MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Seems that enrollment goes a little slower when you have to commit to working, learning or volunteering in order to get the Medicaid card. Opposing view: DCH is not doing a lot of marketing efforts for the new coverage.

 
 

 
 

Clipped from: https://abcnews.go.com/Health/wireStory/georgia-medicaid-program-work-requirement-off-slow-start-102389380

Public health advocates say Georgia appears to be doing little to promote its new Medicaid plan or enroll people in it

 
 

This photo provided by Amanda Lucas shows Amanda Lucas, right, with her father, Thomas Lucas, on Wednesday, Aug. 16, 2023, outside his home in Warner Robins, Ga. Amanda Lucas said she cannot meet the work requirement in Georgia’s new Medicaid pla…

The Associated Press

ATLANTA — Georgia Gov. Brian Kemp signed paperwork creating a new state health plan for low-income residents to much fanfare at the state Capitol three years ago.

But public health experts and advocates say since it launched on July 1, state officials appear to be doing little to promote or enroll people in the nation’s only Medicaid program that makes recipients meet a work requirement.

The Georgia Department of Community Health, which has projected up to 100,000 people could eventually benefit from Georgia Pathways to Coverage, had approved just 265 applications by early August.

“If we’re talking about directed outreach to the population that would most likely be eligible and interested, I haven’t seen anything,” said Harry Heiman, a health policy professor at Georgia State University.

Heiman and other experts say the program’s slow start reflects fundamental flaws missing from Medicaid expansions in other states, including the extra burden of submitting and verifying work hours. And some critics note it’s happening just as the state, as part of a federally mandated review, is kicking tens of thousands of people off its Medicaid rolls — at least some of whom could be eligible for Pathways.

“We’ve chosen a much more complicated and lengthy process that will take a long time even for the few folks who get coverage,” said Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future.

The Biden administration has already tried to revoke Georgia’s Medicaid plan once and will be monitoring it, so any missteps could have broader consequences. They could also hamper future efforts by Republicans to make Medicaid eligibility dependent on work.

A spokesman for the governor’s office, Garrison Douglas, said enrollment would grow as applications continue to be reviewed.

“While the federal government initiated and dictated a process for re-determining the qualifications of traditional Medicaid recipients, Georgia is the only state in the country simultaneously offering a new pathway to healthcare coverage and opportunity,” he said in a statement.

The state’s department of community health said it was engaging stakeholders, community partners and others to help get the word out about the program. It did not provide details about that effort.

“There’s still some more work that we have to do for Pathways,” Lynnette Rhodes, executive director of DCH’s Medical Assistance Plans division, said at a meeting this month. “But overall…the program is working.”

The state launched Pathways just as it began a review of Medicaid eligibility following the end of the COVID-19 public health emergency. Federal law prohibited states from removing people from Medicaid during the three-year emergency.

Georgia has already cut more than 170,000 adults and kids from Medicaid and is expected to remove thousands more as the yearlong review of all 2.7 million Medicaid recipients in the state continues. Nationwide, more than a million people have been dropped from Medicaid, most for failing to fill out paperwork.

The department of community health said it delayed the reevaluations of 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them try to maintain health coverage. It was not immediately clear whether the state reached out to those people and helped guide them to apply for Pathways.

“From what we have seen thus far, they are not doing anything affirmatively to get these people enrolled in Pathways,” said Cynthia Gibson, an attorney with the Georgia Legal Services Program who helps people obtain Medicaid coverage.

In contrast, Oklahoma officials implementing a voter-approved expansion of Medicaid in 2021 moved people in existing state insurance programs directly into the expansion pool without the need for a new application, according to the Oklahoma Health Care Authority. Nearly 100,000 people were enrolled in the expanded program within days of its launch.

“States have a lot of tools that they can use to help make this process go more smoothly,” said Lucy Dagneau, an advocate for Medicaid expansion with the American Cancer Society Cancer Action Network.

Oklahoma and 39 other states have expanded Medicaid eligibility to nearly all adults with incomes up to 138% of the federal poverty level, $20,120 annually for a single person and $41,400 for a family of four. None of those states require recipients to work in order to qualify.

That broader Medicaid expansion was a key part of President Barack Obama‘s health care overhaul in 2010, but many Republican governors, including Kemp, rejected it. In addition to imposing a work requirement, Pathways limits coverage to able-bodied adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four.

Kemp has argued full expansion would cost too much money. State officials and supporters of Pathways say the work requirement will also help transition Medicaid recipients to better, private health insurance, and working, studying or volunteering leads to improved health.

“I’m excited we’re moving forward in this direction,” said Jason Bearden, president of CareSource Georgia, one of the state’s Medicaid health plans. “This is good progress.”

Critics say many low-income people work informal jobs and have fluctuating hours that will make it hard for them to document the required 80 hours a month of work, volunteer activity, study or vocational rehabilitation. They also blast the lack of an exemption to the work requirement for parents and other caregivers.

For Amanda Lucas, the work requirement is insurmountable right now.

Lucas said she had no idea Pathways started in July, but even if she did, she would not qualify because she has to take care of her 84-year-old father in Warner Robins, a city about 100 miles (160 km) south of Atlanta. He had a stroke and needs her to buy groceries, make food, pick up prescriptions, pay bills and manage myriad other tasks, she said.

With risk factors for skin cancer, she worries about living without health insurance.

“I try to keep an eye on my own moles,” she said. “I’m increasingly anxious because I’m 46.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Lots of examples of expansion not being the panacea promised.

 
 

 
 

Clipped from: https://ocpathink.org/post/independent-journalism/medicaid-expansion-failing-rural-hospitals

 
 

When State Question 802 narrowly passed a voter referendum in June 2020, allowing able-bodied adults to be added to the state’s Medicaid program, backers promised it would financially stabilize and save rural hospitals.

But a new report shows that more than two years into Medicaid expansion in Oklahoma the share of rural hospitals facing financial challenges has increased.

A report by the Center for Healthcare Quality and Payment Reform (CHQPR) found that about half of Oklahoma’s rural hospitals are at risk of closing with nearly one-in-three rural hospitals at risk of “immediate” closure.

According to the report, Oklahoma has 37 rural hospitals that are at risk of closing with 24 facing “immediate” risk of closing.

The Center for Healthcare Quality and Payment Reform also reported that 58 of Oklahoma’s 78 rural hospitals, or 74%, are reporting financial losses on services.

Those figures run counter to the promises made by advocates of Medicaid expansion.

Under the 2010 federal Affordable Care Act, better known as “Obamacare,” states were allowed to expand Medicaid to add many able-bodied adults to the welfare program. However, Oklahoma policymakers did not embrace the expansion for several years because of the increased state cost.

Eventually, activists used the initiative petition process to put expansion on the ballot as State Question 802. The measure passed by a very slim margin in June 2020, and Medicaid expansion went into effect starting in July 2021.

The SQ 802 campaign included many promises that Medicaid expansion would provide financial security for rural hospitals.

The website for the “Yes on 802” campaign declared that Medicaid expansion would increase spending by $1 billion per year in Oklahoma “and keep our rural hospitals open.” A campaign ad for “Yes on 802” similarly claimed Medicaid expansion would “keep rural hospitals open.”

But the Center for Healthcare Quality and Payment Reform report indicates that rural hospitals are worse off today than they were prior to Medicaid expansion.

In July 2019, prior to Medicaid expansion, GateHouse Media reported that 52% of rural hospitals in Oklahoma lost money from 2011 through 2017. That’s a lower share than the 74% reporting financial losses today, according to the Center for Healthcare Quality and Payment Reform report.

That outcome doesn’t surprise one expert who has followed Medicaid expansion across the nation.
 

“Medicaid expansion doesn’t save hospitals—it harms them,” said Hayden Dublois, data & analytics director for the Foundation for Government Accountability. “Nearly 50 hospitals have closed in expansion states since 2014–representing almost 5,400 hospital beds—despite the promises by advocates that expansion would be a silver bullet for hospital finances. Some of these hospitals directly cited expansion as a reason for closure. In contrast, hospital closures in non-expansion states are almost never caused by a lack of Medicaid expansion.”

While Medicaid expansion has not reduced the number of at-risk rural hospitals, it has increased taxpayer spending on the program.

The Oklahoma Health Care Authority, which administers Medicaid, reported that Medicaid spending in Oklahoma surged from just over $6 billion in 2021 to more than $7.8 billion in the 2022 state budget year. That was a spending increase of nearly 48% compared to 2017 with much of the new spending in 2022 tied to Medicaid expansion.

So if taxpayer spending went up and the number of patients on Medicaid increased, why have rural hospitals not become more financially sound?

“The reasoning is simple: since Medicaid reimburses hospitals at lower levels than private insurance, hospitals are financially harmed as countless able-bodied adults move off of exchange plans and employers’ plans and onto Medicaid,” Dublois said.

That’s a reality Medicaid-expansion backers previously admitted.

At a September 2019 legislative meeting, Jay Johnson, president and CEO of Duncan Regional Hospital and chairman of the Oklahoma Hospital Association’s executive committee, admitted that hospitals lose money on Medicaid patients.

“On every government payer, we don’t make a profit,” Johnson said. “At our hospital, whether we’re taking a Medicare or Medicaid patient, our expenses are greater than what we will get paid.”

(Johnson endorsed Medicaid expansion anyway even after saying the program creates financial problems for hospitals.)

Critics, such as Dublois, have long noted that individuals added to Medicaid through the Affordable Care Act’s expansion include many people who would have otherwise had private insurance. Because Medicaid reimburses roughly 60 percent of what private insurance reimburse nationwide, that translates into greater financial losses for many hospitals after Medicaid expansion.

The Center for Healthcare Quality and Payment Reform report noted that the factors causing financial losses at rural hospitals include the fact that “at-risk hospitals are losing money on uninsured patients and Medicaid patients.”

At rural hospitals that are not at risk of closure, the report stated those facilities “receive payments from private health plans that not only cover the costs of delivering services to the patients with private insurance, but those payments also offset the hospitals’ losses on services delivered to uninsured and Medicaid patients.”

In effect, that means people with private insurance are paying higher rates to cover the hospital losses created by Medicaid patients.

“Most ‘solutions’ for rural hospitals have focused on increasing Medicare or Medicaid payments or expanding Medicaid eligibility due to a mistaken belief that most rural patients are insured by Medicare and Medicaid or are uninsured,” the Center for Healthcare Quality and Payment Reform report stated. “In reality, about half of the services at the average rural hospital are delivered to patients with private insurance (both employer-sponsored insurance and Medicare Advantage plans).”
 

In neighboring Texas, which has not expanded Medicaid, the report showed that a significantly lower share of rural hospitals report losses than their counterparts in Oklahoma. But in New York, which has expanded Medicaid, 80% of rural hospitals reported losses and 43% were at risk of immediate closure, surpassing even Oklahoma’s dismal numbers.

Dublois noted that the CHQPR study shows that roughly one in four rural hospitals “are at risk of closure in states that have already expanded Medicaid.”

The CHQPR report is not the only study that has highlighted that trend.

A 2019 report by Navigant Consulting included data on states with the most community-essential rural hospitals at risk for closure. The five states with the highest number of those facilities were states that had expanded Medicaid.

Reliance on Medicaid was a factor in the financial woes of rural hospitals, according to the report.

“Residents who remain in rural communities tend to be either very old or very young, and these communities often have higher rates of uninsured, Medicaid, and Medicare patients, leading to more uncompensated and under-compensated care,” the Navigant report stated.

SQ 802 narrowly passed with just 50.49% of the vote with the “yes” vote prevailing primarily because of mail-in absentee votes from urban areas. Statewide, a majority of voters in 70 of Oklahoma’s 77 counties voted “no” on SQ 802.

Some who advocated for Medicaid expansion at that time express no second thoughts despite the worsening trend lines in rural hospitals after expansion was implemented.

“Medicaid expansion has been tremendously successful in every state where it has been implemented and not a single rural hospital has closed in Oklahoma for financial reasons since its implementation two years ago,” said Rich Rasmussen, president & CEO, Oklahoma Hospital Association.

But others express concern about hospital stability although they have not expressly linked those financial challenges to Medicaid expansion.

State Rep. Marcus McEntire, a Duncan Republican who was a vocal advocate for Medicaid expansion, continued to tout the program as recently as last year.

On his campaign website, which is updated through 2022, McEntire declared, “We are at the cusp of rural hospitals being financially self-sufficient since the ACA (Affordable Care Act) was passed.”

But by April 2023, McEntire’s tune had changed regarding hospital stability. In an article in The Oklahoman, which focused on a dispute over $600 million in federal COVID bailout funds, McEntire declared, “My concern is that we don’t use the $600 million for stabilizing the health care system because right now the hospitals are all under water.”

For opponents of Medicaid expansion, the current landscape of rural health care in Oklahoma is not shocking.

“Put simply, expansion isn’t a silver bullet for hospitals,” Dublois said. “It’s a nail in the coffin.”