News

Cook Children’s Sues Texas Over Potential Medicaid Contract Loss

• On June 26, Cook Children’s Health Plan, the Texas Fort Worth-based health system, announced they filed two lawsuits against the state to stop the Texas Health and Human Services Commission (Commission) from removing them as a longstanding Medicaid contractor. The lawsuits are an attempt to halt the $116 billion Medicaid procurement process that will remove Cook Children’s Health Plan and two other hospital-affiliated children’s health plans from Medicaid STAR and CHIP. Texas Medicaid STAR and CHIP cover the cost of routine, acute, and emergency medical visits, and STAR primarily covers pregnant women, low-income children, and their caretakers. If the Commission’s decision stands, the number of managed care organizations contracted in the state that administer STAR and CHIP will be reduced and enrollees will be moved to new insurers by next year (The Texas Tribune, June 27).

Pennsylvania Medicaid Policy Change Boosts Coverage of Philadelphia Street Medicine

• The city of Philadelphia continues to address its opioid crisis by deploying mobile medical units to provide Medicaid-funded “street medicine” to the unhoused population. This initiative was made possible by a Pennsylvania policy change made last Fall that allows medical providers to bill Medicaid for covered services delivered by mobile medical units to unsheltered or homeless individuals. The opioid epidemic has significantly increased homelessness in Philadelphia and the mobile units aim to offer essential care and dignity to unhoused people. The program has a significant impact on participants, with goals of improving medical outcomes, building trust, and enhancing access to health care and support services with trauma-informed and harm-reduction care (MSN, July 2).

Maryland Pauses Behavioral Health Provider Enrollment Within Its Medicaid Program

• The Maryland Department of Health has made the decision to pause Medicaid provider enrollment into psychiatric rehabilitation, psychiatric health homes, level 2.5 partial hospital programs, and level 2.1 intensive outpatient treatment programs for 6 months in an attempt to address potential fraud and abuse. The state will reportedly take this time to assess and evaluate the current provider landscape after a shift to an accreditation only model for licensing. Individual practitioners, clinics within hospitals, and FQHCs will not be affected, and pre-existing providers will continue to have access to the needed support related to licensure and enrollment (Baltimore Sun, June 29).

Colorado Law Aims to Provide Medicaid Coverage for Housing and Nutrition Services

• Colorado aims to join approximately 20 other states in asking CMS to consider if Medicaid can cover safe housing and nutritious food. HB 1322 requires the Department of Health Care Policy and Financing (HCPF) to conduct a study to determine whether seeking federal authorization to provide services that address Medicaid members’ health-related social needs is viable. The state released a request for public comment earlier in June on a proposal planning to cover three groups: individuals who are homeless or at risk of homelessness, individuals with disabilities who are transitioning out of facilities, and young individuals aging out of foster care (Colorado Sun, July 1).

HHS Authorizes Five Additional States to Provide Medicaid or CHIP Coverage to Justice-Involved Individuals Prior to Reentry

• On July 2, CMS approved five 1115 waiver demonstrations, authorizing Illinois, Kentucky, Oregon, Utah, and Vermont to provide Medicaid or CHIP coverage to individuals prior to their release from incarceration. With the approval of these waivers, CMS believes individuals transitioning from the justice system will have a more seamless transition back into their communities and more continuity of care. These five states join California, Massachusetts, Montana, and Washington in expanding access to high-quality, low-cost health care for a population that has higher incidences of substance use disorder and chronic health conditions and has been historically overlooked. Other states continue to submit requests to CMS through the agency’s standard demonstration application and special terms and conditions to accelerate approval. In our latest white paper, Sellers Dorsey experts analyze the impact of Medicaid supports for those individuals within the justice system on improving healthcare and health equity and identify solutions and promising services and practices for states, providers, and other stakeholders to improve health outcomes. Read it here! (Medicaid.gov, July 2).