• Medicaid directors across the country are already planning for next year’s redeterminations and hoping that CMS will allow them to use the variety of unwinding-specific flexibilities currently in place. These flexibilities include Section 1902(e)(14)(A) waivers that allow states to renew beneficiaries’ Medicaid coverage based on their eligibility for the Supplemental Nutritional Assistance Program or Temporary Assistance for Needy Families Program, work with managed care plans to update beneficiaries’ contact information, and to use the National Change of Address Database and United States Postal Service Returned Mail systems to obtain beneficiary contact information (Inside Health Policy, October 6).
• According to a study published in Health Affairs, states that expanded Medicaid saw lower uninsurance rates in nonelderly adults living in redlined areas (neighborhoods designated as undesirable and highest investment risk by the Home Owner’s Loan Corporation). Researchers compared uninsurance rates in Medicaid expansion and non-expansion states prior to (2009-2013) and after (2015-2019) the state option to expand Medicaid pursuant to the Affordable Care Act took effect in 2014. On average, states that expanded Medicaid saw a 6.2% decrease in uninsurance rates in the most heavily redlined census tracts throughout the country. Researchers highlighted the importance of considering structural racism and other contextual factors when evaluating healthcare and health policies. Researchers also claim that states that “do not expand Medicaid delay progress toward health equity” (University of Iowa College of Public Health, October 3).

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Florida Issues RFP for Medicaid Dental Managed Care

• The Florida Agency for Health Care Administration has released an RFP for the state’s Medicaid dental managed care program. The state intends to award at least two contracts that they expect to start in mid-2024 and run through 2030. The Medicaid dental managed care plan contracts will be worth around $12 billion. Currently, the Florida Medicaid program spends $1.7 billion per year on dental services for approximately 3.5 million managed care enrollees. The state is also seeking bids for its full Medicaid contract which is due October 25 (Health Payer Specialist, October 9).

• New York is strengthening certificate-of-need laws to improve health equity in the state. In June, the state started enforcing a law that requires any hospital, nursing home, diagnostic treatment center, birthing center, and ambulatory surgery center that want to expand to hire third-party analysts to conduct health equity assessments. The health equity assessments will include an examination on the impacts of expansions on health disparities as part of the certificate-of-need review process (Modern Healthcare, October 11).
• New York is finalizing its 1115 Waiver amendment proposal with CMS to establish social care networks to serve regional Medicaid-enrolled organizations, like MCOs and community-based organizations (CBOs), in the state. The social care network will be responsible for managing social needs screening, verifying members’ eligibility for health-related social needs services, and generating a social care plan for members. Each social care network will have a designated Medicaid provider to oversee fiscal administration, contracting, data collection, referral management, and CBO capacity building. According to the proposal, the state is expecting three and a half years to set up and implement the networks. In addition, New York Medicaid is overhauling its value-based payment program to focus more resources on reducing health disparities and improving quality of care (Fierce Healthcare, October 11).
• Centene and Blue Cross Blue Shield of Arizona bid on Arizona’s $1.6 billion Long-Term Care Program contract aimed at older adults and individuals with disabilities. Current contract holders, UnitedHealthcare Community Plan, Banner University Family Care, and Mercy Care Plan have also bid on the contract. Successful bidders must offer a Medicare Advantage Dual-Special Needs Plan (D-SNP), to be operational by January 1, 2025, and receive CMS designation as a fully-integrated special needs plan (FIDE-SNP). In addition, the successful bidders must provide dental, hearing, and vision benefits along with over-the-counter drugs, fitness benefits and telehealth services. Winners will be announced on December 13 (Health Payer Specialist, October 9).
• Several states including Hawaii, Tennessee, Kentucky, Michigan, Maryland, and New Hampshire expanded or began dental coverage for adults in 2023. Though advocates are supportive of states expanding their services, they still note that there are barriers to accessing care. Many dentists and advocates claim that Medicaid reimbursement rates are too low, reducing the number of providers willing to take Medicaid beneficiaries. Additionally, dentists explain that certification processes and billing systems are also hinderances to their participation in the Medicaid program. Despite these challenges, patients interviewed expressed their relief at receiving dental care regardless of wait time or additional out-of-pocket costs (Yahoo News, October 7).
• UCare, the nonprofit health plan that services approximately 600,000 consumers in Minnesota and Wisconsin, has selected Navitus Health Solutions, LLC, to take over the pharmacy benefit management (PBM) services. Navitus is a member of Transparency-RX, a recently launched PBM coalition that champions having a 100% pass-through model, ban on spread pricing, national reporting and disclosure requirements, delinking provisions that require PBMs to be paid a flat transparent fee, rebate reforms, and data sharing (Inside Health Policy, October 6).

News

• Uber and UnitedHealth Group’s Optum have forged a partnership that adds Optum’s payment platform to the Uber app, allowing individuals to pay for rides to doctors’ appointments, prescriptions, and healthy food delivery. According to a statement released by Uber, select Medicare Advantage members will be able to make these eligible purchases with health plan benefit cards starting in 2024. Ultimately, Optum and Uber plan to grow the program to include Medicaid and commercial plans but there is no tentative date for the launch of these additional expansions (Health Payer Specialist, October 9).
• During the COVID-19 pandemic, Congress had mandated insurers to pay providers equal rates for virtual and in-person care for Medicare enrollees, and many commercial insurers agreed to pay providers equal rates for telehealth services. However, commercial health insurers are starting to reevaluate their telehealth coverage as consumer demand for most virtual health care visits wanes and hospitals and clinician’s in-person capacity increases. CVS Health subsidiary Aetna will end commercial telehealth coverage for multiple services, including some behavioral health services, by December 1 (Modern Healthcare, October 9).
• Brightside Health is partnering with Optum and other payers to offer telehealth-based mental health services to both Medicare and Medicaid beneficiaries, expanding access to mental health coverage for millions according to the company. The expansion addresses the limited availability of telehealth in the behavioral health space, particularly for Medicare and Medicaid beneficiaries. Though Medicaid is the largest payer of mental health services in the U.S., many beneficiaries do not receive treatment. Brightside offers personalized psychiatry, clinically proven therapy, and Crisis Care (for those at risk of suicide). The company hopes to provide care to more than one in three people in the U.S. when combined with their current commercial partnerships. Studies have supported the effectiveness of telehealth-based mental health services for low-income individuals and older adults, though patient satisfaction has been found to vary with age (Healthcare Finance, October 9).

• Sellers Dorsey is thrilled to attend the MHPA 2023 Annual Conference, where Senior Vice President, Gary Jessee will moderate two engaging panel discussions. The first, “Moving the Needle on SDOH Needs Among High-Risk Populations,” brings together multiple perspectives, demonstrating how stakeholders can effectively address members’ SDOH needs. The second, “A Conversation with State Medicaid Directors,” is sure to spark inspiration and innovation with leaders in Medicaid from around the country. Click here for more info.