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Medicaid directories are inaccurate, but does it matter?
The HHS OIG had some startling findings in a report out today: Fifty-one percent of the providers listed as participating in a Medicaid managed care plan could not offer appointments either because they weren't participating at the location noted in the plan directory or weren't accepting new patients from the plan. Among the providers scheduling appointments for new patients, the median wait time was two weeks — but more than a quarter of providers were backed up by more than a month. "Our findings demonstrate significant vulnerabilities in provider availability, which is a key indicator for access to care," the report concludes, calling for more oversight by CMS.
But cold-calling providers from directories, as the investigators did, is "not actually how Medicaid beneficiaries get access to doctors," said Jeff Myers, president of the Medicaid Health Plans of America. Enrollees usually work through coordinated care agencies, the plans themselves or other intermediaries to get appointments. Myers acknowledged "our plans should do a better job" of keeping directories up to date, but noted that there's no context to compare directory accuracy and access to care with QHPs and the fee-for-service market. He pointed to other government surveys of Medicaid beneficiaries showing growing satisfaction with networks and access.
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Blue Shield moves into Medicaid with Care1st deal
Los Angeles Times
Seizing on the massive expansion in Medicaid, Blue Shield of California has agreed to acquire Care1st, a Monterey Park-based health plan with more than 500,000 patients. Until now, insurance giant Blue Shield hasn't participated in Medi-Cal, the state's Medicaid program for low-income people. As a result, it has missed out on the program's growth to 11.3 million Californians as part of the federal health law expansion.
Rural frail, elderly beneficiaries being shifted to Medicaid
managed care plans
State health officials launched a new phase in the rural expansion of Medi-Cal managed care, moving about 24,000 medically complicated seniors and the disabled into managed care plans. The transition of seniors and persons with disabilities in rural areas into Medi-Cal managed care plans started on Dec. 1. The shift in care affects the SPD population in 19 rural counties.
California governor considering expanding Medi-Cal to immigrants
Los Angeles Times
California Gov. Jerry Brown is considering expanding state-funded Medi-Cal coverage to residents shielded from deportation under President Barack Obama's new immigration policies. Nancy McFadden, the governor's top policy aide, said that possibility is under review by the Brown administration, but implied that the potential cost would be a factor in the decision.
Medicaid reforms pitched as way to help balance budget in Massachusetts
A health plan group wants Massachusetts Gov.-elect Charlie Baker to implement major Medicaid reforms it says will make the system more efficient and could save taxpayer dollars as Beacon Hill tries to close a more-than $329 million budget gap.
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Finding coverage through Pennsylvania's Medicaid expansion
The Philadelphia Inquirer
With minimal time remaining to sign up for coverage that starts Jan. 1, the federal government reports that, as of Nov. 28, 765,135 people had filed applications and chosen a plan on federally run marketplaces, like those in Pennsylvania and New Jersey. An additional 1.5 million had submitted applications but had yet to select a plan. An estimated 600,000 low-income Pennsylvanians — many of whom have never had health insurance — are covered through Healthy Pennsylvania, the state's Medicaid expansion program, which starts Jan. 1.
Expanded Medicaid remains year-round option for many in Michigan
Detroit Free Press
Michigan's expanded Medicaid was made possible under the same law that set up the state exchanges. However, unlike the exchanges, enrollment in the program — called Healthy Michigan — isn't limited to a three-month open enrollment period. You can enroll in Medicaid year-round.
Medicaid expansion by any other name may fly for Florida lawmakers
Kaiser Health News
A coalition of business interests and private citizens, including some prominent Republicans, unveiled a plan to accept federal dollars to extend publicly funded health care coverage to nearly a million Floridians — without calling it "Medicaid expansion," as envisioned under the Affordable Care Act.
Medicaid logjam, skeptics remain in North Carolina legislature
North Carolina lawmakers initially seemed eager last summer to hammer out quickly a solution to stop recurring Medicaid shortfalls by shifting the risks of cost overruns to managed-care organizations or provider networks. Later, Gov. Pat McCrory's administration and House Speaker Thom Tillis hinted it was time to look at possibly expanding Medicaid to more of the working poor through President Barack Obama's healthcare law.
States focus on 'superutilizers' to reduce Medicaid costs
The Pew Charitable Trusts
In health policy circles, they are called "superutilizers," but the name isn't meant to connote any special powers. Just the opposite. They are people whose complex medical problems make them disproportionately heavy users of expensive healthcare services, particularly emergency room treatment and in-patient hospitalizations. The cost of treating them is huge: Just 5 percent of Medicaid's 68 million beneficiaries account for 60 percent of the overall spending on the program.
Nearly 9 percent of Medicaid births delivered early for no Medical reason
Kaiser Health News
Nearly 9 percent of the births covered by Medicaid — or about 160,000 each year — were elective deliveries before 39 weeks of gestation, which lead to worse health outcomes for mothers and children and higher costs, according to a study.
Dec. 10 Webinar Wednesday: 'Care Transitions in Behavioral Health'
Janssen Pharmaceutical Companies of Johnson & Johnson
Take a deeper look at transitioning patients in the current mental health landscape. The consequences of inadequate care transitions, the care transitions policy landscape and an update on how the mental health community is responding to change in the transitions sector. Join Charles Ingoglia, MSW, senior vice president of public policy and practice improvement for the National Council for Behavioral Health where he leads the national charge to ensure people have access to their potential to live full and complete lives.
Capitol Hill briefing on health plan roles to reduce preterm birth on Dec. 11
MHPA's report, "Preterm Birth Prevention: Evidence-Based Use of Progesterone Treatment — Issue Brief and Action Steps for Medicaid Health Plans," will be featured at a Capitol Hill event to educate legislators and their staff on how health plans target the problem of preterm birth, the leading cause of infant morbidity and mortality in the U.S.
Noon–1:30 p.m., NB: NEW location at The Gold Room, 2168 Rayburn House Office Building
Dec. 17 Webinar Wednesday (rescheduled): 'Why All Medicaid Managed Care Organizations Need an ACO Strategy' | 3 p.m. ET
Epstein Becker Green and Health Policy Source, Inc.
The growth and persistence of the state accountable care organizations (ACO) movement is being fueled by CMS' State Innovation Model grants and by state implementation of Medicaid 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.
IIR's FDA/CMS Summit for Payers featuring MHPA's Jeff Myers | Dec. 11-12, Washington, DC
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.
MHPA's Myers to speak at 6th Annual Medicaid Innovations 2015 Forum | Feb. 3-5, 2015 | Orlando
Medicaid Innovations Forum
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. Use Discount Code MHPA200 to receive $200 off the current rate.
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MHPA's Myers to chair WHCC 4th Annual Medicaid and Medicare Reform Summit | March 2015 | Washington, DC
MHPA President and CEO Jeff Myers will chair the WHCC 4th Annual Medicaid and Medicare Reform Summit, a meeting that convenes executives from health plans, hospital systems and policy organizations to share, learn and discuss approaches to improve the quality of government programs and achieve payment and delivery reform. For conference details, agenda and registration, please visit here.
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