This week, our In Focus section reviews the California Medicaid (Medi-Cal) managed care request for proposals (RFP) released by the California Department of Health Care Services (DHCS) on February 9, 2022. DHCS is procuring contracts for commercial plans for three of the Medi-Cal managed care plan models in 21 counties, serving approximately 3 million beneficiaries. Contracts will be awarded to one managed care organization (MCO) in each of the Two-Plan model counties, two MCOs in each of the geographic managed care (GMC) model counties, and two MCOs in each of the Regional model counties. This procurement is the largest released by California, rebidding contracts for commercial plans statewide.
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Delaware Releases Medicaid Managed Care RFP
This week our In Focus section reviews the Delaware request for proposals (RFP) for Diamond State Health Plan (DSHP) and Diamond State Health Plan Plus (DSHP Plus), the state鈥檚 Medicaid managed care programs. The RFP was released by the Delaware Department of Health and Social Services (DHSS), Division of Medicaid and Medical Assistance (DMMA) on December 15, 2021.
Minnesota releases Medicaid RFP for 80 counties outside Twin Cities
This week our In Focus section reviews the Minnesota request for proposals (RFP) for Families and Children Medical Assistance (MA), the state鈥檚 traditional Medicaid managed care program, and MinnesotaCare, the state鈥檚 Basic Health Program (BHP), in 80 counties outside of the Twin Cities seven-county region. The RFP was released by Minnesota Department of Human Services, Purchasing and Service Delivery Division on January 18, 2022. Contracts will begin January 1, 2023, covering approximately 470,000 members.
District of Columbia releases Medicaid Managed Care RFP
This week, our In Focus section reviews the District of Columbia (DC) Medicaid managed care request for proposals (RFP), released on November 19, 2021, by the District of Columbia Department of Health Care Finance. The procurement will cover DC Healthy Families Program (DCHFP), including adults with special health care needs; District of Columbia Healthcare Alliance Program (Alliance); and Immigrant Children鈥檚 Program (ICP). DC expects to award contracts to up to three managed care organizations (MCOs), covering physical, behavioral health, and pharmacy services. Contract approval is expected by June 2022 and implementation in October 2022.
Missouri Releases Medicaid Managed Care RFP
This week our In Focus reviews the Missouri MO HealthNet (MHD) Medicaid Managed Care Program request for proposals (RFP), released on November 19, 2021, by the Department of Social Services (DSS). The MHD managed care program serves about 850,000 Medicaid and Children鈥檚 Health Insurance Program (CHIP) members including the state鈥檚 newly implemented Medicaid expansion population, across all regions of Missouri. Missouri鈥檚 General Plan managed care program covers TANF, CHIP, expansion and similar eligibility groups but does not include individuals with disabilities or those over age 65. The RFP also contains a separate section for a single, statewide Specialty Plan for foster children and children receiving adoption subsidy assistance. Managed care organizations must bid on and win a General Plan contract in order to be eligible for the Specialty Plan contract.
Rhode Island releases Medicaid managed care RFQ
This week our In Focus reviews the Rhode Island Medicaid managed care request for qualifications (RFQ), released on November 12, 2021, by the Executive Office of Health and Human Services (EOHHS). Contracts are worth approximately $1.4 billion annually and cover over 300,000 individuals.
Highlights from 21st annual Kaiser/量子资源网 50-state Medicaid director survey
This week, our In Focus section reviews highlights and shares key takeaways from the 21st annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and 量子资源网 (量子资源网). Survey results were released on October 27, 2021, in two new reports: States Respond to COVID-19 Challenges but Also Take Advantage of New Opportunities to Address Long-Standing Issues: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2021 and 2022 and Medicaid Enrollment & Spending Growth: FY 2021 & 2022. The report was prepared by Kathleen Giff颅ord, Aimee Lashbrook, and Sarah Barth from 量子资源网; Mike Nardone; and by Elizabeth Hinton, Madeline Guth, Lina Stolyar, and Robin Rudowitz from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors (NAMD).
Medicaid managed care enrollment update 鈥� Q2 2021
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 33 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 33 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2020. This report reflects the most recent data posted. 量子资源网 has made the following observations related to the enrollment data shown on Table 1 (below):
Webinar Replay: Continuing the Path to Medicare-Medicaid Integration
This webinar was held on October 4, 2021.
Federal and state policy makers have long been working to expand enrollment in Medicare-Medicaid integrated care programs (ICPs). ICPs can advance independent living and health equity for individuals who are dually eligible for both programs. However, approximately only one in 10 dually eligible individuals was enrolled in an ICP as of 2019. To encourage ICP enrollment and retention, 量子资源网 identified 10 essential elements of ICPs centered around, informed by, and made available to dually eligible individuals. (See 量子资源网 Brief #3 and the brief fact sheet.)
During this webinar, 量子资源网 shared these 10 essential elements for establishing and simplifying ICPs specifically tailored to diverse individuals鈥� needs and preferences. Panelists involved in health justice and community-based healthcare offered practical next steps for advancing ICPs.
Learning Objectives
- Hear about the 10 essential elements for ICPs identified through interviews with diverse stakeholders
- Engage panelists to share their views on how to advance ICPs tailored around members鈥� needs
- Consider the types and level of investment required to advance the essential elements for ICPs
Speakers
- Arielle Mir, MPA, Vice President of Health Care, Arnold Ventures, Washington, DC
- Sarah Barth, JD, Principal, 量子资源网, New York, NY
- Ellen Breslin, MPP, Principal, 量子资源网, Boston, MA
- , Health Justice Policy Analyst, Disability Policy Consortium, Malden, MA
- Linda Little, MBA, RN, CCM, President and CEO, Neighborhood Service Organization (NSO), Detroit, MI
Case study examines Georgia鈥檚 experience unbundling LARC payments from Medicaid prospective payment system
A new case study prepared by colleagues from 量子资源网 (量子资源网) analyzes the Georgia Medicaid program鈥檚 experience with unbundling long-acting, reversible contraception (LARC) devices and services from the Medicaid prospective payment system (PPS) for reimbursement in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
量子资源网 examined Medicaid claims data from 2012-2019 as well as conducted key interviews to understand whether the unbundling reimbursement policy change could have increased LARC utilization and provided analysis for policymakers and stakeholders in other states pursuing similar strategies and programs.
Additional findings and the full report are available here.
量子资源网鈥檚 research was supported by and with support from . The 量子资源网 team included Rebecca Kellenberg, Diana Rodin, and Jim McEvoy.
量子资源网 colleagues conduct environmental scan of NEMT benefit to Medicaid enrollees
As part of a larger Medicaid and CHIP Payment and Access Commission (MACPAC) study on Medicaid non-emergency medical transportation (NEMT) in response to a request from the Senate Appropriations Committee, a team of 量子资源网 colleagues conducted a 50-state environmental scan of NEMT programs and stakeholder interviews to better understand approaches and trends in the provision of the NEMT benefit to Medicaid enrollees across the United States.
The culminating report included NEMT trends, challenges, and innovations drawn from the scan of programs and interviews with stakeholders including federal officials, Medicaid officials from six study states, NEMT brokers and providers, managed care companies, beneficiary advocates, and subject matter experts.
The key findings are outlined in the report and include information about:
- NEMT populations and utilization
- Various modes of transportation
- NEMT delivery system model variations, advantages, and challenges
- NEMT complaints, performance issues, and innovation
- Performance improvement, oversight, and program integrity
- Transportation network challenges and increasing role of transportation network companies
- Coordination across federally assisted transportation services
- Stakeholders鈥� view on the value and role of NEMT
In December 2020, following the completion of the interviews for this study, Congress added a requirement to the federal statute requiring states to provide NEMT to Medicaid beneficiaries who have no other means of transportation to medically necessary healthcare services.
The 量子资源网 team included Principals Sharon Silow-Carroll, MSW, MBA and Kathy Gifford, JD, Senior Consultant Carrie Rosenzweig, MPP, Consultants Anh Pham and Julie George, JD as well as retired Managing Principal Kathy Ryland.
The research underlying this report was completed with support from the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed are those of the authors and do not necessarily represent those of MACPAC.
量子资源网 briefs on Medicare-Medicaid integration
This issue brief听from 量子资源网,听Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals听is part of a multi-phased research initiative to increase enrollment in integrated care programs (ICPs)[1]听that meet full benefit dually eligible individuals鈥�[2]听needs and preferences. Dually eligible individuals have a range of chronic conditions and disabilities requiring both Medicare and Medicaid services, which makes integrated programs important to their lives.
For a succinct overview of the essential elements and policy recommendations, please access the听brief fact sheet. For a full discussion of the elements and policy recommendations, please access the听full brief.
The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.[3]
For further information or questions, contact Sarah Barth, Ellen Breslin or Samantha DiPaola.
[1]听Integrated Care Programs (ICPs): For this research, we defined ICPs as financing and care delivery organizing entities or programs that coordinate and integrate Medicare and Medicaid-covered services and supports for dually eligible individuals.They include the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative (FAI) capitated and fee-for-service models; the Program of All-Inclusive Care for the Elderly (PACE); Medicare Advantage (MA) Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Medicaid Managed Long-Term Service and Supports Program (MLTSS) managed care organizations and aligned MA dual eligible special needs plans (D-SNPs); and state-specific programs that may be proposed to CMS.
[2]听Dually Eligible Individuals:听When using the term dually eligible individuals, we are referencing Medicare-Medicaid full benefit dually eligible individuals (FBDEs), those who qualify for full Medicaid benefits.
[3]听Narda Ipakchi was formerly a Senior Consultant with 量子资源网.