Category: MM Curator

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Monday Morning Medicaid Must Reads: Jan 14th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:    Why 700,000 Ohioans were removed from Medicaid coverage, Columbus Dispatch, Jan 12

Clay’s summary:    Could be: a) improving economy, b) glitch in enrollment system, c) evil Republicans working with Putin to hack Ohio’s democracy. You decide.
Key Excerpts from the Article:   
More than 700,000 Ohioans were removed from the state’s Medicaid program in just the first 10 months of 2018. Franklin County had the most disenrollments, with nearly 90,000 losing the health-care coverage from January through October, the most recent data available show.
But no one quite knows why such a huge shift took place in the state-federal program for low-income Ohioans.
Read full article in packet or at links provided

Article 2:    Trump admin’s Medicaid block grant waiver idea invites legal and political firestorm, Axios, Jan 14

Clay’s summary:    They’re baaack (read in Poltergeist voice).
Key Excerpts from the Article:   
The Trump administration is considering giving states the ability to receive Medicaid block grants, Politico reported on Friday, a move that has experts unsure of its legality and the political world bracing for its volatility.
Read full article in packet or at links provided

Article 3:    Public Option And Medicaid Buy-Ins Emerge From 2020 Democratic Presidential Hopefuls, Forbes, Jan 13

Clay’s summary:    Dems see writing on wall re unravelling ACA, start to work on workarounds at state level.
Key Excerpts from the Article:   
Several Democratic governors – including one likely to run for President – are working on legislation to expand coverage to the poor in their states with legislation that would allow residents to “buy into” government subsidized Medicaid or other state coverage.
In all, “at least 10 states” are looking at Medicaid “buy ins,” Stateline reported last week. These proposals are akin to earlier proposals by some Democratic Senators mentioned as Presidential candidates to expand Medicare to Americans as young as 50 years old.
Such public options are seen by some as an alternative to more progressive single-payer “Medicare for All” proposals that would have the government control health insurance and require more taxpayer dollars. Most public option proposals emerging would continue the role of private insurers in helping administer the health benefit expansions.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: Jan 7th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:   Healthy and Working: Benefits of Work Requirements for Medicaid Recipients, Buckeye Institute, December 2018

Clay’s summary:   Beware the red pill.
Key Excerpts from the Article:
Extending Medicaid benefits to individuals who are able to work may reduce their lifetime earnings over the  long-term and adversely affect their consumption patterns in the short-term. Although households may benefit in  the short-term from Medicaid coverage through little- or no-cost health care, the ACA’s Medicaid expansion does  not promote individual long-term earnings growth or wealth accumulation. Workers have less incentive to invest in  their human capital than if they were required to work in order to receive benefits.
 
To address this concern, states that have participated in the ACA’s Medicaid expansion are now considering—or  have already begun to impose—work requirements for some new Medicaid enrollees. Work and “community  engagement” requirements, such as education and job training, tend to keep benefits recipients participating in the  work force, helping them to gain valuable work experience and generate higher earnings and income over the  long-term.
Using publicly available economic data, this report reveals the potential impact of imposing work requirements on  healthy, single individuals with no children. We study how eligibility work requirements may affect the lifetime  earnings of some Medicaid enrollees and find that Medicaid work requirements could:
 
* • Increase lifetime earnings by $212,694 for women and $323,539 for men—even assuming that the  individual remains on Medicaid for their entire working life; and
* • Raise the hours worked per week by 22 hours for women (from 12 hours to 34 hours per week), and by  25 hours for men (from 13 hours to 38 hours per week), bringing Medicaid recipients well above the typical 20  hours per week requirement.
 
We also find that the financial prospects look even brighter for individuals who transition off of Medicaid; they  may earn close to $1 million more over the course of their working years.
 
Requiring labor force participation for benefits eligibility creates an incentive for individuals to increase human  capital investment through the labor market. We show that there is a significant potential economic benefit for  those able-bodied adults who would change their work effort in response to a work requirement for Medicaid  eligibility.
Read full article in packet or at links provided

Article 2:   State Trends and Analysis, Pew Trusts, November 2018

Clay’s summary:   Turns out you do have to choose between healthcare and education. Until we find where the unicorns are hiding the magic wands, that is.
Key Excerpts from the Article:
Medicaid’s claim on each revenue dollar affects the share of state resources available for other priorities, such as education, transportation, and public safety. Because Medicaid is an entitlement program, states must provide certain federally required benefits for any eligible enrollee, even during times of sluggish revenue growth. So policymakers have less control over growth in states’ Medicaid costs than they do with many other programs.
Read full article in packet or at links provided

Article 3:   Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid, KFF, October 2018

Clay’s summary:   The potential safety net costs for newly arriving Americans may be getting more attention if the rule is passed.
Key Excerpts from the Article:
On October 10, 2018, the Trump administration released a proposed rule to change “public charge” policies that govern how the use of public benefits may affect individuals’ ability to obtain legal permanent resident (LPR) status. The proposed rule would expand the programs that the federal government would consider in public charge determinations to include previously excluded health, nutrition, and housing programs, including Medicaid. It also identifies characteristics DHS could consider as negative factors that would increase the likelihood of someone becoming a public charge, including having income below 125% of the federal poverty level (FPL) ($25,975 for a family of three as of 2018). This analysis provides new estimates of the rule’s potential impacts. Using 2014 Survey of Income and Program Participation data, it examines the (1) share of noncitizens who originally entered the U.S. without LPR status who have characteristics that DHS could potentially weigh negatively in a public charge determination and (2) number of individuals who would disenroll from Medicaid under different scenarios:
Nearly all (94%) noncitizens who originally entered the U.S. without LPR status have at least one characteristic that DHS could potentially weigh negatively in a public charge determination. Over four in ten (42%) have characteristics that DHS could consider a heavily weighted negative factor and over one-third (34%) have income below the new 125% FPL threshold.
Read full article in packet or at links provided
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Medicaid Job Hunter: 1/7/2019

We scour the internets for Medicaid jobs listings to save you time.

In this packet…
1. PROGRAM SPECIALIST | Arizona Health Care Cost Containment System (AHCCCS)
2. Medical Management Quality Examiner | Metroplus Health Plan
3. Care Manager – Registered Nurse (RN) | Metroplus Health Plan
4. Clinical Reviewer (Seasonal) | Metroplus Health Plan
5. Call Center and Claims Representative | Independent Care Health Plan
6. Administrative Sales Assistant | Independent Care Health Plan
7. MVP Health Care REPRESENTATIVE, CARE CENTER MEDICAID Job in Tarrytown, NY
8. Family Care Partnership Supervisor | Independent Care Health Plan
9. Family Care Partnership Supervisor | Independent Care Health Plan
10. Supervisory Health Insurance Specialist. | Centers for Medicare & Medicaid Services

2019 01 07- Medicaid Jobs Hunter

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Medicaid Job Hunter: 12/10/2018

We scour the internets for Medicaid jobs listings to save you time.

In this packet…
  1. Team Lead Medicaid Eligibility Advocate in Helena CA USA – HCA, Hospital Corporation of America
  2. State of Mississippi Medicaid Specialist I – NESHOBA COUNTY, MS
  3. Senior Analyst Medicare Medicaid Job
  4. Medicaid Compliance Dir-Plan PS15467 in Lubbock TX USA – Anthem, Inc
  5. LTSS Care Specialist, New Port Richey, Florida | WellCare Health Plans
  6. Director, State Regulatory Affairs
  7. Behavioral Care Coordinator in Little Rock AR USA – Centene Corporation
  8. RN, Care Manager, Special Needs Plan | Visiting Nurse Service of New York | LinkedIn
  9. Health Insurance Specialist | Centers for Medicare & Medicaid Services | LinkedIn
  10.  Health Insurance Specialist (Program Integrity) | Centers for Medicare & Medicaid Services

2018 12 10- Medicaid Jobs Hunter

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Monday Morning Medicaid Must Reads: Dec 10th, 2018

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:  Medicaid Access & Coverage to Care in 2017 (MHPA’s Institute for Medicaid Innovation, Oct 2018)

Clay’s summary:  The industry survey from this leading Medicaid health plan association doesn’t disappoint.
Key Excerpts from the Article:  … Key findings from the data were noted in the high-risk care coordination, value-based payment models, women’s health, and behavioral health sections. For instance, results from the survey demonstrate that the majority of Medicaid MCOs in 2017 performed a number of core functions in providing comprehensive, high-risk care coordination. The most commonly performed core functions included developing a plan of care for members, supporting adherence to the plan of care, engaging a care team of professionals to address the needs of the member, and conducting risk assessments….The findings also indicate that Medicaid MCOs are increasingly using value-based payment (VBP) models when providing care for their members. In 2017, half of Medicaid MCOs indicated that they were piloting population-specific VBP models, while over 15 percent were expanding successful pilots. Finally, approximately 10 percent of MCOs surveyed reported that they had extensive VBP arrangements in place in 2017. As barriers to VBP adoption are removed, we anticipate an increase in the number of Medicaid MCOs transitioning from the pilot phase to fully implemented arrangements….
 
 
Read full article in packet or at links provided

Article 2:  Who can be believed in medical research? Charles Barta, Nov 21 2018

Clay’s summary:  An AZ physician provides an overview of bogus medical and health systems theories throughout the years. Including that old chestnut about how expanding Medicaid would reduce ER in Oregon (that one’s a real knee-slapper!)
Key Excerpts from the Article:  … One interesting fact that has not been reported involves the idea that increasing Medicaid would clearly lower inappropriate emergency room visits and the expense these visits cost the public. We would save money…Oregon decided to prove this in 2009. It vastly increased the number of residents eligible for Medicaid. Unfortunately, the state didn’t have the funds to pay for this, so they put a lottery in place. Half the people eligible were given Medicaid while the other half became a “control group.” This was a scientifically perfect, randomized experiment. …The results? Two years later, the covered group had a 40 percent increase in unnecessary ER use. When a social experiment doesn’t work, the usual excuse of “we didn’t fund it enough — we need more money” wasn’t applicable. The next excuse, “The newly enrolled didn’t have time to get used to the system so they didn’t attempt to make (free) appointments with their doctors.” Two years later, a follow-up study was done. Surprise! The increase in unnecessary ER rose dramatically. The only news organization that reported this was NPR….
 
Read full article in packet or at links provided

Article 3:  Our opinion: State budget reforms are needed, Houma Today Editorial Board, Nov 19, 2018

Clay’s summary:  A small town newspaper comes out in favor of income verification and work requirements for Medicaid eligibility. They must be evil, GOP-loving, Trump worshiping [Insert current set of slurs media tells you to append to people with opinions non-leftist).
Key Excerpts from the Article:  … But some of these reforms make a lot of sense. For instance, income verification for Medicaid can limit paying out benefits to those who don’t qualify while making sure those who do qualify get the help they need….A recent state audit claimed that as much as $85 million could have been spent over the past several years on people who didn’t qualify for Medicaid. That’s because Health Department officials check income only once, at the time of the enrollee’s initial application for the program. They don’t check again until 12 months later, when the person applies for renewal of coverage. In the meantime, the person could have gotten a new job or increased income, becoming ineligible for Medicaid….
 
Read full article in packet or at links provided
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Medicaid Job Hunter: 11/19/2018

We scour the internets for Medicaid jobs listings to save you time.

In this packet…
  1. Professional Healthcare Resources, Inc. Home Health Visits/Medicaid RN/Personal Care Registered Nurse in Washington, DC at Professional Health Care Resources Job in Washington, DC
  2. Population Health Specialist – Kentucky Medicaid Health Plan (54629BR) at Aetna
  3. New Career Opportunity! Medix has an opening for a Medicaid Biller in Burr Ridge, IL.
  4. Medicaid Eligibility Advisor
  5. Home Health Visits/Medicaid RN/Personal Care Registered Nurse
  6. Behavioral Care Coordinator at Centene Corporation
  7. Supervisory Health Insurance Specialist | Centers for Medicare & Medicaid Services
  8. Medical Director PRN – Medicaid Review | Qlarant
  9. Medicaid Health Systems Administrator 1 | Ohio Department of Administrative Services
  10. Grants Management Specialist. | Centers for Medicare & Medicaid Services

2018 11 19- Medicaid Jobs Hunter

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Monday Morning Medicaid Must Reads: Nov 19th, 2018

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1: COUNTERPOINT: Medicaid expansion is unfunded, unsustainable for state of Nebraska

Clay’s summary: Voters didn’t listen to this dude.
Key Excerpts from the Article:  …It is also likely that expansion costs will far exceed projections, just as costs have in nearly every state that has expanded. Iowa spent over $150 million more than expected. Kentucky’s Medicaid program is facing a $296 million budget shortfall due to unpredictable costs (yes, the program itself is that much in debt). Ohio’s Medicaid program costs the state an average of $437 million a month…
Read full article in packet or at links provided

Article 2: Maryland might not have properly vetted some Medicaid enrollees

Clay’s summary: Perhaps there was maybe some payments that could have been somewhat non-compliant with the law but who’s to say, really? It’s a gray area- move along.
Key Excerpts from the Article: Maryland may have allowed residents who did not qualify for Medicaid into the government health program for the poor by failing to consider all of their income, according to a routine audit of the quasi-governmental agency that oversees the Maryland health exchange.
Read full article in packet or at links provided

Article 3: Virginia facing high unexpected Medicaid costs

Clay’s summary: Well at least they decided to expand and spend even more (this is all costs not-related to recent expansion largess).
Key Excerpts from the Article:
State officials said Friday that Virginia has about $460 million in unforeseen Medicaid costs. …The new costs, first reported by the Richmond Times-Dispatch, are unrelated to Virginia’s recent decision to expand Medicaid eligibility to low-income adults under the Affordable Care Act. …Instead, Secretary of Finance Aubrey Layne said much of the new costs stem from faulty forecasts overestimating the benefits of having private health insurers cover a greater number of some of the state’s more costly Medicaid recipients. Another reason for the increase is a higher-than-expected enrollment of children in the state’s Medicaid program, he said…
Read full article in packet or at links provided
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Medicaid Job Hunter: 11/12/2018

We scour the internets for Medicaid jobs listings to save you time.

In this packet –

  1. Healthcare Insurance Coordinator | Fresenius Medical Care North America
  2. Senior Government Health Plan/Managed Care Financial Consultant at Marsh & McLennan Companies
  3. Medicaid Health Systems Administrator 2 | State of Ohio
  4. Medicaid Compliance Dir-Plan PS14343 – Seattle with Anthem
  5. Insurance Reimbursement Lead – Medicaid & Government Billing – Maitland Job at Florida Hospital
  6. State of Florida MEDICAL HEALTH CARE PROGRAM ANALYST Job in Tallahassee, FL
  7. Program Manager – Arizona Medicaid – Phoenix, AZ
  8. Neighborhood Health Plan of RI Vice President Medicare/Medicaid Integration Job in Smithfield, RI
  9. Manager, Medicaid Case Management | Evolent Health
  10. PacificSource Health Plans Actuarial Analyst – Medicare/Medicaid Job in Springfield, OR

2018 11 12- Medicaid Jobs Hunter