October 2020 Medicaid News Recap Syrtis Solutions


Syrtis Solutions distributes a Medicaid newsletter on a monthly basis to help you stay informed. The newsletter focuses on legislation, insights, comments, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse. Here is a summary of last month’s noteworthy developments.

Reductions in the amount of state money paid health care providers through Medicaid made as a way to tackle the state’s budget shortfall could result in providers leaving the program, according to the Wyoming Department of Health. The department, in a report outlining the impacts of its $28 million reduction in benefits it pays for health care for some Wyoming residents, said the reductions will lead to limits on services in some cases.  read more


After voters expanded Medicaid in conservative states like Missouri and Oklahoma, healthcare advocates are renewing a push for expansion in Mississippi and other Southern states where Republican leaders have long been opposed. Observers say the changing tide has followed rising income inequality, joblessness and pressure from hospitals in economic turmoil—issues exacerbated by the coronavirus pandemic.  read more


WRAL, August 27
A state judge has dismissed claims filed by several losing bidders that Blue Cross Blue Shield of North Carolina was improperly awarded a massive contract for a chunk of North Carolina’s Medicaid program when it shifts to a managed care format next year. Blue Cross was among five providers to divide a $6-billion-a-year contract from the state Department of Health and Human Services to handle Medicaid claims. The state has for years been trying to move from a fee-for-service program, which often ran deficits the state had to pay, to a managed care format, with the providers getting a set amount for each person served. The transition is expected to occur next July. read more


Syrtis Solutions Blog, August 25
Prescription drug costs in the Medicaid program have caused tremendous fiscal pressure on state budgets over the years. In 2017, prescription drugs accounted for 5.1 percent of Medicaid benefit spending and this cost continues to rise. To curb drug costs states generally use MCOs and PBMs to deliver pharmacy benefits. However, some states have opted to carve-out pharmacy and transition to FFS models. In July, Ohio became the most recent state to transition from managed care and released a RFP for a SPBM.  read more


This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through May 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. Data show that after declines in enrollment from December 2017 through December 2019, total enrollment grew to 73.5 million in May, an increase of 0.8 million from April 2020 (1%) and 2.3 million from February (3.2%), right before the pandemic.  (Figure 1) These early data suggest that recent increases in enrollment may be reversing previous trends of flat or negative enrollment growth.  read more


Louisiana’s health department wants to seek new bids for multibillion-dollar Medicaid contracts managing the healthcare of 1.5 million people, trying to end a legal dispute that has dragged out over a year about four contractors the agency previously picked for the work. Health Department Secretary Courtney Phillips announced Friday that she’s asked the governor’s Division of Administration to let her rebid the Medicaid managed care contracts rather than continue the legal wrangling over deals her predecessor approved.  read more


Managed Healthcare Executive, August 20
Whether COVID-19 is going to tip the American economy into a long-lasting, full-fledged downturn is still uncertain. The economy contracted at a record rate during the second quarter, and the number of Americans receiving unemployment started to climb again in July. Of course the state of the economy and job loss is going to affect health insurance coverage and may tip the balance toward public payers.  read more


The Ohio Department Medicaid won’t say whether it will award a big contract to companies against whom the state has filed lawsuits claiming the companies ripped off state agencies in transactions involving prescription drugs. The department says competitive-procurement requirements prevent it from commenting because it is in the “quiet period” of procuring a new vendor.  read more


The National Law Review, August 18
On June 19, 2020, the Centers for Medicare and Medicaid Services issued a proposed rule, “Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review and Supporting Value-Based Purchasing for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability Requirements”.  The Proposed Rule is designed to implement statutory amendments to the Medicaid Drug Rebate Program statute, and add new regulatory provisions to encourage value-based purchasing arrangements between drug manufacturers and state Medicaid programs and Medicaid-contracting payors.  read more


Florida’s Agency for Health Care Administration properly awarded Molina Healthcare of Florida Inc. a contract to provide Medicaid managed care services for beneficiaries in the southwestern part of the state, a state appeals court said. Best Care Assurance LLC—one of four successful applicants for a contract to provide Medicaid MCO services in Florida’s Region 8—couldn’t prevail in either a court challenge or an administrative protest to an additional contract awarded to Molina, the Florida Court of Appeal, First District, said Monday.  read more


The Oklahoma Health Care Authority has withdrawn plans to revamp part of the state’s Medicaid program under a block grant model. On Aug. 11, agency director Kevin Corbett rescinded the authority’s request for a waiver to charge premiums and impose work requirements on some Medicaid recipients. “The Oklahoma Health Care Authority has withdrawn the state’s application for the Healthy Adult Opportunity demonstration waiver,” said agency spokeswoman Katelynn Burns. “Due to the passage of State Question 802, the waiver application is no longer applicable to the Oklahoma Medicaid program.”  read more


The bipartisan Joint Medicaid Oversight Committee wanted answers. And Ohio Medicaid Director Maureen Corcoran was summoned to provide them during a special meeting Wednesday in the Statehouse. After 90 minutes of testimony, leading members of the panel still weren’t satisfied. Chairman Dave Burke, GOP senator from Marysville who’s also a pharmacist, said a “serious trust issue” remains with Corcoran and the department, which provides health-care coverage for 3 million poor and disabled Ohioans.  read more


State health officials told legislators Tuesday they plan to begin open enrollment for the Medicaid transformation initiative on March 15 in order to launch the program as mandated on July 1. The program is expected to cover between 1.6 million and 1.8 million North Carolina participants. Meanwhile, the N.C. Department of Health and Human Services said the state’s Medicaid program was under budget by $116 million, or by 3%, during fiscal 2019-20 after spending $3.8 billion in state funds.  read more


The number of people on Arizona’s Medicaid rolls topped 2 million this summer, after a five-month surge in enrollment that coincided with COVID-19’s hit to the state’s health and its economy. Almost 1.88 million people were covered by the Arizona Health Care Cost Containment System – the state’s Medicaid program – on March 1, the month coronavirus-related shutdowns started to take effect. By July 1, the number had topped 2 million and by Aug. 1 enrollment stood at 2,041,990, an increase of 8.7%.  read more


In the first several months of the COVID-19 pandemic, Medicaid enrollment increased by at least 2.3 million Americans, according to researchers from the University of Minnesota. Medicaid enrollment grew by 1.7 million individuals in the 26 states that reported enrollment data between March 1, 2020, through June 1, 2020. But that number grew significantly after accounting for seven states that published Medicaid enrollment data just through May 1, 2020, the study published in Health Affairs showed.  read more


Hospital associations and business groups have called on CMS to withdraw a rule that aims to strengthen the fiscal integrity of the Medicaid program, arguing that it could exacerbate the challenges hospitals are facing in the U.S. CMS issued the proposed Medicaid Fiscal Accountability Rule last November. The rule aims to promote transparency by establishing new reporting requirements for state supplemental payments to Medicaid providers.  read more


President Donald Trump is still trying to overturn “Obamacare,” but his predecessor’s health care law keeps gaining ground in places where it was once unwelcome. Missouri voters this week approved Medicaid expansion by a 53% to 47% margin, making the conservative state the seventh to do so under Trump. The Republican president readily carried Missouri in 2016, but the Medicaid vote comes as more people have been losing workplace health insurance in a treacherous coronavirus economy.  read more


Forbes, August 5
Voters in Republican-leaning Missouri supported a ballot measure to extend Medicaid benefits to more than 200,000 low-income adults in the latest vote testing the popularity of the Affordable Care Act during the Covid-19 pandemic. The vote by a narrow margin of Missourians to expand Medicaid under the ACA is a political blow to Republican Gov. Mike Parson, who opposed the ballot initiative and the Donald Trump White House, which this summer has taken more steps to try to repeal the ACA, the 10-year-old law also known as Obamacare that has expanded health coverage to more than 22 million Americans.   read more