October 2020 Medicaid News Recap Syrtis Solutions


Syrtis Solutions distributes a Medicaid newsletter on a monthly basis to help you stay informed. The newsletter focuses on legislation, insights, comments, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse. Here is a summary of last month’s noteworthy developments.

Medicaid expansion could bring Texas $5.4 billion in federal dollars, study says  Houston Chronicle, September 30
Expanding Medicaid in Texas could bring as much as $5.4 billion federal dollars into the state and enroll nearly 1 million more people in the federal safety-net insurance program, according to a new study by Texas A&M researchers. Health policy experts said Medicaid expansion would help drive down the state’s uninsured rate, which was the highest nationwide at 18.4 percent in 2019, according to U.S. Census Bureau.  read more


DeWine announces first major overhaul of Medicaid program in 15 years  WCPO, September 29
Governor DeWine announced his administration’s plans for the first major overhaul of Ohio’s Medicaid system in 15 years during his Tuesday afternoon press conference. “The Department of Medicaid is the largest provider of health insurance in the state of Ohio,” said DeWine. “Medicaid covers 3 million Ohioans. Of those, nearly 90% are enrolled in a managed care plan, including nearly every child enrolled in Medicaid in the state of Ohio.”  read more


800K receiving benefits from Michigan’s expanded Medicaid program since pandemic began  WSBT, September 29
More than 800,000 low-income residents in Michigan are receiving health care coverage through the Healthy Michigan Plan, according to Governor Whitmer.“As Senate Democratic Leader, I was proud to work across the aisle with a Republican governor and legislature to expand health coverage for Michiganders through the Healthy Michigan plan,” Governor Whitmer said.  read more


Medicaid managed-care wannabes take protest to new court  NC Health News, September 29
In the middle of a coronavirus pandemic that has tossed up challenge after challenge, the state Department of Health and Human Services also must tend to another enormous project. Over the next 10 months, the department has been told by the legislature to complete the transformation of its cumbersome Medicaid system. In the current system, the state pays for each office visit, test and hospitalization for the seniors and children enrolled in Medicaid.  read more


Molina’s $380M buy vastly boosts managed care footprint in New York  HealthcareDive, September 29
Molina is continuing to double down on its bread and butter of Medicaid managed care, snapping up plans in key markets. The Affinity buy follows the July acquisition of YourCare Health Plan, which doubled Molina’s Medicaid footprint in New York to 66,000 members. At the beginning of September, the payer also closed the acquisition of Kentucky’s second-largest Medicaid plan. And in April, Molina agreed to buy Magellan Complete Care, which has 155,000 members across six states.  read more


What Happens When Medicaid COVID-19 Flexibilities, Funding Expire?  Health Payer Intelligence, September 23
Temporary Medicaid coronavirus flexibilities and funding may be about to expire and CMS needs to be clearer about transition guidelines in order to help states be prepared, Kaiser Family Foundation (KFF) noted in a recent issue brief. The Families First Coronavirus Response Act (FFCRA) established Medicaid maintenance of eligibility requirements in order to infuse more funds into Medicaid programs during the height of the coronavirus pandemic.  read more


New York Comptroller Finds $700 Million in Medicaid Waste  Newsmax, September 22
The comptroller of New York has identified hundreds of millions of dollars in wasteful spending as part of the state’s Medicaid program. In an announcement posted to the state’s website, Thomas P. DiNapoli said that five audits of the New York Department of Health’s Medicaid program found $706.6 million in unnecessary payments. “The state is facing budget gaps of billions of dollars because of the COVID-19 crisis and needs to find cost savings wherever it can,” DiNapoli said.  read more


Nashville Post, September 18
The Centers for Medicare and Medicaid Services is “actively addressing” the proposal from Gov. Bill Lee’s administration that would convert funding for the state’s Medicaid program into a modified block grant structure, administrator Seema Verma said on Friday. Tennessee officials submitted the controversial proposal to CMS last November — with components that included per-capita funding, shared savings and a closed drug formulary — by mandate of the Tennessee General Assembly.  read more


Multi-Payer Alignment Key to Advancing Value-Based Care in Medicaid  Rev Cycle Intelligence, September 17
In a new letter to Medicaid directors, CMS called for multi-payer alignment in value-based care arrangements run by the state healthcare programs. The Sept. 15th letter providers guidance to the Medicaid leaders on how to advance value-based payment, which is a key driver of value-based care according to CMS, by identifying appropriate alternative payment models and aligning financial incentives across payers.  read more


CMS Rescinds Controversial Medicaid Fiscal Accountability Rule  Health Payer Intelligence, September 15
Concerns over provisions of the Medicaid Fiscal Accountability Rule (MFAR) have compelled CMS to rescind the rule proposed last November. In a tweet late Monday, CMS Administrator Seema Verma announced the decision. “The proposed Medicaid Fiscal Accountability Rule (MFAR) was designed to increase transparency in Medicaid financing and ensure that taxpayer resources support the health care needs of our beneficiaries,” she stated.  read more


Medicaid rolls swell amid the pandemic’s historic job losses, straining state budgets  The Washington Post, September 14
The unlikely portrait of Medicaid in the time of coronavirus looks like Jonathan Chapin, living with his wife and 11-year-old daughter in a gated community in the Sierra Nevada foothills. Chapin had a thriving Reno, Nev., production company, We Ain’t Saints, booking bands, managing weddings, hosting 600-strong karaoke nights at the Tahoe Biltmore Lodge & Casino. When the novel coronavirus came, forcing northern Nevada’s entertainment industry to go dark, he said, “everything I knew all disappeared.”  read more


$2,933 for ‘Girl’s Night’: Medicaid chief’s consulting expenses revealed  Politico, September 10
When Seema Verma, the Trump administration’s top Medicaid official, went to a reporter’s home in November 2018 for a “Girl’s Night” thrown in her honor, taxpayers footed the bill to organize the event: $2,933. When Verma wrote an op-ed on Fox News’ website that fall, touting President Donald Trump’s changes to Obamacare, taxpayers got charged for one consultant’s price to place it: $977.  read more


Medicaid Managed Care Rates and Flexibilities: State Options to Respond to COVID-19 Pandemic  KFF, September 9
With 69% of Medicaid beneficiaries enrolled in comprehensive managed care plans, plans play a critical role in responding to the COVID-19 pandemic and in the fiscal implications for states. Given unanticipated costs related to COVID-19 testing and treatment, as well as depressed utilization affecting the financial stability of many Medicaid providers, states are currently evaluating options to adjust current managed care organization (MCO) payment rates and/or risk sharing mechanisms as well as evaluating options and flexibilities under existing managed care rules to direct payments to Medicaid providers (Figure 1).  read more


Effective CMS Oversight and States’ Sharing of Claims Processing and Information Retrieval Systems Can Reduce Costs  GAO, September 9
The Centers for Medicare and Medicaid Services (CMS) has reimbursed billions of dollars to states for the development, operation, and maintenance of claims processing and information retrieval systems—the Medicaid Management Information Systems (MMIS) and Eligibility and Enrollment (E&E) systems. Specifically, from fiscal year 2008 through fiscal year 2018, states spent a total of $44.1 billion on their MMIS and E&E systems. CMS reimbursed the states $34.3 billion of that total amount (see figure).  read more


Medicaid enrollment has jumped 4.3M since February, could grow much more  HealthcareDive, September 8
Medicaid is one of the biggest safety net programs in the United States, providing health insurance to some 66.8 million Americans, or 20% of the nation’s population, as of the end of 2019. And during COVID-19, the Medicaid rolls have grown even further, according to the Families USA analysis. The report notes that the growth in Medicaid enrollment has been extraordinary. By contrast, it noted that “between February 2019 and August 2019, among all states, Medicaid enrollment averaged a decrease of 0.69%, and no state had more than a 2.1% increase.”  read more


Medicaid enrollment strains public finances in New Mexico  AP News, September 4
Enrollment in Medicaid has increased by nearly 7% in New Mexico since the outset of the coronavirus pandemic as employers shed jobs and more families descend into poverty, state health regulators told a panel of legislators Friday. Human Services Secretary David Scrase praised federal legislation approved in March that increased the federal matching rate for Medicaid health care and allowed the state to quickly extend no-charge coronavirus testing to the poor and undocumented immigrants.  read more


Coalition of Medical Providers Urge State to Expand Medicaid During Pandemic  RA News, September 2
In a letter sent to Gov. Greg Abbott, the Texas Medical Association and 33 other organizations representing doctors, nurses, hospitals, community clinics and consumer advocates are calling on the state to enact comprehensive health care coverage for the uninsured in Texas. “To truly defeat COVID-19, Texas must let loose every authority at its disposal,” the letter reads. The group is advocating for the state to expand Medicaid to the more than one million uninsured, low-income Texans who are currently shut out of the federal program.  read more


CMS quietly resumes practice audits
Medical Economics, September 1
The ongoing pandemic and resulting public health emergency (PHE) has brought about massive and quick changes in the healthcare industry, notably among them the temporary suspension of Medicare Fee-For-Service (FFS) audits. The Centers for Medicare & Medicaid Services (CMS) suspended most audits on March 30, 2020, and this change was nearly universally welcomed by the healthcare industry. Although the PHE continues, the hiatus of audits was short-lived. CMS announced the end of exercising audit enforcement action during late July, and it resumed program integrity audits effective August 3, 2020.  read more


Molina Healthcare Announces the Closing of its Acquisition of Passport’s Medicaid Plan Assets  BusinessWire, September 1
Molina Healthcare, Inc. (NYSE: MOH) (“Molina”) today announced the closing of its acquisition of certain assets related to the Medicaid line of business of Passport Health Plan, Inc. (“Passport”). In addition, Passport’s Medicaid contract with the Commonwealth of Kentucky has been novated to Molina. Effective September 1, 2020, Molina Healthcare of Kentucky, Inc. will provide Medicaid managed care benefits to Medicaid members that were previously being served by Passport.  read more