Timely Health Plan News and Commentary
Medicaid is the joint federal and state program that provides health coverage to eligible low-income adults, children, pregnant women, older adults and people with disabilities. The Children's Health Insurance Program (CHIP) covers uninsured children in families that earn too much to qualify for Medicaid but cannot afford private coverage. Each state runs its own program within federal rules, so eligibility, benefits and the names of the programs vary from state to state, such as Medi-Cal in California and TennCare in Tennessee.
This section covers state Medicaid program changes, eligibility redeterminations, Medicaid managed care contracts awarded to private health plans, federal funding and waiver decisions from the Centers for Medicare & Medicaid Services (CMS), and the community health programs that Medicaid plans fund. We also report on CHIP coverage for children and on the access-to-care issues that affect Medicaid patients.
Most Medicaid enrollees today receive benefits through a managed care organization (MCO), a private health plan paid by the state to manage care for its members. That makes Medicaid news closely tied to the carriers covered in our Health Insurance Companies section, including Centene, Molina and Elevance Health, and to the Blue Cross Blue Shield plans that hold state contracts.
Federal budget and legislative decisions shape every state program, so Medicaid coverage also connects to our Healthcare Policy and Law reporting. Readers who are aging into Medicare while enrolled in Medicaid should also review our Medicare section, and families comparing private options can start with our Health Insurance Coverage guides.
The latest Medicaid and CHIP news appears below, newest first.
Nearly 68 million Medicaid enrollees, 78.2% of the program, got their care through a comprehensive managed care plan in 2024, according to federal enrollment data from the Centers for Medicare & Medicaid Services (CMS). Counting dental, behavioral health and other limited plans, 84.8% of Medicaid’s 86.9 million enrollees were in some form of managed care.
Aetna Better Health of Illinois has teamed up with Summer Health to do something simple but powerful: give families immediate access to pediatricians without the drive, the waiting room, or the out-of-pocket cost. And it’s already rolling out statewide. [Read more…]
In a heartwarming celebration of motherhood, the Inland Empire Health Plan (IEHP) launched the first of its three-part Maternal Wellness Event series on May 9 at the Riverside Community Wellness Center (CWC). This inaugural event, designed to support and educate moms and moms-to-be, kicked off a month-long focus on maternal health, coinciding with Maternal Health Awareness Month. [Read more…]
Findhelp has been given a contract by the Tennessee Medicaid Agency (TennCare), as part of Health Starts Initiative, to assist Tennesseans in finding the non-medical care they require. Findhelp, a technology firm, connects people in need of social care with providers through a closed-loop referral system (CLRS) that is easy to use and efficient. [Read more…]
After a thorough review by federal and state regulatory agencies, Health Alliance Plan (HAP), an Ohio-based nonprofit managed-care health plan and CareSource, a Michigan nonprofit health plan have received regulatory approval for their joint venture. The entities will operate as “HAP-CareSource” and develop new products and programs to better serve Michigan residents and provide them with a higher level of health care. [Read more…]
Geisinger Health Plan expanded its Children’s Health Insurance Program coverage (CHIP), GHP Kids to eight additional Pennsylvania counties. This provides parents with an alternative option for children who are not insured for any reason. [Read more…]
(“Gateway Health”), a leading managed care company specializing in caring for its”overall health” of its associates, and Bridges Health Partners LLC, a Clinically Integrated Network, today announced that they have entered an Accountable Care Organization (ACO) partnership. [Read more…]
InComm Payments, a leading global payments technology company, today released the results of its Medicaid subscribers research, which found that many Medicaid members are prioritizing healthy habits during the COVID-19 pandemic. The study was based on responses from 1,700 U.S. Medicaid subscribers during the month of October. [Read more…]
BURLINGTON, Mass. and MANCHESTER, N.H., Feb. 24, 2020 /PRNewswire/ — Groups Recover Together has announced an executed agreement with AmeriHealth Caritas New Hampshire that will allow its members to receive care from any of Groups’ eight locations throughout the state. AmeriHealth Caritas New Hampshire, is a managed care organization (MCO) that began serving New Hampshire Medicaid enrollees in September 2019 and is part of the AmeriHealth Caritas Family of Companies. [Read more…]
RANCHO CUCAMONGA, Calif., Nov. 7, 2019 /PRNewswire/ — Inland Empire Health Plan (IEHP) partnered with the California Governor’s Office of Emergency Services, California State Council on Developmental Disabilities, Earthquake Country Alliance, PrepItForward and the Inland Empire Disabilities Collaborative to host the first public Disability & Access and Functional Needs (DAFN) Preparedness Academy on November 6, 2019. The preparedness academy aimed to meet a state initiative to improve inclusivity of preparedness, response and recovery capabilities for all throughout the Inland Empire, regardless of ability. [Read more…]
The Arkansas Department of Insurance announced today that ForeverCare, Inc. is certified and licensed as a PASSE (Provider-owned Arkansas Shared Saving Entity) to provide access to healthcare for Medicaid eligible residents of Arkansas. ForeverCare, along with three other provider-led health plans, will deliver access to healthcare through the PASSE model of care, which is unique to Arkansas and provides coordination of physical health, behavioral health and home and community services to vulnerable Arkansans who qualify for these services due to specific health conditions. Care coordination is increasingly important to Medicaid programs and has shown success in improving health outcomes of individuals while reducing costs. ForeverCare is comprised of six partner organizations that represent over 300 years of experience and success in delivering high quality healthcare to deserving Arkansans. [Read more…]
Tufts Health Plan today announced it is rated 5 out of 5 – the highest rating possible – by the National Committee for Quality Assurance (NCQA) on its annual rating of private health insurance plans.* It is the only health plan in the nation to receive the 5 out of 5 rating for both its HMO and PPO products.* Only three other plans in the country, from a pool of nearly 500 -earned a rating of “5.” Its Massachusetts PPO is the only PPO plan in the country to receive a 5 out of 5 rating. [Read more…]
KEPRO announced today that the Division of TennCare, the state of Tennessee’s Medicaid program, has awarded the contract for the management of its toll-free call center to support TennCare members to KEPRO.
KEPRO will manage the toll-free call center that allows TennCare’s members to file medical issues or appeals by phone. The call center currently receives an average of 2,500 calls per week.
For more reporting on this topic, see our Medicaid and CHIP news hub.
Missouri Care, Inc., a subsidiary of WellCare Health Plans, Inc. (NYSE: WCG), announced today that it has signed an agreement with SSM Health that provides in-network coverage to Missouri Care’s MO HealthNet Managed Care (Medicaid) members. This agreement includes access to academic medical centers, community hospitals, physicians, urgent care centers, ambulatory care centers and other services and facilities owned by or affiliated with SSM Health. [Read more…]
WellCare Health Plans, Inc. (NYSE: WCG) has signed a definitive agreement to acquire certain assets, including Medicaid membership and certain provider contracts, from Phoenix Health Plan (PHP), a wholly owned managed care subsidiary of Tenet Healthcare. PHP provides health benefits primarily to more than 50,000 Medicaid beneficiaries as of Dec. 1, 2016 in Maricopa County, Arizona, the state’s largest geographic service area. [Read more…]
Effective October 1, 2016, the Medi-Cal Fee-For-Service program provides unrestricted, $0 copay access to NARCAN® Nasal Spray for its beneficiaries. As a result of this decision, beneficiaries can now obtain NARCAN® Nasal Spray from pharmacists across the state within 24 hours, establishing an unprecedented level of access and coverage. [Read more…]
“In just ten days, January 31, 2016, most residents of Atlanta must have health insurance or face new tax penalties,” said Dr. Jane L. Delgado, President and CEO of the National Alliance for Hispanic Health, the nation’s leading Hispanic health advocacy group. She added, “making a decision on health insurance is not easy and many are looking for help they can trust. Our bilingual Navigators are ready to help!.” [Read more…]
The deadline is drawing near for uninsured consumers to sign up for Affordable Health Care this month. Numerous legislators across the country continue to wrestle with whether to expand their state’s Medicaid provisions to accommodate ACA. However states and others can look at the efficiency of DC-based, Trusted Health Plan, a Medicaid Managed Care Organization that has made significant impacts in the marketplace with a business model that is providing cost savings and efficiency. “Our goal is simple… reduce healthcare cost, improve quality and expand access to care. We are positively impacting the lives of our members,” says Thomas Duncan, Trusted Health Plan; CEO. [Read more…]
WellCare of Iowa, a subsidiary of WellCare Health Plans, Inc. (NYSE: WCG), announced today that the company will aggressively contest the order issued by Janet Phipps, director of Iowa’s Department of Administrative Services, which overturned the state’s original decision to award a Medicaid contract to WellCare of Iowa.
“This decision does not accurately reflect the facts, the integrity of Iowa’s procurement process or Iowa law,” said Lauralie Rubel, state president, WellCare of Iowa. “WellCare intends to use every avenue available within the legal system to correct this erroneous outcome. We will immediately seek an injunction that maintains the status quo to allow WellCare of Iowa to continue its participation in the program while this matter is appealed in a court of law.”
For more reporting on this topic, see our Health Insurance Companies news hub.
Meridian Health Plan of Iowa is the number one Medicaid HMO in Iowa and is the number 38 Medicaid HMO in the US according to NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015.
Meridian Health Plan of Iowa’s performance in NCQA’s Medicaid Health Insurance Plan Rankings 2014-2015 immediately follows its recent NCQA accreditation status elevation from Accredited to Commendable for achievement in the areas of consumer protection and quality improvement. NCQA Accreditation evaluates how well health plans manage all parts of its delivery system – physicians, hospitals, other providers and administrative services – in order to continuously improve the quality of care and services provided to its members.
Health Plan Accreditation and the Medicaid Health Insurance Plan Rankings 2014–2015 are separate and distinct review processes and recognition. The complete list of NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015 is available online at http://www.ncqa.org.
For more reporting on this topic, see our Medicaid and CHIP news hub.
Capital BlueCross has long supported programs that increase access to health care and health coverage for our community. This tradition of service continues through our work with the Children’s Health Insurance Program and most recently with our involvement in Governor Corbett’s proposed Healthy Pennsylvania plan to cover many uninsured individuals.
We were proud to be a selected plan by the Commonwealth of Pennsylvania to potentially serve our community through Healthy PA. With the news today the program has been approved by the U.S. Department of Health and Human Services, we congratulate Governor Corbett and Public Welfare Secretary Mackereth on this important milestone.
Capital BlueCross looks forward to continuing our role to increase access to health care in central Pennsylvania and the Lehigh Valley.
SOURCE Capital BlueCross
For more reporting on this topic, see our Medicaid and CHIP news hub.
AARP Pennsylvania released the following statement in response to federal officials today approving a waiver to expand Medicaid for Pennsylvania:
“AARP Pennsylvania is pleased that an agreement has been reached to provide health coverage to more than 500,000 hard-working Pennsylvanians – including 90,000 residents age 50-64 – many of whom are either between jobs or in jobs without health coverage. AARP Pennsylvania was one of many groups encouraging the state over the last two years to close this coverage gap, and we are pleased that so many state residents will not have to wait much longer to get the coverage they need. The final agreement is responsive to many of the concerns AARP Pennsylvania expressed in our comments, but some concerns remain. We look forward to reading the important details of the final agreement and working with state and federal officials as this process moves forward.”
For more reporting on this topic, see our Senior Care news hub.
Sunshine Health, a subsidiary of Centene Corporation, completed the final stages of implementation of the Managed Medical Assistance (MMA) program in 9 of 11 regions and the Child Welfare (Foster Care) program statewide on August 1st. Additionally, Sunshine Health’s Long-Term Care (LTC) program celebrates its first anniversary. LTC implementation began a year ago and was complete on March 1st for the 10 regions in Florida served by Sunshine Health.
Today, Sunshine Health is the largest Long-Term Care plan in the Florida, providing services for more than 30,000 nursing home and home and community based members. Sunshine Health is also the only health plan providing Child Welfare services statewide and is serving nearly 400,000 Medicaid members under the Managed Medical Assistance program.
For more reporting on this topic, see our Medicaid and CHIP news hub.
The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) today sent a letter to House and Senate leaders urging both chambers to reject a proposal to pay for Stafford student loan subsidies with reductions in the Medicaid provider tax rates, also known as provider assessments.
Last week, House and Senate Republican leaders sent a letter to the President offering reduction in the Medicaid provider assessments as a way to offset the cost of keeping student loan interest rates low. The House of Representatives could vote on the measure as early as June 29.
A copy of the letter is below. [Read more…]
Musculoskeletal Clinical Regulatory Advisors, LLC (MCRA), a leading independently-operated medical technology consulting firm focused exclusively on serving the worldwide neuro-musculoskeletal industry, announced today that Joseph “Chip” Thomas, M.D., former Medical Director for leading commercial insurance organizations, has joined the firm’s Health Economics, Reimbursement & Public Policy team. [Read more…]
SOURCE: MedEx, Inc.
LAS VEGAS, NV–(Marketwire – October 4, 2010) – MedEx, Inc. (
“With September being particularly strong, we are excited to be able to include these numbers in our audit,” said Mr. Paul Protzman, President of MedEx, Inc.
“We would like to thank all of our existing shareholders for their patience. It is our goal to be as transparent as possible and we look forward to completing this milestone of becoming a fully reporting company. The company is currently negotiating with a number of potential acquisitions and it is important that we are current with our financials to assist in a smooth transition as we look to continue to acquire companies that we feel bring synergies to our core goal. That is to consolidate a number of DMEs (durable medical equipment) companies that are all in good standing with Medicare, Medicaid, Workman’s Comp. etc. and any other like businesses.”
About MedEx, Inc.
MedEx, Inc. is a development stage Nevada-based medical support services company, which plans to grow through acquisitions of medical supply companies, medical technology companies, and assisted living and care facilities worldwide. For additional information, see www.medexsynergies.com.
Safe Harbor Statement:
This release contains “forward-looking statement” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and such forward-looking statements are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. “Forward-looking statements” describe future expectations, plans, results, or strategies and are generally preceded by words such as “may,” “future,” “plan,” or “planned,” “will,” or “should,” “expected,” “anticipates,” “draft,” “eventually,” or “projected.” You are cautioned that such statements are subject to a multitude of risks and uncertainties that could cause future circumstances, events, or results to differ materially from those projected in the forward-looking statements, including the risks that actual results may differ materially from those projected in the forward-looking statements.
Investor Contact:
MedEx, Inc.
1-800-869-1060
SOURCE: Optimum Performance Institute
WOODLAND HILLS, CA–(Marketwire – September 22, 2010) – In August 2010, the Joint Commission on the Accreditation of Health Care Organizations (JCAHO) granted accreditation to Optimum Performance Institute (OPI), a highly-individualized therapeutic/educational and residential treatment program helping young adults, aged 17 – 25, achieve their goals in education, job skills, and improved social interactions. Located in Woodland Hills, CA, OPI’s coed program helps its participants understand and resolve those issues that have kept them from moving forward in their lives.
The accreditation from The Joint Commission makes OPI one of the first programs in the country focusing exclusively on helping young adults transition into adulthood to receive this prestigious status. Receiving JCAHO’s national accreditation is the highest level of achievement a health care organization can receive signifying its overall commitment to quality of care and services.
“The JCAHO accreditation is a huge honor,” states Robert F. Fischer, M.D., OPI executive director. “It requires key competencies in all areas of performance and validates that we operate at the highest level of professionalism possible with an ongoing commitment to continuing to improve the services we deliver to our participants. Accreditation from JCAHO sets OPI apart from other facilities of our kind in receiving this prestigious accreditation.”
To receive accreditation, a healthcare organization must submit to a substantial review process of its practices to ensure that it complies with JCAHO standards. The Joint Commission accredits over 17,000 health care organizations and programs in the United States. A majority of state governments recognize JCAHO accreditation as a condition of licensure and the receipt of Medicaid reimbursement.
By voluntarily choosing to participate in the accreditation process, OPI asked to be measured against the national standards to which health care professionals agree are most conducive to providing quality care in organized health care delivery settings.
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