Chairman Timothy McBride kicked off the meeting by reviewing a study from the Center for Health Economics and Policy at Washington University regarding how Medicaid expansion under the ACA has differently affected rural and urban areas. Mainly that signups for the program were higher in urban areas versus rural. Nothing too earth shattering.

MO HealthNet Director Joe Parks gave an update regarding Missouri’s Access Monitoring Plan now posted online for public comment. This is part of a new CMS requirement for an analytic report to be done every three years to show that program participant needs are being met. Senator Schaaf added some flavor to conversation saying that it is ridiculous that some of his Medicaid patients have had to wait months before getting in to see a specialist. This is only for the fee-for-service side of MO HealthNet as MCOs already have network adequacy requirements.  

Jay Ludlam the Deputy Director of Administrative Services and Managed Care and Helen Jaco the Director of Managed Care then began their update. They started with the December Market Share Report which showed Aetna to have 279,000 members, Centene with 105,000 and WellCare with 121,000. Jay began then to walk through the timeline for geographical expansion. Enrollment packets have been mailed as of December 6th, the open enrollment period will be from January to April 3rd, then on April 3rd auto-assignments will then begin, and finally go live on May 1. Senator Schaaf began to ask Jay Ludlam and Dr. Parks about if there was any benefit to pushing back the go live date to July 1 to save the state $50 million this fiscal year for the cost of expansion. Parks and Jay, pushed back saying that there is benefit to the state to go live prior to the CMS Managed Care “mega amendment” taking full effect. The only update they gave on the Aetna bid protest was that OA Purchasing should be making their ruling “soon”.  Jay then reviewed the major changes of the new MCO contracts (geo expansion, contract period, medical loss ratio, provider credentialing provisions, mental health parity, performance withhold program changes, min/max enrollment percentages, care management integration and ACO encouragement) and scoring of the bids.  Jay did make a point to say they have been working with MCOs to make sure their NEMT programs are ready to go on May 1 and not lag several days.

 Similar to attempts in the past, Senator Schaaf brought a motion before the committee to recommend to the Governor that statewide managed care expansion should be delayed until July 1. The motion passed unanimously on a voice vote. It was Representative Keith Frederick who seconded the motion.

Helen Jaco then reviewed the managed care “mega-rule” which was first published in the federal registry on May 6th and went into effect on July 15. Then they moved on to updates on the Performance Withhold Program. Jay did mention two sanctions from March and November to Aetna regarding subcontracting arrangements and credentialing of providers.

Dr. Bridget McCandless then began a discussion about how the state and the department  needs to make an investment in IT so the state can make better decisions when it comes to contracting. She tied this to the fact that we have so much room for improvement in regards to how the state and leverage big data. Senator Schaaf also supported her position.

Andrew Bond the Finance Director at MO HealthNet gave an update on the end of FY 2017 as well as the upcoming FY 2018 budget. The department is requesting $144.5 million TOTAL / $22.7 million GR for FY 2017 supplemental. Andrew noted in FY 2018 the costs to continue are $1.375 billion GR / $7.9 billion TOTAL which includes $47 million in specialty pharmacy costs and $2.2 million for non-specialty pharmacy costs. Furthermore, he discussed the $7.1 million GR / $19.5 million TOTAL actuarial increase for managed care. At this point Senator Schaaf pointed out to the committee that managed care companies are not nearly as at risk as they like to say because the state is always there to make sure they are profitable. There is also a $36.6 million GR / $99.8 million TOTAL for the managed care transition.  There is also $100,000 GR / $300,000 TOTAL for a hospice rate increase which is tied to Medicare rates and $1.5 million for MMIS contract extensions while re-procurement is underway.

Patrick Luebbering the acting Family Support Division Director gave a caseload update. I have attached the updated chart to this email. He did note that while enrollees are higher than expected, but because they are kids who are cheaper to cover, we are budgetary on target. Patrick told the committee of the newest rollout on MEDES, which version 2.1 of MAGI went live this week. The department finally getting to the point where the software is making up for the FTE cuts made, this portion of the MEDES project is scheduled to be completed by this summer.

Senator Schaaf and Representative Keith Frederick wrapped up the committee by  asking for an opinion from Missouri’s Attorney General if the expansion of managed care can continue even if the MO HealthNet Oversight Committee disapproved the expansion. The committee unanimously approved the motion and then adjourned.

The next committee meeting is scheduled for February.