Brief Explores Medicaid Funding Options for Social Service Interventions

A new brief prepared for the Milbank Memorial Fund and the New York State Health Foundation by Manatt Health reviews how states can use Medicaid to facilitate access to social services including housing services, employment and job stability programs, and peer and community supports. The brief, which is based on regulatory review and interviews with state and federal experts, describes 1115 Medicaid waivers as “by far the most flexible vehicle” that states have to integrate social services into their Medicaid programs, though the authors caveat that securing an 1115 waiver can be a lengthy process. The brief also finds that states can include case management, preventive and rehabilitative services, habilitation services, and Health Home services in their benefit packages through State Plan Amendments, which “generally are the simplest and easiest way” to secure funding for a service. Home and community-based service waivers, managed care and alternative payment models are also identified as tools available to states.

Arizona: Lift of CHIP Enrollment Freeze Ends Status as Only State Without Active Program

CMS approved Arizona’s plan to begin accepting new applications for KidsCare, the State’s Children’s Health Insurance Program (CHIP), ending a six-year freeze on enrollment that the State enacted as a cost-saving measure during the recession. Arizona had been the only state without an active CHIP program. An estimated 30,000 to 40,000 children up to age 18 with incomes between 133% and 200% of FPL will become eligible for coverage effective in September.

Alabama: Governor Will Propose Lottery to Close Medicaid Funding Gap in Special Session

Governor Robert Bentley (R) has called an August 15 special session to introduce legislation to create a statewide lottery in response to the State’s current fiscal challenges, including an $85 million shortfall in the most recent Medicaid budget. If the legislation passes, a measure will be placed on the November ballot for a constitutional amendment to establish a lottery. The Governor expects the lottery to generate $225 million annually for General Fund programs, including Medicaid. In his video announcing the special session, Governor Bentley reiterated his commitment to the State’s ongoing transition to Medicaid managed care delivered through regional care organizations, which the State has had to delay due to the Medicaid shortfall.

California: Aetna and UnitedHealthcare to Offer Medi-Cal Managed Care Plans

Aetna and UnitedHealthcare will begin offering Medi-Cal (Medicaid) managed care coverage in two counties—San Diego and Sacramento—beginning July 2017, pending State approval. California's Department of Health Care Services opened the program to new insurers because the existing managed care contracts in those counties “have been in place for an extended period of time.” Currently, 22 insurers participate in Medi-Cal managed care; the last new insurer to enter the market was Centene in 2013. This announcement comes as UnitedHealth prepares to exit most ACA Marketplaces for 2017, including Covered California, the State-based Marketplace.

Indiana: CMS Denies Requested Amendments to Medicaid Expansion, Including New Lock-Out Period

CMS denied the State's request to add a six-month lockout period for all Medicaid expansion enrollees who do not complete the annual renewal process, which would have barred nearly 19,000 people from coverage each year. In its letter to Governor Mike Pence (R), CMS noted that it has not granted a lock-out period for enrollees below 100% of FPL in any state waiver. CMS also rejected the State's request to discontinue a “prior claims payment program,” which provides retroactive coverage of medical costs incurred for one year before a parent is enrolled in Healthy Indiana Plan (HIP) 2.0. Even prior to receiving Indiana’s request, CMS had established that this program could only be discontinued if the program was needed by five percent or less of parents enrolled in HIP. The State’s latest data indicates 13.9% of eligible individuals are incurring costs that would have been reimbursed in the absence of the demonstration.

Massachusetts: State's Dual Eligible Demonstration Extended Through 2018

MassHealth (the State’s Medicaid program) and CMS have extended and amended the One Care dual eligible demonstration contract with the program’s managed care plans to include updated quality withhold amounts, savings percentages, and risk corridor terms. The new contract will apply to the final two years of the now five-year demonstration. One Care covers approximately 13,000 adults with disabilities ages 21-64 who are eligible for both MassHealth and Medicare. MassHealth is accepting Letters of Intent through August 12, 2016 from health plans interested in participating in the demonstration beginning January 2018. There are currently two plans participating in the demonstration.

New York: Medicaid DSRIP Provider Networks Earn Top Performance Payments

Efforts to reform New York's Medicaid system via the State's Delivery System Reform Incentive Payment (DSRIP) program are on track, according to new data released by the New York State Department of Health. DSRIP provider networks known as Performing Provider Systems (PPSs) achieved the majority of DSRIP Year 1 Statewide and PPS-specific reporting, process, and implementation milestones, and received 99.44% of available performance-based funding. The State also announced the results of a value-based payment baseline survey, which found that 25.5% of State Medicaid Managed Care Organization (MCO) payments to providers were value-based in 2014. The 2014 figure is a baseline measurement for Medicaid MCOs and providers, who are aiming to meet the New York DSRIP goal of making 80%-90% of MCO payments to providers value-based by 2020.

Washington: State Must Notify Impacted Enrollees of Hepatitis C Drug Coverage

A judge ordered the State Health Care Authority (HCA) (Medicaid) to send an official notice to the estimated 900 Medicaid enrollees previously denied access to Hepatitis C medication, informing them of their new eligibility for the drug. In May a federal judge ordered HCA to cover Hepatitis C medication regardless of the severity of an individual’s liver condition. Prior to distribution, the court must approve the notice language, which will also be reviewed by the lawyers representing the class of affected patients. The judge also granted class certification to the lawsuit, which will add an estimated 22,000 Medicaid enrollees who have the virus and may require treatment in the future.