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Mars and Venus on Medicaid
Forbes
According to evidence cited by Forbes opinion editor and Manhattan Institute Senior Fellow Avik Roy, "patients on Medicaid have the worst health outcomes of any insurance program in America — far worse that those with private insurance and, strikingly, no better than those with no insurance at all." On March 10, 2011, The Wall Street Journal published a column by Forbes contributor and American Enterprise Institute Resident Fellow Scott Gottlieb, M.D., which concluded that "Medicaid coverage is worse than no coverage at all." Yet, others resist these conclusions. The federal and state governments spent $460 billion on Medicaid last year. Is it really feasible that this buys nothing?
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Only 10 days(!) until mhpa2014
MHPA
There's something for everyone at mhpa2014. We've got sessions on the duals, Medicaid/exchange churn and insights from health plan leadership. We have Barbara Edwards from CMS and a state Medicaid directors panel featuring Darin Gordon (Tennessee), Ruth Kennedy (Louisiana), Lawrence Kissner (Kentucky) and Cindi B. Jones (Virginia). And with Gilead's Harvoni recently hitting the market, the session on high-priced specialty drugs with Dr. Steve Miller of Express Scripts will be more relevant than ever.

Register for mhpa2014 today. For more info, please visit bit.ly/mhpa2014.

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Medicaid expansion increases ER visits, but only temporarily
The Atlantic
A new California study replicates an earlier finding from Oregon that the newly insured visit emergency rooms more. But luckily, California found that the boost wasn't permanent.
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Inside Health Policy on Harvoni: MHPA/Viohl & Associates report cited
Inside Health Policy
Gilead Science's revelation on Oct. 10 that it will charge $94,500 for a 12-week course of its newly approved hepatitis C drug Harvoni, though less than some market analysts had expected, stoked the national drug pricing debate. The Campaign for Sustainable Rx Pricing criticized Harvoni's price and urged Congress to make drug companies justify the price of expensive pharmaceuticals. Medicaid health plans simultaneously released a report detailing prescribing and coverage restrictions states have employed to manage the high cost of Gilead's first hepatitis C drug, Sovaldi, and warning that states will increasingly use such methods as more expensive drugs hit the market.
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Inside Health Policy on CMS insurer tax guidance
Inside Health Policy
CMS says that states should reimburse Medicaid managed care plans for the Affordable Care Act's health insurance provider fee and says that the fee itself should be incorporated into plans' capitation rates. However, as the firm JP Morgan notes, the agency leaves some "wiggle room" on whether states should also factor in other potential effects of the fee, such as its non-deductibility status. MHPA President Jeff Myers said CMS' recently released frequently asked questions document provides certainty for plans, particularly in states that hadn't yet agreed to cover those fees.
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Panel backs requiring Arkansas to provide drug
The Wall Street Journal (Subscription required)
An advisory board recommended that the Arkansas Medicaid program eliminate restrictions on the use of an expensive cystic fibrosis drug made by Vertex Pharmaceuticals Inc. that are the subject of a legal battle in federal court. Members of the state's Drug Utilization Review Board, which is made up of Arkansas doctors and pharmacists, recommended that the state adopt a revised set of criteria for prescribing the drug, called Kalydeco, that wouldn't require that patients seeking the drug first prove their health worsened after taking two older, less-costly treatments.
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GOP maverick embraces Medicaid expansion
The Washington Post
In an autumn of discomfort for many incumbent governors, Ohio Gov. John Kasich is smiling. He is coasting toward a second term in a state that long has been one of the nation's presidential battlegrounds, campaigning on policies he believes can put a more empathetic face on the national Republican Party.
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Want to slash Medicaid waste? Reach those patients
mHealth News
Unicorns, jackalopes, abominable snowmen and Medicaid patients — which of these is easiest to find? To administrators of state Medicaid programs and managed care service providers, it could be any of these except Medicaid patients. On any given day, less than 40 percent of those on Medicaid — 72.6 million nationally, at last count — can be located by states and health plans.
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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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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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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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Did you miss our Webinar Wednesday, 'Strategies for Developing a Successful Member Conversion Strategy'?
MHPA
For a copy of the Oct. 15 Webinar Wednesday "Strategies for Developing a Successful Member Conversion Strategy" by Human Arc, please email Linda Roman. Get info on other past webinars here.
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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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Colby Horton, Vice President of Publishing, 469.420.2601
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