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Will North Carolina be ready for Medicaid transformation?
WUNC-FM
North Carolina's 2.36 million Medicaid recipients are in for a big change next July. That's when the state's Medicaid system will be transformed into a managed care program run by private health care companies.
Right now, only behavioral and mental health care is handled by managed care companies like Cardinal Innovations Healthcare. Cardinal serves 20 counties in the state, but that's likely to change. Five counties, including Mecklenburg, say Cardinal has done such a poor job they want to switch to another provider.
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Steady income for your members - direct impact on SDoH Millions of dollars for your health plan's bottom line
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What you need to know as Ohio overhauls Medicaid
Journal-News
The overhaul of Ohio's Medicaid program has farther reaching consequences than CareSource.
The health insurance program for 3 million Ohioans with low incomes and disabilities is a major policy tool. It's a key source of health care for the Dayton region, which is older and less affluent than the state as a whole, and also a source of funding for hospitals, doctors and other providers.
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Why do some Ohioans find it hard to get Medicaid? Survey says it's a glitchy online form
The Columbus Dispatch via Cincinnati.com
The economic fallout from the coronavirus pandemic has devastated many Ohio families, causing thousands to rely on tax-funded benefits such as Medicaid, the Supplemental Nutrition Assistance Program, and cash assistance.
A new survey by the Cleveland-based Center for Community Solutions found that Ohio Benefits, the more than $1 billion eligibility system to process applications and manage benefits, isn't up for the job and is frustrating for those seeking help.
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Kentucky seeks to be first in US to treat substance use disorder in prisons using Medicaid dollars
Kentucky Chamber of Commerce
Kentucky has applied for a Medicaid waiver that would allow the use of Medicaid funding to treat substance use disorder in the state's prisons and county jails. If approved, Kentucky would be the first in the nation to have such an arrangement. Kentucky Cabinet for Health and Family Services Secretary Eric Friedlander says it is critical for the state to take these steps to help those in need, as "what happens to one of us in a community happens to us all, and we need to be concerned about that."
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Groups fret Medicaid prescription drug change
Spectrum News
Prescription drugs for people living with compromised immune systems are more important than ever during this pandemic. But a little-noticed change set to take effect in New York could make it harder for people who need that medication as well services provided by nonprofit entities.
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How Medicaid expansion helps incarcerated persons amid COVID-19
HealthPayerIntelligence
States can use Medicaid expansion and additional Medicaid policies—such as beginning Medicaid eligibility determinations pre-release and suspending Medicaid coverage during incarceration — to handle the coronavirus pandemic's effects on incarcerated populations, a study published in Health Affairs found.
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Apollo delivers evidence-based guidelines in an easy to use format, available 24/7 from any internet-connected device. No software download required. Streamline utilization reviews and lower your costs today.
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Amid financial strains caused by the COVID-19 pandemic, Medicaid plan leaders must take action to contain inappropriate medical costs immediately without sacrificing the quality of care their members receive. Cotiviti’s new white paper offers five areas that Medicaid payers should evaluate to protect their business in this environment.
Download the white paper
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CMS gives states more flexibility in setting Medicaid managed care capitation rates
FierceHealthcare
The Trump administration finalized a rule Monday that aims to increase flexibility for Medicaid managed care plans and overturn a 2016 regulation states deemed too prescriptive and burdensome. The rule, issued Monday by the Centers for Medicare & Medicaid Services (CMS), gives states more power to determine the appropriate payment rates for Medicaid and Children’s Health Insurance Program services. It also gives more flexibility for how states can set capitation rates for managed care plans, a sector of growing interest for the insurance industry.
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