Medicaid: A Winner in the 2018 Midterm Elections

Despite all of the drama surrounding the 2018 midterm elections, one thing was clear: Medicaid had a big night on November 6, 2018.

In particular, the electorate in the Red states of Nebraska, Idaho, and Utah voted to expand Medicaid (i.e. extend Medicaid coverage to low-income able-bodied adults).  Although the Montana electorate rejected a ballot measure that would have permanently funded the Medicaid expansion in that state beyond 2019,… More

CMS Approves Michigan’s State Plan Amendment

In a wide-ranging speech on CMS’s efforts to lower Medicaid drug costs, Administrator Seema Verma announced yesterday that CMS has approved Michigan’s proposed state plan amendment to utilize value-based payment arrangements with drug manufacturers. With CMS’s blessing, Michigan can now enter contracts with pharmaceutical companies in which manufacturers provide the state supplemental rebates when their drugs fail to meet specified treatment benchmarks.

Michigan is the second state that has received CMS’s approval to pursue value-based purchasing agreements.… More

CMS Issues New Guidance Aimed at Addressing Care for Mental Illness

Overview

On November 13, 2018 CMS (as mandated by Congress in the 21st Century cures Act) issued a State Medicaid Director Letter providing states with guidance on both: (1) existing authority for states to provide support for adults with serious mental illness (SMI) and/or children with a serious emotional disturbance (SED); and (2) a new demonstration opportunity  to permit states to offer care for certain individuals with serious mental illness residing in Institutions for Mental Disease (IMDs).… More

Immigration and Health Care:  Some New Developments

We have written recently about the interrelationship between the Medicaid program and U.S. immigration law.  Our post generated a lot of interest and now there’s a new development to report.

On October 10, 2018, the Department of Homeland Security (DHS) published a proposed regulation in the Federal Register that, if finalized, may have an effect on individuals seeking admission to the United States,… More

Administrator Verma Hints at New Work Requirement Guidance

In prepared remarks delivered by Administrator Seema Verma on September 27, 2018 at the 2018 Medicaid Managed Care Summit, the Administrator previewed the release of an impending guidance document on a new/updated “work requirement” demonstration. As noted in the prepared remarks:

Additionally, in January, we released a groundbreaking new demonstration opportunity in response to state requests to test work and community engagement incentives among able-bodied adult beneficiaries.… More

Immigrant Access to Healthcare

Some things in the world would be much simpler if they stayed separate, but we all can’t have what we want. As health care lawyers, Tom Barker and I are used to navigating complex and intersecting fields of law such as tax, contracts, fraud and abuse, insurance, and federal health care program coverage and reimbursement. But we also know a bit about immigration law from our pro bono work representing individuals seeking lawful status in the U.S.… More

Fifth Circuit Decision Jeopardizes Medicaid Protections for Community Health Centers

The United States Supreme Court will have the opportunity to hear an important case out of Fifth Circuit Court of Appeals affecting how states pay community health centers for Medicaid beneficiaries enrolled in a managed care plan.  Community health centers represent the largest primary health care safety net for the nation’s poorest urban and rural communities.

The plaintiff in the case, Legacy Community Health Services,… More

CMS Proposes New Payment Rule That Will Negatively Affect Some Employee Labor Organizations

This is a brief post about a CMS proposed rule that sort of slipped under the radar last week.  But it has the potential to raise some eyebrows because it is clearly designed to make it harder for labor unions to collect dues from some home health care workers who are paid directly by Medicaid.

Section 1902(a)(32) of the Social Security Act prohibits reassignment of Medicaid funds, and only allows Medicaid funds to be paid directly to individuals performing health care services,… More

Kentucky Medicaid Waiver Blocked by Federal Courts

It has not been a good week for states that want to try innovative Medicaid waivers.  First, CMS shot down Massachusetts’ attempt to re-structure the 25-year old Medicaid prescription drug rebate program to achieve additional savings on the cost of prescription drugs.  And then on Friday, the United States District Court for the District of Columbia effectively blocked Kentucky’s attempt to impose “community engagement” requirements on some Medicaid recipients. … More

CMS Issues Long-Awaited Decisions on MassHealth Prescription Drug Request

It was a busy day for CMS today. After keeping everyone in suspense for months, CMS finally issued its decision on the Massachusetts state Medicaid program waiver request that proposed to limit access to covered outpatient drugs to Medicaid (in Massachusetts, called “MassHealth”) enrollees.  As many observers predicted, CMS did not approve the state’s request.  Notably, however, the CMS response letter provided a pathway for Massachusetts to achieve a substantially similar result. … More