JULY MEDICAID NEWS RECAP

Haley Organ thought she had everything figured out. After graduating from a small private college just outside Boston, she earned her master’s degree, entered the workforce and eventually landed a corporate job in St. Louis as a data analyst. Life seemed to be going as planned until the national retailer that Organ worked for announced furloughs during the coronavirus pandemic. After nine weeks of mandatory leave, the 35-year-old was laid off. 

The Coronavirus pandemic has had a devastating impact on the nation’s economy. As of June, the U.S. Bureau of Labor Statistics reported that the national unemployment rate reached 11.1 percent which translates to 17.8 million unemployed people. Many Americans that have lost employer sponsored health insurance are now turning to Medicaid for healthcare coverage. According to the Georgetown University Health Policy Institute, Medicaid enrollment has increased by 5.8 percent in the last three months.  read more

Anthem CFO John Gallina said on the earnings call Wednesday morning that utilization among members was down about 40% in April and 20% in May, but returned to 90% of baseline in June. The payer expects pent up demand to push utilization above normal levels in the third and fourth quarters. SVB Leerink analysts labeled the second-quarter results “solid,” noting the payer has good visibility and should see stable results for the next six to 18 months. 

The Ohio Department of Medicaid has released a request for proposals for a company to act as a single pharmacy benefit manager, advancing its plan to reshape the state’s pharmacy benefit management system, the Journal-News reported. Ohio’s House and Senate leaders agreed on a plan last July to restructure the state Medicaid department’s pharmacy benefit management by contracting with a single PBM. Proposals to become the Medicaid department’s sole PBM are due Sept. 4.  read more

Health insurer Centene is seeing a boost in Medicaid enrollment as unemployment rises amid the spread of the coronavirus strain Covid-19 though Americans are signing up to such coverage at a slower pace than the company originally projected. Centene Tuesday said its overall managed care membership in the second quarter of this year rose nearly 64%, or 9.6 million members, compared to June 30, 2019 to 24.6 million total members.  read more

The predictions were dire: Coronavirus lockdowns would put millions of Americans out of work, stripping them of their health insurance and pushing them into Medicaid, the health insurance program for low-income people. In California, Gov. Gavin Newsom’s administration projected that the pandemic would force about 2 million additional people to sign up for the state’s Medicaid program, called Medi-Cal, by July, raising enrollment to an all-time high of 14.5 million Californians — more than one-third of the state’s population.  read more

Molina Healthcare (Molina) will acquire the Passport Health Plan (Passport) Medicaid and dual special needs plan, Molina announced. The healthcare companies have agreed to a price of around $20 million for the purchase. In addition to the initial cash transaction, Molina may make an additional payment in 2021 based on Molina’s Kentucky health plan performance during 2020 open enrollment.  read more

Following a busy Supreme Court term with two decisions on the Affordable Care Act (ACA), many more ACA-related legal challenges remain pending at appellate and district courts across the country. This post discusses the status of long-standing ACA-related lawsuits and highlights newer lawsuits over ACA implementation. A prior post summarized the implications of recent Supreme Court decisions and California v. Texas. A third post will focus on the resolution of lawsuits over the risk corridors program.  read more

A proposed initiated constitutional amendment and a proposed initiated measure, both that would expand Medicaid eligibility requirements in South Dakota, have been filed with the South Dakota Secretary of State’s Office, according to a news release from Attorney General Jason Ravnsborg’s Office. The explanations for the constitutional amendment and initiated measure will appear on petitions circulated by their sponsor, Rick Weiland.  read more

The Supreme Court recently ended its 2019 term, which included two Affordable Care Act (ACA) decisions and several other decisions with implications for ACA cases. Briefing in California v. Texas is ongoing and will be heard later this fall, with a decision expected in 2021. Beyond the Supreme Court, there are many ACA-related legal challenges pending at appellate and district courts across the country. This post summarizes the recent Supreme Court decisions and the latest in California v. Texas.  read more

Nationwide, resistance to Medicaid expansion has crumbled over the years as, one by one, conservative states have joined the ranks of those that have expanded the program’s health coverage to low-income adults. Missouri remains one of only 13 (mostly conservative southern) states that have not expanded their Medicaid programs to include adults earning up to 138 percent of the poverty level. State Rep. David Griffith, of Jefferson City, and state Rep. Sara Walsh, of Ashland, both Republicans, said they strongly oppose Amendment 2 because the drafters of the amendment didn’t include a funding mechanism for the program.  read more

A federal inspector general report finds that the Centers for Medicare and Medicaid Services (CMS) and its chief, Seema Verma, violated rules around the management of contracts with GOP-aligned communications consultants. The Department of Health and Human Services (HHS) Inspector General, in a report issued on Thursday, found that CMS improperly “allowed a subcontractor individual to perform inherently governmental functions, such as making managerial decisions and directing CMS employees,” as part of $6.4 million in strategic communications contracts.  read more

Job loss stemming from the coronavirus stripped health insurance from an estimated 659,000 Texans between February and May, according to a new study. The analysis, published Tuesday by Families USA, a nonpartisan consumer advocacy group, found that 5.4 million laid-off workers across the country lost their health insurance from February to March. The report called the past few months the “deepest economic crash since World War II,” adding that job loss from the pandemic has left more people uninsured than ever recorded.  read more

America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) have called on Congress to ensure access to coronavirus care and healthcare coverage through federal funds. More specifically, the payer organizations recommended that Congress protect at-risk populations, increase Medicaid support, extend suspended regulations, and stabilize health insurance markets.  read more

Consider this a tale of two hospitals. Four years ago, our health system was forced to shut down Ozark Community Hospital in Springfield. Two hundred employees lost their jobs, and a corner of the city lost its access to both primary and emergency care. We’ve since closed three other clinics in Missouri. One hundred miles to the south, our hospital in Gravette, Arkansas is thriving, with 350 employees on payroll at a facility that includes primary and specialty care clinics.  read more

Madeline Almond can hardly wait for Nebraska to start enrolling people for expanded Medicaid next month. It will mean she can finally see a doctor in her adopted home state for the painful muscles, lung problems and mental health issues she’s struggled with most of her life. “I won’t have to choose between breathing and food anymore,” Almond said. She and her spouse have waited nearly a year for coverage, since moving to Lincoln for work and college.  read more

The expansion of Medicaid benefits via ballot initiative next month in Missouri is gaining momentum after last week’s successful vote in Oklahoma to expand health coverage in that deep red state. “It’s a movement that builds with every election,” Jonathan Schleifer, executive director of the Fairness Project told healthcare reporters on a call following the successful  “Yes on 802” campaign that is putting Medicaid expansion into the Oklahoma state constitution.  read more

Get ready to start hearing the name “Centene” a lot more around Charlotte. In the biggest economic-development deal in state history, the CEO of health-insurance giant Centene said Wednesday that it will build an East Coast regional headquarters and technology hub on an 80-acre site in the University City area — a massive project that he said could eventually employ more than 6,000 workers. Average salaries: more than $100,000 a year.  read more

The state has secured $2.67 billion in federal funding to support Texas hospitals providing care for people receiving Medicaid, officials announced Thursday. The windfall is a $1.07 billion increase from the previous state fiscal year 2020, the governor and officials with the Texas Health and Human Services Commission noted in an advisory. The Uniform Hospital Rate Increase Program is a statewide program that provides for increased Medicaid payments to hospitals for inpatient and outpatient services provided to persons with Medicaid, offiicals explained.  read more

A group of Republican senators introduced legislation Tuesday intended to enshrine two controversial price transparency rules into law and negate legal challenges from payers and providers. The bill called the Health Care PRICE Transparency Act codifies a rule that requires hospitals to post payer-negotiated rates for shoppable services and another rule that requires insurers to post online negotiated rates for in-network providers and allowed amounts for out-of-network providers. read more

Earlier this year, before the country was consumed by the novel coronavirus, Molina CEO Joseph Zubretsky outlined his strategy to the company he helped turn around. Zubretsky said the company would focus on growing its three lines of business organically and through acquisitions. Those bolt-on acquisitions would be added on to the company’s core competencies.  read more

Voters in Oklahoma narrowly approved a ballot measure Tuesday night to expand Medicaid to eligible adults who need health insurance. Oklahoma is now the 37th state to expand Medicaid under the Affordable Care Act; coverage will begin a year from now, on July 1, 2021. Based on the final unofficial count, the measure passed with just over a 6,000-vote margin — less than one full percentage point. Medicaid expansion was a key provision of the Affordable Care Act, but a Supreme Court ruling made it optional and left the decision up to each state.  read more

State fee-for-service Medicaid programs have traditionally based payments to pharmacies for drugs on a percentage of the drugs’ list price. Because list prices have increased more quickly than the prices actually paid by pharmacies, estimating appropriate reimbursements has become challenging. In recent years most states have switched to models where payments were based instead on results from a survey of pharmacy invoices. We examined how this changed fee-for-service Medicaid drug spending.  read more