Medicaid roundup: Florida receives 3-year renewal for managed care program; Illinois limits Sovaldi

Aug 5 2014

About 3 million Floridians are enrolled in the privatized program. Meanwhile, Illinois Medicaid puts limits on who is eligible for Sovaldi, an expensive hepatitis C drug, and Kansas recoups more than $28 million in Medicaid fraud.

The Associated Press: Feds Grant Fla. 3-Year Medicaid Managed-Care Renewal
The federal government has granted a three-year renewal of Florida's Medicaid managed-care program. About 3 million Floridians -; more than half are children -; are enrolled in the program, which has been rolling out statewide over the past few months. Under Medicaid privatization, the state gives insurance companies a set amount of money each month for patient care, giving the insurer broad authority to decide which doctors they can see and what treatments can be prescribed (8/3).

The Wall Street Journal: How Illinois Allocates $84,000 Drug For Hepatitis C
The $84,000-a-patient cost of the Sovaldi hepatitis C treatment has intensified a national debate among lawmakers, insurers and economists about the value of expensive medicines to society at large. The dilemma sparked by Sovaldi, which is made by Gilead Sciences, is also presenting hard choices to state Medicaid programs. In Illinois, for instance, officials recently instituted a new set of 25 stringent criteria for using Sovaldi that includes treating only those patients with the most advanced stage of liver disease and limiting treatment for those with a history of drug use and alcohol abuse (Silverman, 8/3).

Kansas Health Institute News Service: State Medicaid Fraud Unit Recovers More Than $28M
The state recovered more than $28 million in taxpayer funds through its Medicaid fraud enforcement during the recently ended state fiscal year, Kansas Attorney General Derek Schmidt said Friday. During fiscal 2014, which ended June 30, the Medicaid Fraud and Abuse Division of the Kansas attorney general's office recovered more than $28.7 million. The recoveries were reported in the division's annual report to the U.S. Department of Health and Human Services. This was the second-highest year of recoveries, following last fiscal year's record $33.7 million (8/1).