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New Washington Medicaid director will ‘redetermine’ eligibility after pandemic emergency

[MM Curator Summary]: Congratulations to Dr. Fotinos who became the new WA Medicaid director.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Lara Geyrozaga, a nurse with Project Vision Hawaii, administers a COVID-19 vaccine dose to Eileen Pelep at a vaccination clinic in Honolulu, on Wednesday, July 14, 2021. 

Jennifer Sinco Kelleher / AP

(The Center Square) – Dr. Charissa Fotinos has been appointed Washington state Medicaid director. One of her top priorities will be to “redetermine” Medicaid eligibility for Medicaid recipients once the public health emergency created by the pandemic comes to an end.

Washington Health Care Authority Director Sue Birch announced the selection in a statement praising Fotios’s qualifications. “Charissa is uniquely positioned for this new position, with her years of clinical, public health, and leadership experience,” Birch said in a statement.

Fotinos had been the program’s interim director for 10 months.

More than 2 million Washingtonians receive Medicaid benefits, which are called Apple Health in the state. That number has grown by more than 361,000 since March 2000.

An HCA spokesperson declined to estimate the number of Washingtonians who may lose Medicaid eligibility after the pandemic emergency, but said the agency will work to ensure a smooth transition to qualified health plans through the state Health Benefit Exchange.

Fotinos is a family practitioner whose specialty is addiction medicine. She previously served Public Health-Seattle & King County as chief medical officer and has been a faculty member at the Providence Family Medicine Residency Program.

While serving as Medicaid director, Fotinos will continue in her current position as behavioral health medical director for the HCA. The rationale for this dual role is to ensure an integrated approach to physical and behavioral health in the Medicaid program, a spokesperson for the HCA told The Center Square.

Medicaid is a federal and state program established in 1965 to fund medical benefits, including nursing home care, for people with low incomes. Approximately 58 million people in the United States were enrolled in Medicaid in 2020 according to the U.S. Census Bureau.

Clipped from: https://www.kpvi.com/news/national_news/new-washington-medicaid-director-will-redetermine-eligibility-after-pandemic-emergency/article_64441bc9-044e-5beb-a029-6703b192a9ce.html

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Pritzker signs bill that helps Medicaid patients

[MM Curator Summary]: Headline should read: “Pritzker signs bill that keeps $3.9B in hospital Medicaid payments flowing.” Not exactly the same thing as “helps Medicaid patients.”

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Gov Pritzker signs Hospital Assessment Program(WIFR Newsroom)

CHICAGO, Ill. (WIFR) – Governor JB Pritzker signed a bill Tuesday extending and expanding the Hospital Assessment Program in Illinois.

The current program, which signed into law in 2020, runs through the end of 2022. It brought additional funding and improved Medicaid responsiveness in areas of the state most affected by COVID-19.

This bill will help establish refined payment structures for each hospital class and maintain the existing assessment tax structure. The renewed Hospital Assessment program waives $240 million in the assessment imposed on hospitals. It also aligns hospitals with payment and Medicaid needs, as well as offering tax exemptions and waivers to help hospitals recover from the effects of COVID-19.

Pritzker commented Tuesday saying “The Hospital Assessment program was an important support to hospital’s critically in need of additional funding during the worst of the COVID-19 pandemic,”. He’s also optimistic about the impact of the bill, saying “This extension continues to support them on the path to recovery and offers expanded services and Medicaid support to more hospitals to ensure people across the state have access to affordable, high-quality health care.”

House Majority Leader Greg Harris says “The Hospital Assessment program brings an additional $3.9 billion dollars into Illinois’ Medicaid program”.

 
 

Clipped from: https://www.wifr.com/2022/05/17/pritzker-signs-bill-that-helps-medicaid-patients/

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UnitedHealthcare Selected by State of Missouri to Serve Medicaid Beneficiaries

[MM Curator Summary]: United won its MO renewal.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

  • Missourians will continue to have access to UnitedHealthcare’s comprehensive care and preventive health and wellness programs for Medicaid

JEFFERSON CITY, Mo.: The state of Missouri has selected UnitedHealthcare Community Plan of Missouri as one of three managed care organizations to administer its MO HealthNet Managed Care Program for Medicaid members in Temporary Assistance for Needy Families (TANF) and the Children’s Health Insurance Program (CHIP).

UnitedHealthcare is committed to working closely with the Missouri Department of Social Services and its MO HealthNet Division, which administer the state’s Medicaid program, toward the shared goal of improving the overall health and well-being of members. Through UnitedHealthcare’s approach, Missouri Medicaid members will benefit from a value-based, whole-person and integrated care model that focuses on the unique health needs of members and the communities UnitedHealthcare is dedicated to serving.

“We have partnered with the state of Missouri for the last five years and are honored to have the opportunity to continue building a strong Medicaid program that offers innovative programs and solutions for individuals and families,” said Jamie Bruce, chief executive officer, UnitedHealthcare Community Plan of Missouri. “We are deeply committed to Missouri and are privileged to provide access to high-quality care that has a positive impact for our members’ health and the communities we serve.”

UnitedHealthcare Community Plan of Missouri will offer health benefits for a portion of the nearly 1 million adults and children who qualify for the general MO HealthNet Managed Care Program in Missouri. Benefits will include access to UnitedHealthcare’s comprehensive and preventive care including an integrated network of behavioral health and physical health providers, essential community providers, and long-term care providers beginning July 1, 2022.


 
 

Clipped from: https://www.unitedhealthgroup.com/newsroom/posts/2022/2022-05-12-uhc-selected-by-mo-to-serve-ma-beneficiaries.html

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Virginia poised to review eligibility of 2 million in Medicaid ‘safe haven’

[MM Curator Summary]: VA needs to review 400,000 members to see if they still belong in the Medicaid program once they begin efforts to return to normal operations.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Michael Martz

Virginia is poised to begin an exhaustive 12-month review of more than 2 million people in its Medicaid program for the elderly, disabled and low-income families — it’s just a question of when.

The federal-state program, supercharged by Virginia’s expansion of eligibility in 2019 under the Affordable Care Act, has added more than a half-million people since the COVID-19 pandemic began, relying on more than $1 billion in additional federal funding to provide health care for people who can’t afford to pay .

“It’s been our honor for Medicaid to serve as a safe haven for folks with Medicaid coverage during the pandemic,” said Karen Kimsey, director of the Department of Medical Assistance Services, which runs the state’s Medicaid program.

 
 

Kimsey

But a reckoning is coming as the federal government prepares to end the public health emergency as early as mid-July, requiring states that received emergency aid during the pandemic to redetermine the eligibility of people on their Medicaid rolls.

It promises to be a long, painstaking process, which could result in up to 20% of Medicaid recipients losing their coverage because they are no longer eligible.

“That’s 400,000 people [in Virginia],” said Doug Gray, executive director of the Virginia Association of Public Health Plans, whose managed care companies provide most of the coverage. “That’s a lot of people.”

“The size and the significance of it is pretty daunting,” Gray said.

State agencies working with nonprofit health care advocates, medical providers and insurance companies are trying to make the process less daunting for people who rely on Medicaid for medical coverage.

The state has already begun running ads on social media and other digital outlets — in both English and Spanish — soon to be followed by radio and television to let recipients know about the process and ask them to make sure their contact information is up to date so they can stay well-informed.

The campaign is also sending information by mail to more than 1.1 million households.

“We want to let people know what’s coming,” Kimsey said.

They’re also trying to head off confusion and misinformation about what the so-called “unwinding” process means for Medicaid recipients, who tend to be among the most vulnerable people in communities across Virginia — and among the most misunderstood.

About 832,000 Medicaid recipients in Virginia are children and about 814,000 are working-age adults. More than 153,000 recipients are disabled or blind, and almost 85,000 are over 65 years old. Demographically, 54% are white and 35% are Black, with 5% Asian. About 55% are women and 4% are Hispanic.

Children and youths up to 19 years old account for 43% of the Medicaid population, followed by adults between 35 and 64 at 29%, and people from 20 to 34 at 22%.

The profile is a little different for the more than 650,000 Virginians who joined the program under new eligibility standards that took effect Jan. 1, 2019, to expand Medicaid under “Obamacare” to include childless adults for the first time. About 45% of those recipients are from 19 to 34 years old and 37% are from 35 to 54 years old.

The overwhelming majority of people in the expansion population — more than 485,000 — earn less than the federal poverty level, which is $12,140 a year for a single person and $20,780 for a family of three. About 169,000 earned between 100% and 138% of the poverty level, or up to $16,775 for a single person and $28,676 for a family of three.

Where do they live? More than 511,000 Medicaid recipients live in the state’s Central Region: including about 85,000 in Richmond, almost 81,000 each in Henrico and Chesterfield counties, and nearly 16,000 in Hanover County.

The largest number of recipients live in Virginia’s most populous locality Fairfax County, with more than 165,000, followed by Prince William County with almost 103,000.

Medicaid is an expensive program, more than $19 billion a year, divided between the federal and state governments. They split the cost roughly 50-50 for the base Medicaid population, but the federal government pays 90% of the cost for people enrolled under expansion, with a provider tax on hospitals covering the state’s share under the budget deal the General Assembly adopted in 2018.

Almost 49% of the cost provides coverage for the elderly, disabled and pregnant women, who account for just 18% of the Medicaid population.

So why does Virginia have to redetermine the eligibility of all 2 million people enrolled in the program?

After the pandemic began in March 2020, Congress passed the Families First Coronavirus Relief Act, the first of a series of emergency funding bills that provided a higher federal matching share to pay for state Medicaid programs. In Virginia, it was an additional 6.2%, or more than $1 billion through September.

In return, the state could not kick people off the Medicaid rolls, even if they no longer met eligibility requirements. Once the federal government ends the public health emergency, states must begin redetermining eligibility and, as early as Aug. 1, they can remove people from the program.

The U.S. Department of Health and Human Services is expected to decide by Monday whether to end the public health emergency or extend it another quarter of the fiscal year, through September. The government has promised to give states at least 60 days notice before ending the emergency.

 
 

Richmond and Henrico health districts to get new leader in July


Dr. Elaine Perry, most recently interim health director for the Virginia Department of Health’s Central Shenandoah Health District, in July wi…

Once Virginia begins to unwind the program by redetermining eligibility, the state and its partners will look for ways to ensure people continue to receive health care coverage.

“Our fear is that there are people who are eligible who will fall through the cracks,” said Debbie Oswalt, executive director of the Virginia Health Care Foundation, which works to expand health coverage and reduce the number of uninsured Virginians.

Many will reapply for Medicaid coverage if they remain eligible. Some will receive coverage through federally subsidized premiums for insurance on the marketplace that the federal government runs now — the state will take that over at the beginning of 2024. Others who have gotten jobs will gain private insurance through their employers. And some will become eligible for Medicare when they reach 65 years old.

The Virginia Poverty Law Center will be in the middle of those efforts to find health care coverage for people who may no longer qualify for Medicaid. The center, based in Richmond, employs 23 “navigators” across the state in the ENROLL Virginia! program, which helps guide people through the process of finding affordable health insurance.

“We’re expecting a lot of work in helping people to figure out where they belong,” said Sara Cariano, policy specialist and lead health insurance navigator at the law center.

The six managed care companies that provide health care coverage through Medicaid in Virginia also plan to help people find affordable insurance.

“This is a special initiative in which we want to keep people’s continuity of care,” said Gray at the association of health plans.

 
 

Clipped from: https://richmond.com/news/state-and-regional/govt-and-politics/virginia-poised-to-review-eligibility-of-2-million-in-medicaid-safe-haven/article_274566af-5d44-5ae0-9751-53b57979251a.html

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Milliman’s Jennifer Gerstorff appointed to Medicaid and CHIP Payment and Access Commission (MACPAC)

[MM Curator Summary]: MACPAC gains one of the brightest minds in the Medicaid space.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

SEATTLE, May 10, 2022 /PRNewswire/ — Milliman, Inc., a premier global consulting and actuarial firm, is excited to share that Jennifer L. Gerstorff, FSA MAAA, has been appointed to the Medicaid and CHIP Payment and Access Commission (MACPAC), a non-partisan legislative branch agency that advises Congress on issues affecting Medicaid and the State Children’s Health Insurance Program.

Ms. Gerstorff is a principal and consulting actuary of Milliman.  She joined the firm in 2006 and has spent her career consulting to state Medicaid agencies, Medicaid managed care organizations, and safety net healthcare providers, in nearly half of U.S. states and territories.  In addition to her consulting work, she has actively volunteered with the Society of Actuaries (SOA) and American Academy of Actuaries (AAA), having served as a member of the SOA Health Section Council, leader of the SOA’s Medicaid public interest group, and as a member of the AAA’s Medicaid and health equity workgroups.  

“We are very excited to recognize Jenny’s appointment to MACPAC,” said Thomas D. Snook, Milliman’s Global Health Practice Director.  “Programs like Medicaid and CHIP form the bedrock of America’s healthcare safety net.  Jenny’s broad experience working with key stakeholders, including serving as consulting actuary for several state Medicaid agencies and collaborating with providers and managed care plans, positions her as a credible voice to advise decisionmakers about the future of these important programs.”  

Ms. Gerstorff is a fellow in the Society of Actuaries and a member of the American Academy of Actuaries.  She received her Bachelor’s degree (summa cum laude) in Applied Mathematics from Columbus State University.  

About Milliman

Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in healthcare, property & casualty insurance, life insurance and financial services, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. For further information, visit milliman.com.  

 
 

SOURCE Milliman, Inc.

 
 

Clipped from: https://www.goskagit.com/millimans-jennifer-gerstorff-appointed-to-medicaid-and-chip-payment-and-access-commission-macpac/article_b92a2d44-a8b6-5b95-9b94-4fc05789d419.html

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MO- Centene Subsidiary Selected to Continue Serving Missouri’s Medicaid Managed Care Members and Wins Single Source Foster Care Specialty Contract

[MM Curator Summary]: Centene will continue as the single foster care managed care vendor in Missouri.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

ST. LOUIS, May 6, 2022 /PRNewswire/ — Centene Corporation (NYSE: CNC) announced today its Missouri subsidiary, Home State Health, has been awarded the MO HealthNet Managed Care General Plan and Specialty Plan. Under the General Plan, Home State will continue serving multiple MO HealthNet programs including Children’s Health Insurance (CHIP) members and the state’s newly implemented Medicaid expansion population, across all regions of Missouri.

As the sole provider of the Specialty Plan, Home State will serve approximately 40,000 foster children and children receiving adoption subsidy assistance. The Specialty Plan combines health services into a single, specialized health plan for children in the custody of the Missouri Department of Social Services (DSS) and children receiving adoption subsidy assistance. The plan establishes a trauma-informed, comprehensive, and integrated behavioral health and physical health delivery system. The contract is for one year with options for four renewals. Centene Corporation currently provides comprehensive healthcare services and programs to children served in the child welfare system in 19 states, with single source statewide contracts in four states.

“We look forward to the next chapter of our strong relationship with the state, our network of providers and community partners as we continue to deliver member-focused care and improve health outcomes,” said Brent Layton, Centene’s President and Chief Operating Officer. “We are honored to be selected to serve as the Specialty Plan for children involved with foster care. We look forward to bringing our innovative care management programs that address the whole health of these children in Missouri.”

More than 975,000 Missourians receive their healthcare through the state’s Medicaid managed care program (MO HealthNet), which provides access to physical health, behavioral health, pharmacy, hospital, and other services. Today, Home State Health serves more than 300,000 Medicaid enrollees and partners with 25,000 healthcare providers statewide.

Home State Health has served the Medicaid population in partnership with MO HealthNet since 2012. The organization also focuses on under-insured and uninsured individuals through its federal insurance marketplace plan, Ambetter. Additionally, Home State Health provides insurance for the Medicare population through its Medicare Advantage plan, WellCare.

 
 

Clipped from: https://investors.centene.com/news-events/press-releases/detail/1031/centene-subsidiary-selected-to-continue-serving-missouris

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Report finds western Iowa agency improperly billed Medicaid for some services

[MM Curator Summary]: An Iowa referral agency double-billed the state for services over a 4 year period.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

A special investigation by the state auditor’s office has found a non-profit in western Iowa was double-billing for some services.

Iowa Department of Public Health officials asked for the review of a non-profit called FAMILY, Inc. It links needy residents to a variety of government services for women, children and families in Pottawattamie and Mills Counties. The review centered on the organizations’s contracts with state agencies — one for home visits with pregnant women and families with young children and the other for a program called Early Childhood Iowa.

Auditors determined that over a four-year period, FAMILY, Inc. billed Medicaid for more than 20-thousand dollars in services already covered by the contracts. State Auditor Rob Sand said in the report that due to a lack of records, it was not possible to determine if improper billing happened before July 1, 2017. According to the auditor, the Iowa Department of Public Health adopted more cross-checks last year to ensure other providers aren’t double-billing for these same services.

A spokesperson for FAMILY, Inc. was not immediately available for comment when the special investigation by the state auditor’s office was released this morning.

 
 

Clipped from: https://www.radioiowa.com/2022/05/10/report-finds-western-iowa-agency-improperly-billed-medicaid-for-some-services/

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Mental Health Bill Aims to Sync Substance Use, Medicaid Agencies

[MM Curator Summary]: A new federal bill would specify monies to enforce existing MH parity rules.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Mental health services would get a funding boost in bipartisan legislation set to be unveiled Tuesday that aims to improve coordination between agencies focusing on opioid addiction services and paying for treatment.

The measure, by Sens. Bill Cassidy (R-La.) and Chris Murphy (D-Conn.), would provide a path for ramping up existing health plans and coordination between the Substance Abuse and Mental Health Services Administration and the Centers for Medicare & Medicaid Services to better help individuals with serious mental illness.

According to a legislative overview document, the Mental Health Reform Reauthorization Act of 2022 would also authorize $25 million annually for five fiscal years for states to enforce existing mental health parity laws. The existing laws require that insurers cover mental health care to the same extent as other services.

Mental health has been a major focus for both parties in Congress as well as the White House, taking up much space in congressional hearings and administration policy pushes. House lawmakers on May 6 introduced legislation to reauthorize several federal health programs and require non-government plans to comply with mental health parity laws.

“I’m probably always willing to go further on parity, you know, enforcement than some Republicans are. And I’m always kind of sensitive to finding the middle ground when it comes to the way in which we enforce existing parity law,” Murphy told reporters last week.

Murphy also noted that “we’re sensitive to the appetite right now for a lot of new programs,” though noted skepticism from Sen. Richard Burr (R-N.C.) “about the utility of new programs.” Burr is the ranking member of the Senate Committee on Health, Education, Labor and Pensions, which deals with mental health matters.

The legislation would also re-up dollars for one of SAMHSA’s largest programs, the Community Mental Health Services Block Grant, and push for the CMS to coordinate better in serving young individuals earlier when they experience mental health troubles.

“Step by step by step, we want to make it so that the first psychotic episode a young person has is her last psychotic episode,” Cassidy said at a press event on the legislation.

Those eligible for SAMHSA grants to divert people with mental illness from incarceration would be protected from “destabilizing medication changes” under the bill, according to an overview document for the legislation. The bill would also support a SAMHSA program to help those suffering from mental illness and homelessness access housing.

 
 

Clipped from: https://news.bloomberglaw.com/pharma-and-life-sciences/mental-health-bill-aims-to-sync-substance-use-medicaid-agencies

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OH- Rollout of Medicaid reforms delayed

[MM Curator Summary]: All of the OH Medicaid reforms except OH Rise are on hold while the state deals with the PHE wind-down efforts.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The projected launch date of Ohio’s revamped and reformed Medicaid managed care system will still be Julyexcept this month, given a potential crisis where many may be kicked off Medicaid, the state pushed back most of the reforms to the end of this year.

“It seems like this new phased approach still allows them to move forward with everything, but in a way that is manageable…to maybe take smaller bites of the apple,” said Loren Anthes, who chairs Community Solutions’ Center for Medicaid Policy.

Medicaid, government-paid health insurance for more than 3 million low-income or disabled Ohioans, is typically the state’s largest expenditure totaling billions of dollars. The “next generation” system is the result of an extensive process that started in 2019, looking at ways to overhaul the system after years of issues and lack of reform.

According to the Ohio Department of Medicaid, one of those reforms will still be up and running in July. OhioRISE is a new coverage system to treat children with severe behavioral and mental problems so parents don’t have to give up custody.

But all the other more complicated changes, such as a single pharmacy benefit manager to prevent prescription drug “middlemen” from overcharging taxpayers, won’t happen until October at the earliest. The same applies to the two to three new health plan options entering the system: AmeriHealth Caritas, Humana, and Anthem Blue Cross and Blue Shield.

 
 

Why the delay?

The planned July launch date could coincide with the end of the federal government’s COVID-19 emergency declaration, which prevented states from kicking ineligible people off Medicaid. When that ends, almost everybody will have to go through eligibility checks – a daunting task for an understaffed system that could also leave Ohioans confused over if they still have health insurance.

Spreading the Medicaid reforms out to later in the year would prevent a disaster scenario where both the eligibility checks and the new reforms go awry at the same time, said Anthes, the Medicaid policy expert.

“It is important that the reforms and improvements embodied in the Next Generation program are not compromised with a hurried launch, or potentially confusing communications,” the Medicaid department said in a document sent to lawmakers.

Despite the later timeline, Medicaid participants still can choose to enroll into one of the new plan options now, said department spokesperson Lisa Lawless. They’ll just remain on their current health plan until the end of the year when the switch occurs.

Starting dates for the new system were pushed back before, and some lawmakers have been concerned with how long implementation has taken. But the department insists they are not rushed.

“Doing this correctly is more important than meeting an administratively imposed timeline,” it told lawmakers.

 
 

Clipped from: https://insurancenewsnet.com/oarticle/rollout-of-medicaid-reforms-delayed