republican Gov. Rick Scott — who went from opposing Medicaid expansion to supporting it, albeit without ever really lobbying for it — hasn't talked about the issue on the campaign trail.
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Ohio Medicaid expansion faces 2015 political hurdle
Kaiser Health News
A battle is brewing in Ohio. University Hospitals Chief Executive Tom Zenty warned a Cleveland audience that the state's Medicaid expansion may not be permanent. "In July of next year, if there is no intervention, Medicaid expansion in the state of Ohio disappears," Zenty said, during a recent panel discussion.
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Mississippi Medicaid debate expected again in 2015
The Associated Press via The Clarion-Ledger
Advocates who want to extend Medicaid to hundreds of thousands more Mississippi residents know they face long odds at the state Capitol, where opponents of expansion are in control. Still, they say they'll make noise about the issue during the election-year legislative session that begins in January.
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Medicaid eligibility expanded in Nebraska for former foster children
Omaha World-Herald via Kearney Hub
A larger group of Nebraskans than originally estimated may benefit from a provision of the Affordable Care Act that grants Medicaid to young adults who had been in foster care. The state of Nebraska conceded in September that it had interpreted the provision too narrowly, and that more former foster individuals should benefit from the health coverage.
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Senate Republican Leader: Kentucky healthcare exchange can stay,
but not Obamacare

The Hill
VideoBriefSenate Republican Leader Mitch McConnell of Kentucky said he wouldn't mind if the state healthcare insurance exchange, known as Kentucky Kynect, stayed but reiterated his call for the full repeal of Obamacare.
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How the 2014 governors races could impact Medicaid expansion
Governing
In the largest batch of gubernatorial contests since Republicans won big in 2010, this November has major implications for the future of Medicaid expansion in several states. The potential changes are mostly isolated to races where there are good chances that the governor’s office could change parties. In some of those cases, state legislatures — some of which bear the imprint of the 2010 GOP wave — present obstacles to gubernatorial candidates pledging to expand Medicaid to more poor adults.

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Advocates to MCOs: Closely watch how states implement Medicaid HCBS
Inside Health Policy
HHS officials and advocates for people with disabilities are advising Medicaid managed care organizations to pay close attention to how states implement a new home and community-based services rule issued by CMS earlier this year. One advocate warned insurers that states' failure to fully live up to the new HCBS rules could make MCOs the target of lawsuits.

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CMS clears the air about Medicaid tax; MHPA's Myers comments
Government Health IT
The Centers for Medicare & Medicaid Services has issued answers to some frequently asked questions regarding payment of the Affordable Care Act's health insurance fee in Medicaid, with the main clarification being that it should be reimbursed by the states, in accordance with the Balanced Budget Act of 1997. "By issuing this guidance, CMS is saying to states that they should pay the fee in accordance with actuarial soundness requirements," MHPA President and CEO Jeff Myers said.

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Did you miss our Webinar Wednesday, 'Pharmacogenetic Testing in the Clinical Setting'?
MHPA
View and download the Oct. 1 Webinar Wednesday "Pharmacogenetic Testing in the Clinical Setting" by Millennium Health here. Other webinars are available to download, as well.
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IIR's FDA/CMS Summit for Payers featuring MHPA's Jeff Myers | Dec. 11-12, Washington, D.C.
Institute for International Research USA
Hear from the FDA and CMS under one roof, along with C-level executives from top health plans, at the FDA/CMS Summit for Payers. The entire healthcare continuum is coming together to understand how to better interact with the government to remain compliant, adaptive, and successful as our landscape evolves to become more patient-centric. Collaborate with the most influential people in health care, including speakers MHPA's president and CEO Jeff Myers and Janet Woodcock, M.D., director of the Center for Drug Evaluation and Research, FDA. Click here for more information.
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TRENDING ARTICLES
Missed our previous issues? See which articles your colleagues read most.

    CMS seeks input on innovative payment, delivery models to test in Medicaid managed care; MHPA's Amy Ingham comments (Inside Health Policy)
Indiana governor, feds unable to reach deal on Medicaid expansion (The Indianapolis Star)
Pennsylvania Medicaid managed-care expansion plans struggle to sign providers (Modern Healthcare (Registration required))
Ohio under fire for blocking Medicaid for seniors whose spouses bought annuities (The Columbus Dispatch)
Maine governor's race serves as referendum on welfare (The Wall Street Journal)

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


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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