Category: MM Curator

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Timing fluke could garner Missouri $1.7 billion in additional federal Medicaid funds

 
 

MM Curator summary

 
 

As MO took some time to figure out how to pay for expansion, it may get a lot more federal funding under the Democrats new plan to sweeten the deal for expansion hold outs.

 
 

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.

 
 

Republican state Sen. Dan Hegeman, of Missouri, discusses voter approval of a ballot measure he sponsored during an interview on Thursday, Nov. 5, 2020, in his state Capitol office in Jefferson City, Mo. 

AP Photo/David A. Lieb

(The Center Square) – The Missouri Senate Appropriations Committee will engage in a “perfection debate” Monday afternoon on a proposed bill implementing Medicaid expansion approved by state voters when they adopted Amendment 2 in August. 

According to estimates compiled by State Auditor Nicole Galloway, expanding Medicaid under the Affordable Care Act (ACA) could cost the state more than $200 million or save it as much as $1 billion annually by 2026.

But Congress could change the calculus – and potentially provide Missouri with a windfall $1.7 billion over two years in Medicaid funding attributable to timing.

While expansion was approved by 53% of voters in Missouri, it won’t be in effect at least until the start of the new fiscal year, July 1. Oklahoma voters also approved Medicaid expansion last summer that goes into effect in July. 

But Missouri and Oklahoma are still among the 14 states that U.S. House Democrats are trying to induce into expanding Medicaid under the ACA.

Billions in additional federal funding for Medicaid expansion for states that have not done so is included in a $1.9 trillion COVID-19 relief package proponents say would provide health coverage to more than 2 million Americans “falling between the cracks in government programs in the midst of the pandemic and economic downturn.”

Under House Democrats’ plan, Missouri could receive up to $1.7 billion by expanding Medicaid. Texas would receive $6 billion, Florida $3.5 billion, North Carolina $2.4 billion, Georgia $1.9 billion, Tennessee $1.7 billion, Wisconsin $1.3 billion and Kansas $330 million by expanding Medicaid under the ACA.

Amendment 2 expands Medicaid for residents between the ages of 19 and 64 with an income level at or below 133 percent of the federal poverty level. Supporters say the measure will provide healthcare to more than 200,000 Missourians who earn less than $18,000 annually.

 
 

 
 

 
 

Republican Gov. Mike Parson and the Legislature’s GOP leaders vigorously opposed the measure. In his State of the State address last month, however, Parson told lawmakers he expected them to execute the will of the people in implementing the expansion.

How the potential $1.7 billion boost influences Monday’s Senate Appropriations Committee’s “perfection debate” on Senate Bill 1 is uncertain.

The bill, filed by committee chair Sen. Dan Hegeman, R-Cosby, would extend the state’s federal match program — the Federal Reimbursement Allowance (FRA) — for Medicaid payments. Nearly 85 percent of all payments to Missouri hospitals through MO HealthNet are covered by the FRA.

The state’s FRA program was established as voluntary before being enacted into law as a provider tax in 1992. Hospitals contribute to the FRA and Missouri’s Medicaid program — MO HealthNet — uses the funds to earn higher returns in federal matching dollars.

SB 1 would continue maximizing federal matching dollars through Medicaid expansion to the burden on state general revenues, Hegeman told the panel when it preliminarily advanced the measure in an 11-1 vote on Jan. 26.

Among extensions is continuing to allow the Missouri Department of Health (DOH) to collect approximately $1.28 billion in Hospital Tax in Fiscal Year 2022 and in FY23. Hospital tax revenues will, in turn, draw approximately $2.391 billion in federal funds each year to the state.

Missouri Hospital Association (MHA) Executive Director Rob Monsees told the panel that adding 200,000 people to the state’s Medicaid program will generate “a substantial amount of new FRA dollars. Some of those dollars can help provide an offset to the cost of expansion.”

Sen. Bill Eigel, R-Weldon Spring, the lone dissenter, said the FRA is growing too big and needs reform. “We have thrown money at a broken program with no meaningful reform whatsoever,” he said.

 
 

Clipped from: https://www.thegriffonnews.com/news/state/timing-fluke-could-garner-missouri-1-7-billion-in-additional-federal-medicaid-funds/article_72201da5-fce7-5e0b-8c5f-c9015f1ff34d.html

 
 

 
 

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Feds never replied to South Dakota’s request to join Medicaid work program, DSS secretary says

 
 

MM Curator summary

 
 

SD’s work requirement request will not have to be un-approved, because CMS never responded to it.

 
 

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.

 
 

PIERRE, S.D. (KELO) — A 2018 plan by then-Governor Dennis Daugaard’s administration to have many adults in Minnehaha and Pennington counties work in return for Medicaid benefits never went forward, because the federal agency didn’t respond to South Dakota’s application.

That’s according to state Department of Social Services Secretary Laurie Gill. President Biden’s administration sent letters to states Friday halting waivers issued by the federal Centers for Medicaid and Medicare under President Trump and rescinding the offer. More than half the states applied.

There is currently no mandatory work requirement tied to the Medicaid program in South Dakota, Gill said Friday in a written statement to KELOLAND News.

“Currently, the only way a state Medicaid program can implement mandatory work requirements is to obtain a waiver from the Centers for Medicare and Medicaid (CMS). The Dept. of Social Services submitted a waiver request in July, 2018.  As of today, DSS has not yet received a response from CMS,” Gill said.

South Dakota’s Career Connector was to focus on Sioux Falls and Rapid City, the two largest cities in the state. The 32-page waiver application proposed cutting off benefits after three months of non-compliance. More than 200 pages of public comments were included in the August 10, 2018, packet.

The plan called for the state Department of Labor and Regulation to be responsible for “conducting the employment assessment, identifying the integrated resource team, developing the employment and training plan, identifying monthly milestones, tracking achievement of monthly milestones, and tracking/verifying hours worked” and to notify Social Services when a Medicaid recipient in the program didn’t fulfill the requirements.

“Closure of the participant’s Medicaid eligibility will not affect the eligibility of a child, spouse, or other household member that is not required to participate,” the application said.

An estimated 15% of the approximately 1,300 participants in the two counties would have become ineligible annually because of increased income or choosing to not participate, according to the plan, which calculated the 1,300 received approximately $9,672,000 from Medicaid in federal fiscal 2017.

Daugaard spoke about the plan in his State of the State speech opening the 2018 legislative session and distributed a governor’s column on it. After winning election in November 2018, Governor Kristi Noem chose Greg DeSautel to replace Lynne Valenti as secretary, then tapped Gill in mid-2019 following DeSautel’s resignation.

Clipped from: https://www.keloland.com/news/capitol-news-bureau/feds-never-replied-to-south-dakotas-request-to-join-medicaid-work-program-dss-secretary-says/

 
 

 
 

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Biden administration likely to cancel controversial SC Medicaid work requirements

 
 

MM Curator summary

 
 

SC is another state that will be denied the opportunity to test their CMS-approved work requirements.

 
 

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.

 
 

File/Lauren Petracca/Staff

A program approved by the Trump administration requiring South Carolina adults with Medicaid to prove that they work or participate in various community engagement activities will likely be eliminated under the new Biden administration before it even gets off the ground. 

“Healthy Connections Works” was approved by the federal Centers for Medicare & Medicaid Services in 2019, but has not been implemented to date, according to the federal government. It would have eventually required adults with Medicaid coverage in South Carolina to prove that they spend at least 80 hours a month working or engaging in other productive pursuits outside the home, such as education, job skills training or community service. 

In a letter to the South Carolina Medicaid agency dated Feb. 12, the Centers for Medicare & Medicaid Services laid out several reasons why the program was “infeasible.” 

“CMS has serious concerns about testing policies that create a risk of substantial loss of health care coverage in the near term. The COVID-19 pandemic has had a significant impact on the health of Medicaid beneficiaries,” wrote CMS Acting Administrator Elizabeth Richter. “Taking into account the totality of circumstances, CMS has preliminarily determined that allowing work and other community engagement requirements to take effect in South Carolina would not promote the objectives of the Medicaid program.” 

The state will have 30 days to submit information in favor of sustaining the work requirements. 

In the lead-up to its approval three years ago, Gov. Henry McMaster championed the plan, citing that jobs yield healthier lifestyles, financial independence and opportunity. 

“Whenever possible, we should always endeavor to help South Carolinians in need find their path to gainful employment and away from the temporary assistance of government,” McMaster said in 2018. 

 
 

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Understand SC brings perspective and context to the top issues in the state. Produced by and featuring journalists from The Post and Courier.

McMaster’s office did not immediately respond to questions about the federal decision on Saturday.

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Ten states, including South Carolina, approved Medicaid work requirements under the Trump administration, but Arkansas was the only state to fully implement the rules, according to Politico. 

Critics meanwhile argued the plan didn’t take into account a lack of available jobs, child care or transportation. 

Sue Berkowitz, executive director of the Appleseed Legal Justice Center in Columbia, has protested the Medicaid work requirements since they were first proposed. If the rules had been implemented, she said her group would have challenged them in court. 

“The premise that work makes people healthy was just ludicrous. No. When people are healthy, they are able to work,” Berkowitz said. “Needless to say McMaster’s office and our office have differing opinions on this. He was clearly following the lead of Trump … without doing the work of determining if this was really in the best interest of South Carolina.” 

At one point, the state Medicaid agency anticipated 180,000 adult Medicaid beneficiaries in South Carolina would be subject to the work rules, but that most of them already satisfied the requirements or would qualify for an exemption. Former S.C. Medicaid Director Joshua Baker estimated fewer than 10,000 adults with Medicaid coverage would need to look for work or risk losing their health insurance. 

Those estimates are likely low now considering the growth in Medicaid enrollment during the pandemic. Medicaid eligibility rules vary widely from state to state, and in South Carolina, existing rules make it difficult for adults without children to qualify for coverage, no matter their poverty level. Still, adult enrollment in the program has grown substantially during the COVID-19 pandemic. 

In December, more than 1.3 million South Carolinians were enrolled in Medicaid, representing a jump of about 90,000 beneficiaries since last March. About half of all Medicaid enrollees in this state are children, but largest gains in enrollment growth were observed among adults this past year.

Clipped from: https://www.postandcourier.com/health/biden-administration-likely-to-cancel-controversial-sc-medicaid-work-requirements/article_8206b49e-6dfb-11eb-9915-df24179bda51.html

 
 

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Biden’s HHS to rescind Medicaid work requirements; NH attempt thwarted by courts

MM Curator summary

 
 

Biden’s CMS has let 10 states that requested and received approval for their work requirements features that they are being un-approved.

 
 

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.

 
 

WASHINGTON — The Biden administration was planning Friday to wipe out one of the core health policies of the Donald Trump era, taking actions that will immediately rescind permission for states to compel poor residents to work in exchange for receiving Medicaid benefits.

Federal health officials will withdraw their predecessors’ invitation to states to apply for approval to impose such work requirements and will notify 10 states granted permission that it is about to be retracted, according to a draft plan obtained by The Washington Post and confirmed by two individuals familiar with the decision.

The actions anticipated Friday, outlined in bullet points in the draft, will come two weeks after President Joe Biden signed an executive order instructing officials to remove barriers to Medicaid coverage. Work requirements enabled under President Donald Trump were the one policy mentioned in Biden’s directive.

In practice, the moves have little immediate effect because work requirements adopted in three states — Arkansas, Kentucky and New Hampshire — have been ruled illegal by two levels of federal courts, and other states have held back during the legal challenges to the policy. A case on the constitutionality of such requirements is now before the Supreme Court.

Still, the swift rescinding of the Trump administration’s effort to remake the safety-net program represents a particularly sharp pendulum swing on the ideological divide over the proper roles of government and individuals living under economic strain.

Spokesmen for the Department of Health and Human Services did not respond Thursday night to a request for comment on the plan, first reported by Politico.

Medicaid, a collaboration between the federal government and states, was a pillar of the War on Poverty of the mid-1960s and is the nation’s largest source of public health insurance. For years, conservative state leaders had sporadically asked federal officials to allow them to compel some people on Medicaid to work for their benefits, but such requests always had been rebuffed.

However, in early 2018, Seema Verma, then-administrator of the Centers for Medicare and Medicaid Services, issued a letter to state Medicaid directors inviting them to apply for permission to create what she called “community engagement requirements,” in which certain people on Medicaid would need to work or participate in activities to prepare for employment. That letter is expected to be withdrawn Friday, according to the draft and the individuals who spoke on the condition of anonymity before the actions are made public.

Verma and other proponents have contended that such requirements promote economic self-reliance, eventually weaning poor people off government assistance. Undeterred by court rulings against the requirements, she advocated for them until the Trump administration ended last month. “I support innovative efforts by governors that are trying to help people, trying to lift them out of poverty and find a path forward” she told the Aspen Institute in October.

Opponents of the policy, including most Democrats, counter that insurance that helps poor people to be healthy is a prerequisite to being able to work. Unlike the federal welfare system, which has required work since the mid-1990s, they argue, health coverage should be considered a right, not a privilege that is contingent on following other rules.

In its planned announcement, the Biden administration said the requirements were especially unwise during the coronavirus pandemic, which has sickened millions of Americans and forced many out of work. The agency overseeing Medicaid “has serious concerns that now is not the appropriate time to test policies that risk a substantial loss of health care coverage or benefits,” according to the draft plan.

According to the 15-page document, the Trump administration approved work programs in 13 states, and 10 others were still seeking approval. A few withdrew when GOP governors were replaced by Democrats. Arkansas was the only state that actually implemented its requirements, and 18,000 poor residents there were removed from Medicaid rolls over several months before the program was blocked by a judge on the U.S. District Court for the District of Columbia.

Accompanying the steps to reverse the Trump policy, HHS also plans to release an analysis Friday assessing how the Trump policy limited low-income Americans’ access to health coverage, according to the two individuals familiar with the plans.

The analysis was overseen by Ben Sommers, a longtime Harvard researcher who joined HHS last month as a deputy assistant secretary for strategy and planning and had previously written about the drawbacks of Medicaid work requirements, the officials said. “[W]e found no evidence that the policy succeeded in its stated goal of promoting work and instead found substantial evidence of harm to health care coverage and access,” Sommers and colleagues wrote in a September 2020 analysis in the journal Health Affairs.

Sommers did not respond Thursday night to a request for comment.

Clipped from: https://www.unionleader.com/news/health/bidens-hhs-to-rescind-medicaid-work-requirements-nh-attempt-thwarted-by-courts/article_28c3add2-122c-5f41-abd8-0a572b72a6e3.html

 
 

 
 

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Feds temporarily halt approval of Georgia Medicaid overhaul backed by Gov Kemp

MM Curator summary

 
 

Biden administration nullified the work requirements requested by GA (and approved by CMS), citing COVID as too much a barrier to compliance.

 
 

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.

 
 

 
 

October 15, 2020 Atlanta – Governor Brian Kemp and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma celebrate with fist bump after they signed on healthcare reform at the Georgia State Capitol on Thursday, October 15, 2020. The federal government approved Gov. Brian Kemp’s plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act, the governor and a top Trump administration health official announced on Thursday. (Hyosub Shin / Hyosub.Shin@ajc.com)

The Biden administration pulled back approval of Gov. Brian Kemp’s plan to provide Medicaid coverage to thousands of low-income and uninsured adults in Georgia who meet a work or activity requirement because the still-raging coronavirus pandemic makes meeting some of the key guidelines “unfeasible.”

Federal health officials said Friday the state’s Medicaid overhaul proposal was switched from “approved” to “pending” over concerns that it’s “unreasonably difficult or impossible for many individuals to meet the community engagement requirement” in the plan in the midst of a global coronavirus outbreak.

“Taking into account the totality of circumstances, CMS has preliminarily determined that allowing work and other community engagement requirements to take effect in Georgia would not promote the objectives of the Medicaid program,” according to a letter sent to state officials by Elizabeth Richter, the acting administrator for the Centers for Medicare and Medicaid Services.

The decision could undermine the centerpiece of Kemp’s plan to reshape Medicaid in the state, which was greenlit by President Donald Trump’s top health official in October. At the celebratory press conference, Kemp declared the “status quo is simply unacceptable” as he cited the state’s lofty premium costs and high level of uninsured people — second-worst in the nation.

Kemp’s office said Saturday it was reviewing the decision by President Joe Biden’s administration, which throws into doubt the fate of his plan to allow perhaps as many as 50,000 poor and uninsured adults be added to the Medicaid rolls within two years. Kemp’s health deputies have 30 days to respond.

Advocacy groups and Democrats applauded the move and amplified calls for a full Medicaid expansion to all the state’s very poor, as envisioned by the Affordable Care Act and already carried out by 39 states. State Republican leaders say a full expansion is too costly in the long run, although some GOP elected officials have embraced the idea.

State Sen. Michelle Au, a physician and newly elected Johns Creek Democrat, said she was happy to see the “misguided work requirements” were under new federal scrutiny. And state Sen. Jen Jordan said she hoped the decision scuttled Kemp’s “half-measure” and put full expansion of the program within reach.

“This is really positive news,” said Jordan, D-Sandy Springs. “Because if we can be fiscally responsible, cover more people and make sure everyone has access to expanded health care, it would be a big step forward.”

Georgia Medicaid now mostly covers children, and some adults, such as those who’ve been declared disabled by the government. Under Kemp’s plan, other working-aged Georgians could apply but would have to meet requirements the state would impose. That might include working at a registered employer for 80 hours a month or attending college full time.

A separate Kemp waiver program also approved last year by Trump’s administration appears to remain intact. That plan amounts to a “reinsurance” plan to lower premium prices for those who buy individual insurance. If that proposal moves forward, Kemp plans to pour public money into the private insurance market with a goal to reduce premium prices for some Georgians.

Staff writer Ariel Hart contributed to this report.

WHAT IT MEANS

The decision throws into doubt the fate of the governor’s plan to allow perhaps as many as 50,000 poor and uninsured adults be added to the Medicaid rolls within two years.

 
 

Clipped from: https://www.ajc.com/politics/feds-temporarily-halt-approval-of-kemps-medicaid-overhaul/FVWZNMVD7BCYVFJIZZXIUQIJP4/

 
 

 
 

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GAO: Puerto Rico spent most of its ’18 Medicaid budget on contractors

MM Curator summary

 
 

GAO dings CMS for not monitoring vendor payments in the PR Medicaid program.

 
 

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 U.S. Government Accountability Office (U.S. GAO) released a report urging the Centers for Medicare & Medicaid Services (CMS) to crack down on Puerto Rico’s procurement process, as in 2018 the Commonwealth paid contractors almost all of its Medicaid spending, or 97% of its $2.5 billion budget.

The GAO’s recommendation of a “risk-based oversight approach” by the CMS received the backing of the US Department of Health and Human Services.

“States and US territories paid contractors about half of their Medicaid spending for health care and other services in 2018,” the GAO said. “We found that the CMS does not oversee contracting in Puerto Rico, where former officials face allegations of contract fraud. We found that Puerto Rico did not always take steps to ensure competition or to lower the risk of fraud, waste, and abuse.”

“We recommended CMS begin risk-based oversight of contracting in Puerto Rico,” the agency said.

In its report, the GAO found that like other US territories and states, Puerto Rico implements major functions of its Medicaid program by procuring services from contractors, such as the delivery of managed care services to Medicaid beneficiaries.

“In 2018, procurement costs represented $2.4 billion of Puerto Rico’s $2.5 billion in total Medicaid expenditures. A 2019 federal indictment alleging Puerto Rico officials unlawfully steered Medicaid contracts to certain individuals has raised concerns about Puerto Rico’s Medicaid procurement process, including whether this process helps ensure appropriate competition,” the GAO said.

The CMS, within the US Department of Health and Human Services, is responsible for overseeing the Medicaid program. CMS requires states and territories to use the same process for Medicaid procurements as they do for their non-federal procurements.

“However, CMS has not taken steps to ensure Puerto Rico has met this requirement. Instead, CMS has relied on Puerto Rico to oversee the territory’s procurement process and to attest to its compliance,” the GAO said.

“CMS approved Puerto Rico’s attestation of compliance in 2004 and has not required subsequent updates. CMS officials told GAO that states and territories are in the best position to ensure compliance with their respective procurement laws,” it added.

The GAO went on to say that it, and others, “have found that competition is a cornerstone of procurement. Using competition can reduce costs, improve contractor performance, curb fraud, and promote accountability.”

“GAO reviewed selected Puerto Rico Medicaid procurements against federal procurement standards designed to promote competition and reduce risks of fraud. States and territories are generally not required to meet such standards. However, GAO and others have found that such standards can indicate whether a state’s or territory’s procurement process includes necessary steps to achieve fair competition,” it added.

In its assessment, GAO found that seven of the eight selected Puerto Rico procurements skipped over key steps to promote competition and mitigate the risk for fraud, waste, and abuse, underscoring the need for federal oversight.

“The requests for proposals for two of the three competitive procurements GAO reviewed did not include certain information on factors used to evaluate proposals and make awards. In contrast, Puerto Rico’s managed care procurement — the largest procurement reviewed —included this information,” the GAO saids.

It further noted that none of the five noncompetitive procurements it reviewed documented circumstances to justify not using competitive procurements, such as a lack of competition or an emergency.

“Puerto Rico officials explained that territorial law allows noncompetitive procurement for professional services regardless of circumstances,” it said.

“Because CMS does not oversee Puerto Rico’s procurement process, the agency lacks assurance that Puerto Rico’s Medicaid program is appropriately managing the risk of fraud, waste, and abuse. Procurements that did not include important steps to promote competition could have unnecessarily increased Medicaid costs, reducing funding for Medicaid services to beneficiaries,” it noted.

The GAO conducted this study following a 2019 federal indictment alleging fraudulent Medicaid procurements in Puerto Rico, which has raised questions about the program’s oversight.

 
 

Clipped from: https://newsismybusiness.com/gao-puerto-rico-spent-most-of-its-18-medicaid-budget-on-contractors/

 
 

 
 

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Careers | West Virginia University Medicaid Claims Data Specialist (Research Associate) – Health Affairs Job in Charleston, WV

 
 

The Office of Health Affairs are West Virginia University is seeking applications for a Medicaid Claims Data Specialist (Research Associate) located in Charleston, WV. The Medicaid Claims Data Specialist is a key participant in the State-University partnership between the West Virginia University Office of Health Affairs and the West Virginia Department for Health and Human Resources (WV DHHR). Overarching responsibilities include implementation and management of a data science training program to assist faculty and staff at Office of Health Affairs in analyzing administrative Medicaid claims and other state data sources. This position will also be responsible for working with the WV DHHR to leverage data resources and support analytic needs, overseeing the use of state data sources for research at West Virginia University, participating in interdisciplinary research and evaluation teams, and providing oversight and management of other data analysts and personnel embedded within the Department for Health and Human Resources. The Medicaid Claims Data Specialsit will be an employee of the West Virginia University Office of Health Affairs, however, this individual will be embedded within the Department for Health and Human Resource’s Bureau for Medical Services and will work full-time out of the Office of Health Affairs offices in Charleston, West Virginia.

In order to be successful in this position, the ideal candidate will:

  • Provide training in the analysis of administrative Medicaid claims data using SAS or other statistical analysis packages to other faculty, staff, and students at West Virginia University
  • Serves as a University representative and liaison to the West Virginia Department of Health and Human Resources for the planning and performance of projects, programs and activities involving health data analytics and program evaluation.
  • Oversee data governance and data stewardship for the West Virginia University Office of Health Affair
  • Manage a standardized data science training program for faculty and staff in the West Virginia University Office of Health Affair
  • Work as part of a team to advance the partnership between the West Virginia University Health Sciences Center and the West Virginia Department of Health and Human Resources
  • Oversee and conduct analyses of Medicaid claims data and other state data sources at the direction of leadership within the Office of Health Affairs or Department for Health and Human Resource
  • Support both West Virginia University faculty as well as leadership within the Department for Health and Human Resources in using Medicaid claims data as well as other state data sources to answer research questions of interest to the stat
  • Manage the use of state data sources for independent research by faculty, staff, and students at West Virginia University
  • Ensure that data analytic and research/evaluation activities are compliant with University-level policies for the responsible conduct of research as well as federal, and state policies.
  • Provides consultation to faculty and government partners regarding preparation of research proposals, design and methodology, data analytics and interpretation of results
  • Conduct or direct special projects as assigned.
  • Act in other matters and capacities as delegated by leadership within the Office of Health Affairs

     

Qualifications

  • PhD in health or data science-related field; or equivalent amount of combined education and work experience.
  • Two (2) years experience
  • Record of research and achievement in health outcomes and policy research (health services research, public health informatics, health policy, clinical outcomes) as evidenced by publications and / or sustained involvement in a research program.
  • Experience conducting research/evaluation using large administrative claims data sources within the healthcare industry or academic or governmental sectors
  • Experience training and managing other data analysts
  • Extensive knowledge and experience in utilizing large administrative claims databases for research, program evaluation, and policy development.
  • Experience training others in how to analyze administrative claims data using SAS or other statistical package
  • Proficiency in the use of standard statistical analysis packages such as SAS or
  • Ability to project and maintain a positive and collaborative attitude
  • Record of accomplishments in the area of health data analytics.
  • Experience managing other data analyst
  • Strong ability to communicate goals, methods, and results of research initiatives with key stakeholders
  • Proficiency presenting the results of data analyses to diverse groups of stakeholders
     

Requirements

  • Valid driver’s license and ability to travel
     

About WVU

At West Virginia University, we pride ourselves on a tireless endeavor for achievement. We are home to some of the most passionate, innovative minds in the country who push their limits for the sake of progress, constantly moving the world forward. Our students, faculty and staff make this institution one of the best out there, and we are proud to stand as one voice, one university, one WVU. Find out more about your opportunities as a Mountaineer at http://hr.wvu.edu/.

West Virginia University is proud to be an Equal Opportunity employer, and is the recipient of an NSF ADVANCE award for gender equity. The University values diversity among its faculty, staff, and students, and invites applications from all qualified applicants regardless of race, ethnicity, color, religion, gender identity, sexual orientation, age, nationality, genetics, disability, or Veteran status.
 

Job Posting: Dec 10, 2020

Posting Classification: FE/AP

Exemption Status: Exempt

Benefits Eligible: Yes

Schedule: Full-time

Clipped from: https://www.glassdoor.com/job-listing/medicaid-claims-data-specialist-research-associate-health-affairs-careers-west-virginia-university-JV_IC1143753_KO0,65_KE66,98.htm?jl=3768151460&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Help at Home Medicaid and MCO Coordinator in Chicago, IL

 
 

Medicaid and MCO Coordinator

Updated 3 days ago

Help at Home
 Chicago, IL 60602
 

Full-time

Similar jobs pay $9.25 – $15.36
 

Refer friends, get paid!

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Help at Home is still hiring in your community!

Help at Home is the nation’s leading provider of high-quality support, providing a gold standard of care to seniors and people with disabilities.  

Right now, our clients need us more than ever. We are still hiring compassionate caregivers, and we are taking every precaution to protect our communities.

We commit to being transparent and open in our hiring process to ensure your health and safety. Our clients, caregivers and employees will always be our top priority.

Help at Home seeks an experienced Medicaid and MCO Coordinator. In this role, the ideal candidate will be responsible for the administration of all Help at Home Medicaid revalidations and Manage Care Organization (MCO) credentialing functions.  
 
The Medicaid and MCO Coordinator coordinates all aspects of Medicaid revalidations and MCO credentialing. He/she will ensure all renewals are completed accurately and timely. The Medicaid and MCO Coordinator will work closely with all key stakeholders within the Business Development department and with Regional Vice Presidents to ensure all Medicaid revalidations and credentialing are completed per state regulation. Additionally, the candidate will have a solid understanding of Medicaid revalidation and MCO credentialing policies and procedures. The ideal candidate will also be responsible for key reporting, managing key metrics, monitoring due dates, and developing presentations to provide business intelligence.  

 
 

Responsibilities

  • Ensures all Medicaid revalidation is maintained and renewed accurately and timely
  • Ensures all MCO credentialing is maintained and renewed accurately and timely
  • Continued communication with Regional Vice President’s and Medicaid/Managed Care plans for follow up on licensure, applications, (effective dates/terminations), demographic changes, etc.
  • Maintains positive and professional relationships with all providers, field questions and collect data from supervisors, managers, directors, outside vendors, Interact on a project/consistent basis with various departments
  • Problem solving and troubleshooting as needed
    Stays abreast of provider recruitment and strategic partnership opportunities
  • Maintains spreadsheet on current credentials including, user identification and passwords, NPI numbers, State, and expiration dates, effective dates for each Medicaid Provider ID and MCO credentialing period
  • Maintains Medicaid revalidation and MCO credentialing trackers in smartsheet
  • More responsibilities will be added per business needs

 
 

 
 

Qualifications

  • Bachelor’s degree in a related field
  • Minimum of three (3) years of Medicaid Waiver enrollment/revalidation and/or MCO provider credentialing experience
  • 15 % or occasional travel required (adjust as needed)
  • Comprehensive knowledge of data sets and analytics
  • Proficient in Microsoft Office Suite
  • Experienced in smartsheet
  • Exceptional presentation and reporting skills
  • Strong research and analytical abilities
  • Able to work independently, and efficiently with a minimal amount of oversight
  • Excellent oral and written communication skills
  • Experience in working within the non-medical home care or home health care sectors is strongly preferred
  • Ability to work well within a diverse team and across departments
  • Flexibility to adapt to a fast-paced and dynamic work environment
  • Ability to multi-task, organize and meet deadlines
  • Personal attributes include initiative, discretions, sound judgment, collaborator, positive behavior and performance

 Clipped from: https://www.snagajob.com/jobs/603815336?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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Project Manager (Medicare, Medicaid, or Healthcare verticals) – Remote Position

 
 

Working remotely within the United States is acceptable for this position.

What you will do:

Oversees one or more software products end-to-end and assists in the direction of particular project-level activity and associated team personnel.
Works under general supervision.
Maintains relationship with client, project scope can increase in complexity and size.
Manages client relationships at the client customer work site.
Provides project management for prime or sub-contractor, fixed price, or time and materials projects.
Provides project management on projects with a team size that is up to 100 employees concurrently.
Provides project management on projects with annual total contract value of up to $50M and complexity (hours) of up to 300,000 hours.
Provides end-to-end responsibility for one or more products, sub-systems or level responsibilities.
Develops detailed, resource loaded project schedule with the required metrics.
Confers with project personnel to provide technical advice and to resolve problems.
Manages project risk by working with project schedulers to track project schedules, deliverables, and milestones; monitors costs and schedules using EVM and other tools.
Oversees and develops a feasible plan for one or more software products that achieves the goals and objectives of the project and aligns with the organization’s overall business strategy.
Assists in developing a feasible plan that achieves the goals and objectives of the project and aligns with the organization’s overall business strategy.
Determines project scope and recommending and assigning resources as available.
Determines estimated time and financial commitment of project, and in monitoring progress.

General:

Implements, maintains, and reports Earned Value (EV) metrics into project plans.
Implements, maintains, and reports CNSI project delivery metrics into project plans.
Assists in monitoring and developing a project budget and tracking actual spend compared to the planned budget, escalating to senior leadership as needed.

Customer:

Partners with customers and analyzes issues and problems from the customer perspective.
Provides customer-facing presentations on quality.
Communicates and provides status to define, schedule, and accurately estimate the task duration for project schedule.
Possesses unwavering commitment to customer service and operational excellence.
Keeps abreast of new technology and market developments.
Adheres to CNSI CMMI standards and processes.
Manages internal customer relationships for long-term corporate success

Talent Development:

Requests and gives both negative and positive feedback.
Recruits highly skilled, motivated leaders and individual contributors and recommends potential new hire resources to meet client commitments in alignment with program delivery.

Project:

Familiarity with medical bill and provider enrollment forms.
Identify reoccurring problems and provide feedback to management to affect change.
Familiarity with payment adjustments, claim disputes, prior authorization, claims processing,
Manage sensitive data in accordance with HIPAA and Medicaid regulations.

About us:

We are proud to be a partner to the public sector, a trail blazer in health IT and a passionate advocate for better health, better care and lower costs for millions of Americans. Innovation is core to our DNA and through our iCare program we invest in the well-being of our employees and the communities in which we live and work. You will be offered a solid compensation package which includes:

• Annual and Other Paid Leave
• Medical/Dental Insurance
• Flexible Spending Account (FSA) Plan
• Disability Insurance (Short & Long Term)
• Life Insurance
• 401(k) Retirement Savings Plan
• Employee Assistance Program
• College Savings Plan
• Tuition & Training Assistance
• Paid Holidays
• Employee Referral Program

CNSI maintains a policy supporting equal employment opportunity. Employment decisions at CNSI are made without regard for race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status or any other status protected by applicable Federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.

#LI-CV1

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35©

Clipped from: https://motherworks.com/job/995231/project-manager-medicare-medicaid-or-healthcare-verticals-remote-position/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on by

Director of Finance Medicare/Medicaid, Countycare – Finance

 
 

Chicago, IL, USA | America’s Health Insurance Plans (AHIP)

The Director of Finance Medicare/Medicaid, County Care provides leadership and oversight for the Cook County Health’s strategic plan for Medicaid and Medicare products. This includes, but is not limited to, responsibility for County Care financial reporting, driving medical cost action planning processes and execution to achieve established goals and targets. Assists in hiring and managing County Care Finance Department Staff. Work with the Director of Finance to create an innovative department, which is in alignment with and supports the Cook County Health’s mission statement and strategic plan.

This position is exempt from Career Service under the CCH Personnel Rules.

 
 

Minimum Qualifications

 
 

* Bachelor’s degree from an accredited college or university (Must provide official transcripts at time of interview)

* Five (5) years of managed care health plan finance experience

* Two (2) years of management experience

* Current knowledge of Medicare and Medicaid programs, rules and regulations

* Intermediate proficiency with Microsoft Word and Excel

 
 

Preferred Qualifications

 
 

* Master’s Degree in Finance, Economics, or other related quantitative field (Must provide official transcripts at time of interview)

Clipped from: https://www.ivyexec.com/job-opening/director-of-finance-medicaremedicaid-countycare-finance/chicago/illinois/usa?job_id=8061643&ref=ccjsv&promo=ccjsv&ccuid=29504120317