Managed Medicaid

News Briefs: CMS Will Now Cover and Pay for Over-the-Counter COVID-19 tests for Medicare Enrollees

Effective April 4 and through the end of the COVID-19 public health emergency, Medicare will cover and pay for over-the-counter COVID-19 tests at no cost to people with Medicare Part B, including those enrolled in Medicare Advantage plans. Through the new initiative, beneficiaries can obtain up to eight tests per month from participating pharmacies and health care providers, CMS said on April 4. The agency noted that this is the first time that Medicare has covered an over-the-counter self-administered test at no cost to beneficiaries.

UnitedHealth Group on March 29 said it will spend approximately $6 billion in cash to acquire LHC Group, Inc., a home health care company. If the deal goes as planned, LHC will be folded into UnitedHealth’s Optum division; the companies expect to complete the transaction in the second half of the year. The move will make UnitedHealth a major player in home care and hospice care, positioning it alongside rival Humana Inc., which purchased Kindred at Home last year.

Health Insurers Use Data Acumen to Tackle Health Disparities

Fueled by the COVID-19 pandemic’s deepening of disparities and the Biden administration’s own focus on the issue, health equity is undeniably top of mind for health insurers these days. But how can firms move beyond just appointing new C-suite officers or setting lofty mission statements — and instead weave equity initiatives into the fabric of their businesses?

To answer that question, payer executives during AHIP’s recent National Conference on Health Policy and Government Health Programs explained the business case for furthering health equity and how they’re marshaling processes like data analytics and vendor selections to achieve their goals.


HHS Budget Seeks to Give Feds More Power Over Medicaid MCOs

Tucked into the 174-page Fiscal Year 2023 Budget in Brief document recently issued by HHS is a proposal seemingly aimed at giving the federal government more flexibility and power to sanction out-of-compliance Medicaid managed care plans.

“Currently, CMS has inadequate financial oversight and compliance tools in Medicaid managed care, lacking maximum flexibility to disallow and defer individual payments or partial payments associated with contracts with managed care organizations, prepaid inpatient health plans, and prepaid ambulatory health plans,” stated HHS in its budget proposal released on March 28.


News Briefs: Anthem’s Contract to Cover NYC Retirees Hits New Roadblock

Just days before the planned start of Anthem, Inc.’s new contract to serve retired New York City workers and their dependents, the city’s comptroller declined to register the proposed contract and turned it back to Mayor Eric Adams (D) for a revised cost estimate. The move effectively freezes the city’s already delayed transition to a group Medicare Advantage contract, which would have nearly doubled the Anthem’s Employer Group Waiver Plan enrollment. “Due to the legal and budgetary uncertainties that remain while litigation over the City’s contract with Anthem Insurance Companies continues, the Comptroller’s office does not have sufficient information to register the proposed Medicare Advantage Plan contract at this time,” New York City Comptroller Brad Lander explained in a March 30 statement posted to the comptroller’s website. Subsequently, the city’s Office of Labor Relations posted that the transition to the NYC Medicare Advantage Plus Plan would not be implemented as of April 1 as planned and that all retirees “will remain in their current plans until further notice.”


CalOptima Aims for Real-Time Payments, Prior Auth Approvals

CalOptima, a Medi-Cal plan in Southern California, launched a five-year blueprint to cut through delays in care approvals and payments, as it seeks to deliver near-immediate claims processing and to put an end to prior authorization-related lags.

On March 21, CalOptima announced a $100 million investment in technology upgrades, which the Medicaid plan seeks to use to reduce barriers to care and to bridge divides — primarily centered on data-sharing — between the plan, providers and community partners.

The payer, which serves nearly 900,000 members in Orange County, also wants to get money into the hands of providers faster, with plans for an innovative “real-time claims processing” system.


New Centene CEO London Will Bring Tech, Innovation Chops to Her Role

Centene Corp. on March 22 named Sarah London as its next CEO, effective immediately. London, who currently serves as the firm’s vice chairman, will fill the role held by Michael Neidorff for decades, though she has been part of a group of top executives who have handled day-to-day management of Centene since Neidorff took medical leave in late February.

In her previous management role, London was responsible for a “portfolio of companies independent of Centene’s health plans, designing differentiated platform capabilities, and delivering industry-leading products and services to third-party customers,” per a March 22 press release. Before coming to Centene, she worked for UnitedHealth Group’s venture capital arm, Optum Ventures, and its data analytics division.


Millions Will Lose Medicaid Coverage After PHE Ends; Only Half of States Have Plans in Place

More than 14 million Medicaid enrollees could lose their coverage within six months when the COVID-19 public health emergency (PHE) ends, a Commonwealth Fund report projected. Meanwhile, Kaiser Family Foundation’s 50-state survey found that many states have not made key decisions on how to promote continuity of coverage. While the PHE is set to expire on April 16, HHS has said it would give at least 60 days’ notice before ending it, suggesting another extension is coming.


As Insurers Bet Big on Government Business, Challenges Remain

For the country’s major health insurers, an increasing amount of revenue and growth comes from business lines that serve government programs. Industry experts tell AIS Health that they don’t envision this changing anytime soon, but they do see ongoing business risks that will keep insurers on their toes.

“The aging of the U.S. population has had a positive impact on the senior products segment and has led to consistent growth in the segment’s revenues and earnings for health insurers, a trend that is expected to continue in 2022 and beyond,” noted a recent report from the insurance-focused credit rating firm A.M. Best. Medicare Advantage premiums reached $292.9 billion in 2020 — about 13.8% higher than 2019 and more than double that of 2012.


News Briefs: City of New York Appeals Court Decision on Retiree Switch to Group Medicare Advantage

New York City is appealing a recent ruling by the New York Supreme Court that bars the city from imposing a premium on public sector retirees who opt out of group Medicare Advantage coverage that starts April 1. Anthem, Inc. was initially contracted to provide MA coverage to an estimated 200,000 retirees and dependents for a Jan. 1 effective date. Manhattan Supreme Court Justice Lyle Frank on March 3 ruled that automatic enrollment of beneficiaries cannot start until April 1, retirees must be able to opt out of the new coverage up to three months after the effective date, and they do not have to pay a fee to retain their traditional Medicare coverage. The city’s attempt to charge $191 monthly is in violation of New York City law, which requires the municipal employer to “pay the entire cost of health insurance coverage for city employees, city retirees and their dependents,” Frank ruled. The city’s Office of Labor Relations on March 4 filed an appeal; the NYC Organization of Public Service Retirees at press time had filed a cross-appeal and was gathering signatures for a petition urging Mayor Eric Adams (D) not to pursue the appeal.

Departing Neidorff Leaves Legacy of Major Growth at Centene

Centene Corp. on Feb. 24 revealed that CEO and Chairman Michael Neidorff took immediate medical leave. That means Neidorff may have served his last day at the helm of the company he built into a Medicaid managed care powerhouse, given the fact that he has already announced plans to retire later this year after 26 years on the job.

Effective immediately, an “expanded office of the chairman” will handle day-to-day management of Centene. That group includes Vice Chairman of the Board Sarah London, President and Chief Operating Officer Brent Layton, Chief Financial Officer Drew Asher and Chief Administrative Officer Shannon Bagley.