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Medicaid news: HHS grants Texas waiver for managed care, denies family planning request; Florida pilot program criticized

The federal government on Monday granted Texas a waiver that could mean billions more in Medicaid dollars to hospitals over the next few years in return for having them work together to provide better care for the poor. ... State lawmakers cut deeply into the Medicaid budget this year, in part by requiring all Texas Medicaid patients to be enrolled in private health maintenance organizations for their doctor care. In recent years, patients in most urban areas were covered by HMOs, while patients in many rural counties and the Rio Grande Valley had their doctor bills paid directly by Medicaid.

14 Dec 2011

NJ underserved children less likely to receive dental care

When it comes to receiving dental care, New Jersey has its share of underserved children, according to a Rutgers study.

13 Dec 2011

Roundup: Iowans question Wellmark premium hikes; Fla. Medicare audit; Mich. nursing home scandals

The Wellmark Blue Cross/Blue Shield vice president faced dozens of angry customers and tried to explain why the health insurer wants to increase their premiums by 9.4 percent. ... Barbed questions flew throughout the hearing before the state insurance commissioner, who will decide whether to grant Wellmark's proposed increase for 86,000 Iowans who buy their own insurance policies.

13 Dec 2011

Viewpoints: Politics overtakes Plan B; Gingrich's entitlement plans; Cheeseburgers and death

Once again, the politics of birth control have trumped science and sound public policy. On Wednesday, the Obama administration overruled a carefully reasoned decision by the Food and Drug Administration to make the so-called morning-after pill available without prescription to adolescent girls below the age of 17.

9 Dec 2011

Medicaid news: Ariz. appeals court upholds cuts; federal spending increases

In the Arizona decision, a three-judge panel allows an enrollment freeze to continue. Meanwhile, a new analysis finds federal spending on Medicaid nationwide increased 344 percent between 1990 and 2007.

8 Dec 2011

Roundup: Ariz. examines complaints of prisoners' medical health care; Calif. settles suit on kids' mental health services

To stave off a lawsuit, Arizona's Department of Corrections has agreed to investigate scores of complaints by inmates that they are routinely denied medical care for weeks or months even for severe, life-threatening conditions. Inmates who have lost sight, had body parts amputated or been severely disfigured, among other gruesome examples, say proper medical care could have prevented needless suffering.

6 Dec 2011

Assembly Bill 5502-B would raise cost of many prescriptions in NY by 10%

Assembly Bill 5502-B—transmitted to Governor Andrew Cuomo yesterday—would needlessly raise the cost of many prescriptions in New York by 10 percent, according to the Pharmaceutical Care Management Association. If enacted, the Bill would prohibit consumers from getting discounted prescriptions through mail-service pharmacies.

2 Dec 2011

UnitedHealth forecasts increased membership, earnings

The largest insurer in the U.S. says enrollment gains in Medicare and Medicaid plans will outpace declines in other parts of its business.

1 Dec 2011

New hospital clinic in Michigan seeks to reduce traffic to ER; Minneapolis doctors and hospital merge operations

The Grand Rapids clinic is reaching out to people who have been to the hospital's emergency department at least 10 times in the past year.

1 Dec 2011

Study finds use of retail clinics rising

Researchers from the RAND Corporation found a dramatic increase in adults seeking care at clinics in drugs stores and other outlets.

24 Nov 2011

UnitedHealth buying Medicare advantage plan with chronically ill specialty

UnitedHealth Group Inc. (UNH), the largest U.S. health insurer by sales, said it will buy XLHealth Corp., a provider of managed care for chronically ill Medicare members, to strengthen a growth area likely to gain increasing support from the U.S. government as it trims costs. The purchase price was about $2 billion, according to a person familiar with the deal who asked not to be identified because the price wasn't disclosed. … The purchase of XLHealth, with 111,000 members, is the seventh since Jan. 1 involving companies that manage Medicare coverage.

24 Nov 2011

No link between availability of primary care physician and retail clinic use

Use of retail medical clinics located in pharmacies and other retail settings increased 10-fold between 2007 and 2009, according to a new RAND Corporation study.

23 Nov 2011

State roundup: Calif. retirees to retain health benefits; Emory, MinuteClinic partner in Ga.; Free services in Md.

Health benefits for government retirees may not be eliminated if state and local governments had clearly promised workers those benefits, the California Supreme Court ruled in an Orange County case Monday. The unanimous ruling is expected to make it more difficult for state and local governments to shave costs by cutting health benefits to retirees if elected officials in previous years made it clear that those benefits would last a lifetime.

23 Nov 2011

Comprehensive Care nine month revenues increase 212% to $54,039,000

Comprehensive Care Corporation, a leading behavioral health, substance abuse and psychotropic pharmacy management services provider for managed care companies throughout the U.S., is pleased to announce that its revenues for the nine months ended September 30, 2011 increased 212 percent to $54,039,000 compared to $17,344,000 for the same period in 2010.

21 Nov 2011

Medicaid officials struggle with surge in long-term care needs

The company's naming of David J. McNichols comes as a consulting firm for the state is evaluating the current system of delivering care to Medicaid and PeachCare beneficiaries in Georgia. WellCare has part of that multibillion-dollar business, along with two other managed care companies. The state pays the three firms a total of more than $2.5 billion a year to serve the Medicaid and PeachCare populations.

18 Nov 2011

North Georgia to get mental health pilot program; Kansas City providers decry Blue Cross rate cut

Georgia officials are designing a system for 31 counties that will combine a crisis telephone service and authorization and payment under one roof. In Kansas City, insurance officials say payment cuts bring reimbursement in line with other rates.

18 Nov 2011

N.J. plans to use managed care system for Medicaid enrollees with mental health problems

The N.J. effort must secure federal approval first. Also in Medicaid news, a judge in California this week will hear arguments in the challenge to the state's plans for adult health care.

15 Nov 2011

State dual eligible proposals don't focus on managed care for Medicare beneficiaries

States proposing demonstration projects to more effectively care for dually eligible Medicare and Medicaid enrollees have not suggested requiring Medicare patients to enroll in managed care plans, Cindy Mann, the federal official in charge of Medicaid, told state directors on Wednesday.

11 Nov 2011

States cope with health law's MLR, insurance exchange requirements

Georgia was granted some delay in the law's MLR requirements, and in Tennessee and Minnesota, insurance exchange decisions are slowly being made.

10 Nov 2011

Kansas Gov. announces revamping of Medicaid

Kansas Gov. Sam Brownback announced a major overhaul of the state's Medicaid program today, which would put nearly all Medicaid recipients into private, managed-care plans. While low-income families are currently in such plans, elderly and disabled Kansans receive care through a fee-for-service system.