JUNE MEDICAID NEWS RECAP

Oklahoma voters on Tuesday narrowly approved a ballot measure to extend Medicaid to tens of thousands of poor adults, making their state the first to expand government-backed health insurance during the pandemic. The vote, which passed with 50.5 percent support, also throws a wrench in the Trump administration’s plan to make Oklahoma the first state to receive its permission to cap Medicaid spending, a longtime goal of conservatives hoping to constrain the safety-net entitlement program.  read more

Medicaid has been designated as a high-risk government program by the GAO since 2003. The Medicaid program has struggled over the past seventeen years due to poor fiscal oversight and other administrative issues. These challenges will be exasperated as the program expands and enrollment surges during the COVID-19 pandemic. If Medicaid is expected to deliver on its goal to serve the health and wellness needs of our nation’s most vulnerable low-income individuals and families, it is critical that these administrative challenges be addressed.  read more

A question on whether to expand Medicaid in Oklahoma and a crowded Republican field vying to challenge the state’s lone congressional Democrat are drawing the most attention ahead of Tuesday’s primary election. State Question 802 would amend the Oklahoma Constitution to expand Medicaid health insurance to those earning up to 138% of the federal poverty level, which is about $17,200 for an individual or $35,500 for a family of four.  read more

Improper payments in the Medicaid universe are payments full or partial claims payments paid in error or payments made to the wrong party. Improper payments have been a major problem for Medicaid in recent years and have cost the program’s valuable resources.  Across all government programs, improper payments have been estimated to total nearly $1.7 trillion between 2003 and 2019. In March of this year, the GAO released its latest report, GAO-20-344, which estimated improper payments in federal agencies for FY 2019.  read more

Drug manufacturers should immediately evaluate whether they have been correctly classifying their products in data submitted to the Medicaid Drug Rebate Program (MDRP) to minimize penalties they could face for any errors. The Centers for Medicare and Medicaid Services (CMS) recently issued new guidance that sets a July 5 deadline for manufacturers to contact CMS to identify drugs that have been misclassified.1 The Medicaid Services Investment and Accountability Act of 2019 (MSIAA) gave CMS new authority to take compliance actions and impose monetary penalties when drugs are misclassified.  read more

State Efforts to Expand Medicaid Coverage & Access to Telehealth in Response to COVID-19  KFF, June 22

Telehealth can help limit risk of coronavirus exposure during the COVID-19 pandemic, and is important both for those who are unable to physically go to the doctor and more broadly when in-person visits are inadvisable. Telehealth can enable remote screening for those with COVID-19 symptoms, while patients with other health concerns can use telehealth to avoid potential viral exposure at health care facilities. There are few federal requirements, or restrictions, involving coverage of telehealth in the Medicaid program.  read more

Medicaid plans have found success in ACA exchanges. A new study highlights why  FierceHealthcare, June 18

A new study found that Medicaid managed care insurers’ business models are the reason their plans have become a dominant force in the Affordable Care Act’s (ACA’s) insurance exchanges. The study, from think tank Urban Institute and the Robert Wood Johnson Foundation, examined why Medicaid insurers have expanded their footprint in ACA exchanges in recent years. This year, Medicaid plans offered ACA coverage in 255 out of 502 rating regions. 

CMS Proposes Rule to Encourage ‘Value-Based’ Drug Payments in Medicaid  MEDPAGE TODAY, June 18

State Medicaid operations and Medicaid managed care plans will have more opportunities to use value-based purchasing arrangements for pharmaceuticals under a proposed rule from the Centers for Medicare & Medicaid Services (CMS). “This proposed rule really creates the pathway for private insurance companies to enter into value-based agreements with manufacturers,” CMS Administrator Seema Verma said on a call with reporters Wednesday evening.  read more

The Trump Administration has delivered significant policy advancements to lower the price of drugs and spur greater competition and innovation in the American health care system. As a result of actions by the Centers for Medicare and Medicaid Services (CMS), the average basic premium for Medicare Part D prescription drug plans was projected to decline 13.5 percent since 2017, to the lowest level in seven years, saving beneficiaries about $1.9 billion in premium costs over that time.  read more

As the number of individuals who find themselves unemployed due to COVID-19 continues to increase, reports have come out documenting that the majority of those filing unemployment claims are facing significant delays in confirming eligibility and receiving benefits. This led us to wonder if similar issues exist for individuals who are applying for Medicaid coverage after becoming newly eligible. As a result of the COVID-19 pandemic, the number of people unemployed has skyrocketed to more than 40 million individuals, with April 2020 having the greatest net change in unemployment in the past decade.  read more

Many of the tens of millions of Americans who have lost their health insurance along with their jobs are enrolling in Medicaid — and with state budgets decimated by the pandemic, state officials worry they won’t have the money to pay for their health care. Nearly 27 million Americans could lose their employer-sponsored health insurance over the course of the pandemic, the Kaiser Family Foundation projected last month.  read more

As Floridians lost jobs during the coronavirus pandemic, tens of thousands of people enrolled in the state’s safety-net health program. State data show that 3.9 million Floridians were enrolled in Medicaid in April, more than a 4 percent increase over the prior month’s enrollment, according to the latest available numbers from the state. The overall 4.14 percent enrollment increase is the biggest one-month jump since July 2015, when the state started publishing monthly Medicaid information online.  read more

Medicaid enrollment may hit like a tsunami  

While we all hope the novel coronavirus pandemic starts to wane throughout the country (and world), there is another public health storm approaching that stems from two opposing forces. First, the economic downturn will inevitably lead to all states reducing their budgets after collecting less income and sales tax. Simultaneously, many unemployed Americans have lost their health benefits and will be newly eligible for Medicaid, adding to the Medicaid rolls. 

Five healthcare companies were awarded contracts to manage Kentucky’s Medicaid health plan, Gov. Andy Beshear said May 29. Here are four things to know: 1. The five winners are Aetna, Humana, Molina Healthcare, UnitedHealthcare and WellCare. Anthem and Passport Health Plan are among the insurers that lost their bids. 2. Aetna was also selected to manage benefits for children in Kentucky’s foster care program and the Department for Juvenile Justice.  read more