Topic: Medicaid

Gorman Health Group Client Forum Takeaways: Government Programs are Booming, Bar is Rising

John Gorman

We just wrapped our best-ever Gorman Health Group 2015 Client Forum at National Harbor with over 200 of our closest clients and partners.  There was both great and tough news, so here’s a few takeaways, including a couple stunners: Read more

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Medicaid Reimbursement Rates and the Future of the Program

Sunmi Janicek

A recent monumental decision by the Supreme Court was just passed, and it will define the way Medicaid providers will be reimbursed now and in the future.  Many Medicaid providers, including doctors, hospitals, and healthcare organizations, are already concerned with the low reimbursement rates, but now, due to the 5-4 vote by the Supreme Court, many will not have the right to push the states into increasing their payments.

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Network Adequacy Test Submissions for Medicare-Medicaid Plans

Elena Martin

In follow up to the October 2014 Health Plan Management System (HPMS) memo titled “MMP Network Adequacy Standards,” the Centers for Medicare & Medicaid Services (CMS) announced dates in which Medicare-Medicaid Plans (MMPs) and Minnesota Senior Health Options Dual Eligible Special Needs Plans (D-SNPs) can check their network against the MMP standards in the HPMS Network Management Module (NMM). These standards were developed using the same methodology that is used to develop the network standards for Medicare Advantage but were adapted to reflect the population served under the demonstrations. Specifically: Read more

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Kaiser Family Foundation & CCF Release 50-State Survey on Medicaid and CHIP

Susan Roberts

It’s time again for the release of the annual 50-state survey on Medicaid and CHIP enrollment, eligibility, cost-sharing and renewal policies conducted by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families.

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Federal study raises questions about access to care for people gaining Medicaid coverage under the Affordable Care Act

Susan Roberts

Federal investigators said in a new report that large numbers of doctors who are listed as serving Medicaid patients are in reality, not available to treat them.

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Hepatitis C virus (HCV) and treatment with Sovaldi® (sofosbuvir)

Roxanne Newland

The medication Sovaldi® has revolutionized the way HCV is treated and at the same time has shocked health insurance payers and particularly Medicaid prescription drug budgets. With an estimated cost of $1000 or more per pill for a twelve (12) week course of treatment, the cost to treat one person can exceed $84,000.

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Republican Congress to Use “Inside Baseball” and Courts to Maim ObamaCare

John Gorman

Blowing in like a flu outbreak as year-end approaches, ObamaCare Derangement Syndrome has enveloped the Capital. Republican leaders in Congress are plotting to use arcane parliamentary procedures and the courts to do further violence to ObamaCare, and by extension, to the millions who have gained insurance through it.  While it’s red meat for the conservative base, the strategy presents a huge political problem for the GOP: they have nothing to replace it with.

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