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Medicaid Industry Who’s Who Series: Shannon McMahon

Medicaid Who’s Who: Shannon M. McMahon– Deputy Secretary, Health Care Financing with Maryland Department of Health and Mental Hygiene

Shannon M. McMahon, MPA, was appointed the Deputy Secretary of Health Care Financing at the Maryland Department of Health and Mental Hygiene in February, 2015. In this role, she is responsible for the operation of the state’s Medicaid program, which serves over 1.2 million Marylanders.

Previously, Ms. McMahon was the Director of Coverage and Access at the Center for Health Care Strategies (CHCS) where she lead Medicaid eligibility, benefit design and purchasing implementation efforts and learning collaboratives for states and the federal government. Prior to CHCS, she worked in executive and management-level roles in Minnesota Medicaid, most recently as the Chief Administrative Officer, where she oversaw finance and operations for Minnesota’s three public health care programs.

Ms. McMahon also spent several years working on health policy issues as a non-partisan analyst at the Department of Legislative Services in Annapolis and also held the position of senior budget and policy adviser to the Secretary and Principal Deputy Secretary of Maryland’s Department of Health and Mental Hygiene.

Ms. McMahon has a bachelor’s degree in justice from American University, Washington, D.C. and a master’s degree in public administration from Northeastern University, Boston, Massachusetts where she was a recipient of a full tuition public policy fellowship. She is a member of the board of directors of the National Association of Medicaid Directors.

Shannon McMahon is the featured panelist in the upcoming State Spotlight Webinar on Feb. 6th at 2pm EST. Learn more and register for free here.

  1.  What is your current position and with what organization?

Deputy Secretary, Maryland Department of Health and Mental Hygiene/Medicaid Director   

  2.  How many years have you been in the Medicaid industry?

 I’ve been working in health care policy/operations and consulting for 19 years; my focus has always been on the public sector, and Medicaid in particular.

  3.  What is your focus/passion? (Industry related or not)

My passion is making the government side of health care (enrollment, access) more person-centric.  I love Lean and business process re-design.

  4.  What is the top item on your “bucket list?”

Snuba the great barrier reef

  5.  What do you enjoy doing most with your personal time?

International travel with my family; I think that foreign travel is the greatest gift you can give kids, as it imparts two key business and life skills: organization and resilience.

  6.  Who is your favorite historical figure and why?

Eleanor Roosevelt; I’ve always admired her commitment to public service and her ability to problem solve in the most politically charged environments.

  7.  What is your favorite junk food?

Snickers

8.  Of what accomplishment are you most proud?

The recent Section 1115 waiver that we secured for Maryland Medicaid is a very big step to begin addressing the social determinants of health at the local level while also expanding access to substance use disorder services in the State.  The partnership forged between the State and local governments, as well as the support from the provider and advocacy community made it possible.  The amazing team in Maryland Medicaid worked hand and glove with our federal CMS counterparts to get ‘er done.

  9.  For what one thing do you wish you could get a mulligan?

I have a knack for calling people by the wrong name, and have done so with some pretty senior people in both government and the provider community. 

  10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

In Maryland, we are coming off the recognition of the 50th anniversary of Medicaid in 2016.  Our  two big focuses for the next six months are

(1) Implementing the SUD expansion under the 1115 waiver which includes a physical health-behavioral health integration component;

(2)  Developing a new payment and delivery system for individuals dually eligible for Medicare and Medicaid.

(3) Potential changes to the ACA will be of particular interest to Maryland as well, and as a member of the NAMD board, I have had the opportunity to engage with the key executive and legislative branch leaders on potential changes.  

 

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Clay’s Weekly Medicaid RoundUp: Week of January 2nd, 2017

Soundtrack for today’s RoundUp pessimist readers- https://www.youtube.com/watch?v=9jK-NcRmVcw

Or you can click the one for optimist readers –  https://www.youtube.com/watch?v=cYrUW68kggg

BONUS Optimist Song: https://www.youtube.com/watch?v=btPJPFnesV4

 

SOMEBODY TELL THE GOOD GUVN’R HE’S WEARING LAST YEAR’S FASHIONS: Perhaps the protracted battle with the outgoing Guvn’r has left NC Good Guvn’r Roy Cooper a little confused. He is talking about expanding Mcd in the Tarheel State, seemingly unaware that expansion is yesterday’s news. He promised to submit a state plan amendment by this Friday to expand under ACA rules, which have to be approved by CMS. This is either a PR stunt only, or the new Guvn’r is more clueless than the average bear.

 

NOW THERE’S AN IDEA: AK ASKS TO KEEP ACA CASH FLOWING BUT WANTS MORE CONTROL ON LIMITING ELIGIBILITY THAN ALLOWED BY MASTERS IN THE DISRICT (CAN I USE 2 COLONS IN A HEADLINE?): The Good Guvn’r Hutchinson has been in talks with the new cabinet members about letting AR tighten eligibility requirements for its expansion bennies. He may end up getting what he’s been begging CMS for for years after all. Amazing the difference a new king (er, President) makes.

 

AND SO IT BEGINS- One half of the country seems to be moving into the next phase of grief. The denial phase was like watching a train wreck- fascinating (Stein’s stratagem and the attempts at electoral mutiny), terrifying (Fake News pots calling kettles black) and pitiable (b-b-but the Russians did it!) all at the same time. We are now witnessing the negotiation and acceptance phases best I can tell. I now see Op Eds discussing how block grants may not be that bad (as long as its tied to healthcare inflation) and detailed analysis of the expected GOP battle plans to repeal the sacred cow of ACA (as opposed to the previous stance of “but they can’t do that).

 

KS ELIGIBILITY APPS: STILL LATE- 2 years and counting for the backlog. State officials did get it down to 1,400 or so in September (from a high of 15,000), but its climbing again. The latest number is 2,247 apps at least 45 days old.

 

MCO TIDBITS: Item 1) WellCare completed its acquisition of Care1st of AZ this week, adding 115,000 lives to the ledger. Item 2) Iowa newspapers are now reporting they have obtained secret documents showing MCOs calling the Iowa program “drastically underfunded” and a “catastrophic experience.” Sensing that these documents reveal a disconnect between what is being said publicly and privately, Mr. Pin Ochio has stepped in with new evidence that Oceania hacked the Iowa Medicaid agency. He insists we ignore the contents of the documents and focus on the manner of their discovery.

 

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. There’s actually just one this week: Abe Freund, operator of Acacia Mental Health Clinic, LLC in Milwaulkee has been charged by the feds with stealing as much as $7M from Medicaid. Acacia was billing $474 for drug tests that should have been paid at $20. At the end of the feeding frenzy, 99% of all Wisconsin substance abuse counseling payments were going to Acacia. Acacia payments surged from $300k to $3M over a few years. Lesson learned (?)- when you see 99% of your SA payments going to one provider that’s grown tenfold in a few years, maybe you should have something in place to stop paying that provider number before it gets to that point?

  

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 (enjoy the snow! One Yankees nuisance is a Southerners magical experience) and keep running the race (you know who you are).

****

FULL, FREE newsletter: http://eepurl.com/ep81Y . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: o Patéras ésteile ton Yió gia na sósei ton kósmo

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Medicaid Industry Who’s Who Series: Sheila Wilson

Medicaid Who’s Who: Sheila Wilson, BSN, RN, CCM – Director of Care Management, Medicaid with Priority Health

Sheila is a Registered Nurse with over 31 years’ experience in both clinical and managed care environments. She has extensive experience in case management, and is especially knowledgeable about the challenges facing the Medicaid population. Currently Sheila serves as the Director of Care Management for Medicaid at Priority Health, a Michigan based company serving HMO, PPO, Medicare and Medicaid members across the State of Michigan. Her responsibilities include the development, implementation and administration of programs to achieve medical cost goals for the Medicaid Business Unit. She directly oversees case and disease management, as well as medical utilization operations. Sheila and her team recently received two prestigious Pinnacle Awards from the Michigan Association of Health Plans for work done to incorporate children with special health care needs into managed care, and for spearheading a pilot project with the use of a medical mobile application for children with asthma.

Sheila obtained her Bachelor of Science degree in Nursing from Alverno College, and has held her Certification in Case Management (CCM) since 1994. She has completed the first year of a 2 year Executive MBA Program with Grand Valley State University. She currently lives in Grand Rapids, Michigan with her husband Bill and daughter Ashley.

At the Medicaid Innovations Conference, where Clay Farris of Mostly Medicaid is the Event Chairperson, Sheila Wilson is presenting the following case study:

Taking a Multidisciplinary Approach to Care Management and Delivery: Creating Provider, Health System, and Community Partnerships
Priority Health created the Medically Complex Children’s Program to improve the member experience. A team of Pediatricians, Care Managers, Community Health Workers, Nurses and Specialists within the Academic General Pediatric Residency Clinic (part of the Spectrum Health System), coordinate care for members and aid with basic needs like food, housing, clothing, medication management and transportation. One of our most vulnerable members, a child whose family was new to the United States, arrived to the hospital with acute liver failure and needed a transplant. His parents lacked the resources that the child needed for proper care, so he was enrolled in the Medically Complex Children’s Program. After he was enrolled, a complex care plan was created with input from all team members, including the member and family. The care team assigned to his case helped plan, anticipate his needs between appointments, provide ongoing reinforcement of the care plan and minimize unnecessary Emergency Department visits. The program focuses on one patient, one family, one care plan and one care team to create a better member experience and better health outcomes!

You can learn more about this topic and the rest of the agenda at http://www.medicaidinnovations.com/

  1. Which segment of the Industry are you currently involved?

I am currently working within the Medicaid Program at Priority Health.  Priority Health is one of 11 Managed Medicaid Health Plans here in the state of Michigan. 

   2. What is your current position and with what organization?

I am the Director of Care Management for the Medicaid Program here at Priority Health.

  3. How many years have you been in the Medicaid industry?

I have been working within the Medicaid Care Management Field since 2002. 

  4. What is your focus/passion? (Industry related or not)

I have a passion and commitment to the underserved in the counties in which I live and work.   Understanding the barriers and challenges to obtaining the needed health and social services by segments of our population who are often overlooked and disenfranchised is a core element of my being.  I believe that we each can impact the trajectory of another person’s life through the hard work and examples that we set for each other.

  5. What is the top item on your “bucket list?”

I actually have two items that occupy the top spot.  I would love to have the ability to go to Washington, meet with our Legislators and discuss some of the current issues facing our Country and our State today.  My minor in college was Political Science, so I have a strong interest in our political system.  On a more personal note, I would love to travel the country, visiting small towns and big cities along the way.  I particularly enjoy the coastal areas and would love to spend some time sailing with my family.

  6. What do you enjoy doing most with your personal time?

I love spending time with my 3 grandchildren.  Time stops whenever they are around.  I love curling up with a good book in front of the fireplace during the cold winter months and tending to my garden during the summer months.

  7. Who is your favorite historical figure and why?

I would love to meet both Hillary Clinton and Michelle Obama.  I think they are both brilliant women who believe in the strength and tenacity of all women.

  8. What is your favorite junk food?

I love vanilla frosted unfilled long johns.  My father use to get them for me when I was a little girl and I’ve loved them ever since.

  9. Of what accomplishment are you most proud?

I am almost finished with my Executive MBA Program. I was able to do this while caring for my 89yr old mother, my husband and 16 yr. old daughter as well as working full time as the Clinical Lead for our Medicaid Product.  So many times, I doubted my ability to do it all and yet have somehow managed to meet the needs of my family and myself, both professionally and personally. 

 10. For what one thing do you wish you could get a mulligan?

Very early in my career, I was given the opportunity to attend an OB GYN Nurse Practioner Training Program at virtually no cost to myself.   I turned down that offer.  I often wonder how different my life would have been had I decided to take advantage of that opportunity.  

 11. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

  1. With the change of leadership in Washington, I am concerned about the future of Medicaid in general and of Medicaid Expansion more specifically.
  2. Pharmacy cost trends are rising at an unsustainable rate.  There is very little that Care Management can do to impact this as it is largely a pricing/contracting issue.
  3. Payment for Health Care is moving away from a Fee-For-Service Reimbursement Model to a Value Based Reimbursement Model.  I worry that our Provider Partners are not moving as quickly to meet the rapid changes that are State is requiring of its Medicaid Health Plans.

 

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Clay’s Weekly Medicaid RoundUp: Week of November 28th, 2016

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

Or you can click the one for optimist readers –  http://bit.ly/2gUFq0R

 

MAKE MEDICAID GREAT AGAIN- I have had clients and readers ask my thoughts on what President-elect Donald Trump’s shocking (gasp!) victory means for Medicaid. I have intentionally waited a few weeks for the dust to begin to settle.  You can read my thoughts here- http://www.mostlymedicaid.com/?p=1874

Since most of the Medicaid news in the past few weeks has been speculation over what the Trumpening means for Medicaid, I have reserved this week’s RoundUp for news summaries of other items.

BUT FIRST, A CORRECTION – An earlier RoundUp incorrectly listed the Good Guvn’r Brandstad as the Governor of Illinois. I have written it correctly at least a dozen times (he gives me lots of material), but the one time I get it wrong, I hear from Richard, Rob, Marni, Claudia and others who wrote in to Correct the Record. I love it when people write in, and I love it even more when they provide corrections. It means they are paying attention. Thank you, and everyone – keep me honest!

 

SPEAKING OF IOWA- MCOs playing in the Iowa statewide rollout continue to post loss numbers (in the press). Losses in the latest stories range from 18-25% for UHC, AmeriHealth Caritas and Amerigroup in the Hawkeye State. The Good Guvn’r Brandstad tossed another $33M in the MCO pot in October to help cover unexpected costs (especially Rx). Its not all dollars and sense, though- 25,000 members now are getting care coordination services, 230,000 have been engaged with health risk assessments and other outreach efforts and more than 2,000 have been taken off the waiting list for a DD program. Aren’t these smashing successes? Where are the advocates showering confetti and throwing a parade for the MCOs? Seems a bit one-sided to me. Sometimes the naysayers remind me of cavemen- “MCO bad. Me get angry. Me repeat tired arguments against MCOs and me ignore abysmal outcomes in fee for service.”

 

ARKANSAS STRUGGLING TO KEEP UP- About 28,000 Medicaid applications are in purgatory in the Natural State. DHS officials are still saying they can get them all done by year end (that’s now less than 3 weeks when you adjust for the impact of the Christmas break).

 

MEDICA MCO WALKS AWAY FROM MINNESOTA- About 300,000 bennies in the Gopher State will need to cut up their old Medica card (“Medica” is the MCO name, which is confusing, and looks like I dropped an “id” or an “re”). Medica says it will end up losing around $150M on 2016 Minnesota Medicaid business. Of course the party line is: ”The evil MCO is making too much money and got greedy.” Assuming they are not lying, can you blame any business for wanting to not lose money?

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. Deborah Brown of Warwick, RI will serve four years and pay $230k for billing for DME (incontinence supplies) not medically necessary. Gregory Dodds, a counselor in Camdem, AR was ordered to pay $250k for defrauding Medicaid. His counseling practice operated from inside the building for Camden’s “Connection International Ministries Church.” His excuse? Mr. Dodds needed to pay off student loans. Bernie – where are you? Riyad Altalla and his wife Muna Alnoubani pled guilty to using their home health company to steal more than $1M from Ohio Medicaid. The lovely couple from Ohio wins this week’s award.

 

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 (build a fire! And while you are at it, read London’s “To Build a Fire”) and keep running the race (you know who you are).

****

FULL, FREE newsletter: http://eepurl.com/ep81Y . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: mamam moavlina dze gadarch’ena msop’lioshi

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Medicaid Industry Who’s Who Series: Michelle Miller, MS, RN, PMP

Medicaid Who’s Who: Michelle Miller, MS, RN, PMP – Chief Nursing Officer with the Colorado Department of Healthcare and Financing

Michelle received her nursing degree in 1994 from Augustana College in Sioux Falls, South Dakota. She worked until 2004 as a Pediatric and Pediatric Intensive Care Unit (PICU) Registered Nurse, specializing in respiratory disorders, children with special needs, and acute trauma services. Michelle moved to Colorado in 2003 and soon turned her focus to the outpatient clinical setting. She became a nationally certified Organ Recovery Coordinator for Colorado’s Organ Procurement Organization, Donor Alliance Inc., where she focused on increasing successful multi-organ donations in infants and children. In 2006, she accepted a position as a Liver Transplant Coordinator at the University of Colorado Hospital.

Michelle received her Master’s degree in Leadership in Health Care Systems at Regis University prior to joining the Colorado Medicaid team in 2013 as the Pediatric Assessment Tool (PAT) Revision Project Manager. She successfully designed and implemented a PAT pilot study. Michelle transitioned into the Utilization Management (UM) Contract Manager position and made significant contributions to the modernization of the ColoradoPAR Program, the Medicaid Nurse Advice Line, and the Client Over Utilization Program over the past 3 years. Michelle was recently promoted to the Chief Nursing Officer position.

Michelle lives in Larkspur, Colorado where she enjoys gourmet cooking, all forms of exercise, and spending time on her deck with her husband, dogs, and the local wildlife.

At the Medicaid Innovations Conference, where Clay Farris of Mostly Medicaid is the Event Chairperson, Michelle Miller is presenting the following agenda session:

Bridging the Client Engagement and Care Coordination Gap to Improve Outcomes: The Colorado Medicaid Nurse Advice Line Model

The Colorado Medicaid Nurse Advice Line aids clients in determining the appropriate level of care, provides health education and region-specific referral information based on individual needs, and facilitates care coordination. This session will discuss this patient-centered care coordination model.

You can learn more about this topic and the rest of the agenda at http://www.medicaidinnovations.com/

  1. Which segment of the Industry are you currently involved?

State government

  2. What is your current position and with what organization?

I am the Chief Nursing Officer for the Colorado Department of Health Care Policy & Financing (HCPF).  We administer Health First Colorado (Colorado’s Medicaid Program), the Child Health Plan Plus, and other health care programs.

  3. How many years have you been in the Medicaid industry?

I am fairly new to Medicaid; my nursing career began in 1994 and I joined the HCPF team in 2013.

  4. What is your focus/passion? (Industry related or not)

I am passionate about empowering nurses to become leaders, not only at the bedside or in hospitals, but throughout the entire health care industry and the communities for which they serve.  Nursing is consistently rated as one of the most ethical and honest professions, however I am not confident we are utilizing nurses to their full potential. 

I am also passionate about people taking responsibility for their own health and wellness by becoming as involved in their preventative care in much the same way people are with their “sick” care.   Improving one’s health literacy, wellness, and lifestyle changes needs to be a priority for all people regardless of where they receive their medical care.  

In addition, I am very passionate about process improvement.  Innovation is the hot buzz word right now but I am a firm believer that prior to designing new programs or processes we should be certain that our current ones are fully implemented and functioning at capacity.  New does not always mean improved.

  5. What is the top item on your “bucket list?”

My bucket list includes a food and wine filled trip to Italy.   I love to cook and would also like to attend some form of professional culinary training.

  6. What do you enjoy doing most with your personal time?

I am an avid reader and quite literally obsessed with food.  My days off are filled with hiking followed by an afternoon of cooking or baking while simultaneously reading a book.

  7. Who is your favorite historical figure and why?

There are too many intriguing individuals to list just one but I will say that I am fascinated by historical figures who were ostracized for their beliefs only to be vindicated after their deaths. 

  8. What is your favorite junk food?

Forget sweets, I love all things salty and crunchy including nachos, buffalo wings, and french fries.

  9. Of what accomplishment are you most proud?

Graduating with my bachelor’s degree in nursing in 1994.  I worked an average of two to three jobs while attending college full time.  I used to study in my car between jobs and while waiting at stop lights.

 10. For what one thing do you wish you could get a mulligan?

I wish I had prioritized staying in touch with friends as I moved from state to state.  I grew up in North Dakota but left after high-school and then traveled across the southwest during my time as a traveling nurse.  I have met some extraordinary people who I simply lost touch with over the years.

 11. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

There are so many challenges it is difficult to choose only three but I would have to say the future of the Affordable Care Act, improving patient access to care while incorporating strategies to address the social determinants of health, and controlling the rising cost of health care including the increasing cost of pharmaceuticals.

 

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Clay’s Weekly Medicaid RoundUp: Week of November 4th, 2016

Today is Veteran’s Day. In honor of those who have served in our nation’s military, please take a moment to read about the brave men and women who protect us. I have taken stories of fallen servicemen and servicewomen from the site thefallen.militarytimes.com. This selection is in no way meant to slight veterans who did not fall in the line of duty, or who fell earlier this year (the LinkedIn character limits do not allow more than a few to be shown). Please pray for the widows, children, parents and friends of those so recently fallen.

 

Staff Sargent Matthew C. Lewellen. Killed November 4, 2016 in Jordan (7 days ago). Green Beret, 5th Special Forces Group. Hometown: Kirksville, MO. Age 27.

 

Staff Sargent Kevin J. McEnroe. Killed November 4, 2016 in Jordan (7 days ago). Green Beret, 5th Special Forces Group. Hometown: Tuscon, AZ. Age 30.

 

Staff Sargent James F. Moriarty. Killed November 4, 2016 in Jordan (7 days ago). Green Beret, 5th Special Forces Group. Hometown: Kerrville, TX. Age 27.

 

Captain Andrew D. Byers. Killed November 3, 2016 in Afghanistan (8 days ago). Company B, 2nd Battalion, 10th Special Forces Group (Airborne). Hometown: Rolesville, NC. Age 30.

 

Sargent First Class Ryan A. Gloyer. Killed November 3, 2016 in Afghanistan (8 days ago). Company B, 2nd Battalion, 10th Special Forces Group (Airborne). Hometown: Greensville, PA. Age 34.

 

Staff Sargent Adam Thomas. Killed October 4, 2016 in Afghanistan (38 days ago). Company B, 2nd Battalion, 10th Special Forces Group. Hometown: Takoma Park, Maryland. Age 31.

 

Aviation Boatswainís Mate (Fuels) Airman Devon M. Faulkner. Died September 20, 2016 (52 days ago). Assigned to USS Wasp, forward deployed in the central Mediterranean Sea. Home: North Carolina. Age 24.

 

First Lieutenant Jeffrey D. Cooper. Died September 10, 2016 in Kuwait (62 days ago). Headquarters Company, 2nd Battalion, 502nd Infantry Regiment, 2nd Brigade Combat Team. Hometown: Mill Creek, Washington. Age 25.

 

Staff Sargent Matthew V. Thompson. Killed August 23, 2016 in Afghanistan (80 days ago). 3rd Battalion, 1st Special Forces Group (Airborne). Hometown: Irvine, CA. Age 28.

 

Staff Sargent Christopher A. Wilbur. Died August 12, 2016 in Afghanistan (91 days ago). 1st Battalion, 12th Infantry Regiment, 2nd Brigade Combat Team, 4th Infantry Division. Hometown: Granite City, IL. Age 36.

 

Lieutenant Colonel Flando E. Jackson. Died August 4, 2016 (99 days ago). 194th Wing, Camp Murray, Washington National Guard. Hometown: Lansing, MI. Age 45.

 

First Lieutenant Anais A. Tobar. Died July 18, 2016 in Southwest Asia (116 days ago). 4th Aircraft Maintenance Squadron, Seymour Johnson Airforce Base. Hometown: Miami, FL. Age 25.

 

To any veterans reading the roundup today, thank you for your decision to protect me, my family and my way of life. Thank you!

To any of the fallen, you will certainly have much more joy at the feet of Jesus than reading my silly little RoundUp. Thank you.

To Paw Paw (Sargent Major Ott Cecil Farris, Marine veteran of WWII, Korea and Vietnam)- I miss you. We all do. We are all so grateful for what you did for us so many years ago. And we all look forward to seeing you again.

To Private William Robert Caddy of Quincy, MA, thank you for jumping on that grenade on Iwo Jima on March 3, 1945. You saved my grandfather’s life (and the life of another Marine pinned down under Japanese sniper fire). It was thus possible for my father to be born 4 years after that, me to be born 28 years after that and my first child to be born 31 years after that. Your sacrifice upon that grenade has had impact for 61 years and counting. You are in no way forgotten and never will be. I will tell my children of you and they theirs.

Thank a veteran today. Thank one tomorrow. Pray for one today. Pray for one tomorrow. Buy one lunch. Pull your head up from the cesspool of the 24 hour news cycle and do something to honor them.

And each and every day- Praise God you were born in a country worth dying for.

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Clay’s Weekly Medicaid RoundUp: Week of October 31st, 2016

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2eH0oQa

Or you can click the one for optimist readers –http://bit.ly/2eGXWZM

 

Millions in Academic funding Goes Away- I must admit even I haven’t seen this happen in Medicaid. VT has taken $4M from academic medical centers and given it to family doctors. The redistribution was required in a bill passed last session, and appears to be aimed at maintaining the higher primary care payment rates ACA made possible for 2 years back in 2012-2014.

(Illinois) Medicaid Again Gets Allocation increase- Whatever you think of The Good Guvnr’ Brandstad’s managed care strategy, you have to give him props for stick-to-it-ness. When the press just won’t stop criticizing your decision to move to managed care, and attack you for 2 years with every story they can? Add $33M more to the MCO budget this year and tell those journalists to shove it. Brandstad claims the additional spending is possible because managed care has been even more efficient than predicted, and he is still on track to deliver the $110M in annual savings he promised.

(Virginia) Medicaid Annual costs Go up Again- New numbers out from a VA budget groups shows FY 2017 going up $281M. That’s a 7% increase in Medicaid spending over last year. This upward adjustment comes roughly one year after the most recent update to the VA spending forecast, which also showed staggering increases (and a $1.5B budget gap). Can anyone guess what the go-to solution being touted by The Good Guvn’r McAuliffe is?

Managing Affordable (care act’s perception) Goes Awry- It’s just gotten so very hard to pretend like ACA is successful at doing anything besides reducing the uninsured rate. And somehow, John Q. Public has caught on that even that is not so impressive for a policy that forces people to get insurance via penalties. For easy reference, I have placed a few links to the most relevant stories to come out in the last week or so here, here, and here. To me, the funny thing is that ACA really just decreased access for all the people that already had insurance (via higher deductibles that have a clear cooling effect on seeking care). Looks like all the king’s horses (pundits) and all the king’s men (whackjob healthcare economists) couldn’t put poor ACA back together again. I would write more in depth analyses, but it is considered impolite/impolitik/crimethink in our little healthcare world to do so.

 Managed (care) Assessment Gets Adjusted- States that rely heavily on taxing MCOs to deal with budget boo-boos are struggling under the new federal rules that require they broaden (tax more types of managed care entities besides MCOs) or eliminate the revenue stream – good LORD I lost the verb in here somewhere. Wait, nevermind- its just a few words after “boo-boos.” Anyway, they are struggling. Ohio is a good example, with one county standing to lose $20M in annual funding. Kasich is promising a fix but not a lot of details yet. Some predict he could mimic what PA’s Good Guvn’r Wolf did last year, implementing a $13 pmpm “assessment” on all MCOs. So basically, use a different word for tax to keep the money flowing.

LOTS OF OTHER THINGS THAT JUST WOULDN’T FIT – I missed deadline for last week’s RoundUp, so the twitter feed is especially full this week. News from this week and last on there, including lots of fraud stories.

 

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 (go vote on Tuesday! The founding fathers bravely rejected the oppressive, corrupt rule of the elites of their day, and you can too) and keep running the race (you know who you are).

****

FULL, FREE newsletter: http://eepurl.com/ep81Y . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Pai enviou seu Fillo para salvar o mundo

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Medicaid Industry Who’s Who Series: Sara Hall

Sara Hall is a featured panelist for the upcoming Indiana State Medicaid Spotlight Webinar on November 18th. RESERVE your seat today!

 

Medicaid Who’s Who: Sara Hall – HIP Employer Link program director at the Office of Medicaid Policy and Planning

 1.  What segment of the industry are you currently involved?

A: I work at Indiana Medicaid on the policy side.

 2.  What is your current position and with what organization?

A: I am the HIP Employer Link program director at the Office of Medicaid Policy and Planning in Indiana’s Family and Social Services Administration (whew, that’s a mouthful!)

 3.  How many years have you been in the Medicaid industry?

A:  I have been at Indiana Medicaid for a year and a half.  Prior to this, I worked as a Navigator assisting clients at a Behavioral Health Center which is where I first starting working with Medicaid programs and understanding their complexities from a member perspective.

 4.  What is your focus/passion? (Industry related or not)

A:  I am really focused on all Americans having access to quality, affordable healthcare.  Probably sounds like a stock answer, but after working with people as a Navigator I got a look into peoples’ lives.  This was especially true when the ACA was passed and it took Indiana an extra year to get approval for HIP 2.0.  So there was a year when a lot of low income Hoosiers simply fell into the “coverage gap.”  I had the opportunity to see people before and after our alternative Medicaid expansion.  Healthcare really changes lives and I feel privileged to be a part of that.  But, as this audience knows, it doesn’t always work perfectly or as smoothly as it should.  My passion is to continue to make improvements to existing systems and/or help create new systems so that all lives can be improved by healthcare access.

 5.  What is the top item on your “bucket list?”

A: Traveling the Tran-Siberian Railway from Moscow to Beijing.

 6.  What do you enjoy doing most with your personal time?

A:  My 14-year-old daughter is my primary focus.  We like to travel and are planning on backpacking through Belize this summer.  I also like painting, pyrography, and I am currently studying for the GRE….in between watching turn of the century British dramas on Netflix.

 7.  Who is your favorite historical figure and why?

 A: Paul Goodman, because he was a very interesting person who had very interesting ideas.

 8.  What is your favorite junk food?

A:  All of them.  But I really like candy….specifically gummy peaches and Pop Rocks.

 9.  Of what accomplishment are you most proud?

A: Career wise, it would be the development and growth of the HIP Employer Link program I am currently directing.  Personally, it is my daughter and how she is growing into a responsible, smart, bold young woman.

 10. For what one thing do you wish you could get a mulligan?

A: In the second grade, I picked my nose and ate it in front of the whole classroom.  It was a poor decision that haunted me well into third grade.

 11. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

A:  1.)  Obviously, the election.  Medicaid moves at the whim of politics and it is important that programs are funded, staffed, and properly managed when there are legislative changes so that benefits are not lost or decreased for members. 

 2.)  The results of Managed Care Organizations.  Indiana has been working with managed care for a while, but those contracts got bigger with HIP 2.0.  Over the next 6 months we will start to see the results on a number of our performance measurements.  Many other states are working for MCOs for the first time and will also start seeing more results of those relationships.  It will be important for the MCOs to prove that things are working better under their management. 

 3.)  Addiction and mental health services.  The opioid epidemic has hit Indiana hard (along with many other states).  Our Medicaid programs do not always offer ways for people to gain and maintain sobriety through their current health care plans.  Indiana also has a huge gap in mental health providers in and outside of Medicaid.  If we don’t have enough doctors/counselors/case workers to help people who are suffering it will be difficult to see this epidemic decrease.

Sara Hall is a featured panelist for the upcoming Indiana State Medicaid Spotlight Webinar on November 18th. RESERVE your seat today!