Alabama: Medicaid Transformation Waiver Receives Federal Approval
CMS approved the State's 1115 waiver to transition its Medicaid program to managed care delivered through hospital- and provider-led entities called Regional Care Organizations (RCOs) across five regions. Under the new structure, Medicaid will contract directly with RCOs at an established cost for services delivered to Medicaid patients—including children, parents, pregnant women and aged, blind and disabled enrollees who are not receiving long term care services. According to the waiver, the State will receive $328 million over three years to fund the transition to the new RCO delivery system, including RCO start-up costs and provider payments. The Governor's press release indicates that the State may qualify for additional funding to supplement RCO payments. Among other conditions, the waiver requires the State to demonstrate that more pregnant women and children receive recommended checkups, and that fewer patients are admitted to hospitals. RCOs are expected to enroll more than 60% of the State's one million Medicaid recipients. The program will launch in October.
Michigan: Governor Requests Medicaid Coverage for 15,000 Children and Pregnant Women in Flint
Governor Rick Snyder (R) submitted an 1115 waiver to CMS following an announcement from the Obama administration that it plans to extend Medicaid coverage to pregnant women and children affected by the water crisis in Flint. The Governor is seeking Medicaid coverage for children up to age 21 as well as pregnant women and their newborn babies who have resided in Flint's water system service area between April 2014 and a yet-to-be-determined future date when the water system is deemed safe. Children and pregnant women with incomes up to 400% of the federal poverty level (FPL) would be eligible for coverage under the waiver, and individuals with income above 400% FPL would have the option to buy in to the program. Children and newborns would remain eligible until they turn 21; pregnant women would be eligible for the duration of their pregnancy and for two calendar months post-delivery. The waiver also seeks funding for targeted case management services and to enhance and expand current lead abatement programs. An estimated 15,000 additional Flint residents would receive Medicaid and CHIP services if the waiver is approved.
Nebraska: Medicaid Expansion Bill Remains Under Debate
State Medicaid Director Calder Lynch testified in opposition to Medicaid expansion bill LB 1032, citing a consultant report commissioned by the Department of Health and Human Services (DHHS) that estimates the bill's proposals would cost $1 billion over the next 10 years and could limit access to services, in particular for children and individuals with disabilities. The bill, which was introduced last month by a bipartisan group of lawmakers, would require DHHS to submit a waiver to expand Medicaid by purchasing qualified health plans (QHPs) on the Marketplace. Three previous Medicaid expansion proposals have failed in Nebraska.