California: CMS Approves Medi-Cal 2020 Waiver

CMS has approved California's Medicaid waiver renewal (Medi-Cal 2020), providing the State with $6.2 billion in federal funding through 2020 to continue efforts to transform the Medicaid delivery system by building on improvements made through the 2010 "Bridge to Reform" waiver. "Medi-Cal 2020" includes up to $3.7 billion to support the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program, which builds on the State's Delivery System Reform Incentive Program (DSRIP). PRIME will require certain hospitals to improve physical and behavioral health integration and it will require "Designated Public Hospitals" to transition to alternative payment methodologies for Medi-Cal managed care plans. The five-year waiver, preliminarily approved by CMS in November and finalized on December 30, also invests in dental health and whole person care pilots.

Idaho: Administration Announces Proposed Primary Care Access Program

Governor C.L. "Butch" Otter (R) announced the Primary Care Access Program (PCAP), a State-funded proposal to cover basic primary care for the approximately 78,000 Idaho adults age 19-64 who earn too much to qualify for Medicaid but not enough to qualify for federal Marketplace tax subsidies. As part of the program, PCAP providers would receive a per-member-per-month fee to assess the health of each participant, develop treatment plans, and manage care through a patient-centered medical home model. While any licensed provider may participate, the governor anticipates community health centers and rural health clinics will serve as key program providers. Participants will be subject to a currently undefined sliding fee scale for certain services based on income and "must be engaged in the process" to remain in the program. As anticipated by preliminary local media reports, the program's $30 million annual cost would be funded by the redirection of existing tobacco and cigarette tax revenue.

Missouri: State Releases Procurement Details and Timeline for Medicaid Managed Care

Missouri issued a notice further detailing its plans to expand Medicaid managed care from 54 counties to all 114 counties by summer 2017. The State plans to issue a Request for Proposal in April 2016 and will award statewide contracts to three managed care plans, which will include a provision allowing for Medicaid expansion in the event that the State enacts Medicaid expansion legislation. The contracts may be renewed annually for up to five years.

West Virginia: Hospitals' Uncompensated Care Costs Drop by $265 Million

Over two dozen hospitals in West Virginia saw a $265 million or more reduction in uncompensated care costs between 2013 to 2014, according to data compiled by West Virginians for Affordable Health Care and reported on by the Charleston Gazette-Mail. According to the analysis, hospitals are providing less uncompensated care to the uninsured as a result of over 200,000 West Virginians having gained health insurance coverage since the Affordable Care Act's coverage provisions were enacted in 2013, including more than 165,000 individuals newly enrolled in Medicaid. The State's largest hospital, Charleston Area Medical Center, reduced its uncompensated care costs from $137 million to $72.6 million between 2013 to 2014. Six other hospitals saw a reduction of more than $10 million in uncompensated care while total State uncompensated care was reduced by nearly 40%. The State's uninsured rate has dropped from 17.6% in 2013 to 8.3% in the first half of 2015.