MEDICAID NEWS RECAP – JUNE 2021

Medicaid payers of last resort face the challenging task of recovering claims payments made in error when program beneficiaries fail to report primary coverage information at the time services are provided. Plan members do not share other coverage information for a multitude of reasons, but usually, they are not aware that they have other coverage. Without technology at the point of sale to prospectively identify other health insurance (OHI), payers of last resort cannot help but make claims payments in error.  read more

Louisiana has restarted its bid process for multibillion dollar Medicaid contracts managing the health care of nearly 1.6 million people, trying to end its patchwork of emergency contracts after a legal dispute scuttled the last attempt at new deals. The Department of Health has released its request for proposals from contractors interested in handling the taxpayer-financed Medicaid managed care work, with a Sept. 3 deadline for submissions.  read more

The Centers for Medicare & Medicaid Services has scrapped work requirements for Medicaid coverage in Arizona and Indiana, rolling back approvals gained during the Trump administration. In March, the Biden administration began the process of withdrawing approval for Medicaid work experiments, which required certain beneficiaries to participate in community engagement activities, such as employment, education or job skills training, to continue receiving coverage.  read more

Georgia will delay the rollout of its limited Medicaid expansion, originally planned for July 1, until at least August 1, according to a letter the state Department of Community Health sent to Washington dated Thursday. The delay comes after the plan has come under scrutiny by the Biden Administration because of the state’s requirements that beneficiaries either work or attend school or engage in other qualifying activities.  read more

The Biden administration is quietly engineering a series of expansions to Medicaid that may bolster protections for millions of low-income Americans and bring more people into the program. Biden’s efforts — which have been largely overshadowed by other economic and health initiatives — represent an abrupt reversal of the Trump administration’s moves to scale back the safety-net program.  read more

Several recent policy proposals address the cost of prescription drugs to both consumers and payers. Though attention in current federal actions is largely focused on Medicare and private insurance drug prices, federal legislation also has been recently introduced or enacted that would affect Medicaid prescription drug policy. Most recently, the American Rescue Plan included a provision that would eliminate the Medicaid rebate cap and save $14.5 billion between 2021-2030.  read more

Local governments would be able to bypass conservative state leaders and implement their own Medicaid expansion programs for working poor Texans with federal funds under federal legislation announced Monday by U.S. Rep. Lloyd Doggett, D-Austin. Dubbed the “Cover Outstanding Vulnerable Expansion-Eligible Residents Now Act,” the legislation is a “homegrown solution” to a decade of resistance by a handful of red states to allow more people who are struggling financially to access the federal health care program…  read more

The Centers for Medicare & Medicaid Services (CMS) released a new Enrollment Trends Snapshot report today showing a record high, over 80 million individuals have health coverage through Medicaid and the Children’s Health Insurance Program (CHIP).  Nearly 9.9 million individuals, a 13.9% increase, enrolled in coverage between February 2020, the month before the public health emergency (PHE) was declared, and January 2021.  read more

Congressional Democrats are pushing legislation that would expand Medicaid in states that have so far refused to do so, seeking to fill one of the major remaining holes in the Affordable Care Act. There are currently 12 states where Republicans have refused to accept the expansion of Medicaid eligibility provided under ObamaCare, meaning 2.2 million low-income people are left without coverage they otherwise would have, according to estimates from the Kaiser Family Foundation.  read more

State Medicaid officials are asking the federal government for approval of ARHOME, the newest version of Medicaid expansion. They anticipate a decision in November or December. ARHOME will replace the current version of Medicaid expansion called Arkansas Works, which expires Dec. 31. ARHOME stands for Arkansas Health and Opportunity for Me. It was created by Act 530, which the legislature enacted earlier this year during the regular session.  read more

Prescription drugs have returned to the national policy debate, with both Congress and the administration developing proposals to address drug prices. Though attention in current federal actions is largely focused on Medicare and private insurance drug prices, federal legislation also has been recently introduced or enacted that would affect Medicaid prescription drug policy. States also remain concerned about the budgetary impact of new, high cost drugs and Medicaid drug spending, given fiscal pressures.  read more

A lawsuit that sought to block Nebraska from imposing a two-tiered Medicaid expansion system with more benefits for people working, volunteering or meeting other requirements is on hold after state officials said they would give all participants the same benefits. Lancaster County District Judge Susan Strong granted a motion Friday to pause legal proceedings until Oct. 4, the first business day after everyone enrolled in Medicaid expansion will get the extra services available under the state’s premium plan, the Omaha World-Herald reported.  read more

A record 31 million people have gotten coverage through the Affordable Care Act (ACA) thanks to growth in Medicaid expansion and the insurance marketplaces, a new report finds. Biden administration officials used the report released Saturday by the Department of Health and Human Services (HHS) to highlight efforts to expand coverage on the ACA’s marketplaces and in Medicaid, including increased marketplace subsidies passed in the American Rescue Plan Act.  read more

On May 28, 2021, OIG released its Semiannual Report to Congress (the Report). The Report describes OIG’s work during the 6-month semiannual reporting period of October 1, 2020, through March 31, 2021 (the Semiannual Reporting Period). Principal Deputy Inspector General Christi Grimm highlighted that OIG is “aggressively investigating pandemic-related fraud that harms individuals and jeopardizes public health efforts.” The Report highlights OIG’s audit and investigation activities.  read more

The Oklahoma Supreme Court ruled Gov. Kevin Stitt’s plan to privatize much of the state’s Medicaid program is unconstitutional. In a 6-3 ruling Tuesday, the court determined the Oklahoma Health Care Authority did not have the legislative approval to move forward with the plan, dubbed SoonerSelect. “We find no express grant of legislative authority to create the SoonerSelect program nor do we find the extant statutes implicitly authorize its creation,” the ruling states.  read more

Nevada’s plan to launch a public option health plan hinges on participation from the state’s Medicaid managed care organizations. After passing both houses of the legislature, Democratic Gov. Steve Sisolak told reporters Tuesday he will sign the bill that will likely crown Nevada as the second state to pass a public option — a government-run plan that promises to lower premiums and increase access to care by creating an additional insurance option for residents.  read more