Tennessee is the first state in the nation to ask the government for a Block Grant of Medicaid funding, where the fed will give a set dollar amount of to the state for Medicaid programs, including TennCare. TennCare is Tennessee’s Medicaid health insurance program that is jointly funded by federal and state tax dollars.
In exchange for a set dollar amount of federal funding, Tennessee will gain more flexibility and management authority to better customize this health insurance program, to fit Tennessee residents, and potentially increase the program’s efficiency.
As Tennessee’s economy continues to improve, the federal share of funding is reduced and this will leave a $41 Million “hole” in the TennCare budget for fiscal year 2020.
Nationwide, the cost of Medicaid increased 4.9% in the last fiscal year. While Tennessee’s Medicaid costs have increased less than the national average- the state’s TennCare cost is still projected to increase 2.1%. This will cause the people of Tennessee to need to find an additional $66 Million in their budget to shore up the loss of federal funds, increased healthcare costs, and increased enrollments.
The current TennCare budget is $12 Billion dollars. And, like many states, it is the state’s most expensive state agency. Federal funds account for 65 cents of every TennCare dollar spent, and that amount is based on the average household income throughout the state.
“This legislation does not seek to reduce funding or limit current eligibility services to anyone,” said state senator Paul Bailey who co-sponsored the bill.
“We need the flexibility to determine what is best for our citizens instead of continuing down the path of a one-size-fits-all program from Washington DC.”
Source: Brett Kelman, The Tennessean; Rachana Pradhan, Politico.
“The American Hospital Association urged the Trump administration on Wednesday to halt Centene’s $17.3 billion acquisition of WellCare Health Plans, claiming it will reduce competition in Medicaid managed-care and Medicare Advantage services.
“Centene and WellCare are both major players in government-sponsored health plans, with both having a presence in Medicaid and on the Affordable Care Act’s exchanges. All told the two insurers would cover nearly 22 million people in Medicare, Medicaid and the exchanges.
“The insurers’ markets overlap in several states, the AHA said in its letter, and they control over half of the Medicaid market in Florida, Georgia and Illinois.”
Source: Modern Healthcare.
“Centene Corp. has said it will buy fellow Medicaid insurer WellCare Health Plans in an estimated $17.3 billion deal.
“All in all, the two insurers would cover nearly 22 million people in Medicare, Medicaid and the ACA exchanges. Centene CEO Michael Neidorff will serve as chairman and CEO of the merged company.
“‘With the addition of WellCare, we expect to bolster and diversify our product offerings, increase our scale and have access to new markets, which will in turn, enable us to continue investing in technology and better serve members with innovative programs designed to meet their needs,’ Neidorff said in a statement.
“…It would include more than 12 million Medicaid beneficiaries and almost 1 million Medicare members, along with a Medicare prescription drug plan WellCare is acquiring from Aetna…
“Centene saw its ACA exchange membership swell to almost 2 million during the latest open enrollment, giving it about a 20% market share across the country. WellCare’s recent growth focused on Medicaid, where it has million members, thanks in large part to its $2.5 billion acquisition of Meridian Health Plan that closed in September.”
Several healthcare groups, including the American Hospital Association and Blue Cross and Blue Shield plans, have joined coalitions that oppose “Medicare for All” plans, according to The New York Times.
Three things to know:
1. While 2020 presidential hopefuls incorporate Medicare for All into their platforms, hospitals, physicians, drugmakers and insurers are lobbying against the idea and proposed legislation.
2. In June 2018, the Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America created a coalition to combat Medicare for All proposals. The lobbying group, the Partnership for America’s Health Care Fund, also includes the American Medical Association, the AHA and Blues plans, according to the NYT.
3. The AHA’s president and CEO, Rick Pollack, recently cautioned against Medicare for All proposals in a Feb. 22 blog post, writing that such legislation “could do more harm than good to patient care.”
Source: Morgan Haefner, Becker’s Hospital Review.
Improvements in the cost of medications for Medicare-eligible customers may not be too far off. The Centers for Medicare and Medicaid (CMS) has proposed some new ways to lower drug costs for those in the Medicare program, and with drug coverage through a stand-alone prescription drug plan or with a Medicare Advantage plan that includes drug coverage.
One provision in the proposal targets e-prescribing and would require the person’s plan “to adopt a provider Real Time Benefit Tool by the start of 2020.
“‘RTBTs have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit, which can improve medication adherence, lower prescription drug costs, and minimize beneficiary out-of-pocket costs,’ CMS stated.
Another provision of the CMS proposal is that drug coverage Explanations Of Benefits (EOBs) that people receive from their plans will be tasked with including drug pricing information and lower cost therapeutic alternatives as part of these EOBs to give customers the information in hand that can also potentially help them lower their out-of-pocket costs for their particular medications.
This is not a comprehensive list of the provisions of the CMS proposal which could become a set of new rules in the near future. However, we do want to get info about these two particular provisions out there, so everyone can have confidence in any changes to come and know there will be tangible things for American households coming that can help lower their drug costs.
Source: Kyle Murphy, “HealthPayer Intelligence.”
“The CMS on Monday, May 7th, gave New Hampshire the green light to impose work rules for some adult Medicaid recipients. It’s the fourth state to win approval for that requirement.
“The state’s Medicaid 1115 waiver will require adult beneficiaries between the ages of 19 and 64 to participate in 100 hours of “community engagement activities” a month to maintain eligibility for coverage. Community engagement is defined as having a job, being enrolled in school, participating in job skills training, or performing some sort of community service.
“‘Today’s announcement by the CMS … is a transformative step towards a more thriving workforce,’ Gov. Chris Sununu said in a written statement. ‘Work requirements help lift able-bodied individuals out of poverty by empowering them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs—we are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole.'”
Source: Steven Ross Johnson, Modern Healthcare.
On Monday April 9, 2018 the Centers for Medicare and Medicaid finalized the rule that “eliminates (Affordable Care Act) standardized options starting in 2019 to encourage innovative plan designs among insurers.”
This is a good move for the coming years in the, non-Medicare, individual/family health insurance markets of America! This change indicates that our current government recognizes that health insurance plans are not a one-size-fits-all financial product. We have been saying this all along and CMS Director Verma has now been quoted saying as much- and we are thankful.
At this time it is unclear if ACA-compliant plans this fall, for the 2019 calendar year, will reflect this change in standardization requirements, and make health insurance plans more reflective of the coverage needs of the people in each state. However, since the standardization requirements are eliminated in 2019- we do expect the individual/family plans, for the 2020 calendar year, to be more fitted to each state.
As everyone anticipates smart changes coming in the years ahead to the individual/family health insurance market we should be aware that according to Director Verma, the states are still subject to the ACA requirement that insurers offer 10 essential health benefits. Although the standardization requirements are eliminated, this doesn’t mean states can allow ACA-compliant plans to exclude maternity care or mental health benefits.
We do expect to have more appropriate premiums and coverage choices for individuals and families in the coming years. All in all, a good day.
Reference: Shelby Livingston and Susannah Luthi, Modern Healthcare.
“The CMS announced Friday that it will cover diagnostic laboratory tests using gene sequencing technology for Medicare cancer patients.
“The CMS said the tests — called next generation sequencing — can help patients and their oncologists make better treatment decisions as well as help more patients enroll in clinical trials. Patients with recurrent, metastatic, relapsed, refractory or stages III or IV cancers will be eligible to get the tests covered under Medicare, according to the agency.
“‘We want cancer patients to have enhanced access and expanded coverage when it comes to innovative diagnostics that can help them in new and better ways,’ said CMS Administrator Seema Verma in a statement. ‘That is why we are establishing clear pathways to coverage, while at the same time supporting laboratories that currently furnish tests to the people we serve.’
“The CMS’ decision to cover such tests comes shortly after the FDA’s recent approval of Foundation Medicine’s genomic profiling test called FoundationOne CDx. The CMS worked with the FDA to review the effectiveness of the test.” Source: Maria Castellucci, Modern Healthcare.
CMS Administrator, Seema Verma, has announced the initiative to ease the burden of records and reporting management in medical pracctices. Nationally, medical providers and staff typically spend a disproportionate amount of time on maintaining medical records in comparison to actual patient care.
“On a typical day, primary care doctors spent about 27% of their time on “meaningful patient care” and about 49% on administrative activities, he said, according to a 2016 study published in Annals of Internal Medicine.”
The new initiative, “Patients Over Paperwork,” seems to be set to review current regulations and eliminate those that may not be adding to quality of care, or possibly unnecessary altogether. The coming steps to be taken have the potential, in the long run, to lower today’s healthcare costs, increase efficiency and benefit both the healthcare industry and the people in America directly. Source: Medpage.