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Introduction of BTD medications like Sovaldi complicates projections of Medicaid expenses
American Academy of Actuaries
The Medicaid Work Group sent a comment letter to the Centers for Medicare and Medicaid Services on the introduction of Sovaldi and other new Breakthrough Therapy Designation medications and their potential impact on Medicaid costs.
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Plans say duals bring down star ratings
Inside Health Policy (Subscription required)
As CMS looks at possible changes to the Medicare Advantage star ratings program, health plans say that poorer beneficiaries are causing lower-than-appropriate star ratings for some MA plans, though the Medicare Rights Center says that current data do not show that beneficiaries' low income is the root cause of lower quality care for those beneficiaries.
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Rate of premature births fall as health law provisions begin to take effect
Kaiser Health News
The percentage of babies born prematurely fell to 11.4 percent in 2013, its lowest level in 17 years, according to an annual March of Dimes report recently released. While many factors contributed to the decline, officials say the health law's expansion of Medicaid to adults with incomes up to 138 percent of the federal poverty level has played a role.
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World Prematurity Day | Monday, Nov. 17
March of Dimes
15 million babies are born too soon worldwide with about 450,000 of those premature babies being born in the U.S., a rate of 1 in 9 births that is higher than that of most high-income countries. The March of Dimes joins with parent groups and organizations in countries around the world for World Prematurity Day on Monday, Nov. 17 to raise awareness about premature birth and how it can be prevented. Find out more about World Prematurity Day here. To view your state's premature birth report card, click here. For a story on Mollie, 10, living proof of why we should mark World Prematurity Day, click here.
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CMS: Some providers are obstructing dual-eligible demonstration
Modern Healthcare
The CMS official in charge of coordinating care for Americans covered by both Medicare and Medicaid says some healthcare providers are illegitimately trying to dissuade dual-eligible beneficiaries from participating in a managed-care initiative designed to test ways to reduce costs and improve quality. She said her agency has increased its surveillance of these providers, though she did not identify any by name.
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More states expected to expand Medicaid in 2015
Kaiser Health News
Texas and Florida, with their large uninsured populations, are not expected to offer coverage to many low-income patients. In this video, KHN's Phil Galewitz and Mary Agnes Carey discuss the topic.
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WellCare questions Medicare ratings
WUSF
Medicare Advantage plans that draw a lot of their enrollment from the poor side of town say they're at a disadvantage on the government's five-star ratings scale, which commands respect and governs pay. One company pressing the issue is WellCare Health Plans, based in Tampa. Its Medicare Advantage plans are rated at 3 or 3 1/2 stars, below the 4-star minimum required for plans to qualify for bonus payments.
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Millions of Medicaid kids missing regular checkups
Kaiser Health News
Millions of low-income children are failing to get the free preventive exams and screenings guaranteed by Medicaid and the Obama administration is not doing enough to fix the problem, according to a federal watchdog report.
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Corbett administration: Medicaid overhaul will simplify, save money
The Associated Press via TheTitusville Herald
Gov. Tom Corbett's administration is telling hundreds of thousands of adult Medicaid enrollees that their benefits will change as part of an overhaul of the medical coverage plans beginning Jan. 1. Notices were mailed recently, and adult enrollees will be sorted into 1 of 2 plans that best fit their needs, according to a spokeswoman for the Department of Public Welfare. However, precise plan changes were unavailable because the department does not have the federal government's approval yet, spokeswoman Kait Gillis said. "They are working with us," she said.
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Corbett, Wolf could be on Medicaid collision course
Philly.com
Gov. Corbett this summer achieved what few thought was possible: Overcoming unlikely odds, the Republican won Obama administration approval for Pennsylvania to run its own version of Medicaid expansion. With that the program to bring insurance coverage to about 600,000 people gained support from disparate interests — insurance companies, healthcare providers and advocates for the uninsured.
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Feds have new leverage in Texas Medicaid showdown
The Texas Tribune
If Texas wants to keep receiving billions of federal dollars to help hospitals care for uninsured patients, state lawmakers may have to look again at expanding Medicaid coverage for impoverished adults, some political observers say. That's because in 2016, Texas will have to ask the federal Centers for Medicare and Medicaid Services to renew a five-year waiver to pump $29 billion into state healthcare coffers.
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Haley names new leader for SC's Medicaid agency
The Associated Press via Miami Herald
Gov. Nikki Haley recently nominated her former deputy chief of staff to replace the outgoing director of South Carolina's Medicaid agency. Christian Soura will take over from Tony Keck at the state Department of Health and Human Services starting Nov. 20. The Senate still must confirm his appointment. DHHS provides healthcare coverage to nearly 1.2 million of the state's poor, disabled and elderly residents, about a quarter of the state's population.
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Arizona: Court hears arguments over Medicaid
The New York Times
A rift between Gov. Jan Brewer and state legislators in her own party over her support of Medicaid expansion played out before the State Supreme Court on Nov. 6. Lawyers for Governor Brewer, a Republican, asked justices to uphold a lower court's ruling, which stopped a lawsuit by a group of Republican legislators who say the Brewer administration unconstitutionally found a way to pass the expansion with a simple majority rather than the two-thirds support they say is required.
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Haslam: Federal Medicaid discussions ongoing in Tennessee
Miami Herald
Gov. Bill Haslam recently said he's continuing to talk with Washington so he can make a decision about Medicaid expansion in Tennessee before the legislative session starts in January. Haslam told reporters following a veterans' ceremony that he talked to Health and Human Services Secretary Sylvia M. Burwell, and even brought up the subject when President Barack Obama called him to congratulate him on his election win.
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Kansas hospitals pressing ahead with Medicaid expansion proposal
Kansas Health Institute
Kansas hospitals are moving ahead with plans to put a Medicaid expansion plan before lawmakers despite election results that returned Gov. Sam Brownback to office and solidified conservatives' control of the legislature. Democrat Paul Davis favored expansion but came up short in his bid to upset Brownback, a Republican who thus far has opposed expansion. Also, several Democratic House members who likely would have favored expansion lost narrowly to GOP challengers.
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Kasich will try to keep Medicaid expansion in new budget
The Columbus Dispatch
Gov. John Kasich's next budget proposal will continue expanded Medicaid coverage for hundreds of thousands of low-income Ohioans, but whether majority Republicans who opposed the plan last year will support it this time remains to be seen. State Budget Director Tim Keen said that the two-year executive budget plan, which will be rolled out on Feb. 2, will include Medicaid spending that includes expansion. His comments were made in Columbus at the post-election conference Impact Ohio.
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Ohio's Medicaid costs expected to be about $470 million lower than anticipated
The Plain Dealer
The cost of Ohio's Medicaid program is expected to be about $470 million less than what was originally estimated in the current two-year budget, and the bulk of that savings goes directly to the state. The anticipated savings is a result of multiple factors, said Greg Moody, director of the governor's Office of Health Transformation. A big one is that fewer people than expected are signing up for traditional Medicaid coverage, which costs the state more than the expanded Medicaid coverage that began this year.
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GOP sweep clouds Arkansas Medicaid plan's future
The Associated Press via The Washington Times
Republicans' sweeping victory in the midterm election further clouds the future of Arkansas' compromise Medicaid expansion, with voters backing several candidates who vowed to end a first-in-the-nation program providing coverage to thousands of poor residents.
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Missouri primary care doctors face substantial Medicaid cut
Kaiser Health News
Justin Puckett, an osteopathic physician from Kirksville, Missouri, will have a major decision to make at the start of 2015 — whether his family medicine practice can continue to treat Medicaid patients. Looming over Puckett and other primary care doctors is a cut to their reimbursement rate that is set to take effect at the end of this year, barring action from a lameduck Congress reeling from the recent Republican electoral wave.
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New Mexico Human Services Department secretary resigns
The Associated Press via Las Cruces Sun-News
Human Services Secretary Sidonie Squier is leaving her Cabinet-level job in Gov. Susana Martinez's administration after coming under fire for more than a year for her management of an agency that administers the state's largest healthcare program. The Governor's Office on Nov. 6 announced Squier's resignation, which is effective Dec. 1. She has held the post since the Republican governor took office in 2011.
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Did you miss Webinar Wednesday: 'Value of Personalized Medicine in Delivering Quality Cancer Care'?
MHPA
View and download the Nov. 12 Webinar Wednesday, "Value of Personalized Medicine in Delivering Quality Cancer Care" by Genomic Health here. Other webinars are available to download, as well.
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Nov. 19 Webinar Wednesday: 'Moving from Volume to Value by Reducing Waste & Improving Care'
First Quality
Health plans taking on the adult population are also taking on the costs of managing incontinence. ABD, duals and MLTSS populations have a high percentage of incontinent members, who use disposable absorbent products to manage their condition. Join Julie Hyer, director of Medicaid health plan programs, and Christine Pruneau, RN, BSN, RAC-CT of First Quality, to learn more about how the current cycle for absorbent products impacts cost and care, related to direct product costs and ancillary medical costs. First Quality will discuss how health plans can change the dynamic to achieve better outcomes and lower costs.
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Nov. 26 Webinar Wednesday: 'Why All Medicaid Managed Care Organizations Need an ACO Strategy'
Epstein Becker Green
The growth and persistence of the state ACO movement is being fueled by CMS' State Innovation Model grants and by state implementation of Medicaid accountable care organizations (ACOs) — 17 states have already implemented some form of Medicaid accountable care. Join Clifford Barnes, partner at Epstein Becker Green, PC, and Jenny Gladieux, senior health policy analyst for Health Policy Source, Inc., as they provide the tools to develop an understanding of how Medicaid ACOs affect Medicaid managed care and provide the rationale on why Medicaid managed care needs to develop state-specific ACO strategies.
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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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MHPA's Jeff Myers to speak at 6th Annual Medicaid Innovations 2015 Forum | Feb 3 - 5, 2015 | Orlando, FL
Medicaid Innovations
Join MHPA President and CEO Jeff Myers at the Sixth Annual Medicaid Innovations 2015 Forum in February 2015. This meeting offers a unique combination of forward-thinking perspectives including first-hand case studies and examples of true innovation from both Medicaid managed care plans and state government agencies. The forum, which gathers hundreds of representatives from states, health plans and solution providers in one room, goes beyond policy to explore the specific strategies these organizations are leveraging to improve quality of care, reduce costs and position themselves for success in serving the rapidly expanding Medicaid population.
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