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.

…

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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.

Read it here

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.’ ”

Read it here

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.”

…

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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.)

Read it here

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.

Read it here

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 our January 2018 edition of our 5 Slide Series. This edition of our 5 Slide Series tracks the progression of participating Medicare Special Needs Health Plans (SNPs) and their enrollment between December 2010 and January 2018.  Program-wide enrollment is currently at an all-time high, with more than 2.5 million members.  Industry-wide SNP enrollment typically drops down each January due to the loss of all enrollment among plans exiting the market. This year, however, we’ve seen an increase in membership, which could be setting up 2018 to be a year of significant SNP enrollment growth.

January 2018 — Medicare SNP Enrollment Progression

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 edition addresses some aspects of how quality data are reported and are used in performance-based payment structures.

December 2017 — getting out of the stairwell in quality measurement and improvement

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 are our two most recent 5 Slide Series reports, both of which are focused on the Medicaid managed care industry.

The October 2017 edition summarizes an analysis of Medicaid MCO financial performance of Medicaid MCOs in each state, showing the degree to which the health plans are collectively experiencing gains or losses.  During 2015 and 2016, about two-thirds of states with MCO capitation programs landed in what we would consider an optimal place – with the health plans collectively earning a positive margin on their Medicaid business but with that margin not exceeding 5%.

The November 2017 edition looks state-by-state at the degree to which its 2016 Medicaid expenditures were capitated.  Nationally, capitation payments represented 48.9% of FFY2016 Medicaid expenditures.  This figure was 27% as of 2010.  It is highly likely that we have now crossed a threshold where the majority of Medicaid expenditures occur via capitation payments.  This is an encouraging trend given all that the Medicaid MCOs do to systematically facilitate access to care, measure and improve quality, and steer care towards cost-effective settings and treatments.  Our one caution is that for the Medicaid MCO model to achieve taxpayer savings, unit prices need to be held closely in line with Medicaid fee-for-service prices.  When providers with strong negotiating leverage secure payments from MCOs well above Medicaid fee-for-service rates, the Medicaid managed care program in that state is probably adding to taxpayer costs rather than yielding savings.

November 2017 Use of Capitation in Medicaid by State 2016

October 2017 Distribution of States by Medicaid MCO Operating Margin

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 July 2017 edition tabulates Medicare’s per capita costs in each state and U.S. territory, showing the level of cost variation that exists between jurisdictions.  These figures are from 2015 and represent costs in the fee-for-service setting for Part A and Part B services.  The August edition tabulates information from the Medicaid MCO financial statements we collect and compile, showing the overall profitability among plans whose revenue is primarily (and often entirely) obtained through serving Medicaid populations.  The September edition provides suggestions for making Medicaid managed care optimally effective.

August 2017 Medicaid MCO Financial Performance 2011-2016

July 2017 Medicare Per Capita Costs by State 2015

September 2017 Optimizing Medicaid Managed Care — Input from Musicians

Helping you consider differing viewpoints. Before it’s illegal. 

Article 1:   Building the Infrastructure of the Affordable Care Act: Hillary Clinton, UnitedHealth Group/Optum, and the Center for American Progress, Katherine Tillman, Journal of American Physicians and Surgeons, Winter 2015 

Clay’s summary: Wow. This is like a laundry list of the rich and powerful and how they show up under the banner of “health reform” inside the walls of CMS.

Key Passage from the Article

 The ACA is also the legal catalyst for a massive information technology (IT) infrastructure connecting, tracking, and exploiting economic, social, and cultural components of American society. Government departments may now arbitrarily structure thousands of regulations and policies from this poorly written legislation, all of which have an impact on the personal lives of citizens from prenatal exams to hospice.  But who is in charge? 

…

We have yet to understand the full scope of the ACA. Its execution is in the hands of powerful, interlocking individuals and organizations, many having been involved in designing
“healthcare reform” since the Clinton Administration. A central part of the transformation is compiling and tracking our most sensitive data, from health records and tax returns,
which can now be used in making coercive decisions about our medical care, to help achieve the “progressive” social goals of this elite, powerful group.

Read it here 

Article 2:   The War on Medicaid Is Moving to the States, Greg Kaufmann, 8/31/2017, The Nation

Clay’s summary: #Resist!

Key Passage from the Article

 Waivers are intended for state pilot projects designed to improve health-care coverage for vulnerable populations. But that’s not what conservative governors are pursuing. In Maine, for example, as citizens prepare to vote on a referendum that would force the state to expand Medicaid to 70,000 people, Governor Paul LePage is moving in the opposite direction. His Department of Health and Human Services has requested permission to create a 20-hour-a-week work requirement, impose copays and premiums, and implement a $5,000 asset cap on Medicaid beneficiaries. The result, health-care experts warn, will be that low-income people in Maine will be kicked off the program.

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