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🦃 LorNUCOPIA Anthes 🍂 @lorenanthes
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DAY LONG THREAD: Today may be one of the more influential #Medicaid policy days for the next few years, even if it doesn’t feel like it. Here’s why... /1
JMOC is reporting their actuarial findings to establish a growth target for the program. I wrote about that here:… And the agenda/results from the actuary can be found here:…
Later today, there will be the first hearing on Ohio’s new 1115 IMD waiver. That’s a very big deal. @AdamWhite720 and I wrote about that here:… More on IMD later today. Back to #JMOC... /3
#JMOC was a political reaction to expansion. It would’ve been weaponized if @RichCordray won. Now, maybe not as much as @MikeDeWine will be Governor. /4
My question: what will the work requirement waiver do to overall cost? Why? Expansion has *lowered* the average rate. So if there are less expansion folks in @OhioMedicaid, that target may change. The other question: does that matter, politically? /5
The actuary has explained that it’s projections are based on current policy. I think members may want to ask what happens with an IMD and a Work Req waiver. /6
A note: nearly $300M increase for nursing facilities due to market basket update (2.8%). Thats on top of rate increases from the last budget. /7
With this market basket update, #Ohio’s projected rate is between 2.9%-4.5%. REMINDER: 4.5% is higher than what the ACA Repeal effort would’ve allowed, meaning @OhioMedicaid would’ve already had to cut its budget by 100s of millions or make it up in state funds. /8
The dual eligible population (MyCare) is growing less quickly than the non-dual population. This could be an impact of Managed Care on growth, but actuary did not speak to that. /9
The main cost driver in @OhioMedicaid is the aging pop. This is why focusing on #Expansion is inherently political. It in no way could be about controlling costs. Otherwise you’d see more policy on aging, less on expansion. That’s independently, actuarially derived math. /11
Wait. Why is the expansion population no longer listed in the populations slide?
Oh look. A lack of ability to control prices in Rx is a huge cost driver in #Medicaid. Guess what? I wrote about that!… /12
Dear #JMOC: Why is the expansion population no longer broken out in the actuary’s population estimates? cc: @BurkeForOhio @EmiliaSykesOH @DrVernonSykes @SenatorTavares @nickieantonio @RepRomanchuk @matthuffman1 /13
Because it currently lowers the growth target and the two pending 1115s would affect that in the budget. May be worth getting more detail before having the target established. /14
3 year CPI trend: The midwest CPI is at 2.5. The national, 2.73. /15
Here’s why the BCRA, then, wouldn’t make sense:
Sen. Terhar asks the right question: how do we control things that are driving costs other than this rate?

READ:… via @EnterpriseNow /17
.@SenatorTavares asks “Is this automatic update for nursing homes standard?” Actuary: “We would describe it as atypical.”

REMINDER: nursing homes have some of the worst quality in the United States. /18
Actuary says that the things to focus on are the social determinants of health. Highlights NC’s waiver:…
“Other states have done more to hold providers accountable.”

A common ground between R’s and D’s: address regulatory capture. /20 cc: @ReaHedermanJr
.@EmiliaSykesOH asks about impact of the 1115s will do to the rates. Dir. Ackerman defers to the state’s estimates. Explains that she directed the actuary to combine expansion into adult group. /22
.@EmiliaSykesOH appropriately continues, highlighting difference in FMAP. Dir. Ackerman states it’s a “budget issue”. This isn’t a budget issue/function? Hunh. /23
That’s it. Next meeting will be interesting. /24
Settling in for MCAC to talk IMD waiver. /25
.@AdamWhite720’s here.
Blog will be out later, but I’m glad that the focus of #JMOC is turning away from expansion and towards LTSS, Rx and Social Determinants. That’s where the cost is. That’s where the focus should be. /27
.@JimTassie has on a great tie. #NiceJobJim. /28
Given the potential enormity of this proposal, it’s surprising how thin the turnout is. Then again, its seems like this is something the state has to do and something people want so 🤷‍♂️/29
The state’s timeline. Noted absence of the state’s effort re MCO 15 day reg: /30
The goals: /31
IMD waiver’s require 6 “milestones”, an implementation plan for each (not yet available). /32
Milestone 4 is about network. One of the biggest questions I’ve had with this and redesign, generally. /33
Sounds like state is looking to have approval mid-budget next year. /34
Key point: the only authority they are requesting is the spending authority. Why? Read @AdamWhite720 /my piece here! /35… #Content
No public comment today, which is not a surprise. We’ll author ours soon! As always-feel free to reach out with any questions, but comments are due by the 25th!!! THREAD. DONE. 36/36
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