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Archive Monthly Archives: March 2016

Medicaid Industry Who’s Who Series: Linda Rosenberg

Linda Rosenberg is the featured panelist for the upcoming webinar on Certified Community Behavioral Health Clinics on April 4th. RESERVE your seat today!

 

Medicaid Who’s Who: Linda Rosenberg – President and CEO, National Council on Behavioral Health

  1. Which segment of the Industry are you currently involved?

A: Mental health and addictions – behavioral health: advocacy and education

  1. What is your current position and with what organization?

A: President and CEO, National Council for Behavioral Health

  1. How many years have you been in the Medicaid industry?

A: More than I care to count – 25 years

  1. What is your focus/passion? (Industry related or not)

A: Mental Health First Aid; Expansion of the Excellence in Mental Health Act – creating Certified Community Behavioral Health Centers to expand access to services and support services of the highest quality

  1. What do you enjoy doing most with your personal time?

A: Being with my grandchildren

  1. Who is your favorite historical figure and why?

A: Dorothea Dix – her effective advocacy on behalf of people with mental illness

  1. What is your favorite junk food?

A: Frozen devil dogs

  1. Of what accomplishment are you most proud?

A: Personally – raising two wonderful sons; professionally – bringing Mental Health First Aid to the US.

  1. For what one thing do you wish you could get a mulligan?

A:  Not a thing – it is not my style to look back

  1. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A: Establishment of Certified Community Behavioral Health Clinics; development of a continuum of community based services that reflect addictions as chronic medical conditions; pressure on candidates for President/party platforms to detail how they would increase mental health and addictions service capacity and quality

Don’t miss hearing Linda Rosenberg during the upcoming webinar on Certified Community Behavioral Health Clinics on April 4th. RESERVE your seat today!

Medicaid Industry Who’s Who Series: Jay Ludlam

Jay Ludlam is the featured panelist for the upcoming State Spotlight Series Show: Missouri Medicaid on March 18th. RESERVE your seat today!

 

Medicaid Who’s Who: Jay LudlamDeputy Division Director of Administrative and Fiscal Services, MO HealthNet (Missouri Medicaid)

1. What is your current position and with what organization?

 A: Deputy Division Director of Administrative and Fiscal Services for MO HealthNet (Missouri Medicaid)

2. How many years have you been in the Medicaid industry?

A: 9 years

3. What is your focus/passion? (Industry related or not)

A: Demonstrate that a state-run Medicaid program can provide participants with all the services to which they are entitled and also be run efficiently and effectively, like a commercial business.

4. What is the top item on your “bucket list?”

A: Fly in space

5. What do you enjoy doing most with your personal time?

A: Traveling.  If I am not traveling, I spend as much time as possible with my family.

6. Who is your favorite historical figure and why?

A: Charles Darwin because he observed the world around him and gave voice to ideas which challenged the beliefs of his time.

7. What is your favorite junk food?

A: French fries, chocolate chip mint ice cream and blueberry muffins

8. Of what accomplishment are you most proud?

A: My case State of Missouri v. Spilton which establishes Missouri case law that statutorily defined civil penalties are permissible when prosecuting civil Medicaid fraud.

9. For what one thing do you wish you could get a mulligan?

A: I wish I had bought stock in our competitor, America Online, back in 1994.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A: New Access regulations, new Pharmacy regulations and MMIS modularity

 

To ensure that you’re in the loop on all things Mostly Medicaid, be sure to sign up to receive our free newsletter, join the discussion on LinkedIn and check out tons of great content at www.mostlymedicaid.com.

 

Medicaid State Spotlight: Missouri

We spoke with Jay Ludlam and Valerie Howard, both of MO Health Net. Jay and Valerie shared multiple insights with the group on various topics, including prospective payments for community mental health clinics, the Show Me Health Babies program, upcoming MO Medicaid procurements and the performance withhold program.

Clay’s Weekly Medicaid Roundup: Week of February 29th (Leap year!), 2016

MI COVERING HEP C DRUGS IN MCD- We covered the lawsuit in WA to cover these on the last monthly news show. Looks like MI is pre-empting a suit and has decided to cover the insanely pricey drugs in Mcd. State reps approved a budget for it (I don’t know how much yet) this week.

ITS A MANDATE! The Good Guvn’r Hutchison of AR is looking at pro-expansion Republicans winning in primaries this week as a mandate for his expansion plan. Not so fast so wonks in the state. Voters think about other things besides expansion (and usually they don’t care near as much about Medicaid as those of us who make our living off Medicaid wish they would).

DETAILS EMERGING ON TARHEEL STATE TRANSFORMATION PLAN- Based on presentations in the NC General Assembly this week, it looks like Mcd bennies will be able to choose from 1 of 4 MCOs – in about 3 years. CMS is expected to get the official proposal by June 1.

PLAN PROTESTS IN THE PEACH STATE POOH-POOHED- Its a rainy night in GA for AmeriChoice (UHC), Humana and AmeriHealth Caritas. GA Dpt of Administrative Services just threw out their protest over losing bids for the ginormous MCO business awarded recently. New contracts for Amerigroup, Peach State, WellCare and CareSource were set to start July 1, but the latest I have heard is that the implementation date is now Jan 1, 2017. Anyone who knows why, please write in and let me know.

AK JUDGE DISMISSES ANTI-EXPANSIONERS SUIT- The plaintiffs (legislators) sued, saying that the expansion population was optional, and any optional Mcd spending had to be approved by them. The Judge looked at the decision by the SCOTUS that said states could not be penalized for not exercising the option to expand – and then he concluded that Mcd expansion in AK somehow was mandatory and could be done with only the Good Guvn’rs approval. I think this quote from a local newspaper explains the Judge’s misunderstanding best: “Because the Social Security Act requires expansion, state law makes the expansion group eligible for Medicaid services. Because existing law required the governor to provide Medicaid to the expansion group, the governor did not violate the Alaska Constitution by doing so.” Judge Piffner – if you are Roundup reader please call / write in so we can discuss.

SD REPS REMOVE GUVN’RS ABILITY TO STOP EXPANSION- A move to require legislative approval for expansion was killed in committee this week. Make sure you read this slowly- a state legislature (that’s the “legislative branch” for those who have never had a “civics” class) just voluntarily decided to limit their own power and defer to the Guvn’r (the “executive branch”). Maybe I misunderstand my own education about checks and balances. Is it that the legislature is really good at writing checks, and the executive branch’s main job is to make sure the balance of power swings their way?

NE TRYING TO FIGURE OUT HOW TO PAY FOR EXPANSION. HAS ANYONE CALLED BERNIE? Looks like NE needs to come up with $112M in state dollars to pay for 5 years of expanded Mcd. Fun comparison – that’s about $22M/ yr. Average teacher salary in NE is $50k. So NE could hire 440 new teachers, or expand Mcd. Easy choice. Everybody knows Mcd beats out all other priorities, every single time.

MI GETS APPROVAL FOR MOST SPECIFIC MCD EXPANSION EVER- CMS approved expanding Mcd to kids in Flint, MI in households up to 400% FPL this week. An estimated 15,000 new members will be eligible. All this is to help address the water crisis and related health impact in the area, so the expansion is not only narrow in scope but also (likely) time limited.

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (its almost time to plant!) and keep running the race (you know who you are).

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