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Tag: Policy

Publication

Assessment of Pennsylvania’s Medicaid Preferred Drug List Policy Options

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The Pennsylvania Coalition of Medical Assistance MCOs engaged The Menges Group to estimate the fiscal impacts of switching to a uniform PDL in Pennsylvania and to assess the programmatic advantages and disadvantages of this policy change. Our analyses indicate that the Commonwealth of Pennsylvania and its taxpayers would incur significant costs if Pennsylvania adopts a uniform, state-determined Medicaid PDL. The state fund cost of this policy change is estimated at $81 million in the first year (FFY2020) and $442 million across the five-year timeframe FFY2020 – FFY2024. The programmatic dynamics of switching to a uniform PDL are also unfavorable. We encourage Pennsylvania policymakers to preserve the PDL latitude model within HealthChoices.

5-Slide Series

Piloting Medicare Mandatory Enrollment Into Coordinated Care

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The May edition outlines a pilot program we encourage Medicare policymakers to adopt. It involves testing Medicaid’s key design features in the Medicare arena, which if successful could evolve into a fundamental transformation of Medicare as has occurred with Medicaid (whose transformation also began with pilot testing of this approach). We will be releasing a full paper on this framework with a couple months.

5-Slide Series

An Overview of a Pop Up Community Clinic in Redmond, WA

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This edition describes a Pop-Up Clinic founded and led by one of our employees, Nehath Sheriff. This type of construct could be a low-cost, high-value option to consider for organizations seeking to “meet underserved subgroups where they are.”

5-Slide Series

CY2018 Tax Estimates for the Average U.S. Family

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This edition presents our tabulations on an “average family’s” federal, state and local taxes for CY2018 and how their tax contributions are spent.

5-Slide Series

Mid-Term Election Results and Medicaid Expansion

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Our November Edition of the 5 Slide Series focuses on the 2018 election results and conveys some of the potential implications of these results regarding Medicaid expansion.

Publication

Assessment of Louisiana Medicaid’s Prescription Drug Management Performance and Preferred Drug List Policy Options

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Legislation has been proposed in Louisiana to take the Medicaid preferred drug list (PDL) content responsibility away from the MCOs and shift it to a single state-determined PDL. The Menges Group assessed the impact of this policy option and estimated by transitioning to a PDL, Louisiana would experience a 13.5% increase in Medicaid pharmacy expenditures, with State Fund costs growing by $23 million in FFY2019 and $121 million across the five-year timeframe FFY2019-FFY2023. The non-financial programmatic dynamics of MCO latitude relative to a uniform Medicaid PDL are also discussed.

Publication

Assessment of Louisiana Medicaid’s Prescription Drug Carve-Out Option

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Currently, Louisiana includes (carves in) the pharmacy benefit in its capitated contracts with Medicaid MCOs. During FFY2017, Louisiana had the nation’s most favorable Medicaid generic dispensing rate at 90.9% and the nation’s 8th best (lowest) cost per prescription. The Menges Group analyzed the impact of legislation proposing a carve-out of the prescription drug benefit. Based on our analysis, transitioning the Medicaid prescription drug benefit back to fee-for-service would be costly for the Medicaid program and Louisiana’s taxpayers. We estimate that Louisiana would experience a State Fund cost increase of $69.3 million in FFY2019 and $395 million across the five-year timeframe FFY2019-FFY2023. Our report also discusses the programmatic advantages of preserving the pharmacy carve-in model.

5-Slide Series

Getting Out of the Stairwell in Quality Measurement and Improvement

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The December edition addresses some aspects of how quality data are reported and are used in performance-based payment structures.

5-Slide Series

Preserving Medicaid and Reducing the Program’s Spending

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The June edition raises concerns with how Medicaid policymaking is currently being approached and debated. We identify specific areas where excess costs exist in the program and where considerable savings can be achieved without diminishing Medicaid’s current coverage levels.

5-Slide Series

Correctional Health: State Prison Inmate Health Costs and Strategies to Improve Re-entry

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Volume #42 of our Series identifies the number of state prison inmates in each Medicaid expansion state, and describes opportunities to deliver community re-entry care coordination support.

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