Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

State Health Care

Medicare-Medicaid Dual Eligible Care Models Aim to Coordinate Care

September 18, 2018 - Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP report.   Twelve million Americans use services from both Medicare and Medicaid.  However, many dual-eligible enrollees experience challenges when attempting to access care....


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CA Plans Medical Loss Ratio Guidelines for Dental Insurance Plans

by Thomas Beaton

Consumers of dental plans may benefit from more transparency around the medical loss ratio (MLR) of dental insurance options, asserts the California Dental Association (CDA). In a recent research paper published in Health Affairs, the CDA...

1115 Medicaid Demonstrations Should be Budget-Neutral, CMS Says

by Thomas Beaton

CMS has issued new guidelines for state officials around creating budget-neutral 1115 Medicaid demonstrations. CMS informed state governments that the agency will use a formalized methodology to determine if 1115 demonstrations are a...

CMS Provides $8.4M to Stabilize State Insurance Markets

by Thomas Beaton

CMS has awarded $8.4 million to 31 states in an effort to stabilize state insurance markets and increase the number of affordable health plan options for beneficiaries. Recipients are allowed to use the ACA-funded State Flexibility Grant...

New Jersey Gains CMS Approval for Reinsurance Program

by Thomas Beaton

New Jersey has received approval from CMS to implement a five-year reinsurance program that aims to lower individual health plan premiums by 15 percent. The program will operate from 2019 to 2023 and provide $218 million in reinsurance...

CMS Processes State Medicaid Requests, Approvals 23% Faster

by Thomas Beaton

CMS has announced that an agency initiative to streamline state Medicaid approvals and state plan amendments (SPAs) has increased approval processing speed by 23 percent. In 2017, CMS sent a bulletin to state Medicaid programs informing...

Rhode Island Aims to Expand Value-Based Care in Medicaid Program

by Thomas Beaton

Rhode Island officials have requested an extension of a 1115 demonstration from CMS to expand the use of value-based care within the state’s Medicaid program. State Medicaid administrators are looking to add new value-based care...

CMS Proposed Rule Cuts State Authority to Divert Medicaid Payments

by Thomas Beaton

CMS has proposed a new rule that would eliminate a state’s authority to divert Medicaid payments away from providers. The rule is intended to ensure beneficiaries have adequate access to healthcare services through direct...

Vermont Government Plans Regulations for Association Health Plans

by Thomas Beaton

Vermont’s Department of Financial Regulation (DFR) is planning to implement emergency rules and regulations for association health plans (AHPs) following the Department of Labor’s final rule to allow AHP sales nationally. DFR...

Aetna Takes Amerigroup Spot in Kansas Managed Medicaid Contract

by Thomas Beaton

Aetna has received a Managed Medicaid contract from the state of Kansas for plan year 2019 and will replace Amerigroup as one of the state’s three managed care payers. The state received six bids from commercial payers and...

Maine Court to Force Medicaid Expansion Past LePage’s Block

by Thomas Beaton

A state-level court in Maine has forced Governor Paul LePage (R) and the Maine Department of Health and Human Services (DHHS) to uphold a ballot initiative that implements Medicaid expansion under the Affordable Care Act...

Early Health Insurance Premium Proposals Indicate Hikes for 2019

by Thomas Beaton

Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have...

Virginia Legislature Approves Medicaid Expansion

by Thomas Beaton

The Virginia General Assembly has passed Medicaid expansion as part of a two-year budget bill that could provide coverage to 400,000 newly eligible residents. The action would make Virginia the 33rd state in the US to expand Medicaid...

MN Law Allows Some Patients to Override Payers on Step Therapy

by Thomas Beaton

Minnesota Governor Mark Dayton has signed a bill into law that allows patients and providers to execute overrides on payer step therapy programs for prescription drug treatments in certain clinical situations. HF 3196 requires payers to...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

by Thomas Beaton

Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from...

Experts Support Medicaid Work Requirements Lawsuit Against KY

by Thomas Beaton

A lawsuit that contends the legality of Medicaid work requirements in Kentucky has received support from 43 public health experts and 8 medical school deans who say the work requirements directly violate the Medicaid program. In an amicus...

Rising Medical Costs Created Health Plan Enrollment Shifts in MN

by Thomas Beaton

The Minnesota of Council of Health Plans (MCHP) associated rising beneficiary medical costs in 2017 to irregular health plan enrollment shifts in both the private and public market. The Council said in a press release that a three percent...

AR Medicaid Demonstration Adds 9-Month Re-Enrollment Block

by Thomas Beaton

Arkansas received approval from CMS for a 1115 Medicaid demonstration that adds work requirements for Medicaid eligibility and adds a nine-month block on member re-enrollment if individuals don’t find work. Arkansas’...

Idaho’s Expansion of Association Health Plans Risks ACA Market

by Thomas Beaton

The Academy of Actuaries warned insurance officials and government leaders in Idaho that the decision to expand the sale of association health plans (AHP) will destabilize ACA individual health plan risk pools and reduce essential health...

AHA Makes Suggestions for In-State Insurance Market Stabilization

by Thomas Beaton

In order to stabilize in-state insurance markets, stakeholders should consider strategies including reinsurance, Medicaid-sponsored health plans, and high-risk pools, according to the AHA. Several factors are contributing to unstable...

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