Arkansas: State Releases New Purchasing Standards for Private Option Plans

The Department of Human Services (DHS) released coverage year 2016 guidelines for purchasing qualified health plans (QHPs) used to cover enrollees in the State's Private Option Medicaid expansion program, intended to "ensure the continued cost-effectiveness of the program and competitiveness of the market." Prior to these guidelines, Private Option enrollees could select any silver-level QHP on the State's Marketplace that only offered Essential Health Benefits (EHB), regardless of the plan's premium cost. For upcoming coverage year 2016, the new purchasing standards will only allow Private Option members to enroll in EHB-only silver-level plans that are either the lowest cost, second lowest cost or within 10% of the second lowest cost plans in each service area. A DHS spokesman commented that State officials "wanted to first make sure there was enough competition in the market to support the system [and] once that was in place, price sensitivity became a broader part of our purchasing strategy."

Florida: Governor to Take Legal Action against CMS

Governor Rick Scott (R) announced his intent to sue the Obama administration after CMS state that it will take into account Florida’s Medicaid expansion status, along with adequate provider rates, in its decision whether to renew funding for the Low Income Pool (LIP) program. Governor Scott holds that CMS’ approach breaches the 2012 Supreme Court ruling that barred the federal government from mandating Medicaid expansion. This development intensifies the already contentious negotiations between Florida and CMS over the LIP funding, which reimburses hospitals that treat large numbers of poor and uninsured patients and is set to expire on June 30. Shortly after Governor Scott’s announcement, Florida’s Medicaid department filed an amendment request to extend LIP funding through June 2017. Republican leaders noted they believe it is unlikely that the State will approve a budget by the end of the legislative session due to the Medicaid expansion negotiations.

Montana: Medicaid Expansion Bill Primed to Become Law

Pending endorsement from Governor Steve Bullock (D), Montana is expected to become the 29th state to expand Medicaid eligibility, as the Senate passed the Medicaid expansion bill endorsed by the House over the weekend. The Governor is expected to sign the bill, which remains subject to federal approval due to certain program requirements, including monthly premiums of 2% of income for all enrollees and disenrollment of individuals with incomes above 100% of the federal poverty level who fail to pay premiums. The expansion is estimated to cover up to 45,000 Montanans.

New Jersey: Vendor to Process Remaining Medicaid Applications

The New Jersey Department of Human Services (DHS) has contracted with Xerox, its Medicaid health benefits coordinator, to address the final 9,000-12,000 unprocessed Medicaid applications remaining in the system, reports The backlog, which grew to 55,000 applications in May 2014, has remained relatively steady in the last year, with counties reportedly overwhelmed by the volume of applications. DHS estimates Xerox could finish processing the backlog as early as the end of May.