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MHPA
On behalf of Medicaid Health Plans of America, we would like to wish all of you a joyous and safe holiday season.
As we reflect on the past year, we would like to provide the subscribers with a look at the 10 most-read news stories. Your regular news publication will resume on Tuesday, Jan. 3.
Modern Healthcare
From Dec. 6: Given her extensive experience reforming state Medicaid agencies, the next CMS administrator could lead efforts to make Medicaid patients more financially responsible for their insurance coverage. President-elect Donald Trump Tuesday announced that Seema Verma, the president, CEO and founder of SVC, a national health policy consulting company that has helped craft Medicaid expansion plans in Indiana, Iowa, Kentucky, Michigan and Ohio, would work under Rep. Tom Price, who currently is a congressman from Georgia but has been nominated for HHS secretary.
Verma is likely to focus on overhauling CMS' efforts to coordinate care for people dually eligible for Medicaid and Medicare. Demonstrations aimed at better serving an often chronically ill population has lacked participation. Verma has said health plans should have more tools at their disposal to boost participation, according to Jeff Myers, CEO of Medicaid Health Plans of America.
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Modern Healthcare
From Nov. 15: Despite President-elect Donald Trump's campaign promises to repeal and replace the Affordable Care Act, Medicaid expansion might survive, at least in some form.
"States that have expanded will leave it in place," said Joe Reblando, spokesman for Medicaid Health Plans of America. "And given the Republican tenet of giving states more control, states that haven't expanded yet may find increased flexibility on how to do so."
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The Hill
From Sept. 27: Jeff Myers, CEO of Medicaid Health Plans of America, is the top advocate for insurers under Medicaid managed care, where states will contract with a private company to run their Medicaid programs, which he argues is a smarter system than the traditional model of the government paying healthcare providers directly.
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The Hill
From April 26: The Obama administration on Monday unveiled a long-awaited and sweeping regulation governing the Medicaid program that imposes new limits on insurers. Jeff Myers, MHPA's CEO, said Monday that the new MLR regulation is a one size fits all strategy that would hinder states' decision-making process.
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Bloomberg
From April 26: A long-awaited final rule released April 25 by the CMS aims to align Medicaid and Children's Health Insurance Program (CHIP) managed care plans with other sources of health insurance coverage. Among many provisions, the rule for the first time will set a minimum medical loss ratio (MLR) for Medicaid. Jeff Myers, president and chief executive officer of Medicaid Health Plans of America, told Bloomberg BNA he was disappointed with the decision.
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Morning Consult
From May 3: The Medicaid Health Plans of America, a trade association representing the health insurers that sell Medicaid plans, says the recently-released Medicaid managed care rule reflect the shift away from a fee-for-service system. "With the vast majority of beneficiaries being served by Medicaid managed care organizations (MCOs) using a risk-based capitated model, the final regulations released on April 25, reflect the changes that have occurred in Medicaid since 2002 as states shift from a fragmented fee-for-service system to coordinated, comprehensive care for our nation’s underserved," Jeff Myers, the group’s president and CEO said according to a press release released Friday.
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Inside Health Policy
From April 28: In the agency's first major overhaul of Medicaid managed care requirements in over a decade, CMS tossed out the unpopular 14-day fee-for-service period before beneficiaries' are auto-enrolled in Medicaid managed care, stayed with its proposal on the Institutions for Mental Disease (IMD) exclusion, but didn't budge from its 85 percent medical loss ratio. For more, sign up for your no-obligation, one-month free trial to InsideHealthPolicy.com.
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AIS
From Sept. 6: In its second year of expansion under the Affordable Care Act, Kentucky's Medicaid program saw significant increases in outpatient utilization and preventive care, reductions in emergency department use and improvements in healthcare quality and self-reported health. Yet a proposal presented in June by newly elected Gov. Matt Bevin includes several concerning changes for the program's contracted managed care organizations (MCOs), which the governor contends are overpaid citing data from the June 2016 Milliman report.
But Jeff Myers, president and CEO of Medicaid Health Plans of America (MHPA), suggests that the Milliman data alone don't necessarily reflect the costs associated with Medicaid expansion and with starting up managed Medicaid in the state in 2011. "Kentucky has one of the most chronically ill, poorest populations in the United States, and prior to expansion, they had incredibly high rates of uninsured and incredibly high rates of people who had not seen medical help for several years, so moving to a managed care design obviously [was] going to have some challenges," he said. "So I think suggesting that the plans are overpaid or their margins are too high ignores the history of how both [the expansion and the move to managed care] got rolled out."
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USA Today
From Feb. 18: Alabama last week won federal approval to shift most of its Medicaid recipients into managed care organizations. But Alabama's shift to Medicaid managed care turns control over to new nonprofit organizations mostly run by the state's hospitals and other local providers instead of private insurers.
"The state bought half a loaf," said Jeff Myers, CEO of the Medicaid Health Plans of America, a trade group of large insurers. He applauds Alabama for moving to managed care, but he said it could have saved money using experienced insurers that know how to build provider networks, pay claims and manage risk.
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The Hill
From June 23: The pharmaceutical industry is opening a new line of attack against health insurers in the escalating battle over drug prices. Global drug lobby the Biotechnology Innovation Organization (BIO) is accusing insurance companies of funneling cash into a little-known outside group that recommends its own drug prices with hopes of driving down overall costs.
The decade-old group, called the Institute of Clinical and Economic Review (ICER), has been hailed as a "Consumer Reports" for prescription drugs and is one of the only sources of drug data available to the public. "I think trying to silence ICER because you don't like their conclusions is probably not a good idea," Medicaid Health Plans of America CEO Jeff Myers said.
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