MEDICAID NEWS RECAP – OCTOBER 2023

Third-party liability, also known as TPL, is the legal obligation of third parties to pay part or all of the expenditures for medical assistance under a Medicaid state plan. In other words, if a beneficiary has other forms of health insurance, those primary payers are required to pay their legal liability first, and Medicaid covers any remaining liability as the payer of last resort.  

Today, Democratic legislators released four key pieces of Healthy Wisconsin legislation to expand access to quality, affordable healthcare for all Wisconsinites, regardless of income or healthcare needs. BadgerCare Expansion, introduced by Sen. Dianne Hesselbein (D-Middleton) and Rep. Daniel Riemer (D-Milwaukee), would provide insurance coverage for tens of thousands of Wisconsinites who currently lack access to care.  read more

House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), on behalf of the Health and Oversight Subcommittee Republicans, wrote to Department of Health and Human Services (HHS) Inspector General (IG) Christi Grimm and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure regarding improper Medicaid payments, including a significant number of payments made to deceased enrollees.  read more

A report published by the Urban Institute estimates that if the 10 Medicaid nonexpansion states were to implement expansions in 2024, Medicaid enrollment would increase by 5 million people, and 2.3 million fewer individuals would be uninsured. The brief, which updates a series of yearly reports, explores the potential effects of Medicaid expansion on health coverage and costs using the Urban Institute’s Health Insurance Policy Simulation Model.  read more

The Office of the State Comptroller, Medicaid Fraud Division (OSC) conducted this review to identify adult medical day care (AMDC) providers who improperly billed the Medicaid program for duplicative services or who billed for services that exceeded the amount the program permits to be billed. AMDCs are facilities that provide ambulatory care services to adults who require assistance with activities of daily living, including bathing, mobility, and eating.  

With the start of the 2024 Affordable Care Act open enrollment, the Marketplaces have been operating for a full decade and are heading into their eleventh year. This year’s open enrollment season will last from November 1, 2023 to January 15, 2024 in most states and longer in some state-based marketplaces. Even after a decade of operation, there continue to be changes in these markets.  read more

More than a year after Mississippi Medicaid announced it was contracting with three companies to manage the care of their beneficiaries, those contracts have not been awarded. That’s because two companies that weren’t chosen say the selection process was unfair. UnitedHealthcare and Amerigroup, two for-profit managed care companies, were not chosen by Mississippi Medicaid as one of its contracted companies entrusted with managing beneficiaries’ health care.  read more

The uninsured population could drop by 25% in 10 states yet to expand Medicaid, an analysis from the left-leaning Urban Institute found with support from the Robert Wood Johnson Foundation. Just 10 states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming—have not yet expanded Medicaid eligibility, despite having the option under the Affordable Care Act.  read more

Three of Kentucky’s six Medicaid-managed care organizations are participating in a newly established Kentucky Health Alliance. The program is aimed at streamlining the credentialing process medical providers use while working with MCOs. Kentucky Hospital Association President Nancy Galvagni said it means providers can do this once instead of contacting each Medicaid managed care group.  read more

Medicare and Medicaid are projected to grow faster than the economy over the next decade and will therefore require initiatives to reduce expenditures without harming patients, according to an Oct. 20 Health Affairs report. Here are four possible solutions to reduce costs proposed by experts on Medicare, including current Medicare Payment Advisory Commissioners Brian Miller, MD, and Betty Rambur, PhD, RN.  read more

Medicaid redeterminations continue, and one state, Arkansas, has finished the process. States are also seeking new Medicaid contractors and dropping others. Here are 10 updates on Medicaid Becker’s has reported since Sept. 28. North Carolina is expanding its Medicaid program to an additional 300,000 people in December, but the state is facing unique enrollment challenges amid Medicaid redeterminations.  read more

Louisiana’s six Medicaid managed care organizations will be managed by a single pharmacy benefits manager at the end of October, a move that’s expected to save about $2.2 million a month. Pam Diez, undersecretary for the Louisiana Department of Health, and other health officials discussed the cost savings at a Legislative Audit Advisory Council meeting in Baton Rouge on Monday focused on a recent Louisiana Legislative Auditor’s report on the costs associated with the state’s pharmacy plans.  read more

California Gov. Gavin Newsom approved legislation directing the state’s HHS to outline requirements for a federal wage application focused on universal healthcare coverage in partnership with the federal government, according to an Oct. 7 report from CBS Bay Area. The legislation, Senate Bill 770, is the first step to providing access to standard healthcare services for all state residents, potentially including long-term care.  read more

Medicaid is a lifeline that helps low-income, out-of-work, and disabled Americans tap into the country’s innovative healthcare system. But now—under the guise of lowering costs—the Biden administration is threatening to handicap the program by disrupting the lifesaving treatments, therapies, and vaccines that are made available to Medicaid patients.   read more

Oklahoma Receives CMS Approval and Advances Medicaid Transformation with SoonerSelect   Oklahoma Health Care Authority, October 2 

The Centers for Medicare & Medicaid Services (CMS) has granted approval for Oklahoma’s 1915(b) waiver for delivery system reform and the proposal to increase supplemental payments to hospitals. These approvals mark a significant milestone in the transition from a fee-for-service system to the new comprehensive health delivery system, SoonerSelect.  read more

As Hoosiers are getting older and Indiana’s long-term care system evolves to embrace the needs of a more complicated population, state officials are finalizing a potential $15 billion worth of contracts pivoting to managed care. Managed care is a model for delivering health care services, ranging from in-home offerings to institutionalized care like nursing homes.