KHN Morning Briefing

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States Face Difficulties In Move To Managed Care For Medicaid’s Long-Term Care Patients

As about half the states work to keep costs down through these managed care plans, enrollees and their families have faced a rocky transition, The Chicago Tribune reports. In other Medicaid news, federal officials set a new rule on outpatient drug reimbursement, Vermont's governor proposes some changes to help the budget and the debate in Iowa over moving to managed care intensifies.

The Chicago Tribune: Rocky Rollouts As States Try Medicaid-Managed Long-Term Care
The national move to home and community-based care away from nursing homes has been widely supported by senior citizen, consumer and disability rights communities. ... In recent years nearly a million people with disabilities or conditions severe enough to qualify for nursing home admission have been enrolled in Medicaid-managed long-term care programs .... In Medicaid-managed long-term care, states pay private health plans monthly fixed rates to provide eligible beneficiaries' health care and services .... But most of the 26 states involved are new to providing managed long-term supports and services for this population. It's been a rocky transition for many beneficiaries and their families, who have seen cuts in services to parents and loved ones. Many have scrambled to find new doctors, hospitals and personal attendants. And while states like Texas and Wisconsin have seen costs drop, others such as Florida have seen hikes in health care spending. (Taylor, 1/21)

Modern Healthcare: CMS Finalizes Controversial Medicaid Outpatient Drug Rule
By April 1 state Medicaid agencies must start reimbursing pharmacies for prescription drugs based on actual acquisition costs according to a final rule released Thursday. Medicaid programs until now have reimbursed pharmacies for prescription drugs based on the ingredient costs for the drug and a dispensing fee for filling the prescription, according to the Kaiser Family Foundation. The CMS says the change will more accurately reflect pharmacies' purchase prices. (Dickson, 1/21)

The Associated Press: Shumlin: Increase Fees On Doctors, Mutual Funds
Gov. Peter Shumlin on Thursday unveiled a $1.53 billion general fund budget for the upcoming fiscal year that calls for new or higher fees on independent doctors and dentists as well as mutual funds, and strengthens security at state buildings following the August murder of a child protection worker. ... Among health care changes, Shumlin wants to save $4.9 million by lowering the income at which pregnant women are no longer eligible for Medicaid from 218 percent of the federal poverty level to 138 percent — the threshold at which others are deemed to be making too much to be eligible for Medicaid coverage. For a household of 3, 138 percent of this year’s federal poverty level is $27,724. (Gram, 1/21)

The Des Moines Register: Branstad Staff: Medicaid Savings Report Shows More
Some lawmakers were told by state officials Thursday that “additional key observations” in an October report push the savings behind Gov. Terry Branstad’s plan to privatize Medicaid beyond budget projections. But those additional observations and other pieces of the report are also now drawing additional scrutiny by some lawmakers and an Iowa healthcare reform advocate. (Clayworth, 1/21)

Des Moines Register: Jochum: Medicaid Not Ready For March 1 Rollout
Iowa Senate President Pam Jochum said Thursday she doesn’t believe Iowa’s Medicaid program will be ready for a March 1 rollout of a privately managed initiative, adding she worries the plan will hurt Iowa’s poor and disabled people. “This has never been about politics. It has been about policy,” said Jochum, D-Dubuque, whose developmentally disabled daughter, Sarah, is enrolled in Medicaid. Jochum said an adequate Medicaid provider network is needed, as well as a strong ombudsman’s program. (Petroski, 1/21)

Sioux City (Iowa) Journal: Senate Leader: Iowa Still Not Ready For Privatized Medicaid Care
A top Senate Democrat said Thursday she does not believe Iowa will have the safeguards in place by March 1 to proceed with the change to privately managed Medicaid services and she hopes federal regulators again will delay implementation of Gov. Terry Branstad’s modernization effort. ... Jochum said the final decision rests with the federal Centers for Medicare and Medicaid Services (CMS), which funds 55 percent of Iowa’s Medicaid program. (Boshart, 1/21)

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