Monday Morning Medicaid Must Reads: June 18th, 2018

Helping you consider differing viewpoints. Before it’s illegal. 


Article 1:  

State blew $1.3 billion on Medicaid coverage for people already enrolled in other plans, audit finds, Caroline Lewis, Crain’s NY Business, June 13, 2018

Clay’s summary: TPL is hard, and so is not overpaying cap to plans. But hey – what’s $1.3B?

Key Passage from the Article


Thanks to a lack of oversight, the state Health Department doled out $1.3 billion in six years in Medicaid premiums for people who were already enrolled in other comprehensive health plans, according to a new report from state Comptroller Thomas DiNapoli.

The report found that the state Health Department is not quick enough to disenroll people when they sign up for coverage with another insurer. The overwhelming majority of those funds—about $1.2 billion—are not recoverable.

“Glitches in the state Department of Health’s payment system and other problems led to over a billion dollars in unnecessary spending,” DiNapoli said. “The department needs to improve its procedures and stop this waste of taxpayer money.”

The waste in question, while considerable, accounts for a fraction of the annual Medicaid budget. New York’s Medicaid program, which is funded by federal, state and local governments, spent $58 billion for services for some 7.4 million members in fiscal 2017 alone.

The majority of Medicaid members in New York are enrolled in mainstream Medicaid managed-care plans, which are run by private companies or nonprofit organizations that receive monthly payments for each member from the government. The state Health Department is responsible for disenrolling members from those Medicaid plans as soon as it learns they have enrolled in another comprehensive health plan.


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Article 2:   

WellCare to buy Meridian for $2.5 billion, boosting its Medicaid membership, Shelby Livingston, Modern Healthcare, May 29, 2018

Clay’s summary: WellCare continues the acquisition march and buys a stake in the hot mess that is the IL Medicaid market.

Key Passage from the Article


WellCare Health Plans has agreed to acquire Medicaid insurer Meridian Health Plan for $2.5 billion, it announced Tuesday.

The insurers expect the deal to close by the end of 2018. Tampa, Fla.-based WellCare said the acquisition will bolster its Medicaid business by boosting membership in several states. WellCare will also benefit from adding Meridian’s in-house pharmacy benefit manager MeridianRx to its portfolio.

The deal “will grow and diversify our Medicaid and Medicare Advantage businesses” and “add new and enhance existing capabilities,” WellCare CEO Kenneth Burdick said on Tuesday.

WellCare’s announcement comes amid rampant consolidation in the health insurance industry, as health plans pair up with other insurers, ambulatory care providers and PBMs. Anthem last week bought Aspire Health, a Nashville-based palliative care company. Humana has struck deals to buy stakes in home health services provider Kindred Healthcare and hospice operator Curo Health in recent months.

While MeridianRx is a relatively small operation serving mostly Meridian members, bringing a PBM in house could give WellCare a foundation to grow its pharmacy management capabilities as fellow insurers Aetna and Cigna Corp. pair up with PBM giants CVS Health and Express Scripts, respectively.


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Article 3:   

AHCA, Health Plans Huddle Over Medicaid Challenges, News Service of Florida, May 17, 2018

Clay’s summary: Let’s start the protest music. Here we go again…

Key Passage from the Article


Agency for Health Care Administration Secretary Justin Senior is meeting with 12 managed-care companies that filed petitions with the state last week, as he tries to dissuade them from legal fights over the state’s decisions to award five-year Medicaid contracts that could be worth up to $90 billion.

Mallory McManus, an AHCA spokeswoman, forwarded a schedule to The News Service of Florida that showed Senior, Medicaid director Beth Kidder and three other staff members expected to meet with three companies on Wednesday: Aetna Better Health, which is challenging the state’s decisions in eight Medicaid regions; Magellan, which is challenging decisions statewide; and Prestige Health Choice, a plan that is partially owned by insurance company Florida Blue and is challenging decisions in nine Medicaid regions.

Senior kicked off the meetings with managed-care companies on Monday, talking with Lighthouse Health, a provider-sponsored plan hoping to get managed-care contracts in Medicaid regions 1 and 2.



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