Clay’s Weekly Medicaid Roundup: Week of February 22nd, 2016

WEBINARS HAVE BEEN AWESOME- Thank you to the hundreds of folks who have signed up and attended. We had a great State Spotlight show on RI last week, and yesterday’s Medicaid News Roundtable was a blast. If you’re not signed up, it’s free @ .

MULTIPLE CHANGES TO AK MCD ON THE TABLE- Bring in managed care, focus on PCPs, privatize the state-run Pioneer Homes (nursing homes)- it’s all being discussed in subcommittees this week.

BUDGET SHORTFALL #S ROLLING IN- All #s are for the Mcd shortages only: DE- $29M, VA- $125M, MS – $52M. Don’t anyone worry, all the states will wind up spending more on Mcd, as they always do each and every single year. Its just a matter of how much time, how many special sessions and how much fiscal-conservative shaming will be required to get there.

EXPANSION IN MAINE TAKES A TWIST- Maine rep Saviello (D) is pushing a a private-option style expansion plan for Medicaid, but this week started tie-ing it to reducing heroin addiction. Maybe someone should tell the Good Rep that he doesn’t have to expand all of Medicaid but can just get a waiver to run a special heroin treatment program? Especially if you look at the gigantic cash the 2016 White House budget is putting at fighting opiod use alone?

EXPANSION IN WYOMING TAKES A FALL- Expansioners in The Cowboy State are now O for Four the last four years. A 20-10 Senate vote against shot it down on Friday.

EXPANSION IN ARKANSAS TAKES A BEAT- The Good Guvn’r Hutchinson returned down from the mountain after horsetrading concluding talks with CMS and put the ball in the legislature’s court. CMS was not too hot on his employment requirements for expansion cash, but the legislators have to approve any changes before CMS will look at it anyway.

PA REDUCES MEDS USE IN FOSTER CARE- Seems the Keystone State was able to cut psychotropic med use by 75% over 2 years for foster kids when it put in prior auth requirements. Put another way, when docs were slowed down by the hassle of proving it was needed for the vulnerable child (instead of just grabbing whatever samples in their lab coat pocket that the endless stream of pharma reps coming through their door put in there), they prescribed it 75% less. So all you have to do to get doctors treating foster kids to provide quality care is make something inconvenient for them?

SC PUTS UP REAL CONTROLS TO FIGHT OPIOD USE- Sort of like the PA story above, SC is now requiring docs to check a statewide database before prescribing any controlled substance. Not sure it will have the same 75% impact as the PA story, but surely it will slow docs (and doc shoppers) down a good bit. I guess if you don’t want to have your data stored on that new system, you should get an iphone. I hear those things can’t be hacked, even by Jack Bauer.

WELLCARE GOES SHOPPING- It’s been 2 years since WC dusted off the credit card. This week’s acquisition is Advicare, which runs an MCO in SC. WC announced its going on a shopping spree last week, and has nearly $1.3B to spend.

MEGARULE ARRIVES AT OMB- Elvis has left the building at Security Blvd and has trotted on over to OMB. The 653 page mega rule transforming Medicaid managed care (see our webinar on this last summer for a LOT more info) has been commented upon, and now goes to OMB for review. OMB review process rules are a bit tricky, and can take up to 90 days. Or forever if restarts happen. First reader to write in and tell me how many comments the rule received gets a $25 Amazon gift card.

That’s it for this week. As always, please send me a note with your thoughts to or give me a buzz at 919.727.9231. Get outside (build a fire!) and keep running the race (you know who you are).


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News that didn’t make it and sources for those that did: twitter @mostlymedicaid

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