Payer Roundup—UnitedHealthcare may buy Genoa; Mississippi quietly amends work requirements

Home healthcare workers are in high demand, but they earn little, and a proposed rule could prevent that from changing. (Getty Images/jacoblund)

Advent International looking to sell Genoa Healthcare

Rumors abound that Genoa Healthcare could be the next subject of an acquisition.

On Tuesday, Bloomberg reported that Walgreens, "among other suitors," was looking to buy the specialty pharmacy operator. The following day, Axios said UnitedHealthcare is in talks to make the purchase. Genoa could be worth $2.5 billion. It is currently owned by Advent International, a private equity firm.

As noted on its website, Genoa is "the largest provider of pharmacy, outpatient telepsychiatry and medication management services." It serves more than 650,000 people at its 400 locations across the country. (Axios article | Bloomberg article)

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Home healthcare workers fighting to preserve union membership

The Centers for Medicare & Medicaid Services (CMS) proposed a rule last month that would prohibit home healthcare workers who are paid by Medicaid from having their union dues automatically deducted from their paychecks. The workers fear the rule would diminish their ability to organize, as NPR reports.

The rule would make it more difficult for the workers, who earn an average of $23,100 per year, to pay their dues, according to union leaders and members. If the unions cannot negotiate for better pay and benefits, the shortage and high turnover rate the home health industry already sees could worsen. This would worsen the quality of home health care for patients, most of whom are elderly or disabled, as well.

The Health Resources and Services Administration (HRSA) expects 3.4 million more home healthcare workers will be needed by 2030. However, "if nothing is done to improve these jobs, by the year 2040, there'll be a shortage of at least 350,000 paid caregivers—there could be more," according to Paul Osterman, an economist at MIT. (NPR article)

A quiet change to Mississippi's work requirement waiver could have big consequences

Mississippi recently amended its work requirement waiver, extending the transition period from one year to two, and removing language about the state's desire to save money, The Washington Post reported Thursday.

If work requirements would truly benefit the population's health, the state and CMS would have been more transparent about this change, health advocates say. Further, a recent literature review by the Kaiser Family Foundation found that, while unemployment is associated with poor health, employment is not necessarily associated with good health. Work requirements may actually cause certain detrimental health effects for Medicaid beneficiaries.

Nevertheless, the changes to Mississippi's waiver may make it easier for CMS to approve it. After a judge ruled Kentucky's waiver failed to address the consequences of millions of people losing coverage, CMS Administrator Seema Verma said the agency would work with states to help them overcome any hurdles to implementing a work requirement.

Mississippi has not expanded Medicaid; on the contrary, it has some of the most restrictive Medicaid eligibility criteria in the country. The state's work requirement waiver would primarily affect single mothers, but it has not offered resources like child care or transportation to help them be able to work. (Washington Post article)

Breaking down the latest ACA lawsuit

Writing on the Health Affairs blog, policy and legal advisor Katie Keith examines an expansive interpretation of plaintiffs' arguments in Texas v. United States, 20 Republican state attorneys' challenge to the constitutionality of the individual mandate.

At least one prominent attorney has said the federal government may refrain from enforcing parts of the ACA it deems unconstitutional, and states may decide not to enforce those provisions, either. However, Keith says, this is "far from settled law," and it would notably expand executive authority.

Further, while plaintiffs argue that the individual mandate is inseverable from its consumer protections, only the individual mandate is unconstitutional. Thus, the administration could only decline to enforce the individual mandate penalty.

States have the option not to enforce federal insurance law, but the federal government is required to step in when they do not, the article explains. (Health Affairs blog post)