Topic: Medicaid

Best Practices in Medicaid Claims Administration and Oversight

Mae Regalado

Every Medicaid operation needs high-performing claims administration. With strict medical loss ratios as required by healthcare reform, ongoing regulatory changes, timeliness, and payment accuracy relevant to provider pricing and benefit administration, covering operating costs poses significant challenges. Claims adjudication must be efficient and cost effective.

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A Bad Couple Weeks for ObamaCare

John Gorman

It’s been a bad couple weeks for ObamaCare.  It started with a Republican gorilla-stomp in the midterms, a rout that included several Governors’ mansions and state legislatures that essentially froze in place the Medicaid expansion map.  Then, in a shocker, the Supreme Court decided to consider King v. Burwell, the case that could undo ObamaCare’s marketplace subsidies and threaten the coverage of more than 4 million Americans.  It’s enough to give weekend bedspins.

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12 Years in the Making – Rules Guiding Medicaid Managed Care are Getting a Makeover

Aaron Eaton

At the Medicaid Health Plans of America (MHPA) meeting last week in Washington, DC, there was a lot of buzz surrounding the upcoming release of an updated Medicaid Managed Care regulation. Per CMS officials speaking at the conference, the last update was 12 years ago!

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Little Reason for Optimism in Red State Medicaid Expansion

John Gorman

For months several Wall Street analysts and others have predicted near-total adoption of the Affordable Care Act’s Medicaid expansion by the states.  To date, only 27 have, and I see little optimism for more than a handful to do so anytime soon.

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ObamaCare Derangement Syndrome Fades, Medicaid Expands.

John Gorman

Last week’s approval of Pennsylvania’s Medicaid expansion waiver by the Centers for Medicare and Medicaid Services (CMS) may have been good medicine for ObamaCare Derangement Syndrome among Red State governors. Growing numbers are beginning to see the light and resistance to expansion is beginning to crumble like stale crackers.  Expansion momentum is building in Republican-led states after Pennsylvania’s change of heart. Indiana, Tennessee, Utah and now Wyoming (!) may be next in line seeking CMS approval for their conservative-oriented expansion proposals. These custom Medicaid expansion proposals include administration by risk-bearing private health plans, increased beneficiary cost-sharing, job search requirements, and mandatory health assessments, among other conservative tenets.

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PA’s Corbett is Latest GOP Governor to Take Medicaid Expansion. Will Others?

John Gorman

Last week the Center for Medicare and Medicaid Services (CMS) announced the approval of Pennsylvania’s Healthy Pennsylvania plan to expand Medicaid coverage to more than half a million low-income people, becoming the 27th state to do so under the Affordable Care Act (ACA) and the 9th Republican governor. Read more

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Health Plan Strategists: Fish Where the Fishes Is — in LTSS

John Gorman

One of the best pieces of advice I ever got in business was to “fish where the fishes is”, and for health plan strategists it holds up.  In this Golden Age of Government-sponsored Health Programs, one of the biggest fishing holes is Long-Term Services and Supports, and a new primer from KFF lays out the opportunity beautifully.  And the hazards: patients who require LTSS are of course the most vulnerable and complex patients in the entire US health system, literally the final frontier for health plans and coordinated care.  Huge risk, huge rewards.

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