ABQ Journal Article "Tribal opt-in for managed care"

Tribal opt-in for managed care

By Winthrop Quigley / Journal Staff Writer on Wed, Mar 13, 2013

Most of New Mexico’s Indians will not be required to receive Medicaid benefits through a managed-care organization, despite state Human Services Department efforts to bring all beneficiaries under its proposed Centennial Care approach to Medicaid.

In a letter to HSD, the federal Centers for Medicare and Medicaid Services, which must approve state Medicaid programs, told the state that Centennial Care should allow Native Americans to “have the opportunity to voluntarily opt-in to managed care.”
The letter, signed by Cindy Mann, director of the Center for Medicaid and CHIP Services, said the state’s application to establish Centennial Care could include programs to “promote and encourage voluntary enrollment, but there will be no expansion of mandatory managed-care enrollment for Native Americans.”
Indians who now receive managed long-term care services, including those eligible for both Medicare and Medicaid benefits, can continue, she wrote.
Several New Mexico tribes and Indian health administrators and care providers objected to including all Native Americans in managed-care programs. They said care would suffer, costs would rise and tribes’ efforts to create their own health systems would be impeded.
Some tribal officials said the state violated tribal sovereignty by ignoring requirements to consult with tribes and, instead, merely told them of the plan.
CMS officials met at least twice in New Mexico with Indian leaders to discuss their concerns over the winter.
Mann wrote that her letter was intended “to memorialize the work we have accomplished together” to implement Centennial Care.
“We have made significant progress in developing terms for a demonstration that will enable the state to assure Medicaid beneficiaries access to a fully integrated, coordinated service delivery system,” Mann wrote. “We particularly appreciate the focus on care coordination as a means to assuring the delivery of the right care at the right time and in the right settings.”
HSD has estimated the changes it intends to make through Centennial Care will save $453 million over five years. It intends to launch it Jan. 1 and has chosen four managed care companies to serve beneficiaries.
Mann’s letter did not approve Centennial Care but identified issues HSD must address to gain approval.
— This article appeared on page B1 of the Albuquerque Journal

Webinar Medicaid Expansion

From the Kaiser Family Foundation:

ADVISORY

For Tuesday, March 19, 2013

 

Webinar: Translating The Medicaid Expansion Into Increased Coverage: The Role Of Application Assistance

 

RSVP Please register online to attend this webinar contact Chris Lee (202) 347-5270 CLee@kff.org Under the Affordable Care Act (ACA), beginning in 2014 all states will employ streamlined, technology-driven enrollment systems to help eligible people sign up for insurance affordability programs, including Medicaid, the Children’s Health Insurance Program and the new health insurance exchange marketplaces. Even with these streamlined systems in place, application assistance will be important for helping to translate the ACA’s Medicaid and other coverage expansions into increased coverage. At 2 p.m. EST on Tuesday, March 19, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured will hold a webinar to examine the role of application assistance in ensuring eligible individuals successfully enroll in health coverage. The webinar will feature an overview of the importance of application assistance drawing on lessons learned from Medicaid and CHIP and insight into states’ planning efforts to provide such assistance under the ACA. The Foundation also will release a case study highlighting the experience of providing in-person application assistance for Medicaid through community health centers in Utah. Moderated by: Samantha Artiga, Associate Director, KCMU Panelists will include: Donna Cohen Ross, Senior Policy Advisor, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services Jennifer Sullivan, Director, Best Practices Institute, Enroll America Carole Stipelman, Associate Professor of Pediatrics, University of Utah Jennifer Edwards, Managing Principal, Health Management Associates The webinar is part of the Getting into Gear for 2014 series examining key implementation issues as states prepare for the ACA coverage expansions. WHEN: Tuesday, March 19, 2013 2 to 3:15 p.m. ET RSVP: To register for the webinar please RSVP or call Tiffany Ford Fields at 202-347-5270. CONTACT: For further information, please contact Chris Lee at CLee@kff.org or 202-347-5270.

Save the date National Health Insurance Marketplace Tribal Consultation

The U.S. Department of Health and Human Services (HHS) Secretary Sebelius and Centers of Medicare & Medicaid Services (CMS) invite you to the National Health Insurance Marketplace Tribal Consultation on Tuesday, March 19, 2013 at 12:00 p.m. – 1:00 p.m. ET.

 

HHS is deeply committed to participation as it builds a new Health Insurance Marketplace in several states. Through an ongoing consultation process, we have sought input from tribes in State Partnership Marketplace and Federally-facilitated Marketplace states.  

 

The goal of this national call is to keep tribes updated on the operational execution of the Marketplace as well as for CMS to hear directly from tribes. This process will allow interested parties to understand how the Marketplace will work and when it will be ready.  We will continue the consultation process during the Regional sessions to receive further comments.
 
We will follow up with call-in information and an agenda later this week, but please mark your calendars.
 

Other ways of staying engaged: The CMS Center for Consumer Information & Insurance Oversight website includes links to other ways that stakeholders can be engaged in addition to these sessions. Healthcare.gov is where consumers will be able to check if they are eligible to buy insurance from qualified private health plans and eligible for financial assistance – all in one place, with a single application.  Links to all of our regulations, guidance, and other information can be found here: http://cciio.cms.gov/ and http://marketplace.cms.gov/

Article Indian Country Today "Urban Indians May Benefit From Colorado Law's Changes"

Urban Indians May Benefit From Colorado Law's Changes

Carol Berry

March 12, 2013

A 37-year-old statute has dictated the relationship between Colorado’s government and the state’s Native residents, while never fully addressing the concerns of today’s growing urban Indian population. That gap could soon be filled if the state’s government-to-government law is updated to include contemporary voices.
Revisions to the existing law are before the current session of the state legislature, where approval is expected.
Under the present law, the Colorado Commission of Indian Affairs (CCIA) is charged with formal relations among sovereigns—the state itself and the two Ute tribal nations within its present borders. The CCIA, which helped to draft the proposed changes, would continue its formal role but could also tackle urban Native issues, primarily through powers of expanded consultation and public awareness promotion.
Native education inequity, homelessness, addiction, incarceration, poverty and other often-urban conditions surfaced in fact-finding conducted by the CCIA last November, when it was learned that, for example, though Native people are 1.2 percent of the state’s population they are about 10 percent of the homeless and 20 percent of those repeatedly jailed.
Updating the CCIA’a role depends on expanding input beyond that of four state departments—social services, health, natural resources and local affairs – empowered in the 1976 statute.
Wider representation from people involved in CCIA and urban issues would “ensure their voices are at the table when the [CCIA] moves forward,” said Colorado Lt. Gov. Joseph Garcia, CCIA chairman and head of the state department of education. “We need to cast a wide net,” said CCIA executive secretary Ernest House Jr., Ute Mountain Ute.
The CCIA bill has cleared the lower chamber of the Colorado General Assembly and is before a Senate committee that deals with state government issues. Non-Native legislators of the bipartisan Tribal/Legislative Caucus sponsored the House bill—Reps. Don Coram (R-58^th District) and Michael McLachlan (D-59^th District), and also its Senate counterpart—Sens. Ellen Roberts (R-6^th District) and Lucia Guzman (D-34^th District).
Except for Guzman, whose district includes the urban Denver area, the Caucus lawmakers are from districts in southwestern Colorado that include lands of the Ute Mountain Ute and Southern Ute Indian Tribes.
Details of the bill were discussed among supporters before it was introduced February 25 in the state legislature. “Since 1976, the Commission has never touched this legislation to update it or change it to fit the circumstances of today,” House Jr. said at the meeting of CCIA, Caucus and tribal leaders.
Over the years, non-voting ex officio members have been added to the CCIA, and their numbers would be expanded to include representatives from additional state and federal agencies and from such organizations as the Native American Rights Fund (NARF) and Denver Indian health, family assistance, and education advocacy groups.
The revised bill, that includes other updates as well, has seen support from both Ute tribes and organizations such as NARF. Gary Hayes, Ute Mountain Ute tribal chairman, said expanding relationships exemplified “partnership” where before there had been a “disconnect” at times. Mike Olguin, Southern Ute tribal vice-chairman, said the wider collaboration would “make things a lot easier to get projects done.”
Among tasks the CCIA plans to complete is a formal state-tribal consultation policy because “now there’s no obligation to do it [consult],” and uniform, streamlined contract language is needed in contracts between federal and state governments that involve tribes, House Jr. said.
A tribal consultation policy and uniform contract language are both needed for bipartisan-assured continuity and permanency despite administration changes that occur over the years, he said.
The “wide net” CCIA hopes to cast will, House hopes, yield more stakeholders and involve more Native individuals in the civic process, because “lots of Native people don’t know what their rights are.” He recognizes there are Colorado residents whose tribal governments are out-of-state, but “we want to include them, as well.”

Read more at http://indiancountrytodaymedianetwork.com/2013/03/12/urban-indians-may-benefit-colorado-laws-changes-148121#.UT9conZ4h2M.gmail

HB 376 still no scheduled times in Senate Finance Committee

Good Morning All,


According to the NM Legislative Website www.nmlegis.gov there is still no listing of HB 376 to be heard in either the Senate Finance Committee or the Senate Floor.   This is the last week of the Legislature, the session ends on the 16th. Will keep everyone posted on dates and times.  According to the schedule Senate Finance Committee meets regularly Monday-Saturday starting at 11:30PM in Room 322.  It is still Important to continue to call Senators to support the bill as it will head to the Senate Floor for  a Vote after passing the Committee.

Erik

HB 376 call Senators for support

From the Center on Law and Poverty:

 

 

Good morning, Everyone,

 

Checked the Senate floor schedule today and HB 376 is not slated to be heard.  Attached is the Senate roster.  Please call the Senator for your district and ask for support for HB 376 when it reaches the floor.  With the success we’ve had in committees and the House vote of 60-7 in favor, we should be alright but calls from constituents will only help.  If you will, pick out a couple of other Senators outside your district and call them.  When I place calls to Senators outside my district, I identify myself as a member of Laguna Pueblo.   As Native people we can ask for help for all our relations.

Best regards, Evelyn

 

Evelyn Blanchard

News Article The Washington Post "Privatizing the Medicaid expansion: ‘Every state will be eying this"

Privatizing the Medicaid expansion: ‘Every state will be eying this.’

Posted by Sarah Kliff on March 8, 2013 at 1:40 pm

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Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it.

Arkansas has turned heads with its plan to expand Medicaid using the private insurance market. The idea — which is still preliminary — would be to use Medicaid dollars to buy private insurance coverage for the expansion population.
For health policy experts, this has raised a huge number of questions: Will private plans guarantee the same benefits that Medicaid does? How will states pay for the private insurance, which generally costs more than the public program? And does HHS even have the legal authority to do this?
George Washington University’s Sara Rosenbaum, an expert on Medicaid policy, recently dove into the regulations to answer these questions. She wrote an excellent policy primer here and, on Thursday, we had a lengthy conversation about it. What follows is a transcript of that discussion, lightly edited for clarity and length.
Sarah Kliff: Right now, you have a number of governors looking at the idea of using Medicaid expansion funding to buy private health insurance for enrollees. How novel of an idea is that?
Sara Rosenbaum: It’s been treated as this brand, new thing, but I don’t actually think it’s completely revolutionary. Keep in mind that states have been using Medicaid to buy managed care plans since the beginning of Medicaid. The whole notion of this as a conceptual breakthrough for Medicaid feels a bit off for me.
It does happen though that this is in Arkansas, which traditionally has not been a buyer of managed care, not a place like Arkansas, and not somewhere like Texas which has been buying managed care.
One of the good things about it, from my perspective, is that it gives you more stability of coverage, or gives you the chance at stability. You’re brought into a plan to stay.
SK: So the idea is, if your Medicaid expansion population is in private insurance, they won’t have to bounce back and forth between private and public plans.
SR: It does address a problem of churn. Four years ago I raised this and put this forward to House and Senate committees as a model. It was met with a lot of opposition from Medicaid advocates, which I didn’t totally understand having worked in Medicaid for almost four years now.
The need for stability of coverage is so great. These are the youngest, healthiest and lowest-income workers. All they have to do is churn from different insurance plans two or three times, and they’re going to say I’m through with this. And these are the exact people we want to enroll.
SK: One part of this I’ve been confused about is the cost of the program. The CBO estimates that private insurance plans cost $3,000 more than Medicaid. Will Medicaid need to bargain down insurers? Or something else entirely?
SR: When you’re doing premium support for an employer plan, it’s really easy to prove that it’s cost effective. You’re splitting the cost between the public program and the employee, so it’s just generally less expensive.
Here, there is no employer. You’re talking about the Medicaid program buying private coverage. We know from CBO that insurance is more expensive than Medicaid, even more expensive than Medicaid managed care.

  

When dealing only with Medicaid, the question [in the statute] is are the costs comparable. And there are some important considerations for CMS beyond just the price of the premium you’ll pay next month. One is that, if you can keep coverage stable and continuous, your extra outlays might pay for themselves. You won’t have churn, or at least decrease churn, and cut down the cost of dis-enrolling and re-enrolling.
SK: I know you mentioned that the cost of the Medicaid plan and private plan need to, under regulations, be “comparable.” Is there any definition of what comparable means?
SR: It just says “comparable” so there’s a lot of latitude. We don’t know if CMS would decide that a 10 percent differential would count as comparable or not.
SK: I know that Medicaid has some strong protections, in terms of the benefits that enrollees receive and how much they can be expected to pay. What happens to those in the private market?
SR: The cost-sharing would have to be the same [in the private market], so the issuers that take Medicaid lives would have to agree to administer the program in compliance with Medicaid cost-sharing rules.
SK: Would they want to do that? It would really restrict the types of co-pays, for example, that they could charge.
SR: That is a question, and I think there are going to be a bunch of challenges. Insurers sometimes sees this population as high risk and don’t want to cover them. I think we have enough research to show that’s not the case though. These are a lot of young, working folks.
If Medicaid is willing to pay the [private insurer] price, that would be an increase of what Medicaid has historically paid. So some of the opposition might fade away, if they’re now getting commercial level payments.
SK: Arkansas is the one state that has really pushed this idea. Do you see others looking for something similar?
SR: If Arkansas is allowed to do this, I expect it to spread like wildfire. I have three calls with Texas reporters who want to know more about what Arkansas is doing. New York is another state that is looking at something similar.
SK: That’s interesting that you mention New York, since this has usually been an option that Republicans have promoted. Would you expect liberal states to look at this too?
SR: I think that every state is now going to be eying this thing. My own suspicion is it’s going to be very popular. I think CMS sees this as a way to lure in states that might not otherwise do the expansion.
KLIFF NOTES: Top health policy reads from around the Web.
For insurers, the Medicaid expansion is big business. “For industry titans such as UnitedHealthcare and WellPoint, as well as smaller, Medicaid-focused plans such as Molina, the Medicaid expansion is expected to bring significant enrollment and revenue growth. “This is several hundreds of billions of dollars of new market opportunity for these plans over the next couple of years,” says Jason Gurda, managing director of healthcare with investment bank Leerink Swann in New York.” Phil Galewitz in Kaiser Health News.
California’s exchange wants to partner with Wal-Mart—and advocates aren’t pleased. “Labor unions as well as some consumer advocates protest the idea of government officials partnering with Wal-Mart and paying for its help. They contend that the nation’s largest retailer has no place advising others on health coverage when so many of its workers don’t qualify for company benefits and end up in taxpayer-funded programs such as Medi-Cal.” Chad Terhune in the Los Angeles Times.
Wonk battle! Casey Mulligan and Jon Gruber on how the Affordable Care Act will effect the labor market. Rachel Zimmerman in CommonHealth.
The Minnesota legislature rivals the Rand Paul filibuster, stretching on for 12 hours. “After 12 hours of debate and 150 amendments to consider, the Minnesota Senate passed a health insurance exchange bill Thursday night. The legislation passed nearly on a party line vote, with one DFLer, state Sen. Terri Bonoff of Minnetonka, joining the Republicans voting against it. Now, a conference committee must reconcile differences in the House and Senate versions.” Joe Kimball in the Minnesota Post.