Syrtis Solutions Monthly Medicaid News Recap




Syrtis Solution’s May 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.

APhA, May 30 The U.S. Department of Health and Human Services (HHS) has made clear that federal orders allowing pharmacists to order and administer FDA-authorized COVID-19 tests supersede state limits on scope of practice, and in at least one case has instructed a state pharmacy association to stop preventing pharmacists from testing for COVID-19. Now states are taking the baton, making widespread testing a possibility by creating pathways for pharmacists to bill for these services. Lack of avenues for payment has been a major barrier to increased access to COVID-19 testing at pharmacies. Big steps in the Empire State – New York Gov. Andrew Cuomo issued an executive order on May 22 that authorized licensed pharmacists to order COVID-19 tests approved by FDA through emergency use authorizations detect SARS-CoV-2 or its antibodies; administer COVID-19 tests subject to CLIA certificate of waiver in patients suspected of a COVID-19 infection, or suspected of having recovered from COVID-19 infection, subject to completion of appropriate training developed by the…  read more


Kentucky awards contracts to manage Medicaid business   Bradenton Herald, May 29 Five insurance companies were awarded contracts worth nearly $8 billion a year to manage most of Kentucky’s Medicaid business, Gov. Andy Beshear announced Friday. Landing the contracts were Aetna, Humana, Molina Healthcare, UnitedHealthcare and WellCare, Beshear said. About 1.4 million people in Kentucky receive health coverage through Medicaid. The Democratic governor refers to health care as a “basic human right.” He said Friday that ensuring coverage for Medicaid recipients is “of the utmost importance to my administration.” “As we move forward, we must continue to provide equal access for every Kentuckian who needs quality care,” Beshear said. Aetna, Humana and WellCare hold existing contracts with the state, he said.  read more


New Mexico studies single-payer care amid pandemic  ModernHealthcare, May 27 Public officials in New Mexico continue to contemplate a possible transition to single-payer healthcare in the midst of the coronavirus pandemic. Preliminary results of a study commissioned by New Mexico’s Democrat-led Legislature in 2019 were released Tuesday that outline the consequences of combining nearly all financing for healthcare services behind a single, state-administered payer for all residents. The analysis from a team led by Maryland-based KNG Health Consulting says the state’s uninsured rate would likely fall below 1% and that the use of healthcare services would likely increase as the vast majority of residents turn to public insurance. Under a state-administered plan some segments of the private insurance industry would disappear and significant additional funding sources would likely be needed to fully cover the cost of the plan—through some combination of additional contributions by employers, reduced payment rates to medical providers or higher costs for patients.  read more


State Actions to Facilitate Access to Medicaid and CHIP Coverage in Response to COVID-19  KFF, May 22 As many people lose jobs and income due to the COVID-19 outbreak, a growing number will become eligible for Medicaid. To support states as enrollment in Medicaid grows and ensure enrollees maintain coverage, federal legislation provides states a temporary 6.2 percentage point increase in the federal matching rate and establishes conditions states must meet to access the enhanced funding. Beyond the conditions to access the enhanced funding, states can take a range of actions to expand Medicaid eligibility and make it easier for people to enroll. This brief summarizes state changes to Medicaid and CHIP eligibility and enrollment policies in response to the COVID-19 outbreak, beyond those required to access enhanced federal funding. It is based on KFF analysis of approved Medicaid and CHIP state plan amendments (SPAs) and information on state websites as of May 21, 2020. Overall, 43 states have made changes to facilitate access to Medicaid and/or CHIP coverage in response to the COVID-19 crisis, beyond those required to access enhanced federal funding.  read more


Missouri Secretary of State approves Medicaid expansion ballot measure  Missourinet, May 22 Missouri voters will get to decide whether to expand Medicaid eligibility. Secretary of State Jay Ashcroft has certified an initiative petition intended to expand government-funded health coverage and put the question on the election ballot. Ashcroft left Gov. Mike Parson a little time to choose whether to switch the ballot measure from the November general election to the lower turnout primary election in August. The deadline is Tuesday for Missouri’s chief executive to make that decision. In a press release, Ashcroft says his office verified signatures using random sampling – a quicker way – instead of the usual method of sending them to local election authorities. He says he used the approach because local election authorities are busy preparing for the June 2 municipal election. “After visiting all 116 election officials in the state over the last two weeks, I know we made the right decision,” he says. “It would have created a tremendous amount of work for them at the same time they prepare for, conduct and certify their local election.”  read more


A final push for Medicaid expansion in Kansas, May 20 Lawmakers will meet on Thursday for just one day to finish out the 2020 legislative session, as while they have no plans to discuss Medicaid expansion, some Kansans are urging lawmakers to pass it. Medicaid expansion seemed likely to pass this year after bipartisan support on a compromise bill in January. But after delays in the Kansas Senate and the coronavirus cutting the session short, expansion has been put off until next year. Renee Kuhl is the Executive Director of the Lawrence Community Shelter. She works with the Kansas homeless community each day. Kuhl says many people have health conditions that are going untreated because they don’t have access to affordable health care. “Very often, medical costs can be a driver of their homelessness,” said Kuhl. She adds that the coronavirus has made it even more difficult for the homeless community. She says they struggle to get tested or to see a doctor. If they are sick, it makes it difficult to find a place to stay.  read more


Medicaid Spending, Enrollment Exceed Projections Due To COVID-19  Health Payer Intelligence, May 18 States are facing higher Medicaid spending and higher enrollment than expected in 2020 due to the coronavirus, and that impact could continue into the following year, a Kaiser Family Foundation (KFF) survey found. KFF and Health Management Associates (HMA) conducted a survey of Medicaid directors in all 50 states and the District of Columbia and received responses from 38 states. Not all states had data ready for review at the time of the survey. Thirty-four of the states had both projected May 2020 enrollment data, as well as the actual enrollment data, which allowed the KFF researchers to compare the two trends. Going into 2020, the economy was sound, and states were expecting flat enrollment with less than one percent overall expected enrollment growth. Medicaid spending was projected to increase 6.2 percent in total and 5.7 percent on average per state, the survey stated. However, the coronavirus has turned the recent strong employment upside down, leading to significant migration from employer-sponsored health plans to Medicaid.  read more


Early Look at Medicaid Spending and Enrollment Trends Amid COVID-19  KFF, May 15 The coronavirus pandemic has generated both a public health crisis and an economic crisis, with major implications for Medicaid, a countercyclical program. During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling. To help support states as enrollment in Medicaid grows and ensure existing enrollees maintain continuous coverage, the Families First Coronavirus Response Act (FFCRA) authorized a 6.2 percentage point increase in the federal match rate (“FMAP”) (retroactive to January 1, 2020) available if states meet certain “maintenance of eligibility” (MOE) requirements. This brief provides some early insights into the current picture of Medicaid spending and enrollment, as Congress considers providing additional fiscal relief through the federal Medicaid match rate. It is based on a rapid survey conducted by the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) of Medicaid directors in all 50 states and the District of Columbia. A total of 38 states responded to the survey.  read more


Oklahoma Legislature passes bills to boost Medicaid funding  Modern Healthcare, May 15 The Republican-controlled Oklahoma Legislature gave final approval Friday to two separate measures designed to boost funding for the state’s Medicaid program. The House narrowly approved a bill that will increase a fee that hospitals pay from 2.5% to 4% that would generate about $134 million annually to help fund the state’s share of Gov. Kevin Stitt’s proposed Medicaid expansion, dubbed Soonercare 2.0. Stitt wants to take advantage of a block-grant-style Medicaid expansion offered by the Trump administration that would give states more control over Medicaid in exchange for a limit on how much the feds kick in. One requirement that Stitt and other conservative policymakers want to impose would make recipients pay premiums and either work or volunteer in the community. If the Trump administration approves Stitt’s proposal, the Medicaid expansion would take effect July 1. But Oklahoma voters will decide June 30 whether to approve a separate citizen-led Medicaid expansion by amending the Oklahoma Constitution to prevent lawmakers from tinkering with it. If approved by voters, this expansion would take effect in July 2021 and would supersede the governor’s proposal.  read more


FierceHealthcare, May 15 States are about to face a major budget crisis due to exponential growth in Medicaid enrollment and a decline in tax revenue, which experts say could lead to provider payment cuts or other measures to contain costs. Unemployment has been skyrocketing due to the COVID-19 pandemic, which will likely lead to an increase in the Medicaid rolls. With that comes increased costs for states, where Medicaid is the often the biggest budget item. “Almost all of these state legislatures will see the biggest budget gap they have ever seen given the shutdown over the last few months,” said Chris Sloan, associate principal for consulting firm Avalere Health, during a webinar hosted by the firm. “States are going to be looking at both closing budget gaps due to the reduction in revenue and seeing increases in spending in their Medicaid rolls.” That could lead states to a series of moves to contain costs or limit growth in Medicaid, Sloan said. States have used several methods in the past that could come back up, including limiting provider payment rates or even tightening drug formularies to downgrade utilization, he added.  read more


The Utah Department of Health plans to take steps to lower prescription drug costs for Medicaid following audit The Salt Lake Tribune, May 14 A new performance audit released by the Utah Legislature shows that by making a few adjustments, the Utah Department of Health could save the Medicaid program up to $3.4 million a year. “It’s great to see this audit come out to give the Department of Health more information on how to lower the cost of pharmaceuticals for the Medicaid program,” Courtney Bullard, education and collaboration director at Utah Health Policy Project, said in an interview. “It could decrease costs for everyone … if we’re paying less money for Medicaid in general.” Utah Auditor General Kade Minchey recommended the Department of Health research and report back to the Legislature on the feasibility of creating a list of preferred drugs with the lowest net cost to the state. The report also asks the department to create a process to make sure pricing and rebates are processed correctly and to provide better oversight of Accountable Care Organizations (ACOs), which were shown to prioritize prescriptions with higher costs to the state compared to Fee For Service (FFS).  read more


Ohioans rush to Medicaid due to coronavirus; 1 of 4 now getting benefits  The Columbus Dispatch, May 12 As the coronavirus upends the state’s economy, Medicaid added 140,000 Ohioans in April alone, meaning that the taxpayer-funded health insurance program now covers about 1 in 4 residents. It’s going to get worse. Ohio Medicaid Director Maureen Corcoran said she expects caseloads to continue to increase by about 100,000 in May and again in June, with enrollment nearing 3 million. The Medicaid number is likely to continue to swell throughout the year, she said, albeit at perhaps a slower pace as Ohio reopens its economy and many workers return to their jobs. Data provided by the department showed a slowing in the rate of increase in weekly Medicaid applications during April, to 14,416 in the last week of the month from 20,666 in the first week. Despite the increased demand, Corcoran said Medicaid will cut $210 million in spending during the last two months of the state’s fiscal year — May and June — as ordered by Gov. Mike DeWine. In doing so, she said, the state will not restrict eligibility or services for beneficiaries, nor will it decrease payments to doctors, hospitals and other health care providers.  read more


While revenue falls, Medicaid could cost Florida an extra $1B, health agency warns  Miami Herald, May 8 Florida’s economic collapse due to the COVID-19 pandemic is expected to cause ballooning Medicaid enrollment that might blow a $1 billion hole in the state budget, according to new projections by the agency that oversees the healthcare safety net program. The dramatic rise in costs could exert additional pressure on Gov. Ron DeSantis and the Legislature to cut the budget as businesses shutting down and scaling back have dramatically reduced the main sources of tax dollars used to pay for state spending. An Agency for Health Care Administration analysis of projected costs and enrollment obtained by The News Service of Florida shows that as many as 437,390 additional people might turn to Medicaid for healthcare in the fiscal year that starts July 1. The spike in enrollment could increase overall costs in the coming year by as much as $3 billion. Congress recently approved a 6.2 percentage-point increase in the federal government’s share of Medicaid costs, what is known as the Federal Medicaid Assistance Percentage, or FMAP.  


States cut Medicaid as millions of jobless workers look to safety net  Politico, May 5 States facing sudden drops in tax revenue amid the pandemic are announcing deep cuts to their Medicaid programs just as millions of newly jobless Americans are surging onto the rolls. And state officials are worried that they’ll have to slash benefits for patients and payments to health providers in the safety net insurance program for the poor unless they get more federal aid. State Medicaid programs in the last economic crisis cut everything from dental services to podiatry care — and reduced payments to hospitals and doctors in order to balance out spending on other needs like roads, schools and prisons. Medicaid officials warn the gutting could be far worse this time, because program enrollment has swelled in recent years largely due to Obamacare’s expansion. The looming crisis facing Medicaid programs “is going to be the ’09 recession on steroids,” said Matt Salo, the head of the National Association of Medicaid Directors. “It’s going to hit hard, and it’s going to hit fast.”  read more
Molina readies for ‘significant’ Medicaid member bump as more lose jobs  HelathcareDive, May 1 Another 3.8 million Americans filed for unemployment last week, bringing the total of out-of-work Americans to more than 30 million since the outbreak unfolded. That presents an opportunity for insurers like Molina that are primarily positioned in Medicaid and Affordable Care Act exchange lines of business. Medicaid coverage is based on income and reserved for low-income Americans and the marketplace, or exchanges, tie coverage to income and financial help for those with incomes below a certain threshold. Although its membership is likely to swell due to current economic conditions, Molina CEO Joe Zubretsky cautioned investors Friday by saying, “by how much we do not yet know.” Zubretsky said Medicaid has proven it’s a stress-tested model that works in both robust economies and those in a recession. So far, through April 27, 950 of Molina’s members have been hospitalized with COVID-19, a small fraction of Molina’s 3.4 million membership base. The average length of stay was about 10 days for these members, but they have not been able to assess the costs per episode yet, executives said Friday.  read more