Medicaid Outlines Plan To Help Pay For Pricey Sickle Cell Gene Therapies
The Centers for Medicare and Medicaid Services will pursue so-called outcomes-based agreements that would put discounts or rebates in place on two new expensive gene therapies if they don't deliver promised results for patients with sickle cell disease.
Stat:
CMS Will Use Outcomes-Based Agreements In Bid To Help Medicaid Pay For Sickle Cell Gene Therapies
In response to concerns over multimillion-dollar price tags for new gene therapies for sickle cell disease, the U.S. government on Tuesday announced a long-awaited “access model” designed to blunt the cost that state Medicaid programs would pay for these curative treatments. (Silverman, 1/30)
On Medicaid expansion —
Politico:
‘The Politics Have Changed’: South Warms To Expanded Health Benefits
Southern conservatives have for years privately flirted with extending public health benefits to more low-income people. Those talks are now moving out of the shadows. House speakers in three Republican-controlled states — Alabama, Georgia and Mississippi — have said in recent weeks that they need to consider covering more people through their state-run health insurance programs. Their comments represent a stark departure from more than a decade of lawmakers in conservative statehouses arguing vehemently against expanding Medicaid or similar benefits — many of them because of a reflexive revulsion to Obamacare. (Messerly, 1/31)
The Mercury News:
Following Expansion Of MediCal, Officials Call On Santa Clara County Residents To Apply And Renew Coverage
With the state expanding full MediCal coverage this month to include all Californians regardless of immigration status, Santa Clara county officials and health providers are urging county residents to enroll in and renew their MediCal coverage. ... Officials met at the Social Services Agency in Gilroy to push the coverage at a news conference on Tuesday. ... “Healthcare is a human right,” said Arenas. “If we can help everyone now eligible for Medi-Cal coverage take action, this can be a huge step forward towards our goal of health coverage for all in Santa Clara County.” (Melecio-Zambrano, 1/30)
On the 'unwinding' of Medicaid and other cuts —
Louisiana Illuminator:
Louisiana Has Removed 275,000 People From Medicaid Over Six Months
Louisiana took 275,000 people off Medicaid from the end of June through December, as it complies with renewed federal standards for the government-backed health insurance program. Almost a quarter of the people dropped, 66,500, are children. (O'Donoghue, 1/30)
Maryland Matters:
Only Four Months Left In Medicaid ‘Unwinding.’ Who Is Losing Coverage?
Since May, over 245,000 Marylanders have lost health care coverage from Medicaid, an insurance plan aimed at low-income residents, during a eligibility review period often referred to as “Medicaid unwinding.” Eight months into the unwinding period, a new report from Maryland Department of Health shows that some areas in Maryland are retaining Medicaid coverage while some populations are losing it. The department says it will use the data to target harder to reach populations in the remaining four months of the unwinding period. (Brown, 1/31)
Indiana Capital Chronicle:
Lt. Gov, Lawmakers Call On FSSA To Pause Medicaid Cuts For Parents Of Disabled Children
Lt. Gov. Suzanne Crouch and three sitting lawmakers publicly called on the Family and Social Services Administration (FSSA) to pause proposed program cuts for parents of medically complex children during an Intellectual and Developmental Disabilities Task Force meeting Monday. FSSA announced the decision to curb its use of Attendant Care pay for Legally Responsible Individuals (LRIs), usually parents, in response to a $1 billion shortfall in the Medicaid budget. During the COVID-19 pandemic, FSSA allowed parents to be paid for care normally covered by home health nurses — a field with a shortage of workers then and now. (Downard, 1/29)
The Texas Tribune and Propublica:
Texas’ Civil Medicaid Fraud Unit Is Falling Apart
For years, an elite team of lawyers at the Texas attorney general’s office went toe-to-toe with some of the biggest pharmaceutical companies in the world, on a mission to weed out fraud and abuse in the Medicaid system. And the team was wildly successful, securing positive press for the attorney general’s office and bringing in money for the state — lots of it. In a little more than two decades, the Civil Medicaid Fraud Division has helped recover a whopping $2.6 billion. Of that, $1 billion went to the state’s general fund, which pays for critical services like education and health care. (Davila, 1/31)
