Payer Roundup—New Mexico to explore Medicaid buy-in; Highmark offers cost-free diabetes prevention program

Medicaid
Maryland has reached an $81 million settlement with an IT company over an ill-fated effort to overhaul its Medicaid claims-processing system. (Getty/juststock)

New Mexico to explore Medicaid buy-in option

New Mexico’s legislature has voted to commission a one-year study to explore expanding health coverage in the state by allowing people to buy in to Medicaid.

The idea would be to redirect federal subsidies that are earmarked for coverage on the Affordable Care Act marketplaces to a new category of Medicaid for those who currently earn too much to qualify for the program.

The state’s leaders would wait until next year to decide whether to move forward with the buy-in program—after Republican Gov. Susana Martinez leaves office. New Mexico has already expanded Medicaid under the ACA, which helped it cut the number of uninsured residents in half. (Associated Press)

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Highmark offers cost-free diabetes prevention program to some members

Pittsburgh-based Highmark is providing a new diabetes prevention program as a no-cost preventive benefit for members with group insurance coverage.

Eligible employees can take advantage of the program either in person through their local YMCA or online through a personalized weight-management program called Retrofit. Either way, participants have access to sessions led by a trained lifestyle coach that include food, weight and activity tracking, and group support.

Highmark says it aims to help participants achieve at least 5% weight loss. (AHIP blog post)

Company to pay Maryland $81M over failed Medicaid IT overhaul

Maryland Attorney General Brian Frosh announced on Friday that Computer Sciences Corporation has agreed to pay the state $81 million after a contract to rebuild its Medicaid claims processing system went awry.

The state awarded the Virginia-based IT company the $170 million contract back in 2012 but canceled it after Computer Sciences Corporation “refused to perform contractually required work necessary to meet the requirements of the Affordable Care Act,” Frosh’s office said.

Amid all the turmoil, the state continues to use its decades-old computer system to process Medicaid claims. (FierceHealthIT)

Idaho’s Catastrophic Health Care Fund sees uptick in caseloads

Idaho officials say they’re seeing an upward trend in the use of its Catastrophic Health Care Fund, which draws on taxpayer money to help residents who can’t pay their catastrophic medical bills.

Appropriations for the fund had been growing for years until the state established the Your Health Idaho exchange. But now with premiums rising and people opting out of getting covered in anticipation of the disappearance of the individual mandate penalty, that trend is reversing.

Gov. C.L. "Butch" Otter had recommended a 44% budget cut for the fund next year, but now that its caseloads have jumped, the agency that oversees the fund is requesting a 5% increase. (Idaho Statesman)