Author: MM_ADMIN

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Q2 2019 Issue of The Medicaid Black Book Released!

Medicaid Managed Care Insights and Vendors Reviews in Latest Issue of The Medicaid Black Book

Click Here to Subscribe

NOTE: A new reduced rate is available to nonprofits. Email clay@mostlymedicaid.com to find out more

Read the little Black Book that everyone in the Medicaid industry is talking about.

The Medicaid Black Book is the premier market intelligence subscription product for the Medicaid Managed Care industry. Each quarterly issue includes:

  • Exclusive interviews with Medicaid Health Plan CEOs and Investment leaders
  • Highly focused content that matters to Medicaid managed care leaders, including
    • Surveys of what is top of mind for health plan CEOs
    • Analysis of key regulatory changes
    • Analysis of Medicaid health plan financial performance
    • Analysis of mergers and acquisitions activity
  • In depth review and rating of 10 vendor firms that are currently trying to partner with Medicaid health plans

Interviews in this issue include Erhardt Preitauer (President and CEO, CareSource) and Binoy Bhansali (Vice President, Sandbox Industries).

Vendors reviewed include….

  1. 360 Health Systems
  2. Axciom
  3. American Specialty Health
  4. Automated Health Systems
  5. CA Technologies
  6. Collective Medical Technologies
  7. GreatCall
  8. Independent Living Systems
  9. OutcomesMTM
  10. PrescribeWellness

Distribution of results

  • 2.5 or less out of 5 stars – 2 vendors
  • 3 or 3.5 stars 5 stars – 2 vendors
  • 4 or 4.5 stars out of 5 stars – 4 vendors
  • 5 out of 5 stars- 2 vendors

Click Here to Subscribe

NOTE: A new reduced rate is available to nonprofits. Email clay@mostlymedicaid.com to find out more

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Clay’s Weekly Medicaid RoundUp: Week of July 15th, 2019

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2Y8ReSk

For optimist readers- http://bit.ly/2Y93BOl

AND SO IT BEGINS (MCO ENROLLMENT IN NC)- Open enrollment for the first ever Medicaid managed care plans in the Tarheel State began this week. 540,000 members in 27 counties can pick their insurance cards until September (if they don’t pick, one will be picked for them). There could be a monkey wrench though- the MCO rollout costs about $200M in start-up money. And that money is tied up in fights over the current state budget. The Good Guvn’r Cooper is trying to use this fight to force expansion on the state and vetoed the latest Republican compromise bill. Stay tuned.

IOWA RATES FINALLY FINALIZED 2 WEEKS INTO FISCAL YEAR– Which is better than last year which went 2 months past the contract start dates. MCO rates got bumped another 8.6%- but that’s all going right back out to providers (facilities, mostly) and Big Pharma (hep c coverage). There is also new funding included for more MCO “oversight.”

FL COUNTIES RAISING ALARM OVER TRUE COSTS OF MEDICAID EXPANSION DREAMS– See, all that “free” Medicaid money comes from somewhere, even at the state level. And in many states, a ton of that state money comes from counties, who must fund it with property taxes. So, one neighbor’s millage is another’s Medicaid. Whether the funding neighbor likes it or not (or even knows it). Well in FL (where they Expansion Lobby incessantly tells everyone they must expand, just like in every other non-expansion state), some small counties are trying to build awareness. It doesn’t hurt that Florida has a law that requires actual economists (which are different from NYT columnists promoting junk science, by the way) to assess the financial impact to Florida’s “fiscally restrained” counties.

MANY STATES TALK ABOUT CONTROLLING OUT OF CONTROL MEDICAID SPENDING DEATH SPIRAL; ALASKA IS ACTUALLY DOING IT- AK Governor Dunleavy is not playing the normal game of “appear hard on Medicaid spending but eventually cave” and just do what the Medicaid lifers (and industry lobbyists) tell you to do. The Good Guvn’r just vetoed $58M in state monies for Medicaid (including jettisoning the adult preventive dental benefit). The immediate, across-the-board provider rate cuts triggered a lawsuit from the Alaska Hospital and Nursing Home Association (the groups who get the lion’s share of the Medicaid biscuit). Yeah, I just replaced pie with biscuit- and you love it. Hold on tight, Guvn’r.

ID SUBMITTED A 1332 WAIVER TO ALLOW MEDICAID EXPANSION MEMBERS TO NOT ACTUALLY HAVE TO BE ON MEDICAID- Idaho is expanding Jan 1, 2020. Right now there are about 18,000 Idahoans on the exchange who will have to drop their commercial policies because they would qualify for Medicaid. The state has asked CMS for permission to instead subsidize their exchange premiums instead of moving them onto Medicaid. Analysts currently expect CMS approval, since it is similar to a request approved for Utah earlier this year.

 

I SEE WHAT YOU DID THERE (EMPIRE STATE SHENANIGANS MEANT TO COVER UP FAILURE TO CONTROL MEDICAID OVERSPENDING)- This one is delicious. The good Guvn’r Cuomo quietly slid $1.7B in Medicaid spending by delaying a payment 3 days. Why does that matter? Because it was at the very end of a fiscal year, and it allowed the state to look like it was compliant with state law that keeps Medicaid spending increases capped at 3%. If the transaction were made when it was supposed to (and more reflective of actual costs and spending, which is of course more in keeping with both the letter and spirit of the law), then the state’s fiscal failure would be obvious. Its looking like the state is on track to overspend again this fiscal year. Don’t worry, they will just slide the payment again next year!

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker- no fraud follies this week, friends. Just not enough time in the day or space in the column. Let’s all just pretend its not happening this week (makes me feel better, anyway).

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 (pressure wash your driveway, its miraculous!) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

Trystero: Äkesi Ulın qutqarw üşin jiberdi

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Monday Morning Medicaid Must Reads: July 15th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K
In this issue…

Article 1:       California Becomes First In Nation To Expand Medicaid To Undocumented Young Adults

Clay’s summary:     Before all you federal “taxpayers” get upset- I am pretty sure anything the are offering to these folks is paid for by state only funds.. So its not exactly Medicaid. But it makes a great headline, amiright?
Key Excerpts from the Article:
 Some lawmakers argued California should be spending health care dollars on its own citizens, rather than people who are not living in the state legally.
“We are going to be a magnet that is going to further attract people to a state of California that’s willing to write a blank check to anyone that wants to come here,” said Republican Senator Jeff Stone at a recent legislative hearing.
President Donald Trump also criticized California for offering health insurance to undocumented people.
“They don’t treat their people as well as they treat illegal immigrants,” the Republican president told reporters in the White House on Monday. “It’s very unfair to our citizens and we’re going to stop it, but we may need an election to stop it.”
Read full article in packet or at links provided

Article 2:       Block Granting Medicaid is Still a Terrible Idea

Clay’s summary:      Sort of related, sort of serious question: Is a salary sort of a micro-block grant? Like at the individual level?
Key Excerpts from the Article:
While the promise of increased flexibility can sound enticing, the reality is that so-called flexibility pits funding choices against one another and ultimately leads to cuts. Medicaid already has the flexibility it needs to respond to economic downturns or public health crises, and capping funding for the program makes these responses more difficult.
Block grants have not worked in the Temporary Assistance for Needy Families (TANF) program. What we know from 20 years of experience with TANF is that funding has not increased with inflation or in response to poverty and need. Moreover, states have used TANF funds to support alternative programs and have significantly decreased the aid going directly to families.
Read full article in packet or at links provided

Article 3:       The inconvenient truths of Louisiana’s Medicaid expansion

 
Clay’s summary:     All that “free” Federal funding still comes from taxpayers like you and me.
Key Excerpts from the Article:
In the wake of a wave of stories about the tens of thousands of ineligible individuals who received Medicaid benefits, supporters keep trying to defend Louisiana’s expansion of Medicaid to the able-bodied. But their defenses ignore several inconvenient truths.
 
First, money doesn’t grow on trees. Health Secretary Rebekah Gee recently claimed that Louisiana’s “Medicaid expansion comes at no additional cost to taxpayers.” Because she believes the federal government will pay all the cost of Medicaid expansion, she thinks Louisiana taxpayers are “off the hook” for the program’s spending. But anyone who had to mail a check to the Internal Revenue Service on April 15 would disagree. By definition, any new government spending imposes a cost to taxpayers, because Louisiana residents pay taxes to Washington just like everyone else.
 
And Louisiana has seen a ton of new government spending due to Medicaid expansion. In 2015, the Legislative Fiscal Office projected spending on expansion to total $1.2 billion-$1.4 billion per year. In the last fiscal year, Louisiana spent nearly $3.1 billion on expansion—or more than double the Fiscal Office’s original estimates.
Read full article in packet or at links provided
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Clay’s Weekly Medicaid RoundUp: Week of July 8th, 2019

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2XR8wTL

For optimist readers- http://bit.ly/2XQzwD0

CA MAKING IT EASIER TO TEXT- While it pains me to realize that 1991 is now 28 years ago (1991 is when the law blocking spam texts was passed; its also when this album came out and changed all of music), it does seem like maybe our SMS policy needs a touch up. See, when healthcare companies can’t use the communication method that 50% of Americans say is their primary day to day method, we have a problem. Why can’t an MCO text Clay the Medicaid bennie? Because laws. And stuff. The California health agency is working to remedy that by laying out some basic ground rules to make it easier for MCOs. Summary of the rules: submit a form to the state to text to members, make it free, give them an opt-out option and let us know your game plan re: privacy protections (hint- don’t let Amazon or Facebook access the info so they can market them new products via their discounted Medicaid/EBT Prime accounts).

GARDEN STATE WELCOMES NEW DIRECTOR TO THE HELM- Jennifer Jacobs will be the next New Jersey Medicaid Director by late July. Jennifer- We’re glad you’re here!

INDIANA WORK REQUIREMENT BEGAN LAST MONDAY- By Tuesday morning, there were 17 lawsuits filed, 4 HuffPo articles explaining how Evil this is, 2 protests in the streets and 4 new Democratic Presidential Candidates. Ok that last one was unrelated to the work requirements program beginning. Members subject to the requirements (as in all the of the states trying to roll out this feature, almost all members are exempt) will have to work 20 hours a month in year 1 (which boils down to 5 hours a week, or 1 hour a day, M-F).  So 240 hours of total work to obtain a benefit valued around $6,000 comes out to being paid $25/hour if you have to work for your health insurance.

OREGON MCO AWARDS ARE OUT- CCO 2.0 (Coordinated Care Organizations, for those that missed the first memo 5 years ago about how this was the next great idea that was going to save Medicaid from a financial death-spiral) is now live after the MCO awards were announced this week. All incumbents won except for 1 (Primary Health), with 4 newbies given 1-year contracts as a type of probation.  Congrats to our friends and clients in the winning orgs. Here’s to five more years!

EMPIRE STATE TAKING LTC RESIDENTS BACK OUT OF MANAGED CARE- Under new NY policy, skilled nursing facility residents will be back in fee for service if they are in a facility more than 90 days (assuming the carve-out is approved with the CMS waiver in play). The thinking behind the change is that there’s not a lot of cost management achievable for long term institutional residents (NY thinks they will save $158M savings in the first fiscal year)- so why pay an MCO basically an additional administrative fee. I personally am skeptical that there is no room for efficiencies in nursing facility management, but we shall see.

NEED A JOB IN ILLINOIS? There are 300 new job openings to help deal with the pile of Medicaid applications that are backlogged (more than 100,000 currently, which are older than 45 days – which is non-compliant with federal rules).

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. Not a lot to cover this week, but let’s at least scratch the itch… Vasso Godiali of Bay City, MI got popped for his role in a $60M healthcare fraud (not sure how much was Care vs Caid). Seems he had a penchant (been a while since I used that word) for bogus stent claims. What started out as a Medicaid fraud case got bumped up to include Medicare when the state folks realized they were just the tip of the iceberg. Qaiser Gondal of Watervliet, NY plead out in Albany this week. He was part of the dozen or so thugs using Ti Taxi to steal multiple Medicaid millions. And finally, Nikkitta Chesney of Bridgeport, CT joined her partner in crime (Toshirea Jackson) at the sentencing hearing for their Medicaid fraud. Their crime? They stole Medicaid bennie IDs (about 150 of them) and then used them to steal $3.9M using fake claims for psychotherapy services. The lovely ladies Nikkitta and Toshirea are our winners this week, albeit on a technicality (since we don’t know the Care/Caid loot mix for Mr. Godiali). Congrats, fraudsters! You get a Mostly Medicaid Fraud All-Stars T-Shirt. It comes in orange and also in orange.

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 (if you bag the grass when you cut it, it does really help with weeds after a few years. Every think about how many seeds are in the soil in your yard? Scientific notation is surely required) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

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Monday Morning Medicaid Must Reads: July 8th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K
In this issue…

Article 1:       Wayne State generated $112.8 million a year in enhanced Medicaid funding over six years

Clay’s summary:     You can make a lot of money in the Medicaid financing shell game. A lot. Cue outrage from Medicaid lifers who swear IGTs, CPEs, etc are not a scam.
Key Excerpts from the Article:
PEPPAP was designed for Michigan in 2004 as a federal-state Medicaid matching program to give payment add-ons to doctors that would increase their reimbursements to Medicare-equivalent levels. Many states have variations of the program, but all are designed to encourage providers to increase access to care for poor people on Medicaid.
But in order to receive the funds, Wayne State is required under the program to send to the state Department of Health and Human Services matching funds that averaged $32.2 million per year. On a quarterly basis, MDHHS calculates the state-federal match and sends the university a check.
Besides Wayne State, which is considered a “public entity” under the Medicaid state plan amendment rules, there are six others receiving PEPPAP funds in Michigan. They are Michigan State University, Central Michigan University, Oakland University, University of Michigan, Western Michigan University and Hurley Medical Center, the only publicly owned hospital in Michigan, in Flint.
Read full article in packet or at links provided

Article 2:       Letters: Time to ask tough questions about Louisiana Medicaid, The Advocate (Baton Rouge)

Clay’s summary:    Ruh-roh. Someone’s noticing things. Things that make Medicaid expansion look bad. Look- a squirrel!
Key Excerpts from the Article:
From the beginning, Louisiana’s conservative legislators have simply asked that Medicaid expansion serve those most in need. Since then, scathing report after report has revealed that this was not the intention of this administration. The Pelican Institute recently revealed in a report that thousands of individuals per month are dropping their private insurance plans to join the taxpayer-funded program. What’s worse, there are more than 1,000 individuals enrolled in Medicaid who earn annual salaries of $100,000 or more. Medicaid expansion’s original intention was to help those who needed it most, but those are the ones greatest impacted as we expand eligibility while providers shrink.
Read full article in packet or at links provided

Article 3:      Tennesseans Losing Medicaid; State Hasn’t Bounced Back from Software Failure

Clay’s summary:     Advocates concerned over declines in Medicaid rolls point to a software issue that happened in 2013.
Key Excerpts from the Article:
Tennessee is one of three states in the country with the sharpest drop in Medicaid enrollment between 2017 and 2018.
According to a report by the consumer health care group Families USA, the number of Tennesseans enrolled in Medicaid fell by nearly 10%, and more than 100,000 people lost coverage.
Eliot Fishman, senior director of health policy at Families USA, says that since 2013 the state has been struggling to bounce back from a massive software failure linked to TennCare, the state’s Medicaid program.
Read full article in packet or at links provided