Amidst uncertainty around the fate of Medicaid work requirements as they are tested in two separate cases this month, Ohio on March 15 became the ninth state to gain section 1115 demonstration authority to tie work-related provisions to Medicaid coverage. Medicaid managed care organizations in Ohio have reportedly been preparing for the “Work Requirement and Community Engagement” demonstration project since the state legislature passed a bill requiring it in 2017, but one Medicaid expert warns that if the courts eventually strike down these programs, plans in Ohio and other states with similar demonstrations may never recoup the administrative costs associated with implementation.

With switching rates during the 2019 Annual Election Period (AEP) on the rise after years of decline, experts say it’s hard to predict what will happen during the newly reinstated Medicare Open Enrollment Period (OEP) that ends on March 31. But as Medicare Advantage organizations prepare their bids for 2020, emerging market research on consumer behavior during these periods may provide valuable insight into the types of benefits and practices that attract — and keep — enrollees.

Despite observing some positive developments in the Medicare Advantage program such as improved parity in MA and fee for service (FFS) payments, the Medicare Payment Advisory Commission (MedPAC) in its March report to Congress flagged some ongoing issues it feels Congress needs to address, including CMS’s methodology around coding intensity. And although concerns remain about the accuracy and completeness of encounter data used for MA risk adjustment, the commission discussed its possible use in determining star quality ratings.

Despite some noise early on about insurers not being prepared to deal with a yet-to-be-finalized HHS rebate rule that would take effect Jan. 1, 2020, publicly traded insurers during a recent health care conference indicated that they are preparing Part D bids with and without rebates that HHS would like to see passed along to consumers at the point of sale (POS). Meanwhile, because of minimal potential impact to beneficiaries, the inclusion of Medicaid managed care organizations in the rebate rule had some congressional Medicaid advisors scratching their heads during a recent meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC).

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