CMS denies key provisions in Arizona's request for changes to Medicaid

The CMS approved the least conservative aspects of Arizona's request to tweak Medicaid in ways that would make consumers more financially responsible for their coverage. The agency denied Arizona's request to require beneficiaries to search for jobs while on the program and it rejected locking people out of coverage for six months if they failed to pay premiums. Also refused was a request that beneficiaries living under the federal poverty level pay premiums. The CMS will allow Arizona to charge beneficiaries with incomes above the federal poverty level premiums. Those funds will be funneled into a health savings account and cover services such as dental and vision. People living below the poverty level can then receive dental and vision coverage by volunteering to pay into the account or having a charity or third party contribute on their behalf. In place of a job search requirement, Arizona will set up a work search and job training program for enrollees. Federal regulators said they felt the proposals would undermine access to care in Arizona. Medicaid covers 1.7 million people in the state. Since expanding Medicaid, 315,000 people have gained coverage.

—Virgil Dickson

A California state judge granted a motion to coordinate 55 cases filed against Bayer by roughly 900 women who say the pharmaceutical company's permanent birth control device Essure caused them harm. The mechanism of civil case coordination in California allows two or more cases that “share common questions of fact or law and that are pending in different counties to be joined in one court,” according to the state's judicial branch. With coordinated cases assigned to a single judge, one ruling applies to them all. Essure is a tiny coil made of nickel that is inserted without surgery or anesthesia into each of a woman's fallopian tubes. Ideally, scar tissue develops around the coils, blocking the tubes and preventing the fertilization of eggs and their entry into the uterus. But thousands of women have reported problems with the device. The Food and Drug Administration's Manufacturer and User Facility Device Experience database has received 9,900 reports related to Essure, including 6,989 reports of pain, 3,210 of irregular periods, 854 of the device migrating, and 429 of the device breaking, among numerous other problems. Bayer, meanwhile, maintains that Essure is safe for women to use.

—Elizabeth Whitman

WellCare Health Plans has agreed to acquire Care1st Health Plan of Arizona for $157.5 million. The deal, expected to close in the first quarter of next year, marks WellCare's entrance into the Arizona Medicaid managed-care market. WellCare had 2.43 million Medicaid members as of June 30; more than half of that total resided in Florida and Georgia, two states that did not expand Medicaid under the Affordable Care Act. Arizona is one of 31 states that has expanded Medicaid eligibility to more low-income people. Care1st Arizona provides Medicaid coverage to 112,000 people in the state's two largest counties and also has a small Medicare Advantage special needs plan that covers 2,000 people. WellCare executives in February said the company had $1.25 billion in cash reserves to spend on transactions. Care1st Arizona is expected to add about $400 million of premium revenue to WellCare, according to Wall Street projections. WellCare, which also sells Medicare Advantage and Medicare Part D prescription drug plans, had revenue of $3.6 billion in the first half of this year.

—Bob Herman