JANUARY 12, 2012

Welcome to the Medicaid Update eNewsletter
This issue sponsored by The Seventh Medicaid Congress

Final Notice Issued on Medicaid Quality Measures
HHS released a set of 26 quality measures, developed in conjunction with AHRQ, that States can use to judge the relative quality of their Medicaid programs serving adults. (ModernHealthcare.com, January 3)

Ohio Begins Value-based Measure for Medicaid
The State of Ohio Medicaid program became the first in the nation to adopt a set of value-based purchasing specifications that managed care plans must meet using criteria developed by San Francisco-based Catalyst for Payment Reform. (Dayton Daily News, January 9)

New Study Disputes LePage Administration on MaineCare's Childless Adults
Maine Governor Paul LePage has proposed making childless adults and all 19- and 20-year-olds ineligible for Medicaid, thereby removing 65,000 people from the Medicaid (MaineCare) rolls. A new study says that far from all being young and healthy, more than 40 percent of childless adults covered through MaineCare are older than 45 and many have serious medical conditions. (Bangor Daily News, January 9)

State to Host Hearing on Plan for "Dual Eligibles"
The Massachusetts Health and Human Services department has begun public hearing on the Commonwealth's plan to put 109,000 dual eligibles into managed care provider networks. (Boston.com, January 3)

Judge Blocks California Budget Cut to Hospitals for Medi-Cal
A Federal District Court judge has issued an injunction preventing California from implementing reimbursement cuts to hospitals with skilled nursing units, which tend to be rural hospitals. (SacBee.com, December 30)

Blues Plans Create Medicaid HMO
Blue Cross and Blue Shield of Florida has teamed up with AmeriHealth Mercy to form a new Medicaid HMO designed to take advantage of Florida's move to much greater managed care for Medicaid beneficiaries. (HealthNews Florida, January 6)

Washington Week: Medicaid Pays Bonuses to States
HHS has awarded the first set of bonuses to State for streamlining red tape and making it easier for children to enroll in CHIP. A total of $300 million has been paid out to 23 States. (MedPage Today, December 30)

ATA Calls for Medicaid Coverage of Telehealth for Neonatal Care
The American Telemedicine Association has introduced a proposal calling for HHS to allow Medicaid coverage for telehealth monitoring of high risk pregnant women, similar to a program in existence in Arizona for 10 years, arguing that it could save $186 million over 10 years. (iHealthBeat, December 19)

The Constitutionality of the ACA's Medicaid-Expansion Mandate
A New England Journal of Medicine Perspective piece reviews the Supreme Court's decision to include the expansion of Medicaid under the ACA as part of its review of the constitutionality of the health reform law. (NEJM, January 2012 -- subscription required)

Administration Ties Medicaid Managed Care Expansion to Performance
HHS has approved a huge Texas Medicaid waiver proposal that allows hospitals to use supplemental "upper payment limit" funds that will increase from $12 to $30 billion over five years, although they must demonstrate that they are improving both quality of care and access to care. (Kaiser Health News, December 13)

Connecticut Drops Insurers from Medicaid
Bucking a national trend, Connecticut will no longer contract with for-profit Medicaid managed care plans run by Aetna and United Health Care but will now work through a non-profit arrangement. (USA Today, December 29)

Audit: State Agency Oversight of Medi-Cal Managed Care Is Lacking
The California State Auditor releases a report critical of the Department of Health Care Services and the Department of Managed Health Care for poor oversight of Med-Cal managed care plans. (California Healthline, December 14)

Medicaid Cuts Stun N.J. Nursing Homes
New Jersey nursing homes are bracing for cuts in reimbursement that could be as high as 8 percent, after enduring a year in which they started with an expectation of a rate increase and then were told over the summer that there might be a 3 percent cut. (NorthJersey.com, December 19)

Governor Patrick Announces $26.75 Billion Medicaid Waiver Agreement
Massachusetts Governor Deval Patrick is finally able to announce extension of the State's Medicaid waiver from HHS, which represents $26.75 billion over the next three years, an increase of $5.69 billion over the previous waiver. (Mass.gov, December 21)

California and Texas: Section 1115 Medicaid Demonstration Waivers Compared
A new Fact Sheet from the Kaiser Commission on Medicaid and the Uninsured contrasts key provisions of the California and Texas Section 1115 Medicaid demonstration waivers. (KCMU, December 15)

Money Follows the Person: A 2011 Survey of Transitions, Services and Costs
The Money Follows the Person (MFP) program provides states with enhanced federal matching funds for twelve months for each Medicaid beneficiary transitioned from an institutional setting to a community-based setting. This new report provides an update based on a Kaiser Commission on Medicaid and the Uninsured survey of state MFP programs conducted in August 2011. (KCMU, December 8)

Medicaid Home and Community-Based Service Programs: Data Update
While the majority of Medicaid long-term care dollars still go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 19 percent in 1995 to 43 percent in 2008. This new Kaiser Commission on Medicaid and the Uninsured report provides updated national data. (KCMU, December 8)

Health Affairs Article: Medicaid Expansion Under Health Reform May Increase Service Use & Improve Access for Low-Income Adults with Diabetes
This new analysis from the Kaiser Commission on Medicaid and the Uninsured finds that Medicaid's role in financing diabetes care will grow when many low-income uninsured people with diabetes become eligible for Medicaid as the program expansions under the Affordable Care Act in 2014. (KCMU, January 1)

Medicaid's Role for Women Across the Lifespan: Current Issues and the Impact of the Affordable Care Act
Medicaid provides more than 21 million low-income women with basic health and long-term care coverage. (KCMU, January 6)

Medicaid Cost Containment Actions Taken by States, FY 2012 - Provider Payment Cuts

Click map above to view the full, interactive resource.

Source: Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends, Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2011 and 2012, Appendix A-2. Kaiser Commission on Medicaid and the Uninsured, October 2011. Available at: http://www.kff.org/medicaid/8248.cfm.

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Medicaid and CHIP in the Health Insurance Exchanges

Catherine Hess, MSW
Managing Director for Coverage and Access, National Academy for State Health Policy, Washington, DC