Curator – Mostly Medicaid

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Biden picks Chiquita Brooks-LaSure to run Medicare, Medicaid

MM Curator summary Biden's has officially selected his nominee for the top CMS job. The article below has

Aetna protests Oklahoma managed Medicaid picks: 4 things to know

MM Curator summary The protest stage of the OK MCO procurement has begun, with Aetna batting first. The article

Federal government asks court to scrap challenge to Medicaid work requirements

MM Curator summary Biden has asked SCOTUS to cancel a planned case on work requirements. The article below

Congress Requires New Medicaid Payment Reporting

MM Curator summary States will now have to report more information on Medicaid supplemental payments to providers. The

Nevada Medicaid enrolls record 810,000 residents

MM Curator summary Nevada has a new record for Medicaid enrollment, and its nearly 15% higher than the previous

Audit: N.C. Medicaid failed to confirm provider qualifications

MM Curator summary A new NC audit showed the Medicaid agency has extensive problems with using banned providers. The

House Lawmakers Include 7.35% Medicaid Boost for Home- and Community-Based Services in Stimulus Proposal

MM Curator summary One of the Medicaid components of the $2T pandemic bill would be a 7% for

House Plans Medicaid, Drug Price Reforms: Stimulus Update

MM Curator summary Under the current bill, Medicaid will get $350B (18%) of the pandemic relief package. Vaccines and

2 million Washingtonians rely on a Medicaid system that’s driving away doctors and dropping new mothers

MM Curator summary WA state senators are targeting multiple fixes to the state Medicaid program, with a focus

Gov. Stitt likely to prevail in Medicaid fight, says House Speaker Charles McCall

MM Curator summary OK managed care appears safe, with the legislature struggling to get the votes needed to overturn the

Feds woo Georgia, other Medicaid expansion holdouts with billions

MM Curator summary Biden dangles $20B+ in front of non-expansion states. The article below has been highlighted and

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

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

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

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

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

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

Anthem To Buy Puerto Rico Medicare And Medicaid Plans

MM Curator summary Anthem will pick up more than 500,000 lives with the purchase. The article below has

Public Charge Executive Order Met With Cheers and Jeers

MM Curator summary The new HHS administration has been ordered to review the Public Charge rule designed to reduce

Department of Human Services Provides Updates on Work Supports System for Medicaid Recipients

MM Curator summary Pennsylvania continues the rollout of its program to connect Medicaid members who want to work to

State leaders react to Medicaid bill funded by medical marijuana

MM Curator summary Kansas Governor Kelly is proposing to fund Medicaid expansion with marijuana taxes. The article below

Judge blocks Texas effort to remove Planned Parenthood from Medicaid

MM Curator summary The Texas effort to block state funds to the abortion chain is working its way through

The Health 202: Biden narrows picks to lead Medicare and Medicaid down to two choices

MM Curator summary A Manatt consultant and former Bacerra associate is being heralded as the next head of CMS.

Governor drops proposal for Medicaid budget cut

MM Curator summary Governor Little dropped a planned $30M cut to Medicaid because he says the enhanced federal funds

Indiana Lawmakers Propose Using Cigarette Tax For Medicaid

MM Curator summary The state is considering a new $1 tax to cigarettes and redirect 40% of the existing

Medicaid expansion cost-share deal would stay put in Warnock, Ossoff bill

MM Curator summary A Georgia Senator has introduced a bill to expand Medicaid at 100% federal costs for states

Some Illinois Medicaid patients in Chicago have limited pharmacy access

MM Curator summary The Aetna decision to block CVS competitor Walgreens from Medicaid payments has left members with less

Nevada Medicaid provides same-day transportation for testing and vaccines

MM Curator summary Nevada Medicaid is getting members to their vaccination appointments and also providing gas costs reimbursement for

CMS Failed to Flag Medicare Fee-for-Service Healthcare Fraud, Waste

MM Curator summary CMS did not use a method recommended by OIG for preventing payments to providers known to

18 states back Arkansas on Medicaid work rule

MM Curator summary More than 1/3rd of states have registered their support of their right to use work requirements

Humana to Begin Serving Medicaid Managed Care and Dual Eligible Residents in South Carolina

MM Curator summary Humana will begin serving South Carolina Medicaid members July 1, 2021. The article below has

Florida Medicaid website hacked for 7 years, hundreds of thousands affected

MM Curator summary The website that hosts the application for multiple Florida Medicaid programs had a data vulnerability for

Executive Order on Strengthening Medicaid and the Affordable Care Act | The White House

MM Curator summary The new HHS administration has been instructed to open a special enrollment period for the exchanges

Analyzing Recent Trends in Medicaid/CHIP Applications: What We Do and Do Not Know

MM Curator summary KFF is unable to tell if the economy impact of COVID or the moratorium on eligibility

Oklahoma chooses vendors for $2 billion program partially privatizing Medicaid

MM Curator summary Winners include BCBS of Oklahoma, Humana, Centene and UnitedHealthcare. The article below has been highlighted

Threat of Medicaid block grants could be axed under Biden

MM Curator summary The new HHS administration has been ordered to review all policies and waivers that may restrict

DHHS approves Legal Aid of N.C. as Medicaid transformation ombudsman services

MM Curator summary NC awards Legal Aid contract to help members navigate issues during the transition to managed care.

Sweeney, Greenstein Initiative to Improve Medicaid Prescription Drug Services Wins Committee Approval

MM Curator summary NJ is looking to contract with a third party entity to address risks of polypharmacy.

Medicaid, education numbers most notable in Gov. Sisolak’s proposed 2021-2023 executive budget

MM Curator summary Nevada Medicaid enrollment grew 18.7% more than expected, and now the bill is coming due. The

Key MS House leader offers bill to restructure authority over Division of Medicaid

MM Curator summary Mississippi wants to take away Medicaid from the Governor. The article below has been highlighted and

Senators negotiate first steps in funding Missouri’s mandated Medicaid expansion

MM Curator summary Lawmakers are looking for ideas on how to pay for what the voters decided. The

Kentucky Medicaid bill would reduce managed care organization contracts to three

MM Curator summary Lawmakers frustrated with the court decision to squeeze in a sixth MCO are pushing back.

Outgoing HHS Secretary Files Supreme Court Brief Supporting Medicaid Work Requirements

MM Curator summary Azar filed a brief on his way out, reiterating the argument that applying enrollment controls

Medicaid pays $6.6 billion for HCBS for older adults through Section 1915c waivers – News – McKnight’s Senior Living

MM Curator summary HCBS spending decreased 26% in 2018 compared to 2017. The article below has been highlighted

WI Submits Medicaid Demonstration Waiver, Health Savings Account Program

MM Curator summary Wisconsin has asked CMS to put all of the premium payments made by Medicaid members into

Nevada lawmakers told Medicaid will require nearly $12 billion over 2 years

MM Curator summary Medicaid now consumes more than 33% of the Nevada budget, and will spend $2B next year

State senators argue over plans to move Medicaid onto managed care contractors (Oklahoma)

MM Curator summary Lawmakers do the normal "big bad managed care" dance on the eve of managed care coming

Amazon surpasses Walmart for most Nevada employees and dependents on Medicaid

MM Curator summary 7,892 Amazon employees are on Nevada Medicaid now, up from 4,040 last year. The article

New Mexico leads nation in Medicaid health care enrollment

MM Curator summary 43% of all people in New Mexico are on Medicaid now. The article below

Medicaid Concepts: Waivers

What is a Medicaid waiver? A Medicaid waiver program is a special program that allows a state to vary from

Feds boost Florida’s Medicaid coffers by extending COVID-19 public health emergency

MM Curator summary The public health emergency was extended to April, sending $130M more to FL alone. The article

Ohio names one pharmacy benefit manager for Medicaid to save cash

MM Curator summary Gainwell will become the new PBM in Ohio, beating out 5 other bidders including Express Scripts and

Congress Delays Medicaid DSH Cuts, Makes Targeted Medicaid Policy Changes | Manatt, Phelps & Phillips, LLP – JDSupra

MM Curator summary The latest COVID relief bill also delays DSH reductions another 4 years (they have been continuously

California proposes expanding Medicaid coverage of continuous glucose monitors

MM Curator summary California wants to add $12M in the next fiscal year's budget to pay for CGM for adults

Bill to end Medicaid managed care advances in Illinois House

MM Curator summary Illinois lawmakers are ready to be done with MCOs. The article below has been highlighted and

CMS won’t add new Medicaid accountability rule

MM Curator summary Industry opposition has officially killed the last effort to reform entrenched Medicaid financing schemes. The article

Medicaid transformation initiative remains on pace for July 1 launch (NC)

MM Curator summary North Carolina is set to roll out managed care for the first time this July. The

Corrado Bill Raising Reimbursement Rates for Medicaid Private Duty Nurses Advances (NJ)

MM Curator summary New Jersey legislation would raise home-based nursing care rates by about 50%. The article below has

Info of hundreds of Wisconsin Medicaid members may have been exposed

MM Curator summary A data breach in Wisconsin may have revealed personal health information of 1,200 members. The article

Artificial intelligence machine was able to dupe Medicaid.gov

MM Curator summary A bot submitted half the public comments on a proposed Medicaid program change. The article below

Colorado public option bill sponsor says the proposal will be reintroduced this year

MM Curator summary The Colorado public option is back on the table, with perhaps a few changes since we last

CMS Releases Guidance on Funding for SDH Programs

MM Curator summary The 51-page new guidance layouts several details CMS will use to assess whether state programs are

Medicaid Concepts: Waiting Lists

What are waiting lists? Waiting lists are used to ration services for severely disabled Medicaid members who need them. These

CMS issues guidance for state Medicaid SDOH programs

MM Curator summary CMS guidance on priority focus areas for SDH efforts in Medicaid is now out. The article below

Appeals Court Upholds Trump Rule Requiring Hospitals to Show Prices Upfront

MM Curator summary Despite industry opposition, hospitals will now have to report the prices they accept from insurers as payment.

The Centers for Medicare & Medicaid Services Could Improve Its Wage Index Adjustment for Hospitals in Areas With the Lowest...

MM Curator summary A recent CMS audit of wages paid in hospitals will likely be used to increase the wage

UnitedHealth to Purchase Change Healthcare for $8 Billion

MM Curator summary The health insurance giant continues its payer and provider services build out with the $13B purchase of

Trump Team Approves Controversial Request To Revamp Medicaid In Tennesssee

MM Curator summary TN received approval for its first-of-its-kind innovation waiver to share savings it creates in its Medicaid program

Aetna drops Walgreens from its Illinois Medicaid plan

MM Curator summary Analysts speculate that the move is simply CVS excluding a top competitor. The article below has been

Humana files new Medicaid lawsuit over membership assignment – Louisville Business First

MM Curator summary Humana is arguing that Passport did not have the right to sell future enrollment to Molina, as

CMS officially withdraws $50B threat to Medicaid

MM Curator summary CMS officially withdrew the Medicaid Financial Accountability Regulation after a year of intense industry protest on the

Commonwealth Provides Update on Latest Medicaid, SNAP Enrollment Data, Announces Recent Changes to SNAP Benefits and Eligibility

MM Curator summary PA has seen a 10.6% increase in Medicaid enrollment during the pandemic and a 5.6% increase in

Centene Is Climbing on Its Plans to Buy Magellan Health for $2.2 Billion

MM Summary Centene adds a giant pharmacy services component with the purchase of Magellan. M&A activity continues to pick up

Centene Is Climbing on Its Plans to Buy Magellan Health for $2.2 Billion

MM Summary Centene adds a giant pharmacy services component with the purchase of Magellan. M&A activity continues to pick up

Medicaid Concepts: Medical Loss Ratio

What is the Medicaid Loss Ratio? Medical Loss Ratio is the proportion of premium revenues spent on clinical services and

Data Set Review- 2020 MACStats Data Book

Summary While MACPA puts out a Medicaid and CHIP data book each year, this one is especially important because it

Georgia is not reporting adequate Medicaid, PeachCare data

MM Curator summary- Georgia has gone from reporting 75% of CMS program measures to only 25%. The article below has

Virginia May Have to Foot the Bill for Commonwealth Center’s Mistake

MM Curator summary- an incorrect facility type designation lead to $11M in inappropriate payments for a Virginia behavioral health facility.

As relief stalls, restoring Medicaid for Dubuque’s Marshallese is hanging in the balance

MM Curator summary: Funding for Medicaid services in the Marshall Islands may resume at higher levels under the latest coronavirus

Tennessee Medicaid plan’s vendor mails PHI to wrong members, exposes 3,300 individuals’ info

MM Curator summary: Tennessee reported a data breach for members that occurred when mailings were sent to the wrong address

Larry Hogan announces that Medicaid reimbursement increases will go into effect January 1

MM Curator summary: Maryland will begin paying BH and LTC providers more January 1 via a rate increase of

State still waiting to hear word about Medicaid waiver

MM Curator summary: Tennessee has not given up his efforts to get its first-of-a-kind Medicaid block grants approved by CMS.

Work Requirements Can Preserve Medicaid For Those Who Need It Most

MM Curator summary: The author of this Forbes op-ed argues that ACA underprojections and the rich FMAP for expansion enrollees

DHHS childhood reading program gains $3 million in federal Medicaid funding

MM Curator summary: The NC Reach and Read program just got more funding to partner with pediatricians to encourage early

CMS finalizes rule for greater pricing flexibility for Medicaid drug purchases

MM Curator summary: CMS has begun the process to define value based purchasing arrangements for drugs in the Medicaid program,

D.C. Medicaid contract awards violated procurement rules, judge says

MM Curator summary A judge has ruled that the latest round of DC MCO contract awards must be re-evaluated. The

2020 MACStats Released by MACPAC

MM Curator summary The first MacPac data book with T-MSIS data is now available.

Medicaid costs, enrollment spiral in pandemic

MM Curator summary Florida Medicaid will cost 19% more this year- but the state will have a

1199SEIU pushing to repeal medicaid drug carve-out

MM Curator summary Provider groups that can currently use the 340B program to redirect millions of surplus dollars are

With new model, CMS opens up home care opportunities for MCOs serving dual eligibles – Home Care Daily News –...

MM Curator summary A new CMS direct contracting model will allow Medicaid health plans to provide more services in

Medicaid and CHIP enrollment grew 5.6% since last year

MM Curator summary COVID and unemployment drove most of the 5.6% increase in the Medicaid rolls seen from

U.S. Supreme Court takes Medicaid work-requirement appeal with N.C. implications | Local News | journalnow.com

MM Curator summary North Carolina Medicaid expansion is tied to whether the state can have a work requirement,

Medicaid MCOs covering dual-eligibles to join direct contracting

MM Curator summary CMS will start allowing health plans that serve duals to participate in shared savings on the Medicare

HHS Proposes New Prior Authorization Rules for Medicaid, CHIP and Certain Marketplace Plans – Manatt, Phelps & Phillips, LLP

MM Curator summary A new federal DHS rule will require payers to implement technology that reduces complexity and delays

As pandemic tears through Louisiana’s economy, Medicaid enrollment surges by 208,000 | Legislature | theadvocate.com

MM Curator summary COVID has driven a dramatic surge in Louisiana Medicaid enrollment, but the current DHS Director says

A year in, Idaho is paying more for new Medicaid enrollees with expensive conditions… | Eye on Boise | idahopress.com

MM Curator summary Idaho Medicaid expansion will cost the state 50% more than projected this year and 100% more than

annual-report-on-certain-fraud-and-abuse-recoveries-fy-2020.pdf

Texas releases its annual report of fraud recoveries made my Medicaid health plans. Clipped from: https://oig.hhsc.texas.gov/sites/default/files/documents/annual-report-on-certain-fraud-and-abuse-recoveries-fy-2020.pdf