Payer Roundup—Molina loses Medicaid contract with New Mexico; More litigation over CSR payments

Affordable Care Act highlighted
Another insurer has sued the government over its decision to stop making subsidy payments that are part of the ACA. (Getty/Ellenmck)

Molina loses Medicaid contract with New Mexico

Starting in 2019, Molina Healthcare will no longer participate in New Mexico’s Medicaid managed care program after losing its contact with the state.

Molina said it’s trying to learn more about the state’s decision and is exploring its options. “As the largest Medicaid managed care plan in the state of New Mexico, and with 20 years of experience serving Medicaid members, we believe we are well-positioned to continue providing a high level of service to our members and providers,” the company said.

The decision is a blow for Molina, which posted a $97 million loss in the third quarter and recently named a new CEO as part of its restructuring plan. (Albuquerque Journal)

NYC puts Aetna incentive package on hold

CVS’ pending deal to acquire Aetna has led New York City to halt a $9.6 million incentive package that it offered the insurer to move its headquarters there.

“We had a preliminary agreement that still needed formal approval, and we can’t get that approval if they can’t positively affirm to us that the relocation is happening,” said Stephanie Baez, a spokeswoman for the New York City Economic Development Corp.

Aetna said when its deal with CVS was announced that it would evaluate all of its locations as part of its integration with the retail and pharmacy giant, the article noted. (Associated Press)

Another insurer challenges Trump’s CSR move in court

Wisconsin-based Common Ground Healthcare Cooperative has become the second health insurer to sue the government over its decision to stop funding cost-sharing reduction (CSR) payments.

In this case, the insurer amended an existing complaint, which seeks to compel the government to make risk corridor payments after it failed to do so. For the 2017 plan year, Common Ground Healthcare Cooperative estimates that the government will owe it $12 million to $13 million in unpaid CSR reimbursements.

The new legal challenge comes on the heels of a lawsuit filed by Maine Community Health Options, which seeks to collect $5.6 million in CSR payments that it estimates the government owes it for 2017. (Complaint)

CBO projects cost of 10-year CHIP funding

If Congress extends funding for the Children’s Health Insurance Program (CHIP) for 10 years, the federal government would save $6 billion, according to a new estimate from the Congressional Budget Office.

The agency recently estimated that a five-year CHIP funding bill would cost $800,000. But it says a 10-year reauthorization would result in net savings because the federal costs of the alternatives to providing coverage through CHIP—mainly Medicaid, subsidized individual market coverage and employer-based insurance—are greater than the costs of providing coverage through CHIP during that period.

The new projection led Democrats to call for permanent funding for CHIP, according to the Washington Examiner. “I would like this to be as long as possible,” said Sen. Ron Wyden, D-Ore. (CBO score)