Category: Medicaid News and Analysis

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Monday Morning Medicaid Must Reads: October 21st, 2019

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

Article 1:        Medicaid Spending Rises Even As Enrollment Declines, WIBC.com

Clay’s summary:      I feel for the legislators who keep getting the goal posts moved on them. “Look over here – here’s our new shiny thing that will control costs!” 3 years later: “Well here’s why costs were not controlled those last few years. Can we interest you in a new shiny thing as you consider this year’s budget bill?”
Key Excerpts from the Article:
 Last fiscal year’s Medicaid enrollment was Indiana’s lowest in three years, yet spending was up $800 million.  
Read full article in packet or at links provided

Article 2:        Why Medicaid Enrollment And Fraud Has Exploded Under Obamacare, The Federalist

Clay’s summary:      Those expansion states that keep trying to shame your state into taking the plunge? Their expansion enrollment was 2x what their wisest predictors told them it would be.
Key Excerpts from the Article:
By the end of 2016, enrollment in 24 states that expanded Medicaid enrollment to able-bodied adults exceeded the states’ original projections by an average of 110 percent.
New studies and data suggest two related reasons why: Ineligible individuals getting on (or staying on) the Medicaid rolls, and people dropping private coverage to enroll in Medicaid expansion.
Read full article in packet or at links provided

Article 3:        Childless, able-bodied adults are driving cost and enrollment under Medicaid expansion, Adam Crepeau, The Maine Wire

Clay’s summary:      The young adults without children predicted least likely to enroll in expansion in the study used to sell expansion to Mainers? Yep, they ended up being the ones who enrolled at 5x the rate predicted. Its almost like Bernie clued them into the place to get all that free healthcare he’s been talking about.
Key Excerpts from the Article:
Since Governor Mills signed the executive order when she took office in January, more than 37,000 individuals have enrolled under expansion. According to the Maine Department of Health and Human Services (DHHS), adults without children represent 81 percent of those who have enrolled thus far. Of those individuals, 10,500 of them, or nearly one-third of all enrollees, are between the ages of 19 and 29.
These trends are much different than what was projected in a study conducted this year by the Muskie School of Public Service. Their research indicated that adults between the ages of 19 and 24 were least likely to enroll under expansion. This age group represented just 6.6 percent of eligible low-income, childless adults whereas individuals between the ages of 55 and 64 were expected to make up approximately 45 percent of the expansion population.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: October 14th, 2019

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

Article 1:        AAFP Objects to Planned End of Medicaid Access Rule, AAFP

Clay’s summary:      The rule is intended to show whether docs get paid enough to “encourage” them to provide Medicaid services, but it takes a good bit of effort to report on that info. And docs don’t like the idea of removing anything intended to make sure they get paid.
Key Excerpts from the Article:
In the rule,(www.govinfo.gov) published in the July 15 Federal Register, CMS noted its intention to ease some of the administrative burden that states currently face in trying to document whether Medicaid payments in fee-for-service systems are high enough to encourage physicians and other health care professionals to provide services to Medicaid beneficiaries.
The proposed rule outlines CMS’ contention that by compelling states to collect specific information, the agency “excessively constrains state freedom to administer the program in the manner that is best for the state and the Medicaid beneficiaries in the state.”
The AAFP noted its shared commitment to reducing administrative burden for states and clinicians, but argued that the proposed rule, as written, would likely negatively affect Americans in rural areas, as well as some of the country’s most vulnerable patient populations that depend on Medicaid for health care services.
Read full article in packet or at links provided

Article 2:        Walmart’s First Healthcare Services ‘Super Center’ Opens, Bruce Japsen, Forbes

Clay’s summary:      Amazon is creating empty shelves / space in those huge Walmart buildings. So far Bezos hasn’t figure out how to do 2 day shipping on a doctor’s visit, so Walmart is opening clinics. CVS, too…
Key Excerpts from the Article:
 The retailers see 10,000 baby boomers aging into Medicare coverage each day and are also looking to fill emptying space in their brick and mortar stores in the face of changing consumer shopping habits driven by online retail giant Amazon, which is also exploring new ways to get into the healthcare business but has yet to offer face-to-face personalized healthcare services for customers…
This year, CVS has said its new health hub concept store will reach four U.S. metropolitan areas and 50 locations by the end of this year as part of a major expansion. CVS said the HealthHub rollout will grow to 1,500 locations by the end of 2021, or about 500 HealthHubs a year, CVS chief executive officer Larry Merlo told analysts on the company’s second quarter earnings call.
Read full article in packet or at links provided

Article 3:        Medicaid expansion increased ED use, study shows, Modern Healthcare

Clay’s summary:      A Medicaid card provides immunity to medical debt, so ED visits went up. You don’t say?
Key Excerpts from the Article:
Patients under Medicaid don’t have to fear debt collection, removing one big barrier that could deter someone from a hospital visit. Those visits may be perceived as more convenient than a regular doctor’s office visit even if they’re more expensive to Medicaid, since the patient doesn’t have to find a physician who accepts his or her plan…”This pattern of estimates is intuitive,” they wrote. “Medicaid expansion effectively lowers the price of an ED visit for the patient, and so we would expect for an increase in visits for those that are discretionary.”In general, people who qualified for Medicaid under the expansion went to doctors or hospitals at higher rates than the people who didn’t qualify. The authors said that suggests basing the expansion on income rather than specific categories of need “successfully targeted” the people most in need of medical care.
That suggestion held in non-expansion states as well. The people in those states who bought plans on the individual market exchanges with the aid of income-based subsidies were also those who most needed medical care.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: October 7th, 2019

2019 10 07 MMMRHelping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K
In this issue…
Article 1:

New Bombshell Report Reveals Obamacare’s Epic Medicaid Waste, Sally Pipes, Forbes

Clay’s summary:      It’s almost as if when you pass a gigantic, economy transforming bill without reading it, forcing everyone to go along or else they’re evil- and there happen to be some train wrecks, negatives we find out years later. But I have no doubt the Medicaid Left will only ever sing its praises as if it is a complete and total success until the end of time.
Key Excerpts from the Article:
...according to a new study published by the National Bureau of Economic Research, it’s the insurer of record for a significant number of middle-class Americans. The cost to taxpayers? Hundreds of millions of dollars.
The culprit for this epic amount of government waste shouldn’t be a surprise—Obamacare…By the end of 2016, some 11.5 million able-bodied adults had enrolled in Medicaid because of the expansion, more than double the original enrollment projections. This brings the total number on Medicaid to 65.6 million.The cost of the expansion has been higher than expected, too—76% more per person.
Read full article in packet or at links provided

Article 2:        Are the Right People on Medicaid? – Flathead Beacon, Bob Keenan, Tom Burnett

Clay’s summary:      Most people don’t mind taking money from them (“taxes”) to help their needy neighbor. They do mind when it turns out bennies are not actually eligible. Even in Montana.
Key Excerpts from the Article:
... 25% of Medicaid expansion enrollees were likely ineligible in both California and New York. A state audit in Louisiana found 82% of expansion enrollees were ineligible at some point during the year they were enrolled. 25% of Medicaid expansion enrollees were likely ineligible in both California and New York. A state audit in Louisiana found 82% of expansion enrollees were ineligible at some point during the year they were enrolled.
Read full article in packet or at links provided

Article 3:        Analysis: Medicaid deals offer election headache for Edwards, AP, Melinda Deslatte

Clay’s summary:      Sometimes Medicaid helps you get elected (like when you ran on expansion Mr. Edwards). Sometimes it might get you un-elected (like when you are blamed for the current procurement fiasco with MCOs). Good luck with that.
Key Excerpts from the Article:
…The contracts pay for private companies to oversee care for about 90% of Louisiana’s Medicaid enrollees, an estimated 1.5 million people — mostly adults covered by Medicaid expansion, pregnant women and children. The contracts are among the largest in state government, accounting for roughly one-quarter of the state’s annual operating budget…Losing bidders for the next round of multibillion-dollar contracts to manage health services for Medicaid patients are accusing the Edwards administration of bias and conflicts of interest. Republican and Democratic lawmakers are worrying publicly about whether health care access will be disrupted for half a million Medicaid enrollees, many of whom are in Edwards’ expansion program.
Read full article in packet or at links provided
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Menges Group 5 Slides Series for June & August 2019

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. 

The June 2019 Edition was produced by Manisha Gupta and Mohammed Hamdan.  It focuses on the level of marketing spending in the MCO industry, comparing the Medicaid, Medicare, and commercial sectors.  On average, we found that Medicaid MCOs
used 0.19% of their revenues on marketing, advertising, and commissions.  These percentages were much higher among Medicare-dominant MCOs (2.26%) and commercial MCOs (3.43%).

The August 2019 edition was produced by Grace Williams and summarizes our analyses of NCQA’s most recent quality ratings for commercial/private MCOs.  Kaiser Permanente led the multi-state MCOs with a stellar 4.28 average rating, scoring
over half a point higher than the 2nd place MCO and scoring more than ¾  of a point higher than the national average.

MCO Marketing Spending Across Product Types–June 2019

August 2019 Private NCQA Ratings

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Menges Group 5 Slides Series for April & May 2019

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. 

The April edition describes a Pop-Up Clinic founded and led by one of our employees, Nehath Sheriff.  As many of you strive to “bring health care to the people” this type of construct could be a low-cost, high-value option to consider.

The May edition outlines a pilot program we encourage Medicare policymakers to adopt.  It involves testing Medicaid’s key design features in the Medicare arena, which if successful could evolve into a fundamental transformation of Medicare as has occurred with Medicaid (whose transformation also began with pilot testing of this approach).

5 Slide Series — April 2019, Pop Up Clinic

5 Slide Series May 2019, Piloting a New Medicare Coordinated Care Approach

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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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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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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
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Monday Morning Medicaid Must Reads: July 1st, 2019

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

Article 1:       Trump’s Medicare chief, in Chicago, slams ‘Medicare for All’ plan: ‘We’re not going to see savings. It’s actually going to cost more. Chicago Tribune, June 11, 2019. Lisa Schencker

Clay’s summary:     Bbbbbut- Bernie! He promised me it’ll work.
Key Excerpts from the Article:
Q: The doctors who support Medicare for All say it would allow doctors and hospitals to spend less money on administration because they wouldn’t be dealing with multiple insurance companies. What are your thoughts on that argument?
A: One of the things I hear a lot is we should go to Medicare for All because of the lower administrative costs. The reality is we’re not spending enough on administration within Medicare. There’s a lot of bureaucracy that goes on with the Medicare program in terms of access to technology, protecting taxpayers against fraud and abuse and it’s because we haven’t made those investments in administering the program like you would see in the private sector.
The main issue with Medicare for All and having the government take over the entire program, is that we’re not going to see savings. It’s actually going to cost more, which means taxpayers are going to pay more, and when they’re paying more, that’s going to lead to rationing of care and problems with access to care.
Read full article in packet or at links provided

Article 2:

Puerto Rico has a post-Maria Medicaid crisis — and Congress and the White House refuse to do anything about it, RawStory

Clay’s summary:     We now have this in regular rotation in Medicaid news cycles. The key factors all center around statehood status (which ties back to the secondary issue of the federal match). Why does no one point out that the path forward on this either involves another star on the flag or independence?
Key Excerpts from the Article:
Puerto Rico has its own definition of what constitutes poverty level and that, it turns out, is much lower than the federal level.  In order to qualify for Medicaid, a family of four in Puerto Rico must show a yearly income of under the amount set as the poverty level on the island, or $10,200. That’s $850 or less a month on an island where the cost of living is higher than in most of the continental U.S. If Puerto Ricans were to qualify for Medicaid under federal poverty guidelines, they would do so as long as their income (for a family of four) did not exceed $25,750, or a little over $2,000 a month.
This means that a large number of Americans living in Puerto Rico can qualify for Medicaid if they leave the island and move to the 50 states even if their income more than doubles. Puerto Rico government officials are well aware of the problem, but lack resources to address it.
Luz E. Cruz, Medicaid director for the government of Puerto Rico acknowledged that the federal cap on Medicaid funds gives Puerto Rico limited funds and if the poverty level was raised to the level in the 50 states, more people would qualify for the program. “And that would mean that the matching portion from the government of Puerto Rico would be higher and that’s money that we don’t have right now,” she said during a brief telephone interview.
Read full article in packet or at links provided

Article 3:       Requiring People To Work To Get Medicaid Went Really Well In Arkansas Until A Judge Stopped It, The Federalist, June 10th, Victoria Eardley

Clay’s summary:     Not what you wanted to hear, I know.
Key Excerpts from the Article:
 
Since 2000, the number of able-bodied adults using Medicaid quadrupled nationwide. The program is one of the chief costs for state governments, squeezing other priorities.
When last summer Arkansas became the first state to require Medicaid recipients to work in exchange for taxpayer-provided health care, welfare advocates would have had you believing the world was ending: health coverage for the needy was being slashed, the reporting process was too complex, and those who lost coverage didn’t even know about the requirement. On and on the hysteria went.
 
But those apoplectic claims were far from reality. Arkansas’ work requirement was a big step towards restoring the state Medicaid program to its objective. It was saving taxpayers money, freeing up resources for the truly needy, and—notably—changing people’s lives for the better.
 
What critics of the requirement neglected to disclose were the thousands of people who found work as a result of the reform—some for the first time in years. These folks went from a life of government dependency to a life of independence, an undeniably better future for both themselves and their families. These are real people, with real stories, reported by the Arkansas Department of Workforce Services in late 2018.
 
Read full article in packet or at links provided
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Menges Group 5 Slides Series for March 2019

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. 

This month’s edition analyzes and compares prescription volume and drug costs in the Medicaid and Medicare Part D programs. We tabulated pre-rebate cost per prescription for each program from 2013-2017.  We also analyzed trends in specialty drug volume and expenditures during the same time period for each program.

5 Slide Series- March 2019 – An Analysis of Medicare Part D and Medicaid Prescription Drugs