Kris and Clay covered the Medicaid News in the last 45 days. Run time 1hr 16 mins.
Stories we covered in this episode:
Half of States Lack Full SUD Care Coverage in Medicaid Managed Care Plans Over 1.6M people in Maryland enrolled in Medicaid, more than before COVID State report shows most Virginians on Medicaid can’t access prenatal services UnitedHealth’s cyberattack response costs to surpass $2.3B this year HHS releases proposed rule designed to improve patient engagement, information sharing, interoperability Leidos awarded Medicaid Enterprise Systems Integrator contract Court Losses Mount For Pharma In Legal Bid To Block Medicare Drug Price Negotiations Legislation to grant 4-year coverage of breakthrough medical devices passes Ways and Means, with a heavy discount Telehealth 4 Walls Update: CMS Issues Proposed Rule to Eliminate Medicaid Standard Florida appeals a ruling regarding payment of KidCare insurance premiums Kansas official rejects appeal by unsuccessful bidders on state’s $4 billion KanCare contract North Carolina’s Medicaid expansion program has enrolled 500,000 people in just 7 months Hospitals raise hands to pay taxes that plug Medicaid shortfalls Medicaid in Five States Will Cover MOUD for Prisoners Nearing Release Can a Medicaid plan that requires work succeed? Georgia’s experiment is not promising
Kat McDavitt and joined Clay and Steven to cover the Medicaid News in the last 45 days. Run time 1hr 16 mins.
Stories covered:
Uber Caregiver Accenture buys Cognosante Oklahoma managed care rollout challenges $1.5B in questionable payments through NY MCOs Centene says states did redeterminations wrong Centene to spend $1B on housing MN kicks out for profit MCOs TX community plans kicked out NV Medicaid digital efforts MI telehealth pricing parity GSA FedRamp advisory panel Medicaid and weight loss drugs 340B in the courts NH staffing rule (and Clay learns something) DE, TN and babies’ butts Newsom won’t deal with the $40B deficit he created And much more!
THIS ONE GOES UP TO 11! Come hang out at the 11th annual Medicaid Innovations Conference in Orlando in February. One of my favorite events (it must be- I’ve been to all but 1 of them over the years). Check out the agenda and sign up here- https://www.medicaidinnovations.com/agenda.html
ANDY, ANDY- SO FINE AND DANDY- HOW DOES YOUR BUDGET GROW? Continuing our coverage of the Good Guvn’r Cuomo’s Adventures in Bad Leadership this week. Andy announced a 1% cut to Medicaid providers on New Year’s Eve (Happy New Years, Suckers!). That cut will be for 90 days and will save about $126M. Sounds cool until you realize that just the Medicaid budget hole is $4B. Andy also promised a plan to deal with the overall deficit back in December. Part of that plan appears to be cooking the books again by delaying about $1.7B in Medicaid payments so that they appear in the next FY (He also did this last year, but secretly). We all wait with baited (bated?) breath for the new plan. Especially officials (and taxpayers) in the counties of NY. Cuomo’s recent state of the state hinted at increasing the share counties chip in to cover the costs of unfettered Medicaid spending. Innovation abounds in the legislature as well: the brilliant Dems in the statehouse want to “address the deficit” but without “cutting services.” I would also like to lose weight by eating cookies. Idiots.
NEW WAY TO GET A DO-OVER ON AN MCO BID? ELECT A NEW GOVERNOR, OF COURSE- If you lost out on the latest KY bids, dust off your proposal. Beshear- in his effort to undo all things Bevin- has ordered a do-over on the latest contract awards. Is that even legal? Is “legal” even a thing anymore?
MOLINA BACK ON THE WARPATH- The MCO will purchase NextLevel Health for about $50M. The buy will give Molina a strategic path to increase Illinois Medicaid revenues.
CMS TINKERING WITH 340B AGAIN- This time CMS is taking aim at duplicate discounts (that hurt Rx makers by hitting them with having to pay discounts in both 340B and the Medicaid Drug Rebate Program; MDRP). The federalis released a guidance bulletin Jan 8, outlining what The Big House views as best practices. Basically, the recommendations focus on using data to avoid overlaps, writing better contracts and limiting covered entities. Initial opposition was summarized as thus: These are great ideas, but it will make it harder for us to keep the federal money flowing. Doing the right thing is too costly.
YOU HAVE A FEW MORE WEEKS TO TELL CMS HOW MUCH YOU HATE CHANGES TO SUPPLEMENTAL PAYMENTS REGS (BUT DON’T MAKE IT TOO OBVIOUS HOW SELF-INTERESTED YOUR OPPOSITION IS)- I think the gist is best gleaned from a recent quote by CMS Administrator Veerma: “We have seen a proliferation of payment arrangements that mask or circumvent the rules where shady recycling schemes drive up taxpayer costs and pervert the system.” Supplemental payments to skilled nursing (and other) facilities now account for $3.5B each year (about 7% of all Medicaid FFS spend)- but when these payments are passed through the managed care model, CMS has very little idea what they are actually paying for. Feb 1 is the deadline to weigh in on the proposed rule. The rule establishes new reporting requirements about what states are doing with the payments.
KANSAS HOPS ON THE EXPANSION TRAIN- The Good Guvn’r Kelly announced plans to take the free federal money last Thursday. The Kansas expansion plan will seek to get additional funding for services for the thousands of severely disabled members who have been on the waiting list for years. Just kidding – I am sure it will all go to comparatively healthy 20-year olds who don’t want to be forced to work to pay for their own “coverage.” To be fair to KS, they have cleared their waiting list in the past. Not all states (and certainly not expansion ones) can say the same thing.
$2.6B IN 2019 FRAUD RECOVERIES LAUDED BY DOJ. SOUNDS GREAT UNTIL YOU REALIZE CONSERVATIVE ESTIMATES PUT CARE/CAID FRAUD AROUND $100B EACH YEAR- Read the latest annual report here. It is getting better. Long way to go. Very long way.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award. Just a few tidbits this week, dear readers (it is just the first full week of the year, after all). Lets first go to Balmore (Baltimore), where we find someone murdered over Medicaid fraud. This one doesn’t have a dollar amount, but I wanted to share it with you to show you how pernicious and evil Medicaid fraud is. Latrina Ashburne, a teacher’s aide, was murdered (allegedly) by Devon Carter and Clifton Mosby. The broke into her home and shot her, thinking she was a Medicaid fraud whistleblower in a case against a friend of theirs. Lets head north for some less lethal Medicaid fraud. In Danville, New Hampshire we find Richard Gaudette. Mr. Gaudette was sentenced for stealing $111k in Medicaid bucks using a personal care services scheme. He billed for services even when his clients were in the hospital or dead. For our last entry this week, let’s head west, way west- all the way on over to Alaska. We find John Zipperer in Wasilla, where he operated a $9M scam using unnecessary tests. He ran over 1M (or claimed he did) tests on urine samples using a lab he owned in Tennessee. His $9M scam was 10x the total amount that all other providers in Alaska were reimbursed for the same tests. Wow. John Z- you win this week’s award! Taxpayers, you of course lost, yet again.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (finally get those leaves up if you haven’t. I know I haven’t. ) and keep running the race (you know who you are).
We review another 12 months of the Medicaid industry together. And I also attempt to share what has been going on in my life for the past year.
If you have missed the last 3 of these, here is a link. (Hint- each icon in the section breaks represents one of the years in reviews. Not sure if that’s how you pluralize that. Sort of like how toothbrushes works).
So glad you are here this year, all my reader friends.
Let’s review all the work / industry stuff first.
Work Requirements 2019 Edition
Let’s do this in memes.
Yes- you read that right. We are going to review Medicaid 2019 in memes.
Work requirements carried over as an issue from 2018 and the update for most of 2019 was “lawsuits are pending.” I think for me it mostly got tiring hearing lefties monolithically argue against work requirements using one of the 3 following canards:
Most Medicaid bennies are already working, so this is pointless -This argument was supported by a few “studies” (limited surveys) trotted out by the usual ideological suspect publications in 2019- but we don’t really know that this claim is true unless its actually reported, do we? At its heart, the opposition is really resistance to anything that slows down the death march towards universal healthcare paid for by taxpayers. No matter what Kaiser, et al tells you – there are still plenty of people who are not Nazis that oppose universal healthcare funded by taxpayers for a lot of different reasons.
Tracking compliance will cost a lot– sure. But since when do we care about the costs of doing anything in Medicaid? Especially technology investments? And how much is saved for every member removed who should not be on Medicaid if earning your health insurance for the able-bodied is a legitimate requirement for coverage?
Orange man bad– This is just something in the air, I guess.
So here’s my answer to all this nonsense in the form of a meme:
See the thing is – the thing no DoubleSpeaking expansion advocate (work requirements and expansion are inextricably linked) will let you notice – is that healthy, able-bodied Medicaid members who got added under expansion bring lots more (90-100%) federali money than the traditional aged, blind and disabled (you only get regular ole’ federali cash for those folks, usually between 50%-75%). Its not the altruistic pretty picture expansion zombies would have you believe. Its cash, cash, cash. Screw the disabled so that healthy adults can get a Medicaid card. Screw that, I say.
And of course, there are a few intellectual contortionists
who came up with junk analysis to say expansion doesn’t hurt traditional
Medicaid members. Don’t believe them. If you are a state budgeteer and you can
get 100% federal money for one population, or have to come up with millions
more in state funds to increase services for another population- what are you
going to do? And please, please, please don’t trot out the “free federal money”
argument to pretend you can have sufficient money for both ABD and expansion,
too. If I hear that nonsense one more time I just might throw up in my mouth.
I have decided that waiting lists are the absolutely most clear condemnation of Medicaid expansion possible. Get the tens of thousands of truly vulnerable off the waiting lists in states across the nation – then I will listen to you boo-hoo about work requirements. Until then – I have to work for my own healthcare coverage, and I think anyone who can work should have to, too.
Show me the money
2019 was the year Medicaid spending didn’t go up. All these
innovations around value-based payment have finally started to pay off. Just
kidding! (or psych! as we used to say in middle school in 1989).
We saw another round of budget crises in nearly every state
this year. And it was the same script in 2019 as it was in 2018 as it was in
2017… In order to keep services the same, and not have the sky fall and kill
all the children (of course), every statehouse heard the plea for more, more,
more. Some states- like Alaska- actually tried to tighten the belt. Guess what
happened there? You guessed it, a judge ruled that Governors actually don’t
have any power and allowed the provider lawsuits needed to “restore cuts.”
So here’s the conclusion I have come to. Price is the issue. Not cost. Price as set by providers. As differentiated by what it costs to make a product (or provide a service) versus what the merchant charges for it (price).[1] If we don’t address healthcare price- which absolutely has been on a cocaine-fueled, skyrocketing joyride for nearly all of recent history- no amount of policy smoke and mirrors (“innovation”) will ever put a dent in it.
And the scariest thing to me about price is that I don’t think there is a single example of anything (i.e. student loans, housing) that is subsidized by the government ever NOT having nightmarish price trends. Its almost as if the merchants say – “Hey look, the government has to buy it, and we get to set the price, so why not set it higher and higher and higher?”
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One more meme just for giggles
And now for the personal / life stuff. Thanks for letting me wrant (I just made that word up- its when you rant in written form) about the Medicaid industry stuff.
NOTE [1] Don’t believe providers who tell you they are losing money on Medicaid. Once we have actually data on costs, or until we have at least more price transparency, the black box of provider “costs” is simply a tool to allow the merchants to charge uninformed buyers whatever they want. And make the buyers feel guilty for pay “so little.”
Overarching analogy (the glue)
Let’s set up the overarching analogy first. The thing that
will make this globby read stick together.
____________ is what you play and when
you play it.
You can fill in the blanks, but any musicians out there with a lick of theory will know that Music goes in that blank nicely.
I heard it from Earl, my very first
guitar instructor when I was 19 years old.
“Really, Clay – music is just what
you play and when you play it. The notes are the what, and when you play them
is as important as what you play.”
I think this applies to just about
all of the human experience. Let’s run with it.
Reviewing the non-work part of life
This year’s disclaimer: For some reason – I think its
because I write these things in December, which is a reflective time, and
reflection is almost always somber, or at least not chipper- my Year In Reviews
(we are up to 4 or 5 now, I think) tend towards bittersweet. I am not sure why
you people keep reading them, but you do (based on all the wonderful notes I
get each year), so I will keep writing them. And honestly I probably would
write them whether or not anyone read them.
But thank you for reading. Please write in (clay@mostlymedicaid.com) with any
reactions you have.
This year is bittersweet, too. But not as much of a
tear-jerker as last year.
And it includes football, and old people, and hymns, and
dogs and graveyards. What’s not to love about that?
Pros of 2019
No one died this year. Well no one that I know.
I am sure many readers lost some people dear to them.
No pet died this year, although we did lose one.
Funny thing about border collies. They are bred to herd and they herd by
nipping. And they don’t distinguish between 6-year olds and sheep. Up until
December 27th, the verdict was still out if Shepherd remained a
Farris, but we ended up driving him to a farm an hour and a half from home and
setting him off on his next chapter. He was a great dog, but the time was just
not right. Its what you play and when you play it.
I leveled up on my love for my wife. At first I
wanted to say that it is natural that this happens when the one you love has a
progressive auto-immune disorder. But if I am honest, I have simply been able
to see more of her beauty that was always there. Although my eyeglasses prescription
gets worse each year, some things not seen with the eyes are better seen with
age.
I played 48 nursing home gigs. The first Monday
and Friday of every month. More on that later.
Cons of 2019
Taxes are still a thing. If only I could select what they went to (like a sushi menu), I would gladly pay more. As it is now, I resent them and look for all legal ways to minimize them. I guess if the only real con I can think of for a whole year is that I have to pay taxes in the very best country that ever existed on the face of this planet, 2019 really wasn’t bad at all.
Life in the old folks home
One of the very best decisions I
made in recent years was to go into nursing homes and sing old hymns to the
residents. Correction- with the residents.
My first few gigs were in 2017. I
loved them so much I scheduled standing gigs in 2018 and this year I played 48
gigs. The value of those moments with elderly believers worshipping God is incalculable.
I have cried so many tears of joy singing with them. At least once a month my
voice cracks up as I sing Great Is Thy Faithfullness. Or Victory in
Jesus. Precious Lord is the real crowd pleaser, and for me it is tied with Because
He Lives and Precious Memories. Who am I kidding? I love all of
these songs, nearly equally well.
Go into a nursing home the first
Monday of every month and you make friends. They start to look for you. And you
for them.
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Mr. Brown (not his real name) taught me a whole new verse to Amazing Grace. One that is not in my 1975 Baptist Hymnal.[2] But first let me tell you about how I met Mr. Brown.
I and the older 2 kids (they LOVE
seeing children. And I finally learned when I bring the kids to just put them
in front of the mic. The residents do not care what I sound like at that point)
had just finished playing. There were maybe 20 residents there (which is a huge
gig for us). We were packing up the gear, and Mr. Brown asked if he could have
the mic.
At first I hesitated. This hadn’t
happened before.
What was he going to say?
He didn’t say anything, but instead starting
singing.
Let me back up a minute and describe
Mr. Brown so you have a picture of him. Not that his appearance matters, but
just you can visualize him. And maybe so I can, too. Years later when I read
this again, like I obsessively re-read things I wrote years and years later.
Mr. Brown is in his early 80s. He is about 5 10 (I’m just guessing- Ive only every seen him sitting down). About 300 pounds. Wears sweatshirts and jeans and a ball cap. His smile – though missing a few teeth- is on my top 10 smiles of all the ones I’ve seen in my life. Mr. Brown is also black- but from a time where calling him “African-American” would be as weird to him as it is to me.
After I got to know Mr. Brown over the course of a few months, he was sitting out on the front porch while we were loading in. Loading in from out of my 1996 Blazer (I have a thing for old run down cars and keeping them running. There’s an analogy for me in there somewhere. Maybe underneath the catalytic converter). That Blazer was a gift to me from my father in law when we were just starting our family. And at that point it was 10 years old. But it was huge blessing.
I can not see myself getting rid of
it. Ever.
But Mr. Brown remarked that it was a
nice car. And I agreed, but also thought to myself that most people would not
think so. I can almost guarantee you that the majority of people reading this consider
a Lexus a nice car. Or a brand new Pilot. Or maybe – maybe- a new Camry. But
not a 22 year old blazer with 150,000 miles on it.
But I kept my thoughts to myself.
And I’m glad I did, because it gave Mr. Brown space to continue.
“I never had no car. That’s a nice
car.”
In that moment I knew my
appreciation of the blessing of this old car was insufficient. That I had any
car at all was such a blessing. Mr. Brown had lived 80 years and never had a
car.
Back to that secret verse of Amazing
Grace you may not know about.
Once I hand him the mic, Mr. Brown
started singing two words over and over, to the melody of Amazing Grace:
Praise God
Praise God
Praise God
Praise God
I had never heard this done.
It was so powerful. And the other
residents all sang along. He was their leader and I knew in that moment he
played an important role in that community of aging, dying believers. Day in
and day out he was there. Encouraging them with his toothy smile and loving
words. I was just there for an hour every 30 days.
From that moment on I looked to
include Mr. Brown however I could.
But I didn’t get many more chances.
He was there maybe 3 more times. I asked the activities director if he was ok
for a few months. She would always say he was just tired.
Now I haven’t seen him in nearly a
year, and I fear he is gone (dead). I think the activities director wanted to
spare me the sadness because she could see how fond I was of him.
But that’s the gig in these gigs – you are playing (and bonding with) to an audience not long for this world. I often wonder how people who work in nursing homes are not crying every day. Maybe they are.
There are so many people I want to tell you about from these gigs. But let me share just a few more.
There is a lady in the memory care unit of one of the places we go. If you have never been to a memory care unit, the important thing to understand if that these residents are an elopement risk. Many of them wear anklets that are paired to alarms near doors so staff know they may be attempting a break out. There is a wide range of memory issues seen in these units, but in general the very mildest cases are what you would consider “severe” from a lay person’s perspective.
What I noticed early on with this population is you need a different set list. You need older songs. Instead of hymns from say 1940-1960, you need ones from the late 1800s (those songs are what their parents taught them as young children). They know hymns from both time periods, but the older ones resonate with them much more deeply (think Blessed Assurance vs His Name is Wonderful). But the really beautiful thing is that these residents may not know their children’s name (of course that is sad, but wait for the concluding clause)- but they remember all the words to How Great Thou Art. And they light up when they sing it with gusto.
I am very impressed with this particular facility. Not all of them are as compassionate as you would hope. Or maybe the word is not compassionate, but rather thoughtful. This facility does things like buy a jukebox with pop songs from the 1950s in it. And they put cribs in one of the common areas, complete with baby dolls in them. You may think that’s strange. I did at first, too. But then I saw how soothing it is to some residents. And I was thankful that the staff are working to meet the residents where they are in their journey.
I have heard nursing homes referred
to as “Heaven’s Waiting Room.” I think there’s a lot of truth to that. When I
first tell people (people not in nursing homes) the songs I sing, they are
somewhat shocked. Because all the old hymns pretty much talk about death. And
about looking forward to it as the only way to reunite with our Savior. That
last part is key.
But what I noticed is that the residents don’t mind. Not only do they not mind- they are encouraged by it. Sometimes not just encouraged, but emboldened.
And so am I.
Which is one of the reasons I love “When
We All Get to Heaven” so much. I tell them it’s a marching song. And they
love that.
But back to this lady in the memory
unit.
Most times she is completely silent
and sits there and cries while listening to us sing. Sometimes she mouths a few
words of the song. Lately she has actually spoken a few sentences and smiled.
Normally her daughter (I assume its
her daughter) is there when we play. I think she comes to visit on her lunch
break. And I am so grateful that someone has a child that still comes to visit.
Almost none of the residents have that. But that daughter comes to see her
mother regularly – Praise God.
When the daughter is there, she
stands behind her mother (who is sitting on a couch) and leans in to place her
cheek on her mother’s cheek. And they just share the time together like that.
For an hour. Sometime the mom cries. The daughter only ever smiles. She has
never said anything to me.
That woman did something right when
she raised that daughter.
At that same facility is another
lady who without fail asks my oldest son if he has a girlfriend. Like at least 20
times. From the time we are setting up the mic to when we break down. This is
how Caleb remembers this place.
“Is this the one where the lady asks me if I have a girlfriend?”
“Yes, son.”
At first I think it may have
bothered him a bit, but now he understands. And he is nothing but sweet and
answers her question every time.
“Do you have a girlfriend? How old are you?
“No, mam. I am 9.”
“You sure are handsome. You’re gonna have lots of girlfriends.”
“Thank you, mam.”
Repeat that about 20 times.
She asks Nora if she has a boyfriend. The exchange plays out similarly, but when Nora tells her no, the lady adds: “Well, you are smart, then.”
NOTE [2] I have the Broadman Hymnal as well somewhere in this old house. Its red and smells like wood, carpeted pews and maybe holy water. But of course there’s no holy water in a Baptist Church so maybe my smell-brain is confusing memories…
A few quick others.
One lady, wearing a bright read
sweater and hair all done up (it humbles me to tears that they think my songs
are worthy of dressing up for) called out once-
“I have a testimony!”
Having learned to not hesitate after the Mr. Brown incident, I told her by all means to go ahead. And she gave a few minutes of her testimony[3] and it is one of the treasures I carry with me in my heart.
My last example is the lady who
always thanks me for reading Scripture during the set. I think we assume there
are people going in and ministering to these people all the time, but that may
not be the case. She seems like she has been starved of hearing Scripture
spoken each month. And so grateful for me simply reading from the Psalms.
I don’t know that playing these
songs ever would have occurred to me when I was younger. But I learned them all
before I turned 12.
It’s what you play and when you play it. Now is the right time to play these songs for these people. The nursing homes may be Heaven’s Waiting Room, but those folks need music, too. And if I can be a part of singing them into heaven, then I am blessed beyond measure.
[3] For those of you who didn’t grow up in a protestant church, this is when people share either their personal salvation story or something God has done for them in their lives.
Life in the Graveyard
If you are not familiar with the national wreath laying program for our veterans laid to rest in national cemeteries, it’s a wonderful event where families and friends of our lost heroes gather to lay a wreath on their graves. It happens every year in early December. You can find out more at https://www.wreathsacrossamerica.org/. I highly recommend you participate at least once.
We went this year (and have each year so far since Daddy
died and was buried at the national cemetery in Alabama). We are always amazed
at how many new headstones there are each time we visit.
What struck me most this year was that the living have basically made the graveyard (cemetery, I guess, since not attached to a church- but there is a chapel, I think) a part of their life. By that I mean they place everyday items that mean something to them (and I assume to the deceased) at the tombstone. We were accustomed to the coins left on headstones (learn what that is all about here). But there are also very specific rules about what can be used as decoration, and I think we saw lots of violations that day. My guess is the groundskeepers look the other way around Christmas to help the grieving make it through another December without their daddy, or momma. Or daughter, or son. Or best friend.
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Looking at what the grieving choose to leave is eye-opening. In a good way. It shows you that not only does life go on after the burial, but it includes the one buried. Some objects are very specific to that family (like a sea shell or a snow globe). Some are sports teams- we found 2 Alabama Crimson Tide items, and are in the process of making sure we get some Auburn ones in there soon.
To me this shows that there is life in the graveyard. It shows me that the people buried there played the right things and played them at the right time. They left an impression- a good one. They are missed but in no way forgotten.
We took the kids and Momma to see the Christmas lights at
Callaway Gardens this year. This is another thing I recommend you do at least
once- its actually on various lists of top 10 lights events in the world.
On the way back home from Callaway, we stopped in Auburn (see last year’s Year in Review for a similar pilgrimage). We checked out the new Arena first (the basketball facility). And it was cool.
In it I found this quote on the wall:
That quote says it pretty well, I think.
As we were leaving the Arena, my oldest asked to go over to the football stadium. As we also did in last year’s escapade, we snuck in.
Once inside, it all took care of itself.
We were in the right place at the right time. What you
play, when you play it.
We made our way, like salmon back to where we were spawned, to the field. Anyone who was ever a teenager knows its cool to get into places when you’re not supposed to. None of that high school mischief compares to standing on that grass at Jordan-Hare Stadium. And stand on the grass we did.
And we took pictures. And remembered the amazing game where
we beat nasty Alabama just a few short weeks before. It was an astonishing game
and if you watched it and didn’t like it, then you don’t like football and I
can’t help you.
We got into an open construction entrance near section 44. We made our way down about 25 steps or to that little gray gate in the corner of the endzone. It wasn’t locked. We were supposed to be there.
The kids and I took pictures. Walked over spots we knew
those Auburn Tigers had run over with amazing skill just recently. To beat
Alabama. (Praise God)
And quietly Nonna walked 100 yards to the other side of the
stadium to the other endzone.
Where she and my dad had sat together in the same seats for decades. Where their season tickets had been. (We lost my dad 2 years ago).
And she just sat and looked out over an empty stadium. Staring across a lifetime. Back from when she lived there as a young wife with my Dad in the early 1970s. When he went to school, coming off a stint in the Navy to pay for his degree. Back when she and he attended games in this same stadium but in the student section, instead. I am sure much crossed her mind as she sat there and stared on this beautiful December day in 2019 some 40 odd years later than all that long, lost time. But this time she was alone, without her Bill. And he without his Preppie.
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Jordan Hare stadium has seats for about 86,000 people. If its sold out at halftime the will let in another 20,000 or so to stand in the ramps that lead to the upper deck. You then have a gathering of people – all there because they love Auburn and know it is the very best a college or town either of those things can be- that is bigger than most cities in the world.[4]
But that day there were only 7 of us in that stadium. And as momma sat on the cold, metal stadium seats, to her there were only 2. I cannot fathom the feelings of both emptiness and fullness of heart she must have been feeling.
Yet there was life in the stadium that day.
As kids we had season tickets about 2,000 feet in the air in
the upper deck. My kiddos saw these upper seats towering above us and were
amazed. ‘Can we go up there, Daddy?”
Trying to say yes more these days, I said “As long as we can
find a working elevator.”
And we did. Pretty quickly. We were meant to be here this
day.
God was opening stadium gates and turning on elevators.
Once we got to the upper deck, I walked the kids about 70
steps or so to the very top.
“We are as high as the birds,” Nora said in awe as a group
of pigeons flew level with us about 4 sections over.
After a few minutes up there, we descended back down to the
bottom of the upper deck to head home.
We got back to Momma (Nonna) and Stacy (Momma). “Its time to head on,” I said. They had been talking about who knows what while I and the kids journeyed to the upper deck and back down.
And a few minutes later, two police officers walked up to us from behind that little tunnel area where you walk into the stadium from the corridor where the concessions and bathrooms are.
I smiled at the officers and turned back around to look at
the stadium again, committed to acting like we were supposed to be there.
“The stadium is closed.” The officers words came from behind me, and I turned around and smiled.
“Yes, sir. It’s time to head on kids.”
“Are you guys from around here?”
“No, sir. Well, my mom’s husband – my dad- went here. And so
did my sister.”
“There’s just some construction going on in the stadium
today, but no one is supposed to be here.”
“Thank you, officer. We will head out now. Please remind me
where the elevator is.”
We made our way down the elevator and back down to the
ground floor. The officers were walking about 100 feet behind us to make sure
we left.
And we did.
On the way out my oldest daughter asked me if I had ever
been arrested.
“No, Nora.”
“Well have you had a lot of interactions with the police? You seem to know what you were doing speaking with them.”
“Those are stories for another time, honey.”
Life is what you play, when you play it.
Thank you officers, for letting us play that day.
NOTE [4] To give a little more perspective – those 2 numbers together around about 100,000 people, round figures. Shakespeare’s London had about 200,000 people in it. So imagine about half of all Londoners going to see Hamlet, screaming their lungs out, grown men crying tears, women jumping for joy- for about 3 hours straight. And that’s an Auburn football game. Except you can understand all the words, because it ain’t the Queen’s English.
Challenge to readers
I want to leave you with encouragement.
I want to remind you one last time- Life is what you play, when you play it.
I want to wish you this:
When you enter old age, may you have visitors every day. May the graveyards of your kinfolk be filled with mushy trinkets and singing. May your empty stadiums overflow with Precious Memories. And may whatever demons you tilt at turn out to just be windmills after all.
Here’s your assignment- Find something to do consistently (and monthly) that brings joy to strangers and do it 12 times next year. It will change you. Vets are a great target market for this. So are the elderly.
2020 is your year.
Go play something awesome. Play it loud. Make your voice crack. Break a sweat.
Report back December 31st, 2020.
The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full. John 10:10 (NIV)
Soundtrack for today’s RoundUp pessimist readers– http://bit.ly/34fvYO3 (kind of can’t believe this one has never made into the Roundup in all these years. Something we all need about now as we do our umpteenth Christmas party. I also used to do a solid Axl Rose impression in high school, with this one at the top of the set list)
For optimist readers-http://bit.ly/2LP0zvd (this song will grab your heart, and warm it like a wood fire. Or a cup of cider. Or the last hug you got from that lost loved one, when you didn’t know it would be the last one. It’s a REALLY good song, even though its basically sad).
THIS ONE GOES UP TO 11! Come hang out at the 11th annual Medicaid Innovations Conference in Orlando in February. One of my favorite events (it must be- I’ve been to all but 1 of them over the years). Check out the agenda and sign up here- https://www.medicaidinnovations.com/agenda.html
NOT SO FAST ANDY BOY- Stop1 in the Cuomo Medicaid Malarkey Tour: shady deals where you slide big ticket spending out of one fiscal year into another to hide Medicaid spending growth that exceeded the legal limit. Stop 2: pass a hospital gravy deal after they donate boucoup cash to the Democratic Party coffers. Stop 3: Go into damage control mode and do lots of provider cuts real quick-like to cover your tracks. Only problem is that the state Comptroller is on to your schemes, Andy. And he’s asking you to provide more info about the cuts you say will magically deal with the $4B over-run. Looks like maybe you actually got caught this time? Should we get a FISA warrant?
MOLINA JOINS BLUEGRASS STATE MCO ROSTER- Chalk up another win for a Medicaid plan that many thought was on the ropes this time last year. Molina 2.0 (this time with less Molinas) just won an MCO contract in KY. Go live is July 1, 2020. Congrats to all our friends and readers at Molina.
PASSPORT KICKED OFF HOME FIELD, WHAT NOW EVOLENT? But not so good news for longstanding KY MCO incumbent Passport. Passport lost out in the official agency review process. This one could get interesting though (seems each of the MCO awards have their own flavor of jacked-up these days)- the legislature is ticked because they were given the contracts after the award. And the incoming Governor Beshear (continuing the Beshear dynasty after a brief pause- his daddy was Governor 3 Guvs before) is also promising to review the contracts. So there may be some golf course opportunities the next few months. Or at least until July 1, 2020. This news is particularly troubling for Evolent who just sunk $70M into Passport to help the flailing plan meet financial solvency requirements going into the bid.
NEW YORK HAS HIGHEST NUMBER OF MEDICAID INELIGIBLES ON ROLLS– A new study out of George Mason U out estimates that as many as 3.3M working age adults have incomes too high to be eligible for Medicaid, but are enrolled anyway. This data point (enrollees who should not be enrolled based on income) increased 80% between 2012 and 2017. What else was going on then?
MEDICAID EXPANSION RATE CELLS MAY HAVE LED TO $75B IN OVERSPENDING- No one really cares though, because its free federal money. You know, paid by those federal taxpayers (not you of course, so nothing to see here. You don’t pay any federal taxes, right?). In a story related to the NY one above, other news items focused on the national impact of increasing the enrollment streamed to ACA/Expansion rate cells. Basically, the human behavior you would expect to happen happened in expansion states– pay 100% of costs for members in a certain (new) eligibility category, and states were not quite thorough in who they put in those buckets. If you took an Econ 101 class before the downgrade, this would have been covered in the lecture on moral hazard.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award. We absolutely have to start with the Hoverboarding dentist. Seth Lookhart in Alaska was filmed extracting a tooth while riding a hoverboard. This idiot texted it to 8 people and it got passed around from there. His crimes? Not hoverboarding, but rather stealing $25k from Medicare and $10k from AK Medicaid with unnecessary procedures schemes. Technically he doesn’t meet our $50k threshold for the follies, but I just knew many readers would be sad if they did not learn of the Tale of the Hoverboarding Dentist. Or as I like to call him – The Floating Filling Fixer. Let’s head back east to Vero Beach, FL where we find a pretty big ($1M) personal care attendant scheme. Marie Isaac was the latest to be charged, but there were 19 PCAs who falsified time sheets to get more Medicaid bucks. In Isaac’s case, she sometimes billed for 6 hours of service a day, but her patient testified she never was there more than 45 minutes. Slow fraud week this week folks. I guess fraudsters have tons of Christmas parties keeping them otherwise occupied, too.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (get some good firewood if there’s any left in your area. Fires heal.) and keep running the race (you know who you are).
MICHIGAN MOVING PBMS TO THE DOGHOUSE- So it seems that all the news of spread pricing these last 2 years or so has made people a little skittish on PBMs. Michigan Medicaid announced plans to nix its PBMs starting December 21 (interesting start date). At that time the state will take over management of drug benefits and save an estimated $40M. The change comes about 6 months after the Michigan Pharmacists Association rallied behind reports of PBM pricing shenanigans, including some that showed the state overpaying PBMs by $64M.
KEYSTONE STATE MOVING TO SINGLE PDL– All 8 PA MCOs will start using a single preferred drug list Jan 1 2020. The change was triggered by high Hep-C costs as well as an effort to help providers managing care for members with multiple drug regimes. State officials think this will save about $85M each year. Here’s the kicker- the earlier MCOs analysis said it will cost the state $81M each year. If you’ve ever tried to follow Medicaid Rx math you know its all witchcraft, so its not surprising that the MCOs and state came up with entirely different numbers.
WONDERS NEVER CEASE: FEDERAL JUDGE STOPS REGULATIONS PROMULGATED UNDER NORMAL LEGAL PROCESS– I think I have seen this movie before. If you followed the drama of the Public Charge Rule the last few months, you probably knew this was where we would end up. The Trump Administration promulgated rules that would enforce existing law (that requires those asking for admission into the U.S. to prove they will not require safety net services or have someone who can cover their costs. Very similar to what I found out when I wanted to move to Scotland in the late 1990s). The proposed rule made it all the way through the established, legal process- until it was rejected by 2 judges (1 in the southern district of NY and 1 in CA) who decided the right thing to do was to continue to not enforce existing law. My high school civics class really misinformed me about how the three branches of government work.
IDAHO CONSIDERING MAGIC MONEY POOL TO PAY FOR VOTER-APPROVED EXPANSION- And it looks like they will find it hiding in county coffers. Committee leads tasked with passing the hat are eyeballing $10M in county funds that they think are now fair game for Medicaid (since those funds currently go to uncompensated care, and Medicaid will now cover that). My prediction – these funds will be bundled with the disappearing tobacco settlement funds and get matched with the federal magic money cover expansion costs for about 6 months. That will grease the skids needed to get the initial vote done. Then we will hear about a huge Medicaid budget shortfall about 8 or 9 months into the expansion.
MORE NEWS STORIES OF MEDICAID PAYING COSTS FOR DEAD PEOPLE- This week its Minnesota with an estimated $3.2M owed back to the feds. Out of 100 sample capitation payments, 95 had unallowable payments. You can guess the answer by now – that this was during a transition to a new eligibility system, and we promise the new one won’t do the silly things the old one did (see also LA).
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award. Our first fraudster hails from Conway, Arkansas: Karen Todd was popped this week for billing $600k in bogus optometrist claims for her husband (Karen is the office manager; hubby the optometrist). Let’s stay in the south a moment and head to Raleigh, NC where we find Pamela Faulkner. Pam buddied up with Renee Borunda to steal $213,927 in Medicaid bucks. How? Bogus behavioral health services claims. Southerners continue to be represented this week as we head to Nashvegas. There we find Michael Kestner, Brian Richey, Daniel Seely and Jonathan White stealing a cool $100k from Medicaid (they tried for $8.6M but came up short) and another $5.3M from Medicare and TriCare. Their scheme involved rev max and fraudulent claims at their pain clinic. Ok let’s leave the south and head to Texas (its different, I promise). Omar Cuate Canales of Rio Grande City plead out this week to $385k in Medicaid thievery using his DME business. Now its time to head to the heartland. Tracy Wellendorf of Cedar Rapids, Iowa agreed to pay back the $1M he stole from Medicaid using medically unnecessary sinus surgeries. Wellendorf agreed to pay back the $1M as a double-dog promise he did nothing wrong, but we all know something smells funny here (get it? Smells funny? Sinus surgeries…). Mrs. Todd you win this week’s award. Congratulations! Maybe you and hubby can take a nice vacation somewhere? I wanted to give this to Mr. Wellendorf, but since he wrote a big check to get the state to pretend he did nothing wrong, and I don’t want to get sued- Mr. and Mrs. Todd win! Taxpayers, you lost about $7.4M in that last paragraph.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (make your first fire of the year if its cold enough wherever you are) and keep running the race (you know who you are).
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Trystero: de Vader zond de Zoon om de wereld te redden