Paragon Proposes Medicaid Reforms
The conservative think tank Paragon Institute proposes to phase out the current 90 percent federal matching rate for the Affordable Care Act’s (ACA) Medicaid expansion and begin applying the regular federal match after eight years. It would also reduce the 50% Medicaid reimbursement floor to 40% for the richest states, also phased in over eight years. It says spending would be reduced by $600 billion from 2026 to 2034. Trump is known to pay attention to Paragon. While radical and it threatens to reduce coverage nationally, the proposal is less disruptive than the fundamental remake of the ACA and Medicaid attempted by Republicans during Trump’s first term.
#aca #medicaid #coverage #reimbursement
CMS May Take A Tougher Oversight Stance On Medicaid Enrollment
The Centers for Medicare and Medicaid Services (CMS) says it will adopt greater oversight of the Medicaid enrollment process in states given the major problems with the redetermination processes since April 2023. More than 24 million have been disenrolled for some time since April 2023, about 70% of them for procedural issues.
While CMS has allowed some states to go into 2025 to complete their processes, it has adopted some new policies to stop inappropriate disenrollments and to speed enrollment processes. CMS has streamlined enrollment in a new rule as well as improved automatic renewals. Many of the changes will become permanent.
I am somewhat critical of CMS on this issue. It failed to act quickly when there was clear data that most were disenrolled for procedural issues. Its changes are modest to moderate at best – not aggressive. What is it really doing to ensure states have adequate staff investments to ensure timely disposition of enrollment and re-enrollment? While administrative costs are reimbursed at a very high rate, some states do not invest as they want to limit enrollment in the program.
(Article may require a subscription.)
#medicaid #enrollment #coverage #redeterminations
https://www.modernhealthcare.com/medicaid/medicaid-unwinding-redeterminations-cms-oversight
HHS Restructures Cybersecurity and Technology
In light of rising cyberattacks and the advent of interoperability and artificial intelligence, the Department of Health and Human Services (HHS) has reorganized its cybersecurity and technology organization and in essence has elevated it. The Office of the National Coordinator for Health Information Technology (ONC) will be renamed the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC).
#cyberattacks #interoperability #ai
https://www.healthcaredive.com/news/hhs-technology-ai-data-reorganization-renames-onc/722437
Molina Exceeds The Street In Q2
While investors were worried about Molina’s core Medicaid business, the company reported better than expected news for Q2 2024. Revenue was $9.9 billion, up almost 19% year over year. Net income of $301 million was down slightly year over year due to an increase in Medicaid spending. But this was better than forecasts.
Molina’s medical loss ratio (MLR) rose to 88.6% in the second quarter, up from 87.5% for the same quarter last year. But Molina says Medicaid pressures should turn around in the second half.
#molina #medicaid #managedcare
https://www.healthcaredive.com/news/molina-medicaid-growth-offset-redeterminations-q2-2024/722357
Optum Layoffs Continue
UnitedHealth Group’s Optum services unit will lay off 524 employees in California and remote locations. The layoffs include physicians, physician assistants, registered nurses, licensed practical nurses, patient care coordinators, nurse practitioners and social workers. United is using the excuse of the Change Healthcare cyberattack to shed less profitable units within Optum – a revenue and profit powerhouse.
(Article may require a subscription.)
#unitedhealthcare #optum #layoffs #healthcare
https://www.modernhealthcare.com/labor/optum-layoffs-clinicians-nurses-unitedhealth
— Marc S. Ryan
