Close Medicaid gap to fight opioids


From 1999 to 2016, opioid-related overdose fatalities increased by more than 800 percent in North Carolina, resulting in more than 12,000 preventable deaths statewide and a marked increase in the number of children heading into the state’s foster care system. A new report from NC Child explores key elements of the growing crisis of substance misuse by parents on North Carolina’s child welfare system. For working families who cannot afford private health insurance, but earn too much to qualify for Medicaid, closing the health insurance coverage gap is a promising policy to protect children and keep North Carolina’s families together.

Children of parents with a substance use disorder suffer from a wide range of harmful impacts, including increased risk of substance misuse in adulthood. They are also at significantly higher risk of abuse or neglect and subsequent entry into foster care. During 2017, more than 16,500 children in North Carolina lived in foster care. Parental substance misuse was a factor in out-of-home placement for at least 39 percent of children entering foster care in the 2016-17 fiscal year, up from 26 percent in 2007-08.

Because of the high cost of treatment for substance use disorder, many parents who want to get treatment and reunite their families are unable to. Medicaid can be a lifeline for lower-income families. Medicaid covers detox, medication-assisted treatment, outpatient counseling, and other evidence-based treatment and recovery supports. For thousands of families who earn too much to qualify for Medicaid, but too little to purchase private health insurance, such treatments are too often far beyond reach, increasing the risk of overdose death, and prolonging children’s stays in foster care.

Nationally, closing the health insurance coverage gap is estimated to have reduced the unmet need for substance use treatment by as much as 18 percent. States battling the opioid epidemic, including Kentucky, West Virginia, Iowa, New York, and Washington, have found that expanded eligibility for Medicaid coverage is dramatically increasing access to substance use treatment services.

North Carolina is currently considering a proposal that would create an affordable insurance option and close the coverage gap. The bill, HB 662, sponsored by Rep. Donny Lambeth (R-Forsyth), would create the Carolina Cares program, which would use federal funds to expand care to low-income working families who currently earn too much to qualify for Medicaid. By passing HB 662, the North Carolina General Assembly could provide many parents with the insurance they need to access life-saving treatment and prevention services.

Unfortunately, there is a catch. One of the shortcomings of HB 662 is the inclusion of work requirements for beneficiaries, which could prevent individuals struggling with substance use disorders from accessing needed care. While the Carolina Cares proposal includes an exception from work requirements for individuals who are currently receiving treatment for substance use, it fails to acknowledge the long-term and variable nature of successful substance use treatment and recovery. The recovery process can involve multiple episodes of treatment, but someone who leaves treatment under Carolina Cares would no longer qualify for the exemption. The work requirement therefore jeopardizes recovery for individuals who have completed treatment, but may still need recovery supports.

Families are stronger when parents have the tools they need to properly care for their children. Lawmakers should act now to shield kids from the negative impacts of parental substance misuse by ensuring all North Carolinians who need treatment for these conditions are able to receive it. Closing the health insurance coverage gap is an evidence-based policy solution that can help our state address the rising number of children in foster care as a result of the opioid crisis.

Whitney Tucker is the research director at NC Child.

Go to Source

Heart transplant hospital could lose Medicaid funds

Heart transplant hospital could lose Medicaid funds

A Houston hospital that suspended its renowned heart transplant program for two weeks amid scrutiny following the deaths of two patients could lose federal Medicaid funding.
  
The Houston Chronicle reports Baylor St. Luke’s Medical Center was notified Friday that Medicare plans to halt funding to its heart transplant program in mid-August.
  
Federal officials say the hospital has not done enough to fix shortcomings that endanger patients.
  
St. Luke’s says in a statement that it looks forward to discussing concerns with agency officials and believes it’s eligible to take further corrective steps.
  
St. Luke’s temporary suspension of its heart transplant program came after joint reports by the Chronicle and ProPublica. The hospital restarted the program June 15. Experts say termination of Medicaid funding could threaten the hospital’s viability.
  
___
  
Information from: Houston Chronicle, http://www.houstonchronicle.com

(Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

Go to Source

Houston heart transplant hospital could lose Medicaid…

Associated Press

HOUSTON (AP) – A Houston hospital that suspended its renowned heart transplant program for two weeks amid scrutiny following the deaths of two patients could lose federal Medicaid funding.

Baylor St. Luke’s Medical Center was notified Friday that Medicare plans to halt funding to its heart transplant program on Aug. 17, the Houston Chronicle reports .

Federal officials, raising concerns about two deaths in May, said the hospital has not done enough to fix shortcomings that endanger patients.

St. Luke’s temporary suspension of its heart transplant program came after joint reports by the Chronicle and ProPublica.

The hospital reopened the program on June 15 after finding no “systemic issues related to the quality of the program.” It said it was reorganizing its transplant surgery team, refining the criteria for which patients it would accept for heart transplants and making other improvements to strengthen the program.

The funding withdrawal by the Centers for Medicare and Medicaid Services would threaten the hospital’s viability, experts contend, depriving it of an essential source of funding. The termination could trigger private insurance companies to follow suit.

St. Luke’s, in a statement, said it looks forward to discussing CMS’ concerns with agency officials. The hospital said it believes it is eligible to take further corrective steps, including a systems improvement agreement, “which would provide a long-term path forward for our program.”

“Our unwavering focus is always to ensure our patients receive the best possible medical care, and in ways that reflect our core values of reverence, integrity, compassion, and excellence,” the hospital said.

Systems improvement agreements, when they occur, are usually first offered by CMS, not requested by a hospital. No such agreement was offered in the CMS letter.

St. Luke’s can appeal the termination, but that won’t freeze the process, according to Medicare rules.

___

Information from: Houston Chronicle, http://www.houstonchronicle.com

Advertisement

Sorry we are not currently accepting comments on this article.

Go to Source

Houston heart transplant hospital could lose Medicaid funds

A Houston hospital that suspended its renowned heart transplant program for two weeks amid scrutiny following the deaths of two patients could lose federal Medicaid funding.

Baylor St. Luke’s Medical Center was notified Friday that Medicare plans to halt funding to its heart transplant program on Aug. 17, the Houston Chronicle reports .

Federal officials, raising concerns about two deaths in May, said the hospital has not done enough to fix shortcomings that endanger patients.

St. Luke’s temporary suspension of its heart transplant program came after joint reports by the Chronicle and ProPublica.

The hospital reopened the program on June 15 after finding no “systemic issues related to the quality of the program.” It said it was reorganizing its transplant surgery team, refining the criteria for which patients it would accept for heart transplants and making other improvements to strengthen the program.

The funding withdrawal by the Centers for Medicare and Medicaid Services would threaten the hospital’s viability, experts contend, depriving it of an essential source of funding. The termination could trigger private insurance companies to follow suit.

St. Luke’s, in a statement, said it looks forward to discussing CMS’ concerns with agency officials. The hospital said it believes it is eligible to take further corrective steps, including a systems improvement agreement, “which would provide a long-term path forward for our program.”

“Our unwavering focus is always to ensure our patients receive the best possible medical care, and in ways that reflect our core values of reverence, integrity, compassion, and excellence,” the hospital said.

Systems improvement agreements, when they occur, are usually first offered by CMS, not requested by a hospital. No such agreement was offered in the CMS letter.

St. Luke’s can appeal the termination, but that won’t freeze the process, according to Medicare rules.

Go to Source

Governor Rick Snyder Signs Law Creating Medicaid Work Requirement

Snyder signs 80-hour Medicaid work requirement law

Lansing — Most adult Medicaid recipients who receive health care insurance through the state’s Healthy Michigan plan will be required to work at least 80 hours per month or risk losing coverage under a new law signed Friday by Republican Gov. Rick Snyder.

Five years after he led the push to expand Medicaid eligibility under the federal Affordable Care Act, Snyder signed the new work requirements over protests from Democrats and advocacy groups who decried it as a legislative effort to strip health insurance from low-income residents.

But the term-limited governor said the proposal will ensure continued operation of his flagship Healthy Michigan plan, which is available to residents in households with earnings between 100 percent and 133 percent of the federal poverty level, which is about $33,000 a year for a family of four.

The program “has improved the lives of hundreds of thousands of Michiganders, and I’m very proud it has been so successful,” Snyder said in a statement announcing the anticipated bill signing.

“The original estimates were that 400,000 people without health care would be able to obtain it after the creation of Healthy Michigan, and today more than 670,000 people have coverage. I am committed to ensuring the program stays in place and that Michiganders continue to live healthier lives because of it.”

The new work rules could apply to roughly 540,000 able-bodied adults, according to the nonpartisan House Fiscal Agency, which projects about five to 10 percent of recipients will drop out or leave the program as a result.

Snyder’s signature met swift condemnation from the Michigan League for Public Policy, a nonprofit advocacy group that said the governor “betrayed the Healthy Michigan Plan he worked so hard to build.”

“He also betrayed the people it serves,” President and CEO Gilda Jacobs said.

Michigan will need federal approval to implement the new work requirements, and critics note the new law includes a trigger to end the Healthy Michigan program if the state is not able to obtain a waiver.

GOP President Donald Trump’s administration opened the door to Medicaid work requirements for the first time last year and invited states to submit waiver requests.

Snyder said he has met with officials at the Center for Medicare and Medicaid Services and expects federal approval. Without it, his office said, the program would still continue through at least Feb. 1, 2020.

The governor opposed an earlier version of the work requirements legislation but publicly backed revisions earlier this month after negotiating changes with sponsoring state Sen. Mike Shirkey, R-Clarklake.

Shirkey, who was not immediately available for comment Friday, has championed Medicaid work requirements as an economic tool to help employers struggling to fill open positions. But opponents argue most Medicaid recipients who can work already do.

Pending federal approval, the law will require Healthy Michigan beneficiaries to work at least 80 hours per month in a paid job, job training program, volunteer position, internship or undergo substance abuse treatment.

Disabled residents, pregnant women, full-time students, children and one parent in a household with a child under the age of 6 would be exempt from the work requirements.

The law also seeks to tighten a four-year coverage limit for Healthy Michigan recipients, who would need to pay a 5 percent premium and complete healthy behaviors to stay on the plan.

Health care and patient groups including the American Heart Association, American Lung Association and Cancer Action Network had called on Snyder to veto the bill.

Signing the bill will jeopardize “healthcare coverage for 670,000 Michiganders, including those living with serious and chronic health conditions,” the coalition said earlier this month.

“Administering these requirements will not help low-income families improve their circumstances but will lead them to battling administrative red tape to keep coverage. With no way to circumvent this penalty, patients could face serious — even life or death — consequences.”

An earlier version of the legislation would have required all adult and able-bodied Medicaid recipients to work at least 29 hours a week. It also included an exemption for rural counties that critics called racist but was stripped from the bill before it was sent to Snyder earlier this month.

joosting@detroitnews.com

Read or Share this story: https://detne.ws/2yACy6V

Go to Source

State of Kansas Awards Medicaid Contracts to Three Managed Care Companies

Kansas Department of Health and Environment (KDHE) Secretary Jeff Andersen and State Medicaid Director Jon Hamdorf are pleased to announce the selection of three managed care organizations (MCOs) that will serve the Kansas Medicaid program, known as KanCare. The contracts include one new organization and two current KanCare companies.

The companies include:

Sunflower State Health Plan, Inc.
United Healthcare, Midwest Inc.
Aetna Better Health of Kansas, Inc.

The MCOs were selected from a pool of six candidates, which submitted bids during a Request for Proposal (RFP) process that concluded yesterday, June 21, when the winning bidders signed their contracts with the State of Kansas, through the Kansas Department of Administration.

“We appreciate the tremendous feedback we have received every step of the way as the contract language was developed,” Secretary Andersen said. “We took into consideration the concerns we received from KanCare consumers, advocacy groups, legislators and other stakeholders. We strive to provide Kansans with a cost effective and dependable Medicaid program that serves their needs, and the new contracts will further that objective.”

Some of the key improvements in the new contracts include:

Greater oversight and accountability
Improved response to consumer needs
Enhanced care coordination
Supported employment pilot for persons with disabilities and behavioral health needs
New value-added benefits

Adult dental services will continue.

A multi-step process preceded the 17-member review committee’s evaluation of the six RFP bids. Committee members consisted of KDHE and Kansas Department for Aging and Disability Services (KDADS) staff members with experience and knowledge working with the Kansas Medicaid system. The evaluations considered cost and technical capabilities to perform the work outlined. A recommendation was then made to Secretary Andersen, who approved and then forwarded the recommendation to the procurement negotiating committee (PNC) and the Department of Administration for review and approval. Based on that process, the PNC then awarded the contracts.

“KanCare has proven an effective and efficient delivery model for Medicaid in Kansas,” said Governor Jeff Colyer. “We have achieved cost savings, but more importantly, we’ve seen greater preventative care access to improve health outcomes for Kansans.”

Consumers currently enrolled in Amerigroup will have the opportunity to select a new MCO during the open enrollment period, beginning in October. Amerigroup will continue to serve as a KanCare MCO through the duration of the existing contract, which is set to expire on Dec. 31.

“These new KanCare contracts will provide Medicaid waiver consumers with enhanced, comprehensive care and services,” said KDADS Secretary Tim Keck. “We are looking forward to offering them improved care coordination and more work opportunities that will encourage them to grow and thrive while living in their home communities.”

For more information about KanCare, visit www.kancare.ks.gov.

Go to Source

Centene’s Kansas Subsidiary Wins Medicaid Contract

Information contained on this page is provided by an independent third-party content provider. Frankly and this Site make no warranties or representations in connection therewith. If you are affiliated with this page and would like it removed please contact pressreleases@franklyinc.com

SOURCE Centene Corporation

ST. LOUIS, June 22, 2018 /PRNewswire/ — Centene Corporation (NYSE: CNC) today announced its Kansas subsidiary, Sunflower Health Plan, has been selected by the Kansas Department of Health and Environment to provide managed care services to KanCare beneficiaries statewide. The new contract will commence January 1, 2019.

The state’s KanCare program covers low-income families, eligible pregnant women, Aged, Blind or Disabled (ABD), long-term care beneficiaries and the Children’s Health Insurance Program (CHIP). Approximately 400,000 Kansans are enrolled in KanCare, which provides medical and behavioral health benefits as well as long-term services and supports (LTSS). KanCare managed care organizations supplement Medicaid services by offering value-added benefits to improve quality of life for members, their family and the community. 

“Sunflower Health Plan has been providing healthcare services and programs in the State of Kansas since 2013,” said Christopher Bowers, Executive Vice President, Markets, for Centene. “We look forward to continuing our partnership with the state and all stakeholders to provide better health outcomes for Kansas residents at a lower cost to the state.”

“Sunflower Health Plan is committed to ensuring Kansas’ vulnerable populations have access to the quality, comprehensive healthcare they deserve,” said Chris Coffey, President and CEO for Sunflower Health Plan. “We appreciate Governor Colyer’s passion for KanCare, and thank him for his collaboration throughout the past years.”

Over the past five years, Sunflower has partnered with local providers and community groups to support members in their personal health and wellness goals. This impact on its membership has resulted in satisfaction scores and health outcomes earning the health plan a Commendable NCQA accreditation status.

Sunflower Health Plan currently serves approximately 130,000 members in the KanCare program.

About Centene Corporation 
Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long-Term Services and Supports (LTSS), in addition to other state-sponsored programs, Medicare (including the Medicare prescription drug benefit commonly known as “Part D”), dual eligible programs and programs with the U.S. Department of Defense and U.S. Department of Veterans Affairs. Centene also provides healthcare services to groups and individuals delivered through commercial health plans. Centene operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, commercial programs, home-based primary care services, life and health management, vision benefits management, pharmacy benefits management, specialty pharmacy and telehealth services.

Centene uses its investor relations website to publish important information about the Company, including information that may be deemed material to investors. Financial and other information about Centene is routinely posted and is accessible on Centene’s investor relations website, http://www.centene.com/investors.

Forward-Looking Statements
The company and its representatives may from time to time make written and oral forward-looking statements within the meaning of the Private Securities Litigation Reform Act (“PSLRA”) of 1995, including statements in this and other press releases, in presentations, filings with the Securities and Exchange Commission (“SEC”), reports to stockholders and in meetings with investors and analysts. In particular, the information provided in this press release may contain certain forward-looking statements with respect to the financial condition, results of operations and business of Centene and certain plans and objectives of Centene with respect thereto, including but not limited to the expected benefits of the acquisition (“Health Net Acquisition”) of Health Net, Inc. (“Health Net”) and the proposed acquisition of New York State Catholic Health Plan, Inc., d/b/a Fidelis Care New York (“Fidelis Care“) (“Proposed Fidelis Acquisition” or “Fidelis Care Transaction”). These forward-looking statements can be identified by the fact that they do not relate only to historical or current facts. Without limiting the foregoing, forward-looking statements often use words such as “anticipate”, “seek”, “target”, “expect”, “estimate”, “intend”, “plan”, “goal”, “believe”, “hope”, “aim”, “continue”, “will”, “may”, “can”, “would”, “could” or “should” or other words of similar meaning or the negative thereof. We intend such forward-looking statements to be covered by the safe-harbor provisions for forward-looking statements contained in PSLRA. A number of factors, variables or events could cause actual plans and results to differ materially from those expressed or implied in forward-looking statements. Such factors include, but are not limited to, Centene’s ability to accurately predict and effectively manage health benefits and other operating expenses and reserves; competition; membership and revenue declines or unexpected trends; changes in healthcare practices, new technologies and advances in medicine; increased healthcare costs; changes in economic, political or market conditions; changes in federal or state laws or regulations, including changes with respect to income tax reform or government healthcare programs as well as changes with respect to the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act and any regulations enacted thereunder that may result from changing political conditions; rate cuts or other payment reductions or delays by governmental payors and other risks and uncertainties affecting Centene’s government businesses; Centene’s ability to adequately price products on federally facilitated and state based Health Insurance Marketplaces; tax matters; disasters or major epidemics; the outcome of legal and regulatory proceedings; changes in expected contract start dates; provider, state, federal and other contract changes and timing of regulatory approval of contracts; the expiration, suspension or termination of Centene or Fidelis Care’s contracts with federal or state governments (including but not limited to Medicaid, Medicare, TRICARE or other customers); the difficulty of predicting the timing or outcome of pending or future litigation or government investigations; challenges to Centene or Fidelis Care’s contract awards; cyber-attacks or other privacy or data security incidents; the possibility that the expected synergies and value creation from acquired businesses, including, without limitation, the Health Net Acquisition and the Proposed Fidelis Acquisition, will not be realized, or will not be realized within the expected time period, including, but not limited to, as a result of any failure to obtain any regulatory, governmental or third party consents or approvals in connection with the Proposed Fidelis Acquisition or any conditions, terms, obligations or restrictions imposed in connection with the receipt of such consents or approvals; the exertion of management’s time and Centene’s resources, and other expenses incurred and business changes required in connection with complying with the undertakings in connection with any regulatory, governmental or third party consents or approvals for the Health Net Acquisition or the Proposed Fidelis Acquisition; disruption caused by significant completed and pending acquisitions, including the Health Net Acquisition and the Proposed Fidelis Acquisition, making it more difficult to maintain business and operational relationships; the risk that unexpected costs will be incurred in connection with the completion and/or integration of acquisition transactions, including among others, the Health Net Acquisition and the Proposed Fidelis Acquisition; changes in expected closing dates, estimated purchase price and accretion for acquisitions; the risk that acquired businesses and pending acquisitions, including Health Net and Fidelis Care, will not be integrated successfully; the risk that the conditions to the completion of the Proposed Fidelis Acquisition may not be satisfied or completed on a timely basis, or at all; failure to obtain or receive any required regulatory approvals, consents or clearances for the Proposed Fidelis Acquisition, and the risk that, even if so obtained or received, regulatory authorities impose conditions on the completion of the transaction that could require the exertion of management’s time and Centene’s resources, or otherwise have an adverse effect on Centene or the completion of the Proposed Fidelis Acquisition; business uncertainties and contractual restrictions while the Proposed Fidelis Acquisition is pending, which could adversely affect Centene’s business and operations; change of control provisions or other provisions in certain agreements to which Fidelis Care is a party, which may be triggered by the completion of the Proposed Fidelis Acquisition; loss of management personnel and other key employees due to uncertainties associated with the Proposed Fidelis Acquisition; the risk that, following completion of the Proposed Fidelis Acquisition, the combined company may not be able to effectively manage its expanded operations; restrictions and limitations that may stem from the financing arrangements that the combined company will enter into in connection with the Proposed Fidelis Acquisition; Centene’s ability to achieve improvement in the Centers for Medicare and Medicaid Services (“CMS”) Star ratings and maintain or achieve improvement in other quality scores in each case that can impact revenue and future growth; availability of debt and equity financing, on terms that are favorable to Centene; inflation; foreign currency fluctuations; and risks and uncertainties discussed in the reports that Centene has filed with the SEC. These forward-looking statements reflect Centene’s current views with respect to future events and are based on numerous assumptions and assessments made by Centene in light of its experience and perception of historical trends, current conditions, business strategies, operating environments, future developments and other factors it believes appropriate. By their nature, forward-looking statements involve known and unknown risks and uncertainties and are subject to change because they relate to events and depend on circumstances that will occur in the future. The factors described in the context of such forward-looking statements in this press release could cause Centene’s plans with respect to the Health Net Acquisition, actual results, performance or achievements, industry results and developments to differ materially from those expressed in or implied by such forward-looking statements. Although it is currently believed that the expectations reflected in such forward-looking statements are reasonable, no assurance can be given that such expectations will prove to have been correct and persons reading this press release are therefore cautioned not to place undue reliance on these forward-looking statements which speak only as of the date of this press release. Centene does not assume any obligation to update the information contained in this press release (whether as a result of new information, future events or otherwise), except as required by applicable law. This list of important factors is not intended to be exhaustive. We discuss certain of these matters more fully, as well as certain other risk factors that may affect Centene’s business operations, financial condition and results of operations, in Centene’s filings with the SEC, including the annual reports on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K.

Cision View original content:http://www.prnewswire.com/news-releases/centenes-kansas-subsidiary-wins-medicaid-contract-300670853.html

©2017 PR Newswire. All Rights Reserved.

Go to Source

Director Of Office Over Medicaid Not Saying If Pharmacy Benefit Managers Are Or Aren’t A Good Deal

A new audit commissioned by Ohio’s Medicaid program shows that there’s a nearly 9 percent differential between what the state pays the two companies managing Medicaid pharmacy benefits and what those companies pay pharmacies for those drugs. The head of the office that manages Medicaid isn’t ready to say whether that’s appropriate or a rip-off.

Office of Health Transformation director Greg Moody said the $225 million dollar differential sounds like a lot, but that it would cost the state a lot to do what the PBMs do. So he can’t yet say whether that spread is too big or too small. “The PBM is going to have to demonstrate to us the value that it’s providing at that price. We welcome information from the pharmacies that challenges that number and says it’s too high,” Moody said.

Moody says he was pleased the audit showed the PBM CVS Caremark paid independent pharmacies more than its own. Moody also says this audit is the first time a state has been able to shine a light on pricing like this, because he says drug companies go to what he calls extreme lengths to keep prices secret.

Go to Source