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量子资源网 Insights: Your source for healthcare news, ideas and analysis.

量子资源网 Insights鈥攊ncluding briefs, webinars, and our podcast鈥攇ives you easy access to 量子资源网鈥檚 deep expertise, helping you stay current on the latest healthcare trends and topics. Search for a topic of interest or browse the latest insights below.

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量子资源网 examines current state of Medicare-Medicaid integration programs

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The experts at 量子资源网 (量子资源网) have released the Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals issue brief and companion bibliography appendix, the second in a series of issue briefs examining Medicare-Medicaid integrated programs.

Based on 量子资源网’s review of the literature and available public information, this brief summarizes the elements for success and barriers encountered by integrated programs. It concludes with essential questions and next steps to move forward with federal and state public policies and care delivery options centered around, informed by, and available to, more dually eligible individuals.

量子资源网 colleagues Sarah Barth, Jon Blum, Elaine Henry, Narda Ipakchi and Sharon Silow-Carroll contributed to the research and final brief.

For the next phase of research, 量子资源网 will convene and interview individuals, their families and other caregivers, providers, payers, community-based organizations, state government, and other stakeholders in select regions across the country.

The project was funded by a grant from , a philanthropy dedicated to tackling some of the most pressing problems in the United States.听听

Hawaii Releases Quest Integration Reprocurement RFI

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This week, our In Focus section reviews the Hawaii request for information (RFI) regarding reprocurement of the state鈥檚 QUEST Integration (QI) Medicaid managed care program, released on July 21, 2020. QI covers approximately 360,000 individuals, including pregnant women, children, parents/caretakers, adults, and individuals who are aged, blind, or disabled (ABD). The state had awarded contracts earlier this year, however, the contracts were rescinded as the state focused on their response to COVID-19.

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Oklahoma releases Medicaid managed care request for public feedback

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This week, our In Focus section reviews the Oklahoma request for public feedback in the SoonerCare program design, released on June 18, 2020. The Oklahoma Health Care Authority (OHCA) and Governor Kevin Stitt are seeking stakeholder input for the state鈥檚 Medicaid managed care program design before finalizing a request for proposals (RFP). The RFP, which is currently in development, is scheduled to drop in the fall and has an implementation date of October 2021. Individuals, program participants, providers, trade associations, companies, and other organizations are encouraged to submit responses by August 17, 2020.

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Early Bird Registration Expires July 29 for 量子资源网 Conference, October 26-27 in Chicago

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Be sure to register soon for 量子资源网鈥檚 conference on What鈥檚 Next for Medicaid, Medicare, and Publicly Sponsored Healthcare: How Payers, Providers, and States Are Navigating a Future of Opportunity and Uncertainty, October 26-27, at the Fairmont Chicago, Millennium Park. The Early Bird registration rate of $1595 per person expires on July 29.听 After that, the rate is $1795.

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Medicaid and exchange enrollment update 鈥 March 2020

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This week, our In Focus section reviews updated information issued by the Department of Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) on Medicaid expansion enrollment from the 鈥淢arch 2020 Medicaid and CHIP Applications, Eligibility Determination, and Enrollment Report,鈥 published on June 22, 2020. Additionally, we review 2020 Exchange enrollment data from the 鈥淗ealth Insurance Exchanges 2020 Open Enrollment Period: Final State-Level Public Use File,鈥 published by CMS on April 2, 2020. Combined, these reports present a picture of Medicaid and Exchange enrollment in early 2020, leading up to the COVID-19 pandemic and representing 70.9 million Medicaid and CHIP enrollees and 11.4 million Exchange enrollees. Medicaid/CHIP and Exchange enrollment is expected to rise in 2020 according to a team of 量子资源网 Medicaid experts, health economists, and data analysts. Read the previous In Focus on 量子资源网鈥檚 forecast model.

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GAO 50-state Medicaid survey on federal policy challenges

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This week our In Focus section summarizes the United States Government Accountability Office (GAO) Medicaid report, State Views on Program Administration Challenges, released earlier this year. GAO conducted interviews with Medicaid officials from 50 states and the District of Columbia to identify challenges related to federal Medicaid policies.

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Medicaid Managed Care Spending in 2019

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This week, our In Focus section reviews Medicaid managed care spending data collected in the annual CMS-64 Medicaid expenditure report. After submitting a Freedom of Information Act request to the Centers for Medicare & Medicaid Services (CMS), we have received a draft version of the CMS-64 report that is based on preliminary estimates of Medicaid spending by state for federal fiscal year (FFY) 2019. We expect the final version of the report will be completed by the end of 2020 and posted to the CMS website at that time. Based on the preliminary estimates, Medicaid expenditures on medical services across all 50 states and six territories in FFY 2019 exceeded $594 billion, with over half of all spending now flowing through Medicaid managed care programs. In addition, total Medicaid spending on administrative services was $29.5 billion, bringing total program expenditures to $623.5 billion.

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量子资源网 experts publish 50-state Medicaid pharmacy study with Kaiser Family Foundation

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In conjunction with the Kaiser Family Foundation (KFF), a team of 量子资源网 experts have published survey results and analysis examining administration of the Medicaid pharmacy benefit. 量子资源网 contributing colleagues were Kathleen Gifford, Anne Winter and Linda Wiant.Rachel Dolan,听Marina Tian, and听Rachel Garfield from KFF also contributed.

The report, , summarized the survey conducted in all 50 states and the District of Columbia.

The survey outlines Medicaid pharmacy policy areas and key issues to watch based on feedback from the states in several categories including pharmacy benefit administration, cost-containment and utilization controls, payment and rebates, 340B management and long-term priorities.

50-State Survey of Medicaid Pharmacy Directors

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This week, our In Focus听section reviews key takeaways from the report, How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020, prepared by Kaiser Family Foundation (KFF) and 量子资源网 (量子资源网). The report was written by 量子资源网 Managing Principal Anne Winter and Principals Kathleen Gifford and Linda Wiant with Rachel Dolan, Marina Tian, and Rachel Garfield from KFF.

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