On May 19, 2017, the New Mexico Human Services Department (HSD) released a section 1115 waiver demonstration concept paper for the state’s Centennial Care program. First approved in 2014, HSD notes some of the advances that Centennial Care has made in the Medicaid program, including:
- Streamlined administration;
- Created a care coordination infrastructure;
- Increased access to LTSS for individuals residing in the community;
- Advanced value-based purchasing (VBP) initiatives; and
- Reduced per capita costs.
For the next iteration of the program, referred to as Centennial Care 2.0, the state hopes to make the following targeted improvements regarding LTSS:
- Streamline services between the agency-based community benefit (ABCD) and self-directed community benefit (SDCB) program options;
- Create an allowance for start-up goods for when members transition between the ABCD and SDCB programs;
- Increase the number of hours available for caregiver respite;
- Limit the costs of certain services in the SDCB model;
- Establish automatic nursing facility (NF) level of care (LOC) approval for individuals with specific criteria and whose condition is not expected to change; and
- Include nursing facilities in VBP initiatives. (Source: Concept Paper 5/19/2017)
On September 1, 2017, the New Mexico Human Services Department (HSD) released a request for proposals (RFP) to procure MCOs for Centennial Care 2.0, which is the state’s comprehensive Medicaid managed care program that includes LTSS. A concept paper on Centennial Care 2.0 was examined in the August edition of the State Medicaid Integration Tracker©. HSD expects that Centennial Care 2.0 will cover approximately 700,000 Medicaid beneficiaries, but will continue to exclude the following populations from Medicaid managed care:
- Native American individuals who do not need LTSS and have previously opted out of managed care;
- Individuals residing in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IDD);
- Partial benefits individuals;
- Beneficiaries participating in the Program of All Inclusive Care for the Elderly (PACE); and
- Individuals enrolled in a 1915(c) waiver for individuals with IDD—this population will receive acute care benefits only through Centennial Care.
Centennial Care 2.0 does not contain major programmatic changes, but instead builds on program successes, including with rebalancing the state’s LTSS system away from institutions and towards community-based care. HSD intends to award contracts to between three and five MCOs, for an initial five-year period with opportunities to renew. Implementation of the new contracts is scheduled for January 1, 2019. (Source: RFP 9/1/2017; August State Medicaid Integration Tracker 8/4/2017)
On December 6, 2017, the New Mexico Human Services Department formally submitted its application to renew the state’s comprehensive section 1115 demonstration waiver, Centennial Care 2.0, which includes LTSS. The August edition of the State Medicaid Integration Tracker details the programmatic changes and updates the state intends to pursue with the renewal, including streamlined administration and increased access to community-based LTSS. (Source: 1115 Renewal Application 12/6/2017; State Medicaid Integration Tracker 8/4/2017)
On January 19, 2018, the Santa Fe New Mexican reported that the New Mexico Human Services Department (HSD) announced the MCOs selected to serve in the state’s re-procured Centennial Care Medicaid managed care program. The incumbent plans selected are Presbyterian Health Plan and Blue Cross Blue Shield of New Mexico; two other incumbents, Molina Healthcare of New Mexico and United Healthcare, will not have their contracts renewed. HSD instead selected a new MCO, Western Sky Community Care, which is a subsidiary of Centene Corporation. (Source: Sante Fe New Mexican 1/19/2018)
On January 31, 2018, The New Mexican reported that Molina Healthcare filed a suit against the New Mexico Human Services Department (HSD) overall alleged irregularities in the reprocurement of the state’s Medicaid managed care program, Centennial Care. Molina is one of two incumbent MCOs that was not selected for contractual renewal starting in 2019; the other is UnitedHealthcare. At issue is alleged changes to evaluation factors for contracts, and alterations to the timeline. The suit also alleges that the state may have been influenced by a consultant that it has used to assist with evaluating MCO bids. (Source: The New Mexican 1/31/2018)
On February 16, 2018, The New Mexican reported on the response from the New Mexico HSD regarding any irregularities or issues with the state’s recent reprocurement of its Medicaid managed care contracts. In addition to the lawsuit filed by Molina, both Molina and UnitedHealthcare have filed administrative protests with the HSD. The state, in its court filings and public statements, defends its process and the results of the reprocurement. (Source: The New Mexican 2/16/2018)
On February 26, 2018, a District judge dismissed Molina’s lawsuit, stating it was inappropriate at this time given that the company’s administrative protest was still being reviewed. If the company’s protest is denied, a new lawsuit is considered likely. (Source: The New Mexican 2/26/2018)
On May 17, 2018, the Santa Fe New Mexican reported that the New Mexico Human Services Department (HSD) rejected the protest bids of four MCOs that were not selected to contract with the state under its recent reprocurement, which includes MLTSS. In January HSD announced that it had selected Blue Cross Blue Shield of New Mexico, Western Sky Community Care (Centene), and Presbyterian Health Plan as its new contractors. The four bidders that were not selected for contracts, which includes AmeriHealth Caritas, Molina Healthcare, United Healthcare, and WellCare, are now expected to take their protests to state District Court. (Sources: Santa Fe New Mexican 5/17/2018; New Mexico HSD RFP Website)
On November 21st, a District Court Judge ruled in favor of the State of New Mexico in a court battle regarding award of the state’s Centennial Care managed care contracts. In December 2017, New Mexico awarded contracts for Centennial Care, which includes MLTSS, to three companies: Presbyterian Health, Blue Cross and Blue Shield, and Western Sky Community Care (Centene). Incumbents Molina and UnitedHealth Care did not receive contracts under the new procurement. Molina filed suit alleging that there were challenges and inconsistencies in the procurement and award process. The ruling rejected these claims, but Molina indicated intent to appeal the decision. The state has indicated they intend to move forward with implementation on January 1, 2019 barring any further court actions.
Sources: HMA Weekly Roundup (11-28-2018); Albuquerque Journal (11-21-2018); and Santa Fe New Mexican (11-21-2018).