Medicaid

How Mass General Brigham Is Integrating Behavioral Care Into Its Primary Care Model

Mass General Brigham launched a program this month in collaboration with behavioral health medical group Concert Health. Under the program, more than 400 Mass General primary care providers can refer their patients to Concert. The health system's goal is to increase patients’ access to diagnoses and treatment for mild to moderate behavioral health issues — particularly for Medicaid patients, who are the most underserved.

By Katie Adams

Health Tech

3 Questions This Healthcare Investor Finds Herself Asking Startups All The Time

At HLTH, General Catalyst Principal Candace Richardson discussed some of the questions she frequently asks startups during investment meetings. Some of these include "Do you stratify your outcomes data by different populations to ensure your model works well for everyone?" and "Is serving Medicaid populations on your roadmap?"

By Katie Adams

With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?

Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.

Consumer / Employer, Social Determinants

Ounce Raises $5.2M for Housing and Care Coordination Platform

Ounce’s $5.2 million in seed funding was co-led by Meridian Street Capital and Flare Capital and included participation from Chelsea Clinton’s Metrodora Ventures, Wilshire Lane Capital, Hilton CEO Chris Nassetta and Unite Us Co-founder Taylor Justice.

By Marissa Plescia

Consumer / Employer, Payers, Legal

4 States Received Enhanced Medicaid Funding During Covid Despite Wrongly Terminating Coverage

New York, Florida, Texas and Minnesota terminated Medicaid coverage for some enrollees for “unallowable or potentially unallowable reasons” during the Covid-19 public health emergency, according to a recent Office of Inspector General report.

By Marissa Plescia

Consumer / Employer, Legal

HHS: Medicaid/CHIP Coverage To Be Reinstated for 500K People

Thirty states have been conducting Medicaid and CHIP automatic renewals incorrectly, leading to many individuals being wrongly removed from coverage. Because of this, nearly 500,000 children and other individuals will have their coverage reinstated.

By Marissa Plescia

Consumer / Employer, Legal

Civil Rights Groups File Complaint Against Florida for Medicaid Redeterminations Process

More than a dozen civil rights organizations alleged in a new complaint that Florida uses administrative practices that are preventing underserved communities from renewing their Medicaid coverage.

By Marissa Plescia

News, Payers, Consumer / Employer

Is Medicaid Expansion Still a Political Wedge Issue?

When Medicaid expansion was first enacted, it was a hot topic debate between Democrats and Republicans. But more and more states are starting to expand Medicaid, including several conservative states.

By Marissa Plescia

Two Value-Based Care Initiatives That Could Shift the Alternative Payment Model Landscape

The Centers for Medicare and Medicaid Services has announced two value-based care alternative payment models set to launch in July 2024, one focused on dementia and one on primary care.

By Stephanie Baum

Consumer / Employer, Payers

CMS Requires States To Assess Medicaid Disenrollment Process

Some states may not be following federal requirements for the Medicaid renewal process, resulting in many individuals being wrongly removed from coverage, CMS said. Children may especially be affected.

By Marissa Plescia

Daily, MedCity Influencers

The Kids Are Not Alright: Why Pediatricians Need to Take Action to Prevent Medicaid Unwinding

Pediatricians and anyone who works with children should proactively reach out to their patients with resources and information about how to maintain coverage. Ask them to make sure their contact information is updated in state databases. Tell them to expect and respond to any communication from the state about their enrollment status.

By Patricia Pinto-Garcia

Health Services

Maximize Revenue and Patient Care with Strategic Weight Loss Management

We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.

By Build My Health and MedCity News

Consumer / Employer, Payers, Legal

Floridians Sue Florida Over Medicaid Redeterminations Process

Two Florida families allege that tens of thousands of Floridians are being terminated from Medicaid coverage without sufficient information as to why. This comes as the U.S. continues the unwinding of the Medicaid continuous enrollment requirement, which stopped states from disenrolling Medicaid enrollees during the Covid-19 public health emergency.

By Marissa Plescia

Legal, Payers

Congressman Launches Investigation into Medicaid Prior Authorization Denials

U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.

By Marissa Plescia

Consumer / Employer, Legal

House Reps Introduce Bill To Ease State Medicaid Staffing Shortages Amid Redeterminations

The Medicaid Staffing Flexibility and Protection Act was introduced by Representative Earl L. “Buddy” Carter (R-Georgia) and Representative Neal Dunn (R-Florida). It would allow state Medicaid agencies to hire outside contractors to help with Medicaid redeterminations, as many agencies don’t have the workforce to handle the return to the redetermination process.

By Marissa Plescia

Consumer / Employer, Payers

35% of Medicaid Beneficiaries Say Their Health Plan Hasn’t Reached Out About Renewing Coverage

Many Medicaid enrollees are not receiving the information they need from health plans during the return to Medicaid renewals, a new survey shows. Older Medicaid enrollees are especially struggling.

By Marissa Plescia

Consumer / Employer, Payers

Medicaid MCOs Denied 1 out of 8 Prior Authorization Requests in 2019

Medicaid managed care organizations deny prior authorization requests at high rates, according to a recent report by the Office of Inspector General. Of the 115 MCOs the OIG analyzed, 12 had prior authorization denial rates above 25%.

By Marissa Plescia