Oregon Wrestles With High Drug Costs In Medicaid Program

Stat: Oregon Withdraws A Waiver Request To Run A Closed Medicaid Formulary 
In response to a raft of concerns, Oregon has withdrawn a request made to federal officials to restrict medicines covered by the state Medicaid program, which is currently required to provide coverage for all treatments. However, state officials are still seeking to exclude certain drugs from Medicaid when effectiveness evidence is lacking. By seeking a so-called closed formulary, the same approach to coverage taken by private health insurers, Oregon officials had hoped to lower expenses by only covering one drug for each therapeutic class. So far, though, only Tennessee has been granted a waiver to use a closed Medicaid formulary and the Biden administration is reviewing that decision, which was issued by the Trump administration. (Silverman, 2/28)

In other Medicaid news —

AP: Ohio Medicaid Managed Care Plan Enrollment Begins Tuesday 
Medicaid enrollees in Ohio can begin selecting from among a new slate of managed care plans beginning Tuesday. As part of the Ohio Medicaid Next Generation initiative, millions of enrollees in the government health care program for low-income Americans must choose from seven managed care plans or be assigned one. (2/28)

Mississippi Today: Republican Legislators Oppose Medicaid Expansion, But Want Federal Dollars To Pay For Prisoner Healthcare
State Republicans have balked at expanding Medicaid, but are embracing legislation that would take advantage of the federal program to pay for healthcare for very sick incarcerated people — and likely create a money-making opportunity for nursing homes. Senate Bill 2448, which passed the Senate with little opposition and is now with the House Medicaid Committee, would allow “medically frail” inmates to be paroled to “special care facilities.” These would be specially licensed nursing homes where Medicaid could help pay for their care. (Taft, 3/1)

Georgia Health News: Prescription Drugs: Ga. Legislature Considers Changes For Medicaid Insurers
One House bill would make Georgia’s Medicaid managed care insurers face stricter requirements on how they spend their government dollars. There’s a second bill that has also captured their attention – an attempt to wrest control of patients’ prescription drugs from those health plans. House Bill 1351 would remove the function of the three managed care companies — Peach State, Amerigroup and CareSource — to oversee the dispensing of medication, instead placing it under state supervision. The goal of the bill is to improve care for patients and save the state money, said its lead sponsor, Rep. David Knight, a Griffin Republican. (Miller, 3/1)

North Carolina Health News: The Good And The Bad Of The Managed Care Transition 
North Carolina’s transition to managed care hasn’t yet proved to be the disaster some feared, nor the panacea others hoped for, according to a new survey from the coalition North Carolina for Better Medicaid. The organization includes two managed care organizations — Healthy Blue and Unitedhealthcare — in addition to community groups, such as the YMCA and Mountain Projects, a community development non-profit that focuses on the western part of the state. The coalition worked with Health Management Associations, a national health care research and consulting firm, to design and implement the evaluation. (Donnelly-DeRoven, 3/1)

Also —

CBS News: Medicaid Enrollment Is At An All-Time High. Millions May Soon Get Kicked Off. 
Medicaid coverage swelled during the COVID-19 pandemic, with almost one in four Americans now covered by the health insurance plan for low-income people. But as many as 15 million people may be at risk of losing coverage this year as a pandemic rule winds down. Before the public health crisis, U.S. states regularly reviewed Medicaid recipients' eligibility to verify they still qualified for coverage based on requirements such as state residency and income. The latter varies by state, but is typically about 138% of the federal poverty rate. For instance, a single person in California can't earn more than $17,609 a year to qualify. (Picchi, 3/1)

Denver Post: Eligibility Of Half-Million Coloradans On Medicaid To Be Reviewed When Pandemic Emergency Ends
If you or a family member gets health insurance through Medicaid, it’s a good time to make sure the state has your current address on file. During the public health emergency, states were ordered to stop regularly assessing whether members had become ineligible. Usually, that happens when a family’s income increases above a certain threshold. Once the emergency ends, the process will restart, and people who haven’t proven they’re eligible could lose coverage. (Wingerter, 2/28)