Tag: State News

MM Curator summary

[ MM Curator Summary]: A recent audit suggests the two programs do not duplicate services, but the Medicaid agency disagrees.

 
 

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.

 
 

 
 

A look at the millions of dollars Florida is spending on health care and social services for pregnant women, infants and children shows little duplication and offers good news to those who support the programs.

A recently released report conducted by the Office of Program Policy and Government Accountability shows there’s not much overlap in care provided by state-contracted Medicaid managed care plans versus services offered by the Florida Healthy Start program.

“Overall, the report is extremely positive,” Catherine Timuta, chief executive officer of the Healthy Start MomCare Network, told Florida Politics Tuesday. “There weren’t any significant findings of duplication.”

OPPAGA began a review of the services the HealthyStart MomCare Network and statewide Medicaid managed care plans offer pregnant women to see if they were duplicating services and whether those services meet state and federal requirements.

To that end, OPPAGA researchers reviewed contracts between Medicaid-managed care plans and the Florida Association of Healthy Start Coalitions, which contracts with the plans on behalf of 33 local groups.

OPPAGA also reviewed Agency for Health Care Administration contracts, including one between AHCA and the Healthy Start MomCare Network, which holds contracts with the state on behalf of the 33 local Healthy Start Coalitions.

“These agreements show overlap between the entities in two areas: care coordination and data sharing,” the OPPAGA report notes.

Timuta noted, however, data sharing is mutually beneficial for the health plans and the coalitions, because it provides both entities with information on the enrollees and the services they receive.

To delve into the coordination of services, OPPAGA staff conducting the research also did follow up interviews with Healthy Start and representatives from Medicaid health plans to get additional details on the care coordination services provided. Eight of the nine health plans told OPPAGA there was no service duplication.

“While some services provided by health plans and Healthy Start may appear similar, Healthy Start and health plan staff reported that services provided via the two entities are largely distinct and complementary,” the report notes.

The Health plans and Healthy Start both provide home visits, but Healthy Start staff told OPPAGA researchers their program participants are visited at least once a month and are provided prenatal education, parenting education, interconception education, stress management education and screenings. The health plans told OPPAGA researchers home visits for health plans are short-term services and have a more medical focus.

AHCA, though, didn’t see things the same way.

According to the report, “AHCA staff reported that some services included in the AHCA-MomCare Network contract are also covered under the AHCA-health plan.”

However, the report notes that due to data limitations, the existence of duplication cannot be validated.

“OPPAGA staff requested AHCA claims data in an attempt to verify whether service duplication is occurring. However, while Healthy Start services are contained in AHCA’s claims data, health plans reported that the services that may be considered comparable to Healthy Start (e.g., home visits and community referrals) are provided as part of care coordination, which is not a billed service and thus does not appear in the claims data,” the report notes. “Because data for services provided by health plans are not available in AHCA’s encounter data, claims data analysis cannot be used to validate whether there is service duplication between Healthy Start and the health plans.”

According to the report, OPPAGA requested agency staff to provide them with the procedure codes used by health plans to ascertain if there was a difference between social and medical service provisions, but the agency did not provide OPPAGA the information.

OPPAGA is the research arm of the Florida Legislature. It provides lawmakers with data, evaluative research, and objective analyses meant to inform policy decisions.

The report shows that in state fiscal year 2020-21, Medicaid health plans submitted data on 104,935 enrollees to the Florida Healthy Start, of which 66,191 matched a case in the Florida Healthy Start system.

Of those 66,191 women, about 73% of them, or 48,267, received at least one service. When asked about the women who didn’t receive services, Timuta, chief executive officer of the Healthy Start MomCare Network, said the program is voluntary.

The report comes as Florida lawmakers prepare to meet for the 2022 Legislative Session where work on the upcoming fiscal year 2022-2023 budget begins.

The 2021 Legislature appropriated $63.1 million to AHCA for Healthy Start services provided under the contract between AHCA and MomCare, a $21.9 million increase from the prior fiscal year. The funds covered a near $11 million deficit, which AHCA said was caused by COVID-19, and provided services to a growing number of women, infants, and children.

A review of Gov. Ron DeSantis’ proposed budget for fiscal year 2022-2023, though, shows the Governor is not recommending that the $21.9 million bump in funding be continued in the 2022-2023 budget, which lawmakers will work to create when they meet in Session in January.

Christine Jordan Sexton is a Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.

Clipped from: https://www.claytodayonline.com/stories/report-medicaid-health-plans-florida-healthy-start-dont-provide-same-services,32402

MM Curator summary

[ MM Curator Summary]: Molina completes another acquisition, this time adding 50,000 lives.

 
 

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.

 
 

Dive Brief:

• Molina has completed its acquisition of rival health insurer Cigna’s Medicaid contracts in Texas, the California-based payer said Monday, as it continues to invest heavily in the safety-net insurance program.
  
• The purchase price for the transaction was approximately $60 million in cash, according to a recent filing with the SEC.
  
• Though Molina was already active in Texas, nabbing Cigna’s beneficiaries is a significant add: As of November, Cigna covered approximately 50,000 Medicaid beneficiaries in the state. Molina closed out 2020 with 357,000 members in Texas. 
  

Dive Insight:

Molina covers some 4.8 million people in the U.S., but Medicaid is the payer’s flagship business, representing more than three-fourths of its members (and premiums). The program has grown because of the pandemic, causing some players in Medicaid markets to ratchet up their investments and others to jump in for the first time.

Molina is known for being acquisitive, but has been on a tear as it looks to capitalize on this growth. Currently, the payer offers Medicaid plans in 18 states, with the greatest scale and revenues stemming from health plans in California, Ohio, Washington and Texas.

Moving to nab Cigna’s Medicaid contracts in Texas, first announced in April, is one such recent deal that should yield significant financial returns for Molina: Cigna’s some 50,000 Medicaid members in the state represent approximately $1 billion in annual premium revenue.

Along with recent contract wins in Nevada and Ohio, Molina also in October announced it had closed its acquisition of New York Medicaid health plan Affinity Health for approximately $380 million, and that it had entered into a definitive agreement to acquire AgeWell’s New York’s Medicaid managed long-term care business for approximately $110 million.

The AgeWell deal, which will add about 13,000 members to Molina’s rolls representing about $700 million in premium revenue, is expected to close by the third quarter this year.

Like most other major payers, COVID-19 ushered Molina to high profits in 2020, but more recently has negatively impacted the insurer’s finances. Molina’s net income in the third quarter of $143 million was down 23% year over year as the payer shelled out more for patient care than in the prior-year quarter.

Despite COVID-19’s volatility, Molina has been managing well in the markets, outperforming the S&P 500 last year. But the stability of the Medicaid rolls it’s so dependent on is a key area of interest for market watchers, as the longevity of the public health emergency will determine if and when a restart of Medicaid redeterminations will impact managed care organizations this year.

The Families First Coronavirus Act, passed in March 2020, gave states a temporary bump to their federal match funds in the Medicaid program as long as they ensured eligible beneficiaries stayed enrolled during the national emergency. That continuous coverage requirement contributed to Medicaid becoming the largest single source of insurance coverage in the U.S.

But when the emergency ends, states can resume redeterminations, potentially kicking millions off the safety-net insurance due to a change in income or other factors.

Molina said along with its third quarter financial release it expects the public health emergency to run at least through mid-January.

The payer’s Medicaid enrollment has ballooned to about 4 million members at the end of the third quarter, due primarily to the continuing suspension of redeterminations. Molina estimates that’s resulted in an increase of more than 700,000 Medicaid members since the beginning of the pandemic.

However, CEO Joe Zubretsky told investors in October the insurer expects to keep only half of those new Medicaid members gained during the pandemic after redeterminations are resumed nationwide.

Clipped from: https://www.healthcaredive.com/news/molina-closes-60m-acquisition-of-cignas-medicaid-contracts-in-texas/616674/

MM Curator summary

[ MM Curator Summary]: A state legislator wants to pre-empt the MCO protest machine.

 
 

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.

 
 

 
 

Sen. Jason Brodeur filed SB 1950, a 36-page proposal to reduce Florida’s number of Medicaid managed care regions — from 11 to eight — and require managed care plans to contract with two of the state’s cancer hospitals.

Filed Monday, the bill, in an attempt to blunt potential legal challenges to the nine-figure Medicaid procurement, contains language that would preclude any managed care plan from providing care to any of its enrollees until all administrative challenges to the procurement are settled.

Brodeur’s proposal would reconfigure the current 11 Medicaid-managed care regions.

The bill consolidates Medicaid Regions 1 and 2 into a Medicaid Region A. Medicaid Regions 3 and 4 will roll into the new Medicaid Region B. And Medicaid Regions 5 and 6 are rolled together into Region C. The rest of the Medicaid regions remain the same, with letters replacing numbers.

Florida requires most Medicaid beneficiaries to enroll in a managed care plan to receive services from the cradle to the grave. Only Medicaid-managed care organizations that win competitively bid Medicaid contracts in a region can provide the care. The current Medicaid managed care contracts expire on Dec. 31, 2023. The agency is gearing up to begin the new procurement process and work on the new Medicaid managed care contracts to replace the current agreements.

 
 

The bill comes weeks after Agency for Health Care Administration Secretary Simone Marstiller signaled the agency would push for some legislative changes to the program.

Marstiller asked lawmakers in the fall to include an additional $2 million in her agency’s fiscal year 2022-2023 budget to hire outside counsel.

Marstiller said she wanted funding available to the agency “at the ready” to ensure her team can employ the best outside legal help available.

The Senate bill does not propose any changes to the Medicaid dental program, although Medicaid Director Tom Wallace hinted the agency might want to pursue changes.

The bill also requires Medicaid-managed care plans to contract with Sylvester Comprehensive Cancer Center and Moffitt Cancer Center.

The Brodeur bill eliminates the state’s requirement to allow the public to have feedback before submitting Medicaid amendments to the federal government for review. AHCA told Florida Politics Tuesday the public comment requirement being eliminated from the bill was specific to creating the Medicaid managed care program. Federal law still requires a public comment period.

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Clipped from: https://floridapolitics.com/archives/485399-medicaid-managed-care-bill-drops-on-eve-of-2022-legislative-session/