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Wednesday, Jan 31 2024

Full Issue

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.

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 鈥渁ccess model鈥 designed to blunt the cost that state Medicaid programs would pay for these curative treatments. (Silverman, 1/30)

On Medicaid expansion 鈥

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 鈥 Alabama, Georgia and Mississippi 鈥 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 鈥 many of them because of a reflexive revulsion to Obamacare. (Messerly, 1/31)

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聽on Tuesday. ... 鈥淗ealthcare is a human right,鈥 said Arenas. 鈥淚f 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.鈥 (Melecio-Zambrano, 1/30)

On the 'unwinding' of Medicaid and other cuts 鈥

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.聽Almost a quarter of the people dropped, 66,500, are children.聽(O'Donoghue, 1/30)

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 鈥淢edicaid unwinding.鈥 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聽will use the data to target harder to reach populations in the remaining four months of the unwinding period. (Brown, 1/31)

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 鈥 a field with a shortage of workers then and now. (Downard, 1/29)

For years, an elite team of lawyers at the Texas attorney general鈥檚 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鈥檚 office and bringing in money for the state 鈥 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鈥檚 general fund, which pays for critical services like education and health care. (Davila, 1/31)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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