[NYAPRS Enews] OM: Half of States Expanding Medicaid Managed Care in 2012

Mon Nov 7 07:26:04 EST 2011

Half of States Expanding Medicaid Managed Care in 2012

Open Minds Weekly News Wire   November 7, 2011 

To manage their Medicaid budgets during fiscal year 2012, 24 states plan
to expand their managed care programs-either by expanding the geographic
area under Medicaid managed care or by including more populations.
States are using Medicaid managed care to control costs and to expand
the use of disease and care management programs and patient-centered
medical homes to coordinate care for high cost and high need
populations. Kentucky, Louisiana, New Jersey, New York, and Texas are
implementing new or significant expansions of comprehensive managed care
programs. As of October 2010, of the total 54 million Medicaid
beneficiaries in the U.S., about two-thirds were enrolled in some form
of managed care, and all states (except Alaska, New Hampshire, and
Wyoming) operated Medicaid managed care programs, either through
capitated managed care organizations (MCOs), primary care case
management (PCCM), or prepaid health plans (PHPs).

For 2012, the 24 states planning to expand Medicaid managed care adopted
one or more of the following strategies:

*         14 states will expand service areas; in 2010, four states
expanded service areas and in 2011, 13 states adopted this strategy.

*         10 states will add eligibility groups; in 2010 three states
added eligibility groups, and in 2011 six states adopted this strategy.

*         6 states will add mandatory enrollment groups; in 2010 five
states added mandatory enrollment, and in 2011 five more states adopted
this strategy.

*         9 states will include managed long-term care; in 2010 seven
states implemented managed long-term care and in 2011 four more adopted
this strategy.

The state plans for managed care expansions were reported in "Moving
Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and
Policy Trends Results from a 50-State Medicaid Budget Survey for State
Fiscal Years 2011 and 2012," by Vernon K. Smith, Ph.D.; Kathleen Gifford
and Eileen Ellis of Health Management Associates; and by Robin Rudowitz
and Laura Snyder of the Kaiser Commission on Medicaid and the Uninsured,
Kaiser Family Foundation. The Kaiser Commission on Medicaid and the
Uninsured surveyed Medicaid officials in all 50 states and the District
of Columbia.

The researchers noted that nearly every state implemented at least one
new Medicaid policy to control spending in fiscal years 2011 and 2012
following the end of increased federal assistance through the American
Reinvestment and Recovery Act of 2009 (ARRA), which required states to
avoid changes to their Medicaid programs as a condition of receiving
federal assistance. The following trends are driving the push to contain
Medicaid budgets:

During federal fiscal year 2011, Medicaid enrollments increased by an
average of 5.5% and Medicaid spending increased by an average of 7.3%.

ARRA funding and the requirement that states avoid changes to their
Medicaid programs ended in June 2011.

For fiscal year 2012, states are anticipating 4.1% enrollment growth and
legislatures allocated an average of 2.2% more to account for Medicaid
spending growth.

Additional state strategies to control Medicaid costs included the
following:

*         Eliminate, restrict, or reduce optional Medicaid benefits in
areas such as dental, therapies, medical supplies, durable medical
equipment, and personal care services.

*         Nearly all states imposed controls on Medicaid pharmacy
programs by implementing preferred drugs lists, seeking supplemental
rebates, and imposing prior authorization requirements.

*         Provider rates were reduced by 39 states in 2011; 46 states
reported plans for further reductions in 2012.

*         Five states imposed new or increased existing copayment
amounts in 2011; 14 states are planning copayments or increases for
2012.

*         Shift long-term care from institutions to community-32 states
in 2011 and 33 in 2012 took actions that expanded long-term care
services, primarily by expanding access to home- and community-based
services.

*         Integrated care for dual eligibles-15 states were selected by
the federal Centers for Medicare and Medicaid Services (CMS) to
participate in demonstrations that blend Medicare and Medicaid funding
streams and services for individuals eligible for both programs.
Additionally, 37 states have submitted letters of intent to CMS related
to additional options to integrate care for dual eligibles.

The full text of "Moving Ahead Amid Fiscal Challenges: A Look at
Medicaid Spending, Coverage and Policy Trends Results from a 50-State
Medicaid Budget Survey for State Fiscal Years 2011 and 2012" was
published October 27, 2011 by the Kaiser Family Foundation. The report
may be accessed online atwww.kff.org/medicaid/upload/8248.pdf (accessed
November 2, 2011).

For more information, contact: Chris Lee, Communications Officer, Kaiser
Family Foundation, Public Affairs Center, 1330 G Street, NW, Washington,
District of Columbia 20005; 202-347-5270; Fax: 202-347-5274; E-mail:
clee at kff.org; Web site: www.kff.org/medicaid/8248.cfm. 

Half of States Expanding Medicaid Managed Care in 2012. (2011, November
7). OPEN MINDS Weekly News Wire.

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