Syrtis Solutions Monthly Medicaid News Recap




Syrtis Solution’s February 2020 Medicaid News Recap: A roundup of Medicaid news, legislation, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse.

StarTribune, February 25
The state agency that oversees Minnesota’s Medicaid program disclosed that it incorrectly paid up to $28.9 million over three years to managed care organizations and health care providers for tens of thousands of enrollees with duplicate personal accounts. The state Department of Human Services (DHS) said the overpayments stemmed from gaps in its electronic system for tracking eligibility and enrollment, which led to the creation of multiple personal identification numbers for more than 47,000 Minnesotans. The errors may have disrupted health care services for some Medicaid enrollees, who could have had claims delayed or denied because of problems with the computer system, according to a report sent to the state Legislature this week.  read more


mLive, February 25
Gov. Gretchen Whitmer on Tuesday announced the state had filed a motion for partial summary disposition in U.S. District Court for the District of Columbia, arguing Michigan’s Medicaid work requirements won’t stand up because of a higher court’s ruling. Passed in 2018 and signed into law by former Gov. Rick Snyder, the work requirements went into effect Jan. 1. Under the new law, able-bodied adults receiving Medicaid under the Healthy Michigan Plan must do 20 hours per week, or 80 hours per month, of “workforce engagement” — things like working or going to school.  


Medicaid managed care organizations (MCOs) saved states and taxpayers billions on prescription drugs in 2018, a new report backed by the insurance industry found. Consulting firm The Menges Group analyzed the financial performance of MCOs on behalf of America’s Health Insurance Plans (AHIP) and found the private Medicaid plans accounted for $6.5 billion in net savings on drugs in fiscal 2018. Net costs per prescription in managed care were 27% lower than those for traditional Medicaid, according to the study. “When states rely on Medicaid managed care plans to provide integrated drug benefits to enrollees, they do even better and deliver more savings for taxpayers every day,” said AHIP CEO Matt Eyles in a statement. “This study shows that when the private and public sectors work together for better healthcare, everyone wins.”  read more


surfKY NEWS, February 21  
After years of claims and counter claims and several attempts to legislate controls over Pharmacy Benefit Managers, the Kentucky Senate appears to be ready to throw in the towel and fire the PBMs managing Medicaid for the commonwealth. Independent pharmacies are celebrating the unanimous approval by the Senate Health and Welfare vote to forward to the House. Gov. Andy Beshear has indicated support. The state will hire one PBM or establish its own PBM and strictly control its operations.  read more


The Hill, February 19 
Republicans and Democrats alike are warning that a recent proposal from the Trump administration could lead to billions of dollars in cuts to Medicaid, forcing states to eliminate benefits, reduce enrollment or cut payments to health providers. In a rare sign of unity, hospitals, insurers, patient advocates and members of both political parties are on the same page in their opposition to the Trump administration’s plan, and most have urged the administration to withdraw a proposal they say would “cripple” Medicaid, the federal-state partnership that provides health care for the poor. The proposal hasn’t received as much attention as the administration’s other efforts to reform Medicaid, such as implementing work requirements, but it could have the most damaging effect because of how far-reaching it is, experts argue.  


The ruling, written by a Reagan-appointed judge, upheld a lower court’s stance that Arkansas’ plan to add work requirements to its Medicaid program was “arbitrary and capricious” and failed to show how such rules would help Medicaid to meet its mission of covering the poor. The Trump administration has been encouraging states to add work requirements, but so far has come up short in the courts.  read more


A late proposal to amend the state constitution to expand Medicaid failed Friday afternoon, the second time in five days that lawmakers roundly rejected the program. Casper Republican Rep. Pat Sweeney filed the bill Wednesday. It faced a tall order: It would’ve required two-thirds of the House and Senate to vote yes before being sent to Wyoming’s voters for approval. Early Friday evening, the House voted overwhelmingly — with 40 nos and 16 ayes — to end the effort for this session. In testimony before the vote, Sweeney told his fellow lawmakers that he wanted to avoid what had happened in Idaho, Nebraska and Utah. “What I don’t want us to get into is what our neighboring three states had in 2018 — not that long ago,” he said. “Ballot measures that they didn’t control. With this constitutional amendment, that’s what this is about.”  read more


A federal appeals court panel on Friday unanimously upheld a lower court’s ruling striking down work rules for Medicaid recipients in Arkansas, casting more doubt over broader Trump administration efforts to require poor people to work, volunteer or train for a job as a condition of getting government health coverage. A three-judge panel of the United States Court of Appeals for the District of Columbia Circuit found that approval of the Arkansas work requirement by the health and human services secretary, Alex M. Azar, was “arbitrary and capricious” because it did not address how the program would promote the objective of Medicaid as defined under federal law: providing health coverage to the poor.  read more


KHN, February 11
While President Donald Trump’s budget doesn’t offer specifics on his “health care vision,” an $844 billion mystery pot — along with other Medicaid changes — signal deep cuts to health programs. Critics were quick to challenge Trump’s promises to protect people’s coverage despite any funding cuts. “You can’t cut $1 trillion from these programs and protect the most vulnerable,” said Aviva Aron-Dine of the Center on Budget and Policy Priorities. The budget also includes a big funding drop for CDC, a proposal to strip the FDA of its authority over tobacco products, a provision to slash funding for the agency currently working to create a coronavirus vaccine, and more.  read more


Health Affairs, February 7
On January 29, 2020, at an event titled “Transforming Medicaid: A New Opportunity for Better Health,” CMS Administrator Seema Verma unveiled the administration’s “Healthy Adult Opportunity” (HAO) initiative, with details described in a State Medicaid Directors Letter. Because the state invitation to participate in the HAO experiment is laid out in a policy letter rather than through a proposed rule, there is no opportunity for formal public comment before the terms of the initiative become final. HAO becomes the newest chapter in the long history of Section 1115 of the Social Security Act, which empowers the HHS Secretary to approve state social welfare experiments involving programs authorized under the Act that, “in the judgment of the Secretary, [are] likely to assist in promoting the objectives of” the program that is the subject of the experiment.  read more


What are Impacts of the Medicaid Fiscal Accountability Regulation  
It is no secret that Medicaid reimbursement is low. Extra payments that well-intentioned states give providers to compensate for the low Medicaid reimbursement rates add a layer of complexity to an already intricate payment structure. The technicalities of these arrangements allow for loopholes which some providers use to unlawfully finagle extra funds. But in an attempt to close these loopholes, CMS may have made it even more laborious for honest providers and states to receive and report reimbursement. The Medicaid Fiscal Accountability Regulation (MFAR) is meant to solve improper payments in Medicaid, clarify states’ responsibility in provider payment, and arm CMS with the data it needs to enforce proper payment procedures. Since 2010, Medicaid spending has been escalating. In 2019, states spent 2.9 percent more than the previous year, even though Medicaid enrollment remained relatively flat.  read more


TIME, February 1
The Trump administration says it will not allow California to collect a key health care tax on managed care organizations, a decision that could cost the state nearly $2 billion a year for low-income benefits. The news does not immediately affect California’s budget because the state did not plan to receive that money this year or the budget year that begins July 1. But it could cost California $1.2 billion in the fiscal year that begins July 1, 2021, California Department of Finance spokesman H.D. Palmer said. That number increases to $1.9 billion after that. “The Administration will continue its ongoing discussions with federal Medicaid officials on this issue,” Palmer said. “Consistent with the federal government’s prior approvals of similar financing waivers, we believe and expect that we can reach an agreement that allows this type of financing to continue.”  read more