Three things drug manufacturers and CEs can do to build trust and enable effective collaboration

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Virginia Medicaid beneficiaries now have access to Aeroflow Health’s breast pumps and lactation consultants.

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Heali’s new Medical Nutrition Therapy tool offers patients and providers access to a library of evidence-based dietary recommendations.

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Coordination of benefits is a critical pillar of the Medicaid program as it ensures the efficient use of resources, prevents overutilization, promotes equity in resource distribution, mitigates fraud and abuse, contributes to program longevity and ultimately enhances healthcare access for beneficiaries.

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Blue Shield of California Promise Health Plan is working with the GED Testing Service to help members earn a General Educational Development (GED) diploma for no cost. Members can register online and gain access to GED study materials in both English and Spanish.

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The Medicaid Innovation Collaborative announced five pilot programs in Kentucky, New York and Iowa. Each program addresses the health-related social needs of Medicaid beneficiaries living with a chronic condition, like diabetes.

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Elevance Health will provide smartphones with unlimited data, talk and text to some Medicaid members in 2024, it announced at CES 2024.

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A new KFF report analyzed recent trends in Medicaid outpatient prescription drug utilization and spending. It discovered that although there’s been lower utilization of prescription drugs in recent years, Medicaid spending on prescription drugs has increased.

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HHS announced a new care model that aims to provide mothers with Medicaid coverage with more personalized maternal health care. This includes access to doulas and midwives and screening for health-related social needs.

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A higher share of Medicaid beneficiaries rate their physical and mental health as fair or poor compared to adults with Medicare, employer-sponsored insurance or Marketplace coverage, according to a new KFF report. However, 83% of Medicaid enrollees gave their health insurance a positive rating.

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Many digital health startups aren’t built with Medicaid members in mind. That’s why Health Net created a request for information process to help the insurer determine which startups are the best fit for its Medicaid population, according to Dr. Pooja Mittal, vice president and chief health equity officer at Health Net.

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New KFF focus groups revealed that some thought the process of renewing Medicaid coverage during the unwinding of the continuous enrollment provision was simple. Others, however, faced challenges with communication from state Medicaid agencies, and some weren’t aware their coverage had been terminated.

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About half (47%) of nonelderly uninsured veterans will be eligible for Medicaid or subsidies through the ACA Marketplace in 2024, according to a new report from the Urban Institute.

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Amid the unwinding of the continuous enrollment provision, more than 10 million people have lost Medicaid coverage, according to data from KFF. Of those disenrolled from Medicaid coverage, 71% were removed from coverage for procedural reasons.

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Pair Team’s $9 million Series A funding round was led by Next Ventures and included participation from PTX Capital, Create Health Ventures, OCA Ventures, CHCF Innovation Fund, Kapor Capital and other investors. In total, Pair Team has raised about $20 million.

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If the remaining 10 states expanded Medicaid, uninsured rates would greatly drop for women of reproductive age, non-Hispanic Black adults and young adults, a new Urban Institute report found.

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Investors who dabble in healthcare are a “red flag,” and startups in the Medicaid space should avoid these investors, said Adaeze Enekwechi, operating partner of Welsh, Carson, Anderson and Stowe, during a panel discussion at HLTH 2023.

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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.

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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?”

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

The post The Kids Are Not Alright: Why Pediatricians Need to Take Action to Prevent Medicaid Unwinding appeared first on MedCity News.

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.

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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.

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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.

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