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In the newsletter, NAMD welcomes a new staff member; Fall conference is less than one month away; MMCO update; CHIP reauthorization; Medicaid Director job openings.

October 11, 2017
From the NAMD Desk
NAMD Welcomes Hilary Kennedy!
NAMD is excited to welcome Hilary Kennedy to the team as our new Program Director for Medicaid Leadership! Hilary will be building and expanding NAMD’s leadership program to ensure our members and their teams have the skills, knowledge, and support needed to lead in Medicaid.


She has worked with state officials for over decade. She previously worked at the National Governors Association on issues related to Medicaid waiver and delivery system reforms. She was also a member of the state team working on coverage issues with AcademyHealth.


NAMD 2017 Fall Meeting Registration
Registration for NAMD’s 2017 Fall Meeting (November 6-8, 2017 in Crystal City, VA) is live and can be found here!  If you have any questions, please contact: .
In This Issue

Save the Date
NAMD Fall Meeting
November 6-8, 2017
Hyatt Regency Crystal City
Register here.


Reg Update


Updates from the Medicare-Medicaid Coordination Office (MMCO) 
  1. MMCO is planning to reach out directly to a few states to highlight some of the technical ways to create new efficiencies and improve experiences for dually eligible beneficiaries: MMCO is hoping to find some win-win opportunities related to Medicare Part A buy-in agreements and data-sharing. They are starting with the handful of states that are “1634” states that do not have Part A buy-in agreements in place.
  2. New brief: MMCO’s state technical assistance contractor released a new brief to help states with Dual Eligible Special Needs Plans keep abreast of key dates and action items.
  3. Webinars: MMCO’s state TA contractor hosted a webinar attended by 25 states on coordinating Medicare and Medicaid behavioral health. It can be found here. MMCO hosted an additional webinar on how states can obtain and deploy Medicare prescription drug data for the purposes of detecting and managing opioid misuse; a recording of that webinar is available here.
The Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) recently released its 2016 National Survey of Children’s Health (NSCH) 
The Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) recently released its 2016 National Survey of Children’s Health (NSCH). The survey, which included more than 50,000 U.S. households, provides annual national- and state-level estimates of key measures of child health and well-being such as obesity, mental health, and bullying. The agency works with the U.S. Census Bureau to conduct the survey, oversee sampling, and produce a final data set of results.


NSCH is designed to assess the prevalence and impact of special health care needs among children, and explores the extent to which children with special health care needs (CSHCN) have medical homes, adequate health insurance, access to needed services, and adequate care coordination. Other topics include functional difficulties, transition services, shared decision-making, and satisfaction with care. HRSA says the data informs programs such as the Maternal and Child Health Services Title V Block Grant national performance and outcome measures, and HHS’s Healthy People objectives.
The data is free for public access via the Census Bureau’s website
here, and additional information may be found here.


CMS Issues Request for Information (RFI) on the Future Direction for the Center for Medicare and Medicaid Innovation (Comments due by November 20, 2017)
The Centers for Medicaid & Medicare Innovation (CMMI) is looking to revamp its priorities for the new administration and has issued an informal Request for Information seeking YOUR input. They intend to chart “a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.”   


The Innovation Center welcomes stakeholder input on the ideas on additional ideas and concepts, and on the future direction of the Innovation Center.
CMMI has laid out eight priority areas in which they intend to test models. They are:
  1. Increased participation in Advanced Alternative Payment Models (APMs);
  2. Consumer-Directed Care & Market-Based Innovation Models;
  3. Physician Specialty Models;
  4. Prescription Drug Models;
  5. Medicare Advantage (MA) Innovation Models;
  6. State-Based and Local Innovation, including Medicaid-focused Models;
  7. Mental and Behavioral Health Models; and
  8. Program Integrity.
The RFI is leaves considerable opportunity for stakeholders to offer your insights as to what CMMI should be prioritizing and testing. To be assured consideration, please submit comments online or by email to by 11:59 p.m. EST November 20, 2017.

Hill Update


CHIP Reauthorization Negotiations Continue as Senate Heads into Recess
The Senate is in recess this week in observation of Columbus Day, leaving negotiations around reauthorization of the Children’s Health Insurance Program (CHIP) unresolved. CHIP funding expired at the end of FY 2017 on September 30, and while both the House and Senate have advanced packages to reauthorize the program, offsets continue to be a point of partisan contention. While there is some hope of finding common ground on the offsets in October, there is some possibility CHIP funding decisions could become part of larger budgetary questions Congress considers in December.


Both the House and the Senate marked up their respective packages during hearings on October 4. On specific CHIP policy, both chambers are closely aligned, envisioning a five-year reauthorization period which would maintain the ACA’s 23-percentage point FMAP enhancement through FY 2019, reduce the enhancement to 11.5 percentage points in FY 2020, and return to the normal CHIP FMAP in FY 2021-2022. Further, CHIP maintenance of effort (MOE) requirements would be relaxed for beneficiaries above 300% FPL starting in FY 2020, though MOE would remain in place for all other beneficiaries.


Unlike the Senate, the House also aims to include additional health spending in its CHIP package, including funding for community health centers, additional Medicaid funds for Puerto Rico, and other measures. The House also identified offsets to pay for their package, though these offsets were considered partisan and led to a party-line vote to advance the bill out of the Energy and Commerce Committee. Specifically, Democrats objected to using the ACA’s public health prevention fund to fund CHIP, the proposal to increase Medicare premiums for wealthier seniors, and insufficient funds for Puerto Rico and the Virgin Islands in the post-hurricane environment.


The Senate opted to not allow amendments during its markup, as a show of bipartisan support for CHIP. Its package does not yet identify offsets, though Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) have indicated they are prioritizing this part of the conversation.


10 Republican Senators Send Letter to HHS on Increasing Fraudulent Opioid Prescription Safeguards
On October 3, a group of 10 Republican Senators who serve on the Senate Finance Committee sent a letter to the U.S. Department of Health and Human Services (HHS) requesting information on fraudulent opioid prescription schemes identified by the Medicare Fraud Strike Force this summer, as well as recommendations on Congressional actions that could address issues identified by that work. The letter also requests information from Medicare Part D prescription drug benefit audits by the HHS Office of the Inspector General, and calls on HHS to strengthen collaboration with the Committee.

In the News


The Wall Street Journal: In Puerto Rico, Health Concerns Grow Amid Lack of Clean Water, Medical Care 
In the aftermath of Hurricane Maria, reports the
Wall Street Journal, many Puerto Ricans are grappling with growing health concerns due to a lack of reliable access to medical care, supplies, and clean water. As of last Tuesday, the official death count from the strongest storm to hit the island in almost a century had risen to 34 from 16. Three of those, said Governor Ricardo Rosselló, were due to failed oxygen delivery following electrical outages. Other causes of death include suicide following the storm, heart attacks, and drownings. While volunteers and government agencies are working to deliver food and medicines to communities across the island, access is spotty. So far, only 51 out of a total of 69 hospitals are open, while most of the island is without stable power and is relying on generators. Mosquito-borne diseases, such as Zika and chikungunya, are also becoming a source of significant concern. In the words of Gov. Rosselló, “Mosquitoes, incidents that might be occurring in hospitals, incidents that might be occurring in shelters-we want to be two steps ahead of them before they become a big problem.”
To read the full article, please click here.
Kaiser Health News: Hepatitis C Drug’s Lower Cost Paves Way for Medicaid, Prisons to Expand Treatment 
The drug, Mavyret, is the first to be approved by the Food and Drug Administration that can cure all six genetic types of hepatitis C in about two months in patients who haven’t previously been treated, compared to the typical 12 weeks. In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about $55,000 to $95,000. Historically, the high prices of drugs like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks but at a significant cost ($94,500), several states threw up roadblocks to limit approval for Harvoni and other expensive drugs until the disease was advanced; some required people to be drug- and alcohol-free for six months or more before treatment would be approved. Yet now it stands to reason, said Matt Salo, executive director of NAMD, “that the continual march downwards on cost will lead to continual opening up of criteria.”
To read the full article, please click here.
CNBC: Google is Putting its Massive Amount of Health and Disease Data to Use 
Last week, Google’s News Lab, designed to help journalists and researchers use Google tools for storytelling and understanding data, introduced a new tool specifically focused on health care and disease. The tool shows that in geographic areas where searches for cancer, heart disease, stroke, and depression are high, so are actual occurrences of those diseases; the data also show trends over time: Google searches for obesity, for example, have been steadily on the rise for the past decade.
To read the full article, please click here.
Politico: Rural Hospitals Are Dying and Pregnant Women Are Paying the Price 
With debates surrounding the repealing and replacing of the Affordable Care Act ever-present, rural hospitals are “in a kind of purgatory, unsure about their Medicaid budgets and the private health insurance that sustains them.” At least 81 rural hospitals, reports Politico, have shut down across the country since 2010, and the current health care policy limbo – which leaves hospitals and insurers unable to predict their income – has significantly exacerbated the problem. “The uncertainty is really impinging providers, particularly hospitals, from making the kinds of decisions that might put them on a better footing,” says Mark Holmes, director of the North Carolina Rural Health Research and Policy Analysis Center at UNC.
To read the full article, please click here.

Take Note


Health Affairs: Medicaid Expansion Reduced Unpaid Medical Debt And Increased Financial Satisfaction 
In this brief, Health Affairs presents new evidence that the ACA’s Medicaid expansion reduced the share of low-income Americans with unpaid medical debt and improved their satisfaction with their own financial situation. Reviewing how Medicaid expansion has affected families’ finances, the brief reveals several key findings, including:
  • By 2015, the uninsurance rate among low-income adults had fallen by 16 percentage points in states that did not expand Medicaid compared to 27 percentage points in states that did.
  • In 2015, the share with medical debt fell 7 percentage points in non-expansion states compared to 13 percentage points in expansion states.
  • The effect of the Medicaid expansion closes about a quarter of the gap in financial satisfaction between low-income and median-income individuals.
To read the full brief, please click here.


Texas Seeking Medicaid DirectorUnder the direction of the HHS Deputy Executive Commissioner for Medical and Social Services, the Associate Commissioner for Medicaid and CHIP Services provides senior-level leadership and oversight to the State Medicaid Program, the Children’s Health Insurance Plan and other operations within the Medicaid and CHIP Services department within the Health and Human Services Commission. The Associate Commissioner for Medicaid and CHIP Services is the senior advisor to the Executive Commissioner, the Chief Deputy, and to the Deputy for Medical and Social Services on the Medicaid program and the Children’s Health Insurance Plan (CHIP). Consistent with the Health and Human Services system mission, vision, values and strategic priorities, the Associate Commissioner for Medicaid and CHIP Services establishes and maintains strategic goals, administrative rules, policies/procedures, and performance measures that structure, govern and measure performance of the department’s operations.


Director of Medicaid Services in New Hampshire
The New Hampshire Department of Health and Human Services is now recruiting for an experienced, highly motivated and energetic individual to join the Department’s executive leadership team as the Director of the Division of Medicaid Services to lead and manage the Division’s programs and services, including Medicaid Policy, Clinical Operations, Dental Services, and Managed Care.  This is a unique opportunity for an individual who desires to have a big impact in a small state.


The Department of Health and Human Services is New Hampshire’s single state Medicaid agency.   The Department is an integrated agency that, in addition to the Office of Medicaid Services, includes the Divisions of Public Health, Behavioral Health, Human Services, Client Services and Quality Assurance and Improvement.   Working with the Department’s executive leadership, this position will oversee and manage a Medicaid program with an annual budget exceeding $1 billion that covers over 190,000 children and adults.


This position reports to the Commissioner of the Department with additional reporting responsibilities to the Associate Commissioner for Population Health.  The Director also represents Medicaid to key stakeholders, including the Governor’s office and state legislature, the Centers for Medicare and Medicaid Services, provider communities and managed care plans, and other stakeholders and advocacy groups.


Full posting can be found  here.


Oregon Seeking State Medicaid Director
The Oregon Health Authority  is looking for a passionate leader who is eager to influence and advance health system transformation in Oregon, to join our innovative team as the State Medicaid Director.


This key position is a catalyst in building strong collaborative relationships with public health, behavioral and oral health champions throughout the state. The State Medicaid Director provides overall leadership and direction for strategic program development, health policy and program implementations for the Oregon Health Plan, with an enrollment of over one million individuals.
We invite you to view additional details about this opportunity in our electronic brochure.


Iowa Seeking Medicaid DirectorIowa Department of Human Services seeks a professional to lead the Iowa Medicaid Enterprise (IME).  IME is a health care payor that provides comprehensive health care benefits to over 600,000 Iowans annually and has annual expenditures in excess of $ 5.6 billion.  This key critical position serves on the Department’s executive management team.


The Medicaid Director is the primary architect of the strategy that establishes IME’s goals for optimal health outcomes and financial performance. This position defines program objectives and performance measures to ensure goals are attained.  The role requires a superior knowledge of the insurance industry’s healthcare payment systems and CMS regulations, in order to integrate federal mandates into compliant state policy. This pivotal role provides vision and direction for IME staffs and contractors to implement strategies focused on effective delivery results.  The Director must be an effective communicator to craft initiative messages and continually collaborate with a broad and diverse group of stakeholders inclusive of consumers, provider associations, legislators and CMS.
Nebraska Posting for Policy and Communications Deputy Director
The Nebraska Department of Health and Human Services (DHHS) has an exciting opportunity for a Policy and Communications Deputy Director to join our team within the Division of Developmental Disabilities. The Deputy Director will be responsible for overall policy formulation for the Division. Successful candidates will have policy development experience, strong interpersonal skills, and share in our mission of “helping people live better lives.”
The Deputy Director will be responsible for all the administration and management of planning, coordinating, and implementing the overall policy formulation for the Division of Developmental Disabilities with delegated authority to provide communication for the Division; interacting with stakeholders on behalf of the Division Director to promote system reform and transparency; monitoring and communicating Division objectives, activities, and potential areas of concern regarding policy or precedent as well as proposed remedies to the Director and other members of the leadership team; and play a key role in efforts of internal reorganization, management of the state’s newly redesigned Medicaid home and community-based waiver programs for people to lead healthy, independent, and active lives in communities throughout Nebraska.
If you are interested in joining our team and have a desire to fulfill our mission to “help people live better lives,” please submit a Resume/CV and letter of interest to Human Resources at


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