A lot happens in Medicaid in 30 days. We covered it all in 60 minutes with Elena Nicolella, Cathy Huff, Joel Menges and Darin Gordon.
2018 May Medicaid News Roundtable
Author: MM_ADMIN
Monday Morning Medicaid Must Reads: May 21st, 2018
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
Can ‘Texas v. United States’ Set Us Free From Obamacare? David Catron, American Spectator, March 12, 2018
Clay’s summary: ACA has gone to the gallows several times. Last time it was saved under the “its still a tax so its ok” argument. Now that the IRS made then penalty zero, that doesn’t work anymore…
Key Passage from the Article
Ignore everything you have been told by the “news” media about Texas v. United States, the lawsuit recently filed by 20 states challenging the constitutionality of Obamacare. The Fourth Estate, in its all but official role as the public relations department of the Democratic Party, has generally downplayed the suit as yet another futile attempt by fanatical Republicans bent on destroying former President Obama’s “legacy.” Following their usual playbook for reporting constitutional challenges to the “Affordable Care Act” the media briefly sneered about its merits and then, to paraphrase David Burge, “covered the story with a pillow.”
It is nonetheless an important case and it’s useful to review the basis on which the plaintiffs actually base their case against the mandate: In 2012, a majority of the Supreme Court’s justices — including Chief Justice Roberts — rejected the government’s claim that Congress could impose the individual mandate pursuant to the Commerce Clause of the Constitution. Yet Roberts held that the mandate was still constitutional because its penalty was a tax collected by the IRS to raise revenue. The plaintiffs argue that this “saving construction” evaporated when Congress reduced the penalty to zero last year. Their complaint puts it as follows:
The Patient Protection and Affordable Care Act… as recently amended, forces an unconstitutional and irrational regime onto the States and their citizens. Because this recent amendment renders legally impossible the Supreme Court’s prior saving construction of the Affordable Care Act’s core provision — the individual mandate — the Court should hold that the ACA is unlawful and enjoin its operation.
In other words, because Congress has no authority to impose the individual mandate pursuant to the Commerce Clause, and it can’t be justified as a revenue-raising device (since enactment of the Tax Cuts and Jobs Act of 2017), the mandate must be struck down.
…
Article 2:
“State Medicaid Programs Are Seeing the Value of Telehealth at Home” Eric Wicklund, mHealthIntelligence, May 15, 2018
Clay’s summary: This is important. The need to do hub / spoke keeps a lot of services from not happening that could happen via very simple technology (facetime, skpe, etc) in the patient’s home. Expect new rounds of billions to be blow by private equity chasing the latest MIT grad who thinks they discovered the Medicaid telehealth opportunity for the first time and can code an app.
Key Passage from the Article
In its spring 2018 update of the State Telehealth Laws and Reimbursement Policies Report, the Center for Connected Health Policy reports that 10 states have amended their telehealth policies since August 2016 to specifically make the patient’s home an originating site for Medicaid-accepted telehealth and telemedicine programs. Those states are Delaware, Colorado, Maryland, Michigan, Minnesota, Missouri, New York, Texas, Washington and Wyoming.
Meanwhile, the report notes that six states have limited the geographic requirement altogether since 2013. And 16 states have added schools to the list of approved originating sites, though some are placing restrictions on those services.
According the CCHP’s sixth annual report, some 160 telehealth-related bills have been introduced during the 2018 legislative session in 44 states, continuing a digital health trend that saw more than 200 pieces of legislation introduced during the 2017 session. But not all of those bills are supportive of new healthcare services.
Article 3:
Clay’s summary: Lefties don’t like it when people float the idea that double Medicaid enrollments with promises of free federal magic money may put some hurt on state budgets. No way. No how. You are a TERRIBLE PERSON for even thinking it, let along examining it. Thoughtcrime! But hey – this segment is for all viewpoints so let’s run it anyway.
Key Passage from the Article
Contrary to claims that Medicaid expansion would make approximately 630,000 additional citizens eligible, most estimates are half that. Professor Hall’s data shows that enrollment “has either fallen short of or not substantially exceeded expectations.” There also is a study of 10 states that confirms providers have not been overwhelmed. Adult males have not crowded out women and children.
Since the program has been going for five years, predictions for costs rely on track records and have become progressively more accurate. No state has repealed Medicaid expansion. Governors of red states (including Arkansas, Arizona, Michigan, Nevada and Ohio) argued against repeal of the Affordable Care Act to preserve their Medicaid expansion.
Clay’s Weekly Medicaid RoundUp: Week of May 14th 2018
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2ISXzOf
For optimist readers- http://bit.ly/2y9t7L7
HEADED TO BALMORE. DO DROP BY AND SAY HELLO- I will be at MMCC 2018 starting Monday. Chairing a panel Tues morning. Would love for any and all readers at the event to say hi.
Y’ALL SIMMER DOWN NOW- NM recently awarded new MCO contracts. So the protests were filed by the losers. And HHS rejected the protests via the administrative process yesterday, so now the losers can take it to court. Yay! Even longer time to make changes needed for the program… Member impacts include uncertainty over whether they will have to switch providers Jan 2019. You have to understand the losers’ position though. It’s a lot of cash. Example – Molina had $1.3B in premium revenue in NM Medicaid last year. Assuming a 2% profit yields $26M a year lost if the protests don’t work out. So as long as the litigation costs less than $75M or so (3 years of premium profit in the market), why not roll the dice and sue? And that doesn’t even take into account impacts on market capitalization on news of losing key contracts, etc. Want to track the impact of lawsuit on stock price? Follow ticker symbol MOH on the NYSE.
SOUTH CAROLINA EXPANSION LOBBY PRIMES THE PUMP- The Urban Institute (are they still around?) just released a study showing the amazingly 1-sided impacts of a potential Medicaid expansion in SC. 194k would get “coverage” (please define “coverage” class, and then compare and contrast it to “access,” then triangulate it with “intersectionality” – oh bother, I lost myself) if the state moved forward with expansion. Per the study, the state would “only need to chip in $111M per year.” Because you know its magic federal money, that comes from the sky every time you wish upon a star. It makes no difference who you are. Anything your heart desires will come to you (and other states will pay for it!).
ALASKA SLOWING HOSPITAL PAYMENTS- Since the legislature did its job and passed a budget (you know, how the US Constitution and all state ones work?), there is $20M less than requested (do not make the mistake of confusing requested with “needed”) going to Medicaid between now and June 30. That’s about 45 days, people. So when you realize how people are freaking out (that they have to follow what the legislature says when it comes to appropriations) its clear Medicaid is living check to check. Normally the state cuts the checks weekly, but starting this week they will float larger providers a bit longer. Some reps point out that all this is driven by higher than projected costs of Medicaid expansion (remember when the Good Guvnr Bill Walker did it all by his lonesome back in 2015?), but those reps are quickly silenced and reminded on the non-politic nature of such comments. Even more daring reps point out that services for the most vulnerable are being impacted because of expansion overloads. Those reps are so offensive that they are immediately sent to Siberia. You can see it from the Governor’s back yard, you know.
PATIENTS SUE ILLINOIS OVER MEDICAID DELAYS- Illinois just can’t get it together. Seems like the state thinks after it sent us the best-President-ever they don’t have to do anything else at all. Resting on their laurels. Latest chapter in the dumpster-fire story (tragi-comedy? Especially considering sub-plot arcs over the years like Blagojevich) of the Prairie State is a lawsuit from patients suing over long-delayed eligibility applications. Seems the state is out of compliance with federal rules on determining temporary eligibility for new applicants. They are supposed to process apps within 45 days. The biggest pain points are in nursing homes. Per the write-ups I’ve seen, there has not been a single applicant approved under temporary eligibility since the summer of 2016.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph – not so fast. I was too wordy up top this week. Plus gotta keep you coming back for more.
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 (time to get the yard in shape for your Memorial Day party) 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: lēākaṁ rakṣikkānāṇ pitāv putrane ayaccat
Menges Group 5 Slides Series for February 2018
The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do.
Attached is the February 2018 edition of our 5 Slide Series. This edition focuses on the 46 health care companies on the current Fortune 500 list, conveying their ranking in CY2016 revenues and profits, and their percentage profit margins. During CY2000, no health care companies were in Fortune’s top 25 – now there are seven.
v57 The Health Care Fortue 500
Monday Morning Medicaid Must Reads: May 14th, 2018
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
Trump Administration cools on Mississippi Medicaid work requirements, Larrison Campbell, May 10, 2018
Clay’s summary: CMS is giving mixed messages. Must be related to Stormy Daniels somehow. Get me Anderson Cooper on the line so we can sort this out.
Key Passage from the Article
For months, Mississippi’s application for a program that would require certain Medicaid recipients to work has been considered a lock by supporters and opponents of the program.
But last week the Trump Administration walked back support for the waivers in states like Mississippi that have opted out of Medicaid expansion, placing a question mark over a controversial program that has the strong support of Gov. Phil Bryant.
Last week Seema Verma, administrator for the federal Centers for Medicare and Medicaid Services, warned non-expansion states that their waiver applications would need to include a plan to avoid the “subsidy cliff,” in which a person earns too much to keep their Medicaid coverage and too little to qualify for a tax credit on the insurance exchange. Like many conservatives, Verma had long endorsed Medicaid work requirements, saying they “promote community engagement.” But last week’s comments echoed critics of the waiver program who have argued that work requirements could force more than 20,000 Mississippians out of the Medicaid program.
…
Article 2:
WISCONSIN FACES DRASTIC MEDICAID FUNDING SHORTFALL FROM CENSUS UNDERCOUNTING, Milwaukee Independent, May 14, 2018
Clay’s summary: Wisconsin census numbers are down, and this leads to lower Medicaid cash (basically via parts of the FMAP formula that use per-cap income.. if your “cap” count is off, will look like avg income is higher). Study authors say letting counties and local governments do the counting lead to errors.
Key Passage from the Article
If you are still scratching your head about what the census count has to do with Medicaid reimbursement rates, bear with me. Per capita income is calculated using two separate pieces of data; a measure of total person income in each state is divided by an unrelated census count of each state’s population. As a result, a census undercount has the effect of increasing the official estimate of a state’s per capita income, and in most states that boost to estimated per capita income means that federal cost-sharing will fall for Medicaid and several related programs. (That isn’t true in 13 higher income states, such as Minnesota, because they receive the minimum 50% level of federal cost-sharing.)
There are many things that state and local governments can do to prepare for the 2020 decennial census and to minimize the number of their residents who aren’t counted. For starters, state or local officials should be verifying the Census Bureau’s residential address list, so the Census Bureau can correct errors and omissions. Most states are working hard to do just that. New Mexico is digitally scanning the census address lists and comparing those with data like state construction records. Then it works with local governments to help document the validity of omitted addresses.
Unfortunately, Wisconsin appears to be one of a small number of states that have decided to leave to counties and tribes the responsibility for reviewing and filling in the address lists. What makes that even more worrisome is that there are about a dozen Wisconsin counties that are not checking the addresses, as shown in this map from the Census Bureau.
Article 3:
Clay’s summary: Ruh-roh.
Key Passage from the Article
During a hearing on the HHS budget, Kennedy said many Medicaid beneficiaries who aren’t working “would like to know the dignity of work” noting he would like to see HHS work with Congress to put together a program that would institute a mandatory requirement that Medicaid beneficiaries work 20 hours a week. “I appreciate that [the Centers for Medicare and Medicaid Services] is willing to grant waivers, but why don’t we take the next step?” Kennedy said, adding separately that “it’s not going to be optional for governors.” The Trump administration has been encouraging states to apply for waivers that would allow them to institute work requirements on Medicaid recipients — a policy that was denied by the Obama administration.
Kennedy though, said he wants to focus on finding people jobs, not punishing them for being unemployed.
“We don’t want to throw people out in the cold, but we want to help them understand the dignity of work,” Kennedy said. “Let’s put together an aggressive program that’s not optional for the states … not to throw people out in the cold, but to say ‘you can keep your benefits, but let us help you get a job.’ ”
Clay’s Weekly Medicaid RoundUp: Week of May 7th 2018
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2IaCtew
For optimist readers- http://bit.ly/2jNiSm7
QUICK ANNOUNCEMENT – Our webinar provider had a “major outage” yesterday and we did not get to do the full MESC 2018 preview webinar. Look for details re a rescheduled show in the newsletter.
BEEHIVE STATE TILTS AT WINDMILLS – Please write in if you get the reference (no googling!- but you can go to your local library and check the 863s under Cer)… Officials in Utah continued the farce of a post-obama expansion this week by trotting out a series of public hearings to discuss adding 90,000 adults to the rolls. Do people really think CMS will approve this? Or maybe I missed something and Utah is willing to pay 50% of the costs (vs the sweet, sweet 90-100% deal offered in years past?). Think they will agree when CMS comes back with work requirements and other “evil” conditions of paying for it?
IT’S GETTIN’ HOT IN HERE; I’M GONNA CUT SOME BUH-JETS – Apologies to Nelly fans worldwide. Louisiana may be doing it for reals, though. Letters were sent to 37k bennies that they may get booted from Caid based on recent changes to Medicaid budgets. The proposed budget would remove 4 programs (not sure which ones, please write in if you know more). Bennies will also get contacted about getting services on other programs they may still be eligible for.
NO DICE, KANSAS! CMS rejected the KS waiver request to establish a 3-year limit on Medicaid benefits for non-disabled adults. This doesn’t bode well for AZ, UT, ME and WI who have asked for a similar budget relief measure. Since this rejection is in keeping with the dominant paradigm of The Healthcare Left, many are confused. At time of running this article, CNN was trying to figure out how to tie this to Stormy Daniels. Or the Russians. #Resist!
ILLINOIS GETS A LOT OF CASH TO HELP FIGHT THE OPIOID CRISIS- CMS approved a $2B transaction to IL this week, as part of an 1115 waiver application to address challenges in meeting the needs of behavioral health patients. Per analysis used to make the case for the funding, bennies with behavioral health needs drive more than half of all Medicaid spending. July 1 will see new efforts funded around short-term drug addiction treatment centers, moms and babies showing drug withdrawal symptoms, employment assistance and other programs. IL had asked for some of the cash to go to things related to social determinants of health (like rent payments), but CMS shot that down.
TRIBES CONCERNED OVER NEW MEDICAID RULES APPLYING TO THEM- Seems some policy statements / positions in April from CMS / Trump classify tribes as a race. The next step in the Administration’s argument is that exempting tribes from work requirements would show preference for one racial group over another and thus be discriminatory. Different tribes are assessing the impact on them, with Cherokee Nation putting about $46M impact due to a proposed work requirement in OK.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Beverly Coker of Windsor, CT was sentenced for her part in a $214k fraud that involved unlicensed providers. (She got probation while her co-conspirators got much harder sentences. May be because she is 70 years old). New Era Rehabilitation Center in Bridgeport, CT will pay back $1.37M for double-billing for methodone treatment. There are some services-not-delivered details in that one, too (check the twitter feed for more). Mrs. Coker – You win this week’s award because you are the oldest convict ever to appear in the Roundup! Congratulations!
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 (Meet a new neighbor this weekend) 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: Bapa menghantar Anak untuk menyelamatkan dunia
Monday Morning Medicaid Must Reads: May 7th, 2018
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
States Can’t Afford Medicaid Expansion — Neither Can Patients, Sally Pipes, Forbes, April 30th, 2018
Clay’s summary: All that extra spending may be for naught (in terms of healthcare outcomes anyway. For political influence, its gravy).
Key Passage from the Article
Activists in Utah, Idaho, and Nebraska are trying to follow Maine’s lead, by putting expansion to the voters this fall.
Before they cast their ballots — and approve millions of dollars in new spending — residents of the three states ought to consider whether Medicaid actually improves the health of its beneficiaries. Surprisingly, research shows that it doesn’t.
Consider Oregon’s experience. In 2008, the state extended Medicaid coverage to 6,300 uninsured patients chosen at random through a state lottery. Researchers from Harvard, Columbia, and Massachusetts Institute of Technology compared health outcomes for these newly eligible beneficiaries to those for uninsured people who weren’t chosen in the lottery.
They concluded that the new enrollees displayed “no significant improvements in measured physical health outcomes in the first 2 years.”
…
Article 2:
Medicaid Is Right to Demand Lower Drug Prices, Peter Bach, Bloomberg, May 1, 2018
Clay’s summary: Dollars are getting short and docs are getting trigger-happy with the price tags on human life / quality.
Key Passage from the Article
During the board meeting, the Institute for Clinical and Economic Review, a nonprofit that assesses the value of prescription drugs, presented its report on Orkambi. ICER found that the drug’s list price amounts to $1.3 million per additional year of life it provides, or $900,000 if you take into account the improved quality of life Orkambi brings. Those numbers are more than four times the current benchmark for cancer drugs.
Oh, and those prevented hospitalizations? ICER found that the state had to spend about $326,000 on Orkambi to prevent each one of them. (Disclosure: ICER is in part funded by the Laura and John Arnold Foundation. My research is, as well. Our grants are unconnected.)
Article 3:
Higher Ed, Lower Spending, Douglas Webber, Education Next, Summer 2018, Volume 18, No.3
Clay’s summary: Doesn’t this guy know that Medicaid is a sacred cow and we will happily sacrifice college for all to keep it going?
Key Passage from the Article
I find that state and local public-welfare spending is easily the dominant factor driving budget decisions, with a $1 increase per capita associated with a $2.44 decrease in per-student higher-education funding—enough to explain the entire average national decline. In particular, my analysis finds that state Medicaid spending is the single biggest contributor to the decline in higher-education funding at the state and local level.
Clay’s Weekly Medicaid RoundUp: Week of April 30th 2018
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2HSgc0S
For optimist readers- http://bit.ly/2wbzcGu
LET’S JUST PRETEND THERE IS AN ENDLESS SUPPLY OF MONEY FOR MEDICAID AND EDUCATION. YOU KNOW, IT’S FOR THE KIDS- A new study finds that investments in public education (higher ed in particular) are the only budget item decreasing in recent years (since 1987 if you want to get precise. Please help me continue the fantasy that 1987 was not 31 years ago). It also finds that Medicaid is the single biggest reason less money is being spent on your local college. Here’s a link to the study- http://bit.ly/2HRqGxP
LOTS OF UPDATES ON STATE FLEXIBILITY REQUESTS TO CMS- The next several items are part of a larger trend in activity on the state flexibility requests front.
VERMA TOYS WITH NEW SUBSIDY? There’s a new donut hole in town. The one between Medicaid and exchange ineligibility. Recent comments from CMS head Seema Verma have some analysts looking for a new subsidy that would help pay costs for those who make too much for Medicaid but also too much to get an exchange subsidy. Keep an eye on this one, but don’t spend too much time on it. I don’t see newer tax-payer funded payments for able-bodied adults in keeping with the current Verma Vibe.
MICHIGAN WORK REQUIREMENTS BILL DEBATED THIS WEEK- Supporters point to 100k unfilled jobs in Michigan, and the 47k Medicaid members who would be required to find work.
OHIO MOVES FORWARD WITH WAIVER APP TO CMS- We now have a new one in the hopper as of Monday. Kasich was reportedly found sobbing in a closet in Toledo when he heard the news. This one has pretty normal exemptions – no one over 55, no one seeking substance abuse treatment, and no one with serious physical or mental health issues. About 5% of expansion enrollees (you know that group that never had Medicaid until the magic wand of Obama fixed healthcare for everyone by ballooning Medicaid to ginormous sizes) will be subject to the requirements. From what I have read, you and I also have to go to work on Monday. #Resist!
LOUISIANA AUTHORIZES ENFORCEMENT OF BASIC MEDICAID ELIGIBILITY REQUIREMENT- In the “wait- aren’t they already doing that department?”, LA has passed a bill (in the house only, still time to #Resist! in the Senate) that would allow the state auditor to review income tax returns to verify Medicaid eligibility. How dare they?
THE LAST FRONTIER TAKES LAST STAND AGAINST MEDICAID BUDGET IMPLOSION- AK Senator passed a work requirements bill this week to require about 10% of bennies to work. It will force pregnant women who are on crutches waiting in line for opioid treatment to work 100 hours a week. Just kidding you silly goose! All the normal exemptions are baked into this one. Track SB 193 if interested- here’s a link: http://bit.ly/2wdJ1Up
SEVERAL IMPORTANT ANNOUNCEMENTS:
- We released our HIPAA Awareness Online Course last week: http://bit.ly/2HzzUP1
- Medicaid Managed Care Congress 2018 | May 21-23 (Balto)- http://bit.ly/2vTwDZm
- 3rd Annual Medicaid Managed Care Leadership Summit | June 4-5 (Chicago)- http://bit.ly/2HwGtlk
WELLCARE DOING WELL- Net income was up 51% YOY in Q12018 (now at $102M vs $67M for same quarter in 2017). While there’s a lot going on driving the success, expanding Medicare Advantage business is a big part of the story. There have also been decreased Rx costs in both its Caid and Care programs (not sure what drugs, or what programs have driven down costs – may be a good success story in there for some med-management / case-management program?). Finally, a lower tax-burden based on Evil Darth Trump’s tax cuts helped to increase the net income number as well.
SPECIAL SEGMENT THIS WEEK: FARRIS’S MEDICAID FAKE NEWS FOCUS- For years I have smiled at the immaturity of “newspapers” who publish “cutting Medicaid will kill babies” headlines. Now its just time to shame them. If some idiot can claim fiscal policy in modern America will kill babies when Medicaid is cut, then others can claim cutting education (surprise- because of runaway Medicaid spending done at the barrel of an emotional gun loaded with “cut my Medicaid budget and kids will die!”) will kill babies, too. Long wind-up. Winner of this week’s Lazy Thinking, Political Bullying Award goes to Detroit Free Press for “Here’s why Michigan Medicaid work requirements will kill people.” Pshaw. Save it for the White House Correspondent’s Dinner you hacks.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Shephard Spruill of Raleigh, NC got sentenced this week for stealing $6M from North and South Carolina Medicaid (2 states – impressive). David Johnson of Detroit was sentenced this week for his role in stealing $1.7M from Medicaid by billing under another dentist’s provider number for 3 years. Interesting fact about this one – once the PoPo was onto him, Johnson fled to the Dominican Republic to evade arrest and was picked up by federalis there. Mr. Spruill – you win this week’s award! (Not much by way of fraud this week. We must have fixed the problem last week).
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 (water some plants, cut grass. Enjoy that cut grass smell.) 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: Ny Ray dia naniraka ny Zanaka mba hamonjy izao tontolo izao
MMA Final Base Rates 2018-10 SMMC Impl
This post is only available to members. You register for FREE here or login if you are already a member
Monday Morning Medicaid Must Reads: April 30th, 2018
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment, KFF, Julia Zur, April 11, 2018
Clay’s summary: A good primer on the demographics and coverage patterns for those hit hardest by the Opioid epidemic. Some of the findings may surprise you – almost 2M Americans are addicted to opioids.
Key Passage from the Article
Medicaid covers a disproportionate share of nonelderly adults with opioid addiction, and an even greater share of those with low incomes. In 2016, nearly 4 in 10 (38%) were covered by Medicaid and a similar share (37%) had private insurance. Approximately 1 in 6 (17%) was uninsured (Figure 3). Low-income nonelderly adults with opioid addiction are typically less likely than adults with higher incomes to have jobs that offer health insurance.8 In 2016, over half (55%) were covered by Medicaid, while only 13% had private insurance. Nearly 1 in 4 (24%) were uninsured (Figure 3), although if they lived in states that expanded Medicaid, they would likely be eligible for coverage.
…
Article 2:
When it comes to the opioid crisis, Medicaid is part of the solution, Eric Blevins, Richmond Times Dispatch, April 26, 2018
Clay’s summary: Good perspective from a recovering Opioid addict.
Key Passage from the Article
As Virginia legislators consider Medicaid expansion, we need to keep in mind the important role it plays in addressing the opioid epidemic. I live in Southwest Virginia, and I’ve been dealing with addiction since I was 12 years old. It didn’t start out with opioids, but by my 20s I was a heavy opioid user, taking high doses daily just to avoid withdrawal.
Recovery from opioid addiction is never an easy road, especially when you live in a small, rural town like mine. Where I live, there are only two choices for mental health treatment. Neither one specializes in treatment for substance use disorders.
Article 3:
GOP panel proposes lifting Medicaid limits on opioid care, Peter Sullivan, April 5, 2018
Clay’s summary: Dems want to look good supporting the fix to the opioid crisis – but don’t want to pay for it with cuts to other programs.
Key Passage from the Article
Republicans on the House Energy and Commerce Committee on Wednesday night unveiled a proposal to lift limits on Medicaid paying for opioid treatment.
The proposal could be one of the more significant and costly steps that Congress takes to fight the opioid epidemic, but there are concerns about how to pay for it. Members of both parties have called for lifting these limits on Medicaid paying for treatment at facilities with more than 16 beds, saying they are a major barrier to care as lawmakers work on a package of opioid bills that could reach the House floor by Memorial Day.
Article 4:
Congressional Hearings Examine Medicare, Medicaid Opioid Crisis Roles, Patrick Connole, Provider Magazine, April 13, 2018
Clay’s summary: A lot of new regulations on physician prescribing behavior will be out soon. Why were they not there before?
Key Passage from the Article
The key witness to appear before the panel was Kimberly Brandt, principal deputy administrator for operations, Centers for Medicare & Medicaid Services (CMS), who told lawmakers that the number of Americans struggling with an opioid use disorder (OUD) is staggering.
“In 2016 alone, nearly 64,000 Americans died from drug overdoses, the majority (over 42,000) of them involved opioids,” she said.
Brandt said CMS recently finalized a series of changes for 2019 to further the goal of preventing OUDs. To reduce the potential for chronic opioid use or misuse, beginning in 2019, the agency expects all Part D sponsors to limit initial opioid prescription fills for the treatment of acute pain to no more than a seven days’ supply.
“This policy change is consistent with the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain that states that opioids prescribed for acute pain in most cases should be limited to three days or fewer, and that more than a seven-day supply is rarely necessary,” she said.