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April 15, 2021

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Ohio Medicaid Defers Buckeye Renewal as Centene Suit Lingers

April 15, 2021

More than three months after the intended award announcement date, the Ohio Dept. of Medicaid (ODM) on April 9 named six managed care organizations that will serve its newly redesigned Medicaid program starting in 2022. One notable exclusion from that group was Buckeye Community Health Plan, the Ohio subsidiary of Centene Corp. that received a designation of “Defer” as alleged violations of its current pact with ODM are the subject of ongoing litigation and, according to one industry expert, could have devastating effects for Centene.

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MAOs Dabble in FFS Medicare Via Direct Contracting Model

April 15, 2021

As CMS kicks off the first performance year of a new care delivery model — in which provider groups and other entities will share risk and receive capitated payments for serving fee-for-service Medicare beneficiaries — the initial round of participants indicates solid interest from Medicare Advantage organizations. Meanwhile, CMS has paused applications for future years of the so-called direct contracting model and is reevaluating a component that would have included Medicaid managed care organizations, raising questions as to what other value-based care models the CMS Innovation Center might have in the works or what modifications it could potentially make to this one.

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Federal Report on HIP 2.0 Offers Lessons for Holdout States

With Chart: ‘Personal Responsibility’ in Medicaid Begets Lukewarm Results, Federal Report Shows

April 15, 2021

As holdout states consider whether to accept the Biden administration’s offer of enhanced federal funding to expand Medicaid, a recent evaluation report on Indiana’s conservative Medicaid expansion demonstration may hold some lessons learned for states that look to managed care plans to do some of the heavy lifting for such programs.

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Centene Alleges ‘Misunderstanding,’ Seeks Transparent Resolution in Ohio Medicaid Dispute

April 15, 2021

As Centene Corp. defends allegations made by the Ohio Attorney General regarding its pharmacy benefit practices, recent court filings indicate the company’s strong desire to clear the air in a public way. At the same time, Centene and its affiliates allege that the plaintiffs lack a basic understanding of Medicaid billing and pharmacy benefits.

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