Author: MM_ADMIN

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Communications Lead,Services/Medicare/Medicaid

Clipped from: https://www.learn4good.com/jobs/springfield/missouri/healthcare/1826647876/e/

Position:  Communications Lead, Insurance Services (Medicare/Medicaid)
** Description*
* ** Responsibilities*
* Humana’s Marketing Organization is seeking a Communications Lead to join the Corporate Communications team. The Communications Lead, Insurance Services is responsible for developing and executing integrated internal communications strategies that enable Humana’s growing Insurance Services business.

The Communications Lead, Insurance Services is responsible for developing and executing integrated internal and executive communications strategies in support of Humana’s largest business – Insurance Services, including our growing Medicare and Medicaid businesses. The individual is a strong strategic advisor who creates end-to-end plans and creative campaigns, giving employees the knowledge and inspiration they need to navigate a complex industry. The Communications Lead helps employees successfully manage transformation and organizational change through engaging communications that create a positive culture and employee experience.

** Key Role Functions**   

+ Create integrated messaging for diverse audiences related to the Insurance Services business to create a positive employee experience

+ Develop messaging and content that advances business priorities within the Insurance Services segment and across the enterprise

+ Partner with cross-functional teams to drive cohesive, consistent communications activities

+ Bring Humana’s strategy to life on new and existing communications channels through impactful storytelling and high-impact messaging

+ Work closely with senior leaders and change sponsors to engage employees during organizational transformation, helping to position changes appropriately and reach segmented internal audiences with relevant information

+ Develop clear and consistent internal communications, creative multimedia content and compelling storytelling packages that promote associate understanding of Humana’s purpose, culture, employee value proposition, and insurance business

+ Build strong alignment with cross-functional colleagues, including other corporate communicators, on internal communications strategies and content prioritization

+ Leverage data, analytics and feedback from stakeholders to inform strategy and decision making

+ Work in close collaboration with external vendors and partners to deliver against communications plans and goals

This is a remote role working anywhere in the U.S. and may require quarterly travel.

** Required

Qualifications *
* + Bachelor’s degree in communications, public relations or related field

+ 8+ years of employee communications or public relations experience with proven expertise in change communications

+ Experience and knowledge of change management principles, methodologies and tools

+ Adept ytics, as well as emerging practices and technologies

+ Self-organized – can independently plan, lead and implement integrated communications projects

+

Ability to work under tight deadlines, multitask and deliver quality work under pressure

+ Exceptional written communications skills and deep experience as a content creator

+ Proactive, flexible and always seeking improvement and positive change

+

Ability to influence

+ Foster an open, inclusive and diverse community at Humana

+ Advanced skills using O365 suite, including Teams and Share Point

** Preferred

Qualifications *
* +

Education or Certification in Organizational Change Management

+ Experience at large, matrixed corporate organization with diverse stakeholder groups

+ Previous experience in project management

** Additional

Qualifications *
* ** Covid-19 Vaccine/Testing Requirement*
* Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask s while in a Humana facility or while working in the field.

** Work te

Requirements *
* + Must ensure designated work area is free from distractions during work hours and virtual meetings

+ Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10×1 (10mbs download x 1mbs upload) for optimal performance of is required

** Scheduled Weekly Hours*
* 40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

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Policy Advisor Medicaid Job Dover Delaware

Clipped from: https://www.learn4good.com/jobs/dover/delaware/government/1806419911/e/

Overview

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe.

PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit  .

Responsibilities

  • Provides subject matter expertise in support of advising clients regarding health policy strategy, development and implementation.
  • Conducts policy research on behalf of clients and the practice area and drafts formal written positions, policy briefs and recommendations on key policy issues identified.
  • Analyzes relevant legislative and regulatory matters and keeps up-to-date with government policy discussions in related areas.
  • Drafts technical documents including legislation, regulations, guidance, Medicaid State Plan Amendments and waivers.
  • Identifies and supports client implementation of strategies for developing, advancing, communicating and operationalizing agreed-upon policy decisions.
  • Liaises and consults with relevant colleagues and stakeholders in the conduct of policy work.
  • Assists with planning and implementing stakeholder engagement on behalf of clients.
  • Establishes good working relationship with local, state, federal and private service agencies.
  • Uses existing client networks to provide a perspective on future business.
  • As appropriate, assist project leads with coordination of strategic planning, project reporting, and technical activities.
  • Writes articles and policy briefs to disseminate public health findings and evidence based best practices.
  • Other tasks as to be determined by PCG management.

Qualifications

Education:

Bachelor’s degree required. Master’s degree or professional equivalent highly preferred

Experience:

5+ years’ experience in healthcare and policy advising with progressively increasing level of leadership responsibility. Experience in working for e government is preferred.

Required skills:

 

  • Subject Matter expertise related to Health and Human Services; specific expertise in the Medicaid program, CHIP and related authorities preferred.
  • Strong leadership, assertiveness and interpersonal skills.
  • Outstanding verbal and written communication skills.
  • Must be tactical in delivering project tasks under tight deadlines, with the ability to keep the big picture in mind  a strategic perspective.
  • Demonstrated ability to manage multiple deliverables in a cross-functional capacity.
  • Self-starter, assertive, enthusiastic and has the political savvy to get things done, yet maintain a likeable presence.

    Ability to deal with adversity and differing opinions.

#LI-remote

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications.

We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, r status protected under federal, state, or local law.

PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

>

Job Location s
US

Posted Date
5 days ago
(11/17/2022 12:08 PM)

Job 2022-8827

# of Openings
1

Category
Other

Type
Regular Full-Time

Practice Area
Health Services

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

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Manager Medicaid Plan Marketing in New York USA – Elevance Health – D7595B

Clipped from: https://www.recruit.net/job/manager-jobs/D7595B9E424403E1?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description
Manager, Medicaid Plan Marketing
Territory: Bronx County and Manhattan County
Develops objectives, policies, and programs for marketing activity related membership growth, retention, acquisitions, and business initiatives.
Primary duties may include, but are not limited to:
– Develops short and long term marketing and retention strategies and objectives.
– Directs and coordinates activities of the business if Initiative to assure alignment with corporate goals.
– Researches and evaluates competitive activity.
– Develops and implements an effective tracking mechanism for daily, weekly, monthly, and yearly activities and productivity.
– Develops and conducts office and field rep training methods.
– Oversees the quality control process and procedures.
– Ensures compliance with state and municipal laws, rules, and guidelines for marketing and outreach.
– Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Minimum Qualifications
Requires a BA/BS degree in a related field and a minimum of 7 years of related experience, including at least 3 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications
MBA preferred
Familiarity and experience in working with providers and reviewing membership reports to increase growth
Experience with MS Office and SalesForce
Strong analytical skills
Strong written and presentation skills
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $104,544 to $156,816
Locations: Colorado; Nevada, Jersey City, NJ; New York City, NY; Ithica, NY and Westchester County, NY
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.elevancehealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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Medicaid Waiver Case Manager

Clipped from: https://us.bebee.com/job/20221201-3e4faa8c751b7aa73e5b2e6794a4a215?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Found in: beBee S2 US – 19 hours ago

 
 

Description

Starting Date: 1/1/2023

Service Area:
Case Manager will be serving Jefferson and surrounding Indiana counties . This position requires working remotely from your home office and travel within your service area. This is NOT a fully remote position. You must live within the service area to be considered for this position.

Job Summary:
Case Managers support individuals participating in a Medicaid waiver program.

The CM will ensure they have access to services available on the waiver, other Medicaid state plan services as well as providing additional resources within their community.

A primary role in this position is one of advocacy for the individuals we serve.

Responsibilities and Duties:

Following a person-centered process; Annual Planning; Quarterly Monitoring face to face; Maintaining and managing all electronic records; Facilitating interdisciplinary team and other meetings; Completing/maintaining each individuals waiver budget; Monitoring service delivery and utilization; Ensuring individuals health and welfare; Maintaining/Building relationships with individuals, families, guardians, providers.

Skills:

Ability to plan, organize, manage time, and work productively in a virtual environment under minimal supervision to provide timely and quality service delivery for Individuals; intermediate level of technology skill; strong oral and written communication skills; team facilitation; critical thinking; quality orientation; attention to detail; and team collaboration.

Work

Schedule:
Monday- Friday 8-4:30 forty hour work week.

At times it will be necessary to flex schedule to accommodate a later afternoon meeting for working parents and school aged individuals.

Knowledge/

Experience:

Bachelor’s degree in Psychology, Social Work, Counseling, Nursing, Special Education, Rehabilitation, Gerontology, or another field of study with one year of direct work experience with persons with intellectual disabilities.

Plus, one year of experience working with individuals with intellectual disabilities.

Required:
Authorization to access State of Indiana’s operating systems. CPR certification, current and valid driver’s license. Ability to pass a thorough background screen. CM must have a dedicated home office space where Protected Health Information cannot be accessed by others. They are required to have all furnishings for a home office- internet, phone, computer, and ability to print. They will need reliable transportation. Ability to physically enter Individual’s homes and other community settings.

Preferred:
Previous case management experience; experience in team facilitation; and experience working from home. Experience with Aged & Disabled Waiver, Tramatic Brain Injury Waiver, Family Support Waiver or Community Integration Habilitation Waiver.

Benefits:
Medical, dental and vision; 401K; 15 days paid vacation plus paid holidays; iPad with a hot spot. Salary ranges are based on level of experience and ability to meet quality expectations for caseload.

Connections Case Management understands that our mission values and objectives will be best supported in your role as case manager by providing support to our case managers in the same manner.

Connections understands that employees are more than just case managers. They have families and lives outside of their professional careers. Our company values the health and well-being of our employees.

We understand that if we provide supports that allow our employees to have a quality life at work and home, via a good income and personal time away from work responsibilities, the return will be in quality supports for those they have on their caseload.

Everyone in the company has a caseload.

Each case manager is part of a smaller, regionally based team of 3-6 people which allows for direct quality support and monitoring by a supervisor.

Additionally, your role as case manager is supported with an open and accessible team concept.

Because Connections serves all 92 counties in Indiana, employees are encouraged to use all forums to connect with colleagues and utilize a team approach to case management.

For more information about Connections Case Management please visit us at where you can also download an application. Please also look us up on social media and check out our reviews on Glassdoor

Job Type:
Full-time

Pay:
$40,000.00 – $50,000.00 per year

Benefits:
401(k)
Dental insurance
Flexible schedule
Health insurance
Paid time off
Parental leave
Vision insurance

Schedule:
8 hour shift
Day shift
Monday to Friday

COVID-19 considerations:

To keep our individuals and case managers safe we follow all CDC and IDOH protocols as well as local health department guidelines.

Education:
Bachelor’s (Required)

Experience:
Case management: 1 year (Preferred)

License/Certification:
Driver’s License (Required)

Willingness to travel:
50% (Required)

Work Location:
On the road

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Behavioral Health Medical Director – Oklahoma Medicaid – Humana

Clipped from: https://www.adzuna.com/details/3734407813?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Location: Company:

Tulsa County, OK

Humana

 
 

Description
Humana’s Oklahoma Medicaid BH Medical Director will oversee our behavioral health (BH) clinical program for Oklahoma Medicaid plan members. They will collaborate closely with the Chief Medical Officer (CMO) to integrate the day-to-day administration and strategic management of behavioral and physical health services, including utilization management (UM), quality improvement, and value-based payment programs. The BH Medical Director will be based in Oklahoma and will also lead the development of new products and services in Humana’s Medicaid BH delivery model
Responsibilities
Essential Functions and Responsibilities
– Lead major clinical and quality management components of Humana’s BH services
– Oversee, monitor, and assist with the management of the establishment of Prior Authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all Enrollees under the age of eighteen (18); consultations and clinical guidance for contracted Primary Care Providers (PCPs) treating behavioral health-related concerns not requiring referral to behavioral health specialists;
– Develop comprehensive care programs for the management of youth and adult behavioral health concerns typically treated by PCPs, such as ADHD and depression;
– Develop targeted education and training for contracted PCPs to screen for mental health and substance use disorders using evidence-based tools (e.g., AUDIT-C, PHQ-9 and GAD-7), perform diagnostic assessments, provide counseling and prescribe pharmacotherapy when indicated, and build collaborative care models in their practices;
– Coordinate with the Medical Director to integrate the administration and management of behavioral and physical health services;
– Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated Appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD)
– Lead BH policy development in Oklahoma, driving implementation, oversight, and accountability for both Humana internal and external stakeholders
– Adhere to and comply with federal and state laws and programmatic requirements
– Collaborate with provider relations personnel to ensure high-quality and appropriate care delivered through the BH provider network
– Establish and maintain relationships with providers, advocates, and other key Oklahoma stakeholders by maintaining open and ongoing communications; represent Humana at public forums and engagement opportunities
– Maintain compliance with BH-related contract requirements and attend oversight committee meetings to ensure appropriate procedures are adhered to within Humana and within care delivery
– Collaborate closely with corporate and local population health teams in developing programs and strategies to address BH needs at a population health level
Required Education, Certification, & Experience Qualifications
– Physician with a current, unencumbered Oklahoma-license as a physician
– Board-certified in psychiatry
– At least three (3) years of training in a medical specialty
– Knowledge of the managed care industry
– Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, UM, discharge planning and/or home health or rehab
Preferred Experience Qualifications
– Five (5) years or more clinical experience working in BH
– Familiarity with Oklahoma-based BH organizations
– Medicaid Managed Care clinical or behavioral health leadership experience
Additional Information
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.
#physiciancareers
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

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STATE NEWS- NC health agency appealing ruling on services for disabled

MM Curator summary

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.

 
 

[MM Curator Summary]:

The Medicaid agency is appealing a court ruling that would stop admissions to facilities for I/DD members in 2028, but has also offered a counter-proposal.

 
 

Clipped from: https://www.stltoday.com/lifestyles/health-med-fit/nc-health-agency-appealing-ruling-on-services-for-disabled/article_429ab8ee-ca1c-56cb-a53b-6013d1ecb0d3.html

 
 

FILE – North Carolina Health and Human Services Secretary Kody Kinsley speaks during a news conference, Jan. 4, 2022, in Raleigh, N.C. North Carolina government is appealing a trial judge’s order that demands many more community services by certain dates for people with intellectual and development disabilities who live at institutions, Kinsley said Wednesday, Nov. 30, 2022.

Julia Wall – member image share, The News & Observer

By GARY D. ROBERTSON – Associated Press

RALEIGH, N.C. (AP) — North Carolina’s government is appealing a trial judge’s order that demands many more community services by certain dates for people with intellectual and development disabilities who otherwise live at institutions, the top state health official said Wednesday.

Department of Health and Human Services Secretary Kody Kinsley said the formal challenge is needed because he has “grave concerns” about some of the directives issued Nov. 2 by Superior Court Judge Allen Baddour. The group that was the driving force behind a 2017 lawsuit that led to his order said it was discouraged by Kinsley’s challenge.

Kinsley pointed in particular to Baddour’s directive that new admissions at state-run development centers, privately intermediate care facilities and certain adult care homes must stop as of January 2028 for people with intellectual and developmental disabilities.

The secretary said that could ultimately lead to closures of small group homes, leaving potentially 1,000 or more clients seeking new accommodations while creating instability for people who are happy in their current situations.

“We cannot have a ruling go into place that’s going to bind our hands, that’s going to push people into homelessness, essentially,” Kinsley told reporters. “We’ve got to find a different path.”

Kinsley also on Wednesday unveiled a policy and funding counterproposal of sorts that he said would promote independence for people with such disabilities and choices for services in a deliberate fashion.

Some formal General Assembly legislation would be needed to ultimately reach the $150 million in annual federal and state spending starting next July that the proposal envisions. These requests and others should be in Democratic Gov. Roy Cooper’s upcoming budget proposal, the secretary said.

Kinsley said the GOP-controlled legislature appears willing to help improve community services and called 2022 a “year of considerable advancement.”

“This plan recognizes the real, sizable investments and I believe puts us on a path for a vision of a very different North Carolina, that instead of pushing people out of safety, gives people choice,” Kinsley told reporters.

Baddour already had ruled in 2020 that too many people with such disabilities were forced to live away from home in violation of state law. In ordering remedies four weeks ago to address that ruling, Baddour told DHHS that at least 3,000 people must be diverted or shifted to community-based programs by early 2031. No one would be forced to move.

He also told DHHS to eliminate by mid-2032 a waiting list of roughly 16,000 people who are qualified to participate in a Medicaid-funded program that helps them live at home or outside of an institution. Baddour’s order also directs DHHS to a shortage of well-paid direct-care workers. Kinsley’s summary released Wednesday doesn’t identify specific long-term dates to complete initiatives.

The head of the nonprofit Disability Rights North Carolina — a plaintiff in the lawsuit — said the appeal likely will fail and delay “justice for North Carolinians with I/DD (intellectual and developmental disabilities) even longer.”

“It is so deeply disappointing to hear over and over that I/DD services are a priority, but then have progress undermined in this way,” Disability Rights CEO Virginia Knowlton Marcus said in a news release.

The price tag to carry out the judge’s directives isn’t clear, although Disability Rights has suggested it could take hundreds of millions of dollars annually. Federal dollars would cover much of the Medicaid-related services, however.

Disability Rights has said the order would lead private facilities to transition to more community-based services instead, and that the injection of federal funds would generate more jobs and services.

The DHHS proposal in part would spend $36 million next year to help raise wages for direct-support professionals and $24 million to reduce the waiting list for the Medicaid-funded Innovations Waiver option by another 1,000 people.

Kinsley mentioned Keith McDonald, whose 18-year-old daughter lives at TLC, an intermediate care facility in Raleigh for young people with disabilities. McDonald said later Wednesday that he’s worried that denying new admissions even years from now will discourage investments at private facilities and harm their current clients.

“It’ll have a disastrous impact,” McDonald said.

The lawsuit’s lead plaintiff is a western North Carolina woman who had been forced to move into a state-run development center in Morganton when community-based services dried up. She is no longer living at the center.

Posted on by

REFORM- Georgia Set to Implement Medicaid Work Requirements

MM Curator summary

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.

 
 

[MM Curator Summary]: The state is moving forward with its work requirements program, despite Biden’s best efforts to stop it.

 
 

Clipped from: https://www.medpagetoday.com/publichealthpolicy/medicaid/101982

— Demonstration program expected to add 50,000 recipients to the state’s Medicaid rolls

 
 

Georgia’s new Medicaid demonstration program that requires recipients to be working, going to school, or volunteering is expected to start up next year, but critics say it will be expensive to administer and will result in far fewer people added to the Medicaid rolls compared with a regular Medicaid expansion.

“The systems being set up for work requirements are very costly to implement for states,” said Laura Harker, a senior policy analyst at the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C. She noted that a 2019 Government Accountability Office report found that the cost of administering work requirements could cost a state millions to hundreds of millions of dollars; it requires adding more staff people to keep up with who is and who is not reporting their hours, among other costs.

Wider Eligibility Criteria

Georgia’s demonstration program, known as Pathways to Coverage, would widen the state’s Medicaid eligibility criteria to include individuals with annual incomes up to 100% of the Federal Poverty Level, or $13,590 for a single person. Currently, adults in Georgia are only eligible for Medicaid if their incomes are less than 35% of the poverty level, or $4,757, although eligibility criteria for children are more generous.

To stay eligible for the program, beneficiaries must continue to spend at least 80 hours per month working, volunteering, or going to school, according to the state’s application with the Centers for Medicare & Medicaid Services (CMS). “If a member does not meet the hours and activities threshold, they will be suspended from Medicaid and no longer able to receive the Medicaid benefit,” the application noted. “The member has 3 months to meet the hours and activities threshold for Georgia Pathways for the suspension to be lifted. If the member does not meet the requirement, after 3 months of suspension, then the member will be disenrolled from Medicaid,” although they can be reinstated later if they achieve the 80 hours.

State officials estimate that the demonstration program, which will last for 5 years, will add 50,000 people to Georgia’s Medicaid rolls. This is in contrast to the approximately 448,000 people that could be added if Georgia agreed to a more traditional Medicaid expansion as outlined in the Affordable Care Act (ACA), Harker said.

In addition, the Pathways program is eligible for reimbursement at the standard federal Medicaid matching rate for Georgia of 67%, whereas under an ACA expansion, the federal government would reimburse at a 90% rate. As a result, under the Pathways program, “it’s much more expensive to cover a lot fewer people,” she said.

Debate Over Work Requirements

Why did the state go for a work requirements demonstration program instead? “The foundation of the Georgia Pathways to Coverage program is incentivizing and promoting employment and employment-related activities,” according to the application. “Research shows the various positive effects of employment on an individual. Employed individuals are both physically and mentally healthier than those who are unemployed. Work improves various measures of general health and wellbeing, such as self-esteem, self-rated health, and self-satisfaction. Employed individuals are also more financially stable.”

Chris Denson, director of policy and research at the Georgia Public Policy Foundation, a right-leaning think tank in Atlanta, pointed out in an email that the 50,000 people potentially being added to the Medicaid rolls “would not be the same 50,000 recipients at any given time. Whereas traditional Medicaid discourages recipients from earning more money to avoid losing eligibility and thus their coverage, the [demonstration project] proposal is designed to create a more seamless transition from Medicaid eligibility for many workers.” For instance, if the enrollee has a job with a health insurance benefit, the Pathways program would pay the premium for the employer plan if it was financially advantageous for Pathways.

In addition, “in the event their income rises above the eligibility threshold, they could keep their coverage and not have to move from one plan to another,” he said.

But critics of the program say other motives are involved. “The motivation behind work requirements comes from a misguided ‘poor law’ mindset that sees Medicaid as something that people don’t ‘deserve’ unless they fit one of the categorical eligibility groups like disability or pregnancy,” Katherine Hempstead, PhD, senior policy advisor at the Robert Wood Johnson Foundation, said in an email. “According to this line of thinking, those who are merely poor should work for their benefits. Repeatedly courts have found that this framework is inappropriate and inconsistent with the purpose of the Medicaid program, which is to provide access to healthcare services.”

“The purpose of a work requirement is not to promote work so much as it is to deter enrollment,” she added. “The vast majority of those eligible for Medicaid under the expansion are already working or face significant barriers to work such as health problems or family caregiving responsibilities. Studies of Medicaid expansion in other states have shown that expansion supports work by allowing people to manage health issues that can sometimes present a barrier to work. It stands to reason that healthy people are better able to work and be productive.”

Rocky History

CMS approved the Pathways program in October 2020 during the Trump administration. Since then, however, it has been the subject of several administrative and federal court actions, beginning in February 2021 when CMS notified Georgia officials that the agency was considering withdrawing its approval of the Pathways program because the COVID-19 pandemic made it difficult for some potential beneficiaries to fulfill the work requirement. Georgia officials responded that the pandemic “provides no basis to excise the [work requirements] from the Georgia Pathways program.”

In December 2021, the Biden administration rescinded CMS’s approval of Pathways. The state of Georgia sued the Biden administration in federal court, and in August, Judge Lisa Godbey Wood of the U.S. District Court for the Southern District of Georgia ruled in favor of the state, saying that the Biden administration’s rescission of the program “was arbitrary and capricious on numerous, independent grounds.”

The government decided not to appeal the decision, possibly because it was worried about what would happen next, Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, told Kaiser Health News. “The decision not to appeal may have been based on fear that the result would get confirmed on appeal, since most of the appellate judges in the [federal] 11th Circuit are Republican-appointed,” he said. That confirmation could set a stronger precedent for similar programs.

Arkansas was the first state to implement a Medicaid work requirement, but that program — later halted by a federal judge — resulted in about 18,000 beneficiaries losing their Medicaid coverage, often because they couldn’t comply with the reporting requirements. In addition, “many faced negative consequences such as medical debt,” said Hempstead. “It did not improve employment.”

Denson, on the other hand, noted that the Georgia program differs from the Arkansas program because it “imposed this [work] requirement on potential recipients rather than existing Medicaid beneficiaries … Because Georgia is expanding healthcare coverage for previously uncovered applicants, there is no reduction in the legally mandated Medicaid coverage for current enrollees.”

  • Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow
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OP/ED- Biden Turning Medicaid into Welfare For All – AMAC

MM Curator summary

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.

 
 

[MM Curator Summary]: While this op-ed is guaranteed to make most of you furious, there are some decent points about the new CMS reg on Medicaid eligibility if you can see past the bombastic tone.

 
 

Clipped from: https://amac.us/biden-turning-medicaid-into-welfare-for-all/

AMAC Exclusive – By Sam Adolphsen

 
 

The nation’s largest welfare program, Medicaid, is a total mess. We are fast approaching 100 million people on the program, mostly because of expansions to able-bodied adults. States spend one of every three state budget dollars on the program – and more than one of every five of those dollars is spent in error. On top of that, states have been banned from removing ineligible people since early 2020 because of the so-called public health emergency that President Joe Biden keeps extending.

If Medicaid were a person, they would be drowning.

Now, the Biden administration’s Centers for Medicare & Medicaid Services (CMS) is proposing a new regulation that would make things much worse. The rule would make significant changes to state welfare eligibility processes, adding millions to welfare and adding $100 billion in new costs to taxpayers.

This latest proposed Medicaid rule would be like helping that poor drowning person by throwing them a cement block.

If President Biden is looking to finish off the program and send it to the bottom, he nailed it.

Of course, the administration isn’t really hiding its plan. The stated goal of the rule is to “maximize enrollment.” They talk about “retention rates” as if it’s a for-profit business, and how they need to “remove barriers to enrollment,” as if that’s a problem, with nearly a third of the country already on the program.

Biden’s 300-plus-page regulation has so many terrible welfare eligibility policies that it’s difficult to pick just a few on which to focus. But there are some that stand out as especially damaging to the integrity of the country’s safety net.

First, the new rule would prohibit all states from checking eligibility more than once a year. Under President Obama, CMS had already banned states from more frequent checks for certain populations. This proposed rule would expand that bad policy by making the previous minimum level of eligibility checks (once a year) the new maximum for everyone in the program. Some states check more often than once a year right now, and they should, because there are at least 16 million ineligible people on the program.

Second, the rule would ban states from requiring face-to-face interviews for any eligibility groups. This change comes despite the constant news about the significant problems with identity theft across all welfare benefits and COVID-19 unemployment programs. It is common sense that if states are going to hand out a costly welfare benefit, they should require one simple office visit before awarding that benefit. President Biden wants to ban that common-sense check.

Third, the rule creates an entirely new eligibility process for states, requiring them to keep cases open for months even after they determine someone is ineligible. This new “reconsideration period” would also force states to handhold someone to apply for alternative coverage before they can remove them from Medicaid. This also contradicts the entire stated justification for the rule, that it will “reduce the administrative burden” on states.

As if that weren’t bad enough, the rule would also require states to ignore returned mail if the new address is an in-state address. CMS outrageously claims that a change of address “does not indicate a change in circumstances.” Any reasonable person knows that isn’t true. A change in mailing address likely signals a meaningful shift in life circumstances that could affect eligibility.

Another crazy requirement in the Biden administration’s welfare proposal is that states will be required to accept as gospel certain government data sets. While this may seem smart at first glance, the policy only applies when the data indicates that the person is eligible for Medicaid. What happens if the data shows they are ineligible? Then the state must undertake a series of administrative-intensive follow-ups to ensure the person is ineligible. CMS only wants “administrative efficiency” when it will add someone to welfare, never when it would keep someone ineligible from being added.

One final bit of Medicaid madness is that the proposed rule would prohibit states from requiring ID verification as part of the process of reviewing an immigrant’s citizenship status when they apply for Medicaid. This is not surprising coming from Open Borders Biden, but it is alarming. There are many more problems with the proposal, including that it is probably illegal.

The bottom line is that one of the country’s chief safety net programs, Medicaid, has already been stretched and shredded by expansions to able-bodied adults and abysmal program integrity. Now Biden has doubled down, throwing program integrity completely out the window to push the country toward welfare for all. States need to step up and oppose this latest attack on Medicaid.

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REFORM- More than 4 in 5 pregnancy-related deaths are preventable in the US, and mental health is the leading cause

MM Curator summary

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.

 
 

[MM Curator Summary]: More details on what is really going on with pregnancy related death: There are a total of 700 in the US each year, 13% of them happen during childbirth- 65% occur in the year after childbirth and most of them have to do with substance abuse/ suicide.

 
 

 
 

Clipped from: https://theconversation.com/more-than-4-in-5-pregnancy-related-deaths-are-preventable-in-the-us-and-mental-health-is-the-leading-cause-193909

Rachel Diamond, Adler University

Author

 
 

Rachel Diamond

Clinical Training DIrector and Assistant Professor of Couple and Family Therapy, Adler University

Disclosure statement

Rachel Diamond does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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According to the CDC’s latest numbers, 65% of pregancy-related deaths occur in the first year following childbirth. Petri Oeschger/Moment via Getty Images

Preventable failures in U.S. maternal health care result in far too many pregnancy-related deaths. Each year, approximately 700 parents die from pregnancy and childbirth complications. As such, the U.S. maternal mortality rate is more than double that of most other developed countries.

The Department of Health and Human Services declared maternal deaths a public health crisis in December 2020. Such calls to action by the U.S. Surgeon General are reserved for only the most serious of public health crises.

In October 2022, the Centers for Disease Control and Prevention released new data gathered between 2017 and 2019 that further paints an alarming picture of maternal health in the U.S. The report concluded that a staggering 84% of pregnancy-related deaths are preventable.

However, these numbers don’t even reflect how widespread this problem could be. At present, only 39 states have dedicated committees in place to review maternal deaths and determine whether they were preventable; of those, 36 states were included in the latest CDC data.

I am a therapist and scholar specializing in mental health during the perinatal period, the time during pregnancy and postpartum. Research has long demonstrated significant mental health risks associated with pregnancy, childbirth and the year following childbirth. The CDC’s report now makes it clear that mental health conditions are an important factor in many of these preventable deaths.

A closer look at the numbers

The staggering number of preventable maternal deaths – 84% – from the CDC’s most recent report represents a 27% increase from the agency’s previous report, from 2008 to 2017. Of these pregnancy-related deaths, 22% occur during pregnancy, 13% during childbirth and 65% during the year following childbirth.

This raises the obvious question: Why are so many preventable pregnancy-related deaths occurring in the U.S., and why is the number rising?

For a pregnancy-related death to be categorized as preventable, a maternal mortality review committee must conclude there was some chance the death could have been avoided by at least one reasonable change related to the patient, community, provider, facility or systems of care.

The most commonly identified factors in these preventable deaths have been those directly related to the patient or their support networks, followed next by providers and systems of care. While patient factors may be most frequently identified, they are often dependent on providers and systems of care.

Take, for instance, the example of a new mother dying by suicide from a mental health condition, such as depression. Patient factors could include her lack of awareness about the warning signs of clinical depression, which she may have mistaken for difficulties with the transition to parenthood and perceived personal failures as a new parent.

As is often the case, these factors would have directly related to the inaction of health care providers, such as a failure to screen for mental health concerns, delays in diagnosis and ineffective treatment. This type of breakdown – which is common – would have been made worse by poor coordination of care between providers across the health care system.

This example illustrates the complexities of the failures and preventable outcomes in the maternal health care system.

The U.S. has a far higher rate of pregnancy-related deaths than other developed nations.

The role of mental health

In the CDC’s latest report, mental health conditions are the overall most frequent cause of pregnancy-related death. Approximately 23% of deaths are attributed to suicide, substance use disorder or are otherwise associated with a mental health condition. The next two leading causes are hemorrhage and cardiac conditions, which combined contribute to only slightly more deaths than mental health conditions, at about 14 and 13%, respectively.

Research has long shown that 1 in 5 women suffer from mental health conditions during pregnancy and the postpartum period, and that this is also a time of increased risk for suicide. Yet, mental illness – namely, depression – is the most underdiagnosed obstetric complication in America. Despite some promising reductions in U.S. suicide rates in the general population over the last decade, maternal suicide has tripled during this same time period.

As it relates to maternal substance use, this issue is also worsening. In recent years, almost all deaths from drug overdose during pregnancy and the postpartum period involved opioids. A review from 2007 to 2016 found that pregnancy-related deaths involving opioids more than doubled.

Many of these issues stem from the fact that up to 80% of women with maternal mental health concerns are undiagnosed or untreated.

Barriers to care

In 2021, the first national data set of its kind showed that less than 20% of prenatal and postpartum patients were screened for depression. Only half of those who screened positive received follow-up care.

Research has long demonstrated widespread barriers and gaps in maternal mental health care. Many health care providers do not screen for mental health concerns because they do not know where to refer a patient or how to treat the condition. In addition, only about 40% of new mothers even attend their postpartum visit to have the opportunity for detection. Non-attendance is more common among higher-risk populations of postpartum women, such as those who are socially and economically vulnerable and whose births are covered by Medicaid.

Medicaid covers around 4 in 10 births. Through Medicaid benefits, pregnant women are covered for care related to pregnancy, birth and associated complications, but only up to 60 days postpartum. Not until 2021 did the American Rescue Plan Act begin extending Medicaid coverage up to one year postpartum.

But as of November 2022, only 27 states have adopted the Medicaid extension. In the other states, new mothers lose postpartum coverage after just 60 days. This matters a great deal because low-income mothers are at a greater risk for postpartum depression, with reported rates as high as 40% to 60%.

In addition, the recent CDC report showed that 30% of preventable pregnancy-related deaths happened between 43 and 365 days postpartum – which is also the time frame suicide most commonly occurs. Continued Medicaid expansion would reduce the number of uninsured new parents and rates of maternal mortality.

Another challenging barrier to addressing maternal mental health is the criminalization of substance use during pregnancy. If seeking care exposes a pregnant person to the possibility of criminal or civil pentalties – including incarceration, involvement with child protective services and the prospect of separation from their baby – it will naturally dissuade them from seeking treatment.

At this time, 24 states consider substance use during pregnancy to be child abuse, and 25 states require health care professionals to report suspected prenatal drug use. Likewise, there are also tremendous barriers in the postpartum period for mothers seeking substance use treatment, due in part to the lack of family-centered options.

With all these barriers, many pregnant and new mothers may make the difficult decision to not engage in treatment during a critical window for intervention.

Looking ahead

While the information described above already paints a dire picture, the CDC data was collected prior to two major events: the COVID-19 pandemic and the fall of Roe v. Wade, which overturned nearly 50 years of abortion rights. Both of these events have exacerbated existing cracks in the health care system and, subsequently, worsened the maternal health in the U.S.

In my view, without radical changes to maternal health care in the U.S., starting with how mental health is treated throughout pregnancy and postpartum, it’s likely parents will continue to die from causes that could otherwise be prevented.

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FWA (WV)- State Medicaid Fraud Office Expansion To Include CHIP Fraud Investigations

MM Curator summary

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.

 
 

[MM Curator Summary]: After the state took the fraud investigation team away from the health agency and gave it to the AG, recoveries grew 286%.

 
 

Clipped from: https://www.wvpublic.org/government/2022-11-29/state-medicaid-fraud-office-expansion-to-include-chip-fraud-investigations

 
 

The Attorney General’s Medicaid Fraud Control Unit is expanding to include investigations of Children’s Health Insurance Program (CHIP) fraud across the state.

CHIP offers health insurance to children whose families earn too much money for Medicaid.

Attorney General Patrick Morrisey said this expansion puts West Virginia’s fraud unit more in line with the majority of states and that investigating claims of CHIP fraud will save taxpayers more money.

“I just view that if you have the ability to save an extra dollar more with really not much effort, why wouldn’t you do that for the taxpayers and for the beneficiaries of the program?” Morrisey said.

The expansion was announced during a Tuesday press conference scheduled by Morrisey, who touted the successes of the fraud control unit under his office over the past three years. During that time the unit was expanded from 12 individuals to 21 with the average amount of civil recoveries from fraud per year climbing 268 percent.

Investigations of Medicaid fraud were previously housed under the West Virginia Department of Health and Human Resources before being placed under the jurisdiction of the Attorney General’s office in 2019.