MEDICAID NEWS RECAP – JULY 2024

New Mexico reinstates Medicaid for 21,000 children, ensures ongoing coverage  ABC 7 News, July 30 
As July comes to a close, New Mexico will be reinstating Medicaid coverage for approximately 21,000 children the New Mexico Health Care Authority announced Tuesday. “Keeping children covered was one of our biggest priorities as the Public Health Emergency ended,” said Kari Armijo, Cabinet Secretary of the New Mexico Health Care Authority. “Being able to reinstate thousands of children who lost coverage means increased access to vaccinations, checkups, well child visits, and behavioral health services that otherwise they may have gone without.” A program change that went into effect in January 2024 will grant continuous Medicaid enrollment for roughly 3,700 children up until they turn 6.  read more

Medicaid by the numbers  PHRMA, July 30
Today marks the 59th anniversary of Medicaid, a state-administered program designed to ensure the most vulnerable in our communities can access the health care services they need. The program is jointly funded by states and the federal government, and today it provides coverage of prescription medicines in all 50 states. Here’s a snapshot of how Medicaid provides access to medicines across the country: 82 million: Medicaid, and CHIP the program for children, provides access to medicines for 82 million Americans; 40%: Medicaid provides coverage to 40% of expectant mothers nationwide; 66%: Medicaid provides coverage to 66% of expectant mothers who are Black Americans and American Indian and Alaska Natives.  

Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State  KFF, July 25
This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health. States may obtain “comprehensive” Section 1115 waivers that make broad changes in Medicaid eligibility, benefits, provider payments, and other rules across their programs; other waivers may be more narrow and address specific populations or benefits.  read more

Florida awards additional Medicaid contracts to CVS, UnitedHealth, Molina  HealthcareDive, July 22
Florida’s managed care program, wherein the state contracts with insurers to deliver health benefits for Medicaid beneficiaries, represents a significant financial opportunity for insurers. The state’s Medicaid managed care program is one of the largest in the country, and accounts for two-thirds of its more than $28 billion in annual Medicaid spend, according to health policy research firm KFF. Florida’s first round of contract awards was a particular boon for Centene, a major Medicaid payer, analysts said in April. Meanwhile, losses for UnitedHealth, CVS and Molina weren’t expected to materially affect their earnings. Still, Molina said it would challenge its contract loss in the state, along with another loss in Virginia.  read more

Rhode Island Current, July 16 
Neighborhood Health Plan of Rhode Island and UnitedHealthcare of New England Inc. will share a coveted contract to run Rhode Island’s more than $3 billion Medicaid program for the next five years, the Rhode Island Executive Office of Health and Human Services announced on Tuesday. The two private health insurers were among the four vendors competing for part of the massive contract, which serves one-third of state residents and comprises 25% of the state’s annual budget. The Centers for Medicare & Medicaid Services lets states decide how to structure their contracts with private health insurers, or managed care organizations, who oversee Medicaid services.  read more

WVTF, July 12
During the COVID-19 pandemic Virginia and the federal government greatly expanded access to subsidized healthcare known as Medicaid. But now that period is over, and many have lost that insurance, but some legislators would like to see new pathways for folks to get covered. At its peak during the pandemic, Virginia had over two million people receiving healthcare thanks in large part to federal dollars. Now, the federal money has dried up and the state has redetermined the eligibility of almost all in the program. They found about half a million people no longer qualified, but elected officials like Democratic Senator Creigh Deeds want to see that trend reversed.  read more

After a year of ‘unwinding,’ Maryland Medicaid rolls drop from 1.8 million to 1.69 million  Maryland Matters, July 11
In March 2023, the Maryland Department of Health began the laborious process of evaluating the eligibility of 1.8 million Marylanders who had Medicaid coverage, many as a result of pandemic-era policies designed to boost enrollment. A year after that “unwinding” began, a total of 1,687,343 Marylanders still had health care through Medicaid, according to department data released Thursday. “We are very proud of the work and the efforts to ensure we did everything that we possibly could to ensure that every single eligible Marylander remained covered,” said Ryan Moran, the health department’s deputy secretary for health care financing. “Today does mark a monumentous effort.”  read more

Improving Access in Medicaid Managed Care Using State Directed Payments  Georgetown University Center for Children and Families, July 10
The Centers for Medicare & medicaid Services (CMS) recently released new Medicaid managed care regulations that update CMS policy on State Directed Payments (SDP). In this blog we’ll cover what SDPs are, how they can be used to improve access to care, and some changes in how CMS will allow and regulate them. You can find all of our blogs on CMS’s Managed Care Rule and companion Access Rule here. The default policy in Medicaid managed care is that once a state contracts with a managed care plan, the state cannot direct the managed care plan’s spending. In other words, the state sets out the covered services and capitation levels, but then the plan controls how the capitation is spent, including timing and payment rates for…  

Montana Renews Pharmacy Benefit Management Contract with Conduent  BusinessWire, July 10 
Conduent Incorporated (Nasdaq: CNDT), a global technology-led business solutions and services company, today announced a three-year Pharmacy Benefit Management (PBM) contract renewal with the Montana Department of Public Health and Human Services (MDPHHS). The renewal builds on Conduent’s nearly 38-year relationship with the MDPHHS of providing advanced Medicaid management solutions to further the agency’s mission to deliver healthcare services that help improve and protect the health and safety of Montanans. As part of the Conduent Medicaid Suite (CMdS), the pharmacy module helps MDPHHS reduce costs and streamline operations within its PBM model with advanced applications for point of sale, prior authorization, rebate…  read more

1 in 8 enrollees exited Medicaid during redeterminations in 4 Southern states: study  HealthcareDive, July 3 
Enrollment in the insurance program for low-income Americans swelled during the COVID-19 pandemic, spurred by policies that kept beneficiaries covered by Medicaid during the public health emergency. But that period of continuous enrollment ended last spring, and states began rechecking eligibility for their Medicaid rolls. More than 23 million people have since been removed from the program, according to health policy research firm KFF. The unwinding process has hit snags. Last year, federal regulators paused disenrollments in some states due to high levels of improper removals and threatened to cut funding to those that failed to comply with reporting or eligibility requirements. Some states have also disenrolled more people than expected… read more

More than 80% keep coverage as Oregon Health Plan eligibility checks near completion  OPB, July 2
Oregon health officials are nearing completion of a reinstated program of eligibility checks for the roughly 1.4 million people covered by the Oregon Health Plan, and 82.5 percent of those checked have been renewed so far. Now, the state is reaching out to the remaining members of the program, which provides free care to low-income Oregonians using state and federal Medicaid funds. And it’s urging members of the program to check their mail for renewal notices, as well as their online benefits account. During the pandemic a federal rule intended to maintain coverage caused states to pause their Medicaid eligibility checks. Last April, they resumed, and Oregon was expecting to disenroll as many as 300,000 people from the program.  read more

Medicaid Coverage Expanded for Thousands of People in 5 States  Newsweek, July 2
The U.S. Department of Health and Human Services (HHS) has now approved five states to offer Medicaid for Americans transitioning out of incarceration. The approvals for Illinois, Kentucky, Oregon, Utah and Vermont mark a significant shift from the way Medicaid has historically been available to those leaving prison. Typically, adults and minors transitioning out of prison have been forced to deal with delays in getting Medicaid or CHIP (Children’s Health Insurance Program) coverage. But now the five states will offer coverage before prisoners are released into the outside world and forced to navigate any gaps in coverage. Already, California, Massachusetts, Montana and Washington allow inmates to get health care before they leave prison, but…  read more

Axios Dallas, July 2
The Cook Children’s Health Plan is suing the State of Texas over its plans to end its Medicaid contract next year, alleging the decision was “unilateral” and “flawed.” The big picture: For decades, the state’s health commission has contracted with community-based health systems to provide care to low-income families and families with specialized needs. The commission now wants to give Medicaid’s STAR and CHIP contracts to for-profit companies. Why it matters: The changes will affect 1.8 million Texans, per Cook Children’s.The Fort Worth-based system has helped hundreds of thousands of Tarrant County families for over 20 years through its partnership with STAR and CHIP. State of play: The state also plans to remove Driscoll Health…  read more

Health Insurer Financial Performance in 2023  KFF, July 2
The largest private health insurance companies often offer plans in multiple markets, including the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer) health insurance markets. Each market has unique features, including eligibility, payment, and coverage rules, which affect insurers’ overhead and potential profit. In recent years, private insurers are playing a growing role in public insurance programs, with more than half of eligible Medicare beneficiaries enrolled in a private Medicare Advantage plan and nearly three-quarters of Medicaid enrollees obtaining coverage through a managed care plan (typically a private insurer). This brief examines two measures of financial performance…  read more