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Managed Medicaid News from MCOL |
February 2020 |
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"Although the Medicaid managed care landscape and rankings
remained relatively stable between 2018 and 2019, we are
expecting to see significant changes in the upcoming year.
Health plan consolidation is something that is going to have a
major effect, not only on the market share, but also on provider
organizations operating within that space."
Corinne
Kuypers-Denlinger, Executive Vice President, OPEN MINDS
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Medicaid Expansion Associated With 6%
Lower Rate of Opioid Deaths
AMA recently published an analysis comparing
opioid overdose death rates in states that
expanded Medicaid versus states that did not.
Here are some key findings:
• Adoption of
Medicaid expansion was associated with a 6%
lower rate of opioid overdose deaths.
•
Counties in expansion states had an 11% lower
rate of death involving heroin.
• Expansion
states had a 10% lower death rate involving
synthetic opioids other than methadone.
• An
11% increase was observed in methadone-related
overdose mortality in expansion states.
Source:
JAMA Network
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10 Things to Know about Medicaid Managed Care
1. Today, capitated managed care is the dominant way in
which states deliver services to Medicaid enrollees.
2.
As of July 2017, over two-thirds (69%) of all Medicaid
beneficiaries received their care through
comprehensive risk-based MCOs.
3. Children and adults
are more likely to be enrolled in MCOs than seniors or persons
with disabilities;
however,
states are increasingly including beneficiaries with complex
needs in MCOs.
4. In recent years, many states have
moved to carve in behavioral health services, pharmacy benefits,
and
long-term services and
supports to MCO contracts.
5. In FY 2018, payments to
comprehensive risk-based MCOs accounted for the largest share of
Medicaid
spending.
6. A
number of large health insurance companies have a significant
stake in the Medicaid managed care
market.
7. Although MCOs report challenges recruiting
specialty providers, which may be linked to broader market
trends, plans report a variety of strategies to recruit
providers.
8. Over time, the expansion of risk-based
managed care in Medicaid has been accompanied by greater
attention to measuring quality and outcomes.
9. An
increasing number of states set a target percentage of MCO
provider payments that must be in
alternative payment models (APMs).
10. With increased
attention to social determinants of health at the federal and
state levels, states are looking
to Medicaid MCOs to develop strategies to identify and address
social determinants of health.
Source:
Medicaid: What to Watch in 2020, Kaiser Family Foundation, Jan
17, 2020
Check out HealthSprocket,
the home for healthcare lists
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Why and how L.A. Care Health Plan is tackling social
determinants of health
Advisory Board: Determining how
to tackle social determinants of health is not a simple
undertaking. They are numerous and vast, each can be
tackled in many different ways, and resources are
limited. L.A. Care had been working to inflect social
determinants for many years, but its efforts were
disjointed and uncoordinated and therefore difficult to
track, measure, and optimize.
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Check out
HealthshareTV, the home for health care videos
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'Hotspotting'
for Medicaid Patients Lowers Healthcare Spending
and Utilization
CareMore
Health's care management program in Tennessee
has multidisciplinary care teams with community
health workers, primary care providers, and
social workers. A care management program in
Tennessee for high-need, high-cost Medicaid
patients reduces healthcare service spending and
healthcare utilization, research published this
month indicates.
HealthLeaders, February
25, 2020
New Study: Medicaid Managed Care Saves
Billions on Prescription Drugs for Taxpayers
Every Year
Analysis by The
Menges Group finds that Medicaid managed care
plans saved over 25% more per prescription than
traditional Medicaid fee-for-service and help
keep Medicaid affordable and effective for
enrollees and taxpayers
AHIP, February
24, 2020
82% Of States Suspend Medicaid Benefits
For Incarcerated Populations
A
new report by OPEN MINDS, State Policy On
Medicaid Benefits For State Prison Inmates: A
State-By-State Review, found that 42 states
(82%) suspend, rather than terminate, Medicaid
benefits for incarcerated populations as of
2019. This is up 19 percentage points from 2014,
when just 12 states (23%) suspended Medicaid
benefits for this population.
Open Minds,
February 24, 2020
Pregnant women with Medicaid less likely
to get recommended vaccines
Pregnant women who rely on state-administered
Medicaid health insurance programs are far less
likely to receive recommended vaccines that
could protect them and their babies, compared to
those with private coverage, a study from
Florida suggests. Researchers at the University
of Florida analyzed vaccination data from 341
adult women randomly selected from nearly 7,000
whose healthcare costs were covered by Medicaid
or private insurance and who gave birth between
from 2016 through 2018.
Reuters, February
10, 2020
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FEDERAL NEWS:
Appeals court rejects Trump-approved
Medicaid work requirements
A
federal appeals court on Friday ruled against
Trump-approved Medicaid work requirements in
Arkansas, the latest legal setback to the
administration’s efforts to remake the safety
net health care program. A three judge panel in
a unanimous ruling said HHS didn't have the
authority to require some Medicaid enrollees to
work in order to receive coverage.
Politico, February 14, 2020
Implications of CMS’s New “Healthy Adult
Opportunity” Demonstrations for Medicaid
On January 30, 2020, the Centers for Medicare
and Medicaid Services (CMS) released guidance
inviting states to apply for new Section 1115
demonstrations known as the “Healthy Adult
Opportunity” (HAO). These demonstrations would
permit states “extensive flexibility” to use
Medicaid funds to cover Affordable Care Act
(ACA) expansion adults and other nonelderly
adults covered at state option who do not
qualify on the basis of disability, without
being bound by many federal standards related to
Medicaid eligibility, benefits, delivery
systems, and program oversight.
Kaiser
Family Foundation, February 8, 2020
Providers, payers, others speak out
against federal proposals for Medicaid funding
Providers, insurers and other healthcare
organizations have come out against two federal
proposals to change how states fund Medicaid.
The Centers for Medicare and Medicaid Services
released the initiatives in the state optional
Healthy Adult Opportunity and in a proposed
Medicaid Fiscal Accountability Regulation rule.
Healthcare Finance, February 3, 2020
STATE NEWS:
Frustration mounts over Louisiana
Medicaid contract dispute
Louisiana lawmakers are growing frustrated with
an ongoing dispute over $21 billion in state
Medicaid contracts, with a crucial decision on
the deals expected next month but which is
unlikely to settle the matter. Legislative
irritation about the handling of the contracts
by Gov. John Bel Edwards’ administration spilled
out Thursday evening in a joint House and Senate
budget committee hearing.
Greater Baton
Rouge Business Report, February 24, 2020
How soaring enrollment, big spending,
waste, fraud are boosting NY Medicaid costs
Spending on an increasingly popular New York
Medicaid program that lets the elderly and
disabled hire people, including their own
relatives, to care for them at home soared 85
percent between 2017 and 2018. The Consumer
Directed Personal Assistance Program – CDPAP for
short – is intended to keep people out of
high-cost nursing homes and other institutions.
Syracuse.com, February 21, 2020
Appeals court rejects Trump-approved
Medicaid work requirements
A
federal appeals court on Friday ruled against
Trump-approved Medicaid work requirements in
Arkansas, the latest legal setback to the
administration’s efforts to remake the safety
net health care program. A three judge panel in
a unanimous ruling said HHS didn't have the
authority to require some Medicaid enrollees to
work in order to receive coverage.
Politico, February 14, 2020
PROVIDER NEWS:
In N.J., Medicaid patients lose doctors
as UnitedHealthcare pares down its network
For five years, Rasha Salama has taken her two
children to Inas Wassef, a pediatrician a few
blocks from her home in Bayonne, N.J. Salama
likes the doctor because Wassef speaks her
native language — Arabic — and has office hours
at convenient times for children.
The
Philadelphia Inquirer, February 25, 2020
SNF Providers Could Find Managed Care
Relief By Banding Together in IPAs
Creating or joining an independent practice
association (IPA) empowers providers to
negotiate managed care plan services and rates,
a potential game-changer for nursing home owners
amidst Medicare Advantage headaches — pains that
include shorter lengths of stay, or the
elimination of skilled nursing stays altogether
in favor of home care.
Skilled Nursing
News, February 2, 2020
HEALTH PLANS:
Aetna Medicaid Launches New Approach To
Integrated Care Supporting Children And Their
Families
Aetna Medicaid, a CVS
Health company announced the launch of its Child
and Family Welfare (CFW) training model. This
new resource leverages a whole-person,
whole-family approach to physical, behavioral
and social well-being for all children and
families involved with Child Protection Systems.
Additionally, it emphasizes primary prevention
and early intervention benefits across a variety
of issues.
CVS Health, February 13, 2020
New Healthy Blue Benefit Allows
Louisiana Medicaid Members to Access Healthcare
via Telehealth
Healthy Blue now offers Louisiana Medicaid
members the option to access medical and
behavioral healthcare providers through
telehealth visits at no cost. Healthy Blue
recently launched a new Medicaid benefit that
allows eligible members to log into LiveHealth
Online through a smartphone, tablet or computer
that has a webcam to visit with board-certified
doctors, licensed therapists, psychologists and
psychiatrists who are licensed and credentialed
in Louisiana.
Anthem, February 4, 2020
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