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Medicaid, education numbers most notable in Gov. Sisolak’s proposed 2021-2023 executive budget

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Nevada Medicaid enrollment grew 18.7% more than expected, and now the bill is coming due.

 
 

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.

 
 

CARSON CITY, Nev. (KLAS) — The COVID-19 pandemic devastated Nevada’s economy which relies so heavily on tourism. Gov. Steve Sisolak’s 2021-2023 proposal reveals the financial challenges the state continues to face. Medicaid and education numbers were of the most notable in his plan.

When the state legislature first approved budget cuts, it was for a devastating 12%. That will not be the case, however, due to higher December revenue projections than predicted.

“My Executive Budget for 2021-2023 recognizes the emergency we are
experiencing as a result of the COVID-19 pandemic while also setting forth a clear plan to revitalize, innovate, and grow Nevada’s economy,” Sisolak said in a news release. “I am committed to remaining flexible and working closely with the legislature in this unprecedented and evolving fiscal situation.”

Full 2021-23 executive budget highlightsDownload

Moving into Medicaid, the proposal preview shows that during the current biennium, 2019-2021, the number of enrollees increased by 18.7% more than projected. An additional increase of 2.2% is projected for 2021-2023. These numbers are due in part to job losses.

The budget predicts by the end of the upcoming biennium, one in four Nevadans will be enrolled in Medicaid.

Education is also highlighted, with $331 million in supplemental appropriations designated to K-12. In the current biennium, K-12 and Nevada System of Higher Education (NSHE) state expenditures total $7 billion. Federal aid is expected to be a large part of funding for education.

A state official also noted no school will receive less than they did coming into this budget, which includes revenue from marijuana excise taxes.

Another big item to note is that state employee furloughs that went into effect on January 1, 2021 will not continue in fiscal year 2022-23.

Sisolak says his priorities are still recovering from the ongoing crisis, creating jobs, educating children, promoting justice and equality and protecting citizens’ health.

The proposal lists general fund expenditures $8,688,624,000, a 2% reduction from 2019-2020.

“Ultimately, State revenues, while still severely impacted by the economic crisis, never dropped as low as our worst expectations and this budget reflects that inconsistent, if not positive, ending point,” the news release says.

Sisolak will discuss his proposal during the State of the State address, slated to air at 6 p.m. on Tuesday, Jan. 19. Channel 8 will carry coverage of the speech and it will also be livestreamed on 8NewNow.com as well as the governor’s Facebook page.

 
 

 
 

Clipped from: https://www.8newsnow.com/news/local-news/medicaid-education-numbers-most-notable-in-gov-sisolaks-proposed-2021-2023-executive-budget/

 
 

 
 

 
 

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Key MS House leader offers bill to restructure authority over Division of Medicaid

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Mississippi wants to take away Medicaid from the Governor.

 
 

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.

 
 

Rep. Trey Lamar

A new bill from the Mississippi House of Representatives, HB 1013 authored by House Ways and Means Chairman Trey Lamar (R) would establish a Medicaid Commission to oversee the Division of Medicaid currently operated under the instruction of the Governor’s office.

The proposed Commission would be made up of seven members. Three would be appointed by the Governor and four by the Lt. Governor initially, with later appointments made with the advice and consent of the state Senate. The Speaker of the House would have the ability to nominate two of the Lt. Governor’s appointees.

This marks a departure from the current circumstance as Medicaid is part of the executive branch with the Executive Director appointed by and reporting to the Governor.

The bill further clarifies the qualifications of the members and what experience they bring to the table, requiring some be a representative of Medicaid providers or from each Supreme Court or Congressional District.

It will then be up to the Commission of seven to appoint an Executive Director, who is required to either be a physician with administrative experience or a person holding a graduate degree in medical care administration, public health, hospital administration or something similar. The individual can also hold a bachelor’s degree with at least three years experience in management-level administration for policy development for Medicaid.

“House bill 1013 would essentially remove the Division of Medicaid from underneath the Governor and place a seven member board over the Division of Medicaid,” said Representative Lamar.

The language of the bill could cause some confusion when it states that it would “Abolish the Division of Medicaid and transfer the powers, duties, property and Employees of the Division to the Medicaid Commission.”

However, Lamar said this language is a matter of semantics. In laymen’s terms the bill would take the infrastructure and operations of the Division of Medicaid and rename the program under the Medicaid Commission within Mississippi Law. The substantive change would be that the authority would be moved from the Governor to the commission.

Rep. Lamar said with this change you would have seven sets of eyes over what has become a $6 billion industry. Medicaid is the largest budget in the state. There is roughly $1 billion of state dollars that go into the program and $5 billion of federal. While much of how those dollars is dictated by the federal government, the new board would also have input.

He said this commission would function similarly to the Department of Education, Institutions of Higher Learning, and Department of Health.

This would go into effect by July 1, 2021.

The appointment of the Medicaid Executive Director is at this time reserved for the Governor.

Currently, Medicaid is led by Executive Director Drew Snyder who was first appointed to the position by Governor Phil Bryant. The team also consists of a Deputy Executive Director, with several offices that work in conjunction with each other to accomplish regular work.

Medicaid serves roughly 720,000 Mississippians.

Mississippi’s Division of Medicaid was established in 1969 by the Mississippi Legislature.  It is housed within the Office of the Governor and is designated by state statute as the single state agency responsible for administering Medicaid. It currently employs over 1,300 people with 30 regional offices and over 80 outstations.

Lamar said this bill would not impact those jobs, but simply remove the division from under the Governor’s purview.

While tensions have been high in the past concerning Medicaid spending, the Division of Medicaid has made great strides fiscally since Snyder took over. For FY 2022, Medicaid did not request the typical $50 million deficit that the Legislature has become accustomed to in recent years.

Prior to the COVID-19 pandemic, the Division had roughly $40 million in special funds due to safe budgeting for the last few years. They have also continued to expand telemedicine opportunities, a program that was being prepped before the necessity of at home doctor visits due to social distancing.

In late 2020 Medicaid hearings, even providers complimented Snyder on the job he was doing to re-vamp the program, applauding his “open door” policy with everyone. Lamar echoed many of these sentiments, saying Snyder has done a great job over the Division.

The current concerns over Medicaid in Mississippi seem to revolve around Managed Care, the five percent reimbursement for providers and the difficult credentialing process. Many providers told lawmakers in October that they would like to see a more streamlined credentialing process.

Over the years there have been unsuccessful attempts by Legislative Democrats to expand Medicaid in Mississippi.  Republicans have fought the measure believing that the long term impact of substantially higher Medicaid enrollments would have a devastating effect on the state’s budget.  Many lawmakers believe that Snyder and his team have demonstrated Medicaid expansion is not necessary to run an efficient and effective program.

Lamar said a change like this is not unprecedented. It was only in the mid-80’s that the authority over the Division of Medicaid was handed over to the Governor.

“This would just be returning the state of Mississippi back to the way we use to do it and I think it makes sense,” said Lamar.

 
 

Clipped from: https://yallpolitics.com/2021/01/22/key-house-leader-offers-bill-to-restructure-authority-over-division-of-medicaid/

 
 

 
 

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Senators negotiate first steps in funding Missouri’s mandated Medicaid expansion

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Lawmakers are looking for ideas on how to pay for what the voters decided.

 
 

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.

 
 

Republican state Sen. Dan Hegeman, of Missouri, discusses voter approval of a ballot measure he sponsored during an interview on Thursday, Nov. 5, 2020, in his state Capitol office in Jefferson City, Mo. 

AP Photo/David A. Lieb

(The Center Square) — Missouri voters in August approved a constitutional amendment that expanded Medicaid despite fierce opposition by the Legislature’s GOP majority and Republican Gov. Mike Parson. 

Now, those same lawmakers and governor must execute the will of the people when they approved Amendment 2 by a 53-percent margin, meaning they must find a way to fund healthcare coverage for an additional 200,000 people now potentially Medicaid eligible this session, which began Jan. 6 and ends May 31.

Amendment 2 expands Medicaid eligibility under the 2010 Affordable Care Act (ACA), which provides a higher federal funding share for states that extend Medicaid to adults earning up to 138 percent of the federal poverty level.

State Auditor Nicole Galloway, the Democratic gubernatorial candidate defeated by Parson Nov. 5, estimates expanding Medicaid under the ACA could cost the state at least $200 million or save it as much as $1 billion annually by 2026.

But it will require upfront investment and some Republicans vow not to fund it. A more common goal among Republicans is to restrict its growth by imposing work requirements and creating a stringent enrollment-verification process.

“Amendment 2 will be a knockout blow to the state budget as more services will be cut or eliminated to pay for the healthcare of able-bodied adults,” state House Budget Chairman Rep. Cody Smith, R-Carthage, said before the session began.

Parson and legislative leaders, however, say they will push for Medicaid expansion as approved by voters less than six months ago under Amendment 2.

As part of that effort, the Senate Appropriations Committee got its first look at a bill that would extend the state’s federal match program — the Federal Reimbursement Allowance (FRA) — for Medicaid payments.

Senate Bill 1, filed by committee chair Sen. Dan Hegeman, R-Cosby, would extend the FRA for another year as state lawmakers have done every year since 2005.

The state’s FRA program was established as voluntary before being enacted into law as a provider tax in 1992. Hospitals contribute to the FRA and Missouri’s Medicaid program — MO HealthNet — uses the funds to earn higher returns in federal matching dollars. 

The FRA has grown to surpass all but two general revenue sources in the state budget. Nearly 85 percent of all payments to Missouri hospitals through MO HealthNet are covered by the FRA.

SB 1 would continue maximizing federal matching dollars and reducing the burden on state general revenues, Hegeman told the panel Wednesday.

“As most of you know, the FRA is how we fund over $1 billion of our state Medicaid program, and it is vitally important to our state budget,” Hegeman said. 

Among extensions is continuing to allow the Missouri Department of Health (DOH) to collect approximately $1.28 billion in Hospital Tax in Fiscal Year 2022 (FY22), which begins July 1, and in FY23. Hospital tax revenues will, in turn, draw approximately $2.391 billion in federal funds each year to the state.

Missouri Hospital Association (MHA) Executive Director Rob Monsees told the panel that adding 200,000 to the state’s Medicaid program will generate “a substantial amount of new FRA dollars. Some of those dollars can help provide an offset to the cost of expansion.”

If SB 1 fails, he said, it “would radically destabilize that funding mechanism.”

Sen. Bill Eigel, R-Weldon Spring, wondered why the FRA is approved each year with little debate when it is one the largest troughs of public money in the state budget.

“The FRA is a mechanism, which (funds) the largest government program we have, sees no reform,” he said. “We have thrown money at a broken program with no meaningful reform whatsoever.”

Clipped from: https://www.mdjonline.com/neighbor_newspapers/extra/news/senators-negotiate-first-steps-in-funding-missouri-s-mandated-medicaid-expansion/article_10d759f9-d05e-5959-9b60-0e229b969621.html

 
 

 
 

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Kentucky Medicaid bill would reduce managed care organization contracts to three

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Lawmakers frustrated with the court decision to squeeze in a sixth MCO are pushing back.

 
 

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.

  
 

Gov. Andy Beshear spoke out against a bill that would reduce the number of companies with Kentucky Medicaid contracts from six to three.

The bill, Senate Bill 56, includes language that would allow it to go into effect immediately if passed by the General Assembly and signed into law by the governor. That could have a significant bearing on a months-long, expanding legal fight over how the state awarded five contracts last May.

“We have had in our history, of having [Managed Care Organization], one quit,” Beshear said at a press conference on Tuesday, referring to Kentucky Spirit Health Plan abandoning its Medicaid contract in July 2013 with about a year left in the contract. “And if we only had three [Medicaid companies] and one quit, a huge number of people would be without service and would be in a very difficult spot that could be the difference between life and death.”

He acknowledged the potential frustration of lawmakers critical of the Medicaid program seeing a sixth Medicaid company added to the program through an order from the judge presiding over the Medicaid lawsuits.

The bill’s sponsor Sen. Stephen Meredith, a Republican from Leitchfield, Kentucky, said of Beshear’s response: “That’s a typical response from state government because we never approach things from a business model.

“If you truly apply the principles of the business world, there is no way that you would justify six [Medicaid] companies.”

 

Sen. Stephen Meredith, R-Leitchfield, is sponsoring a bill that would cut down the number of Medicaid companies in the state to three. There are six companies operating in Kentucky now.

LRC Public Information Office

Meredith, a retired hospital executive, said the bill would remove administrative redundancies and inefficiencies from the Medicaid program and for the health care providers that interact with Medicaid companies — especially small and rural health care providers.

Meredith has run a version of Senate Bill 56 every year since 2018. His first session was in 2017. He called his previous failed attempts to get the bill passed an “educational process” to help legislators understand the bill.

His case for passing the bill includes references to the importance and the plight of rural health care providers. He believes that reducing the number of Medicaid companies would bring them some financial relief, say that about 28 rural Kentucky hospitals are vulnerable to closure. Often, rural hospitals are major employers in rural communities and provide access to care that would not otherwise be easily accessible.

The legal foofaraw around the Medicaid contracts, in part, inspired Meredith to run the bill again in 2021, even after he told me he wouldn’t do so. In an October interview, he said there was a lack of interest from legislative leadership who he said “turned a deaf ear” on the matter.

He also said that the Medicaid lawsuits and the perceived expansion of bureaucracy with the sixth Medicaid company have Increased political buy-in for the bill, even while the General Assembly tackles other major pieces of legislation prompted by the coronavirus outbreak and the Beshear administration’s reaction to it.

The bill has been assigned to start its legislative journey in the Senate health and welfare committee, where Meredith is vice-chairman. He said the bill is slated to be heard in February.

“I think the Covid situation has actually kind of helped this bill and that [other legislators] recognize the challenges to hospitals, particularly rural hospitals, in trying to stay profitable, and literally survive, and that we can provide some kind of relief,” Meredith said.

 
 

 
 

Clipped from: https://www.bizjournals.com/louisville/news/2021/01/21/stephen-meredith-three-kentucky-medicaid-companies.html

 
 

 
 

 
 

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Outgoing HHS Secretary Files Supreme Court Brief Supporting Medicaid Work Requirements

 
 

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Azar filed a brief on his way out, reiterating the argument that applying enrollment controls helps preserve limited resources in Medicaid and thus facilitates the goals of the program.

 
 

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.

 
 

[author: Regina DeSantis]

On December 4, 2020, the Supreme Court agreed to hear arguments to decide the legality of the Department of Health and Human Services’ (HHS’s) authorization for states to incorporate work requirements into their Medicaid programs.  The consolidated cases, Azar v. Gresham and Arkansas v. Gresham, challenge the legality of work requirements in two states’ Medicaid programs—Arkansas and New Hampshire.  On January 19, 2021, the last full day of the Trump Administration, outgoing HHS Secretary Alex Azar filed HHS’ main Supreme Court brief supporting the states’ work requirements.

We first wrote about the Centers for Medicare & Medicaid Services’ (CMS’s) policy allowing states to require some Medicaid recipients to hold employment or participate in community engagement activities back in 2018.  Since then, we also reported on how a federal district court twice invalidated those requirements.  Last year, we reported that a three-judge panel of the D.C. Circuit Court of Appeals struck down Arkansas’ work requirements [1].  The D.C. Circuit reasoned that a waiver can be approved if it “promotes the objectives” of Medicaid, and Medicaid’s principal “objective” is to provide health coverage to low-income people.  By approving Arkansas’ waiver, the court determined that HHS did not assess how requiring Medicaid beneficiaries to work (as a condition for receiving health coverage) promoted the program’s main objective.

In the Supreme Court brief, Azar and the petitioners argue that HHS was acting within its authority by approving the waivers, explaining that 42 U.S.C. 1315 allows the HHS Secretary to approve experimental state initiatives if the Secretary determines they are “likely to assist in promoting the objectives” of Medicaid.  Further, Azar argued, the statute allows the HHS Secretary to “waive compliance with any of the [state Medicaid plan’s] requirements” under §1396a if the Secretary determines doing so is “necessary to enable” the experiment.  The brief reiterates the argument that requiring Medicaid recipients to work as a condition of coverage helps stretch limited state resources by giving beneficiaries opportunities to seek commercial health coverage (e.g., through an employer).  “Conserving scarce resources enables the States to expand or maintain coverage, and thus promotes the Medicaid statute’s undisputed objective of providing health coverage to needy persons,” the brief explains.

The Supreme Court might not hear arguments before the early spring, and it is possible the new Biden Administration could rescind approval for the Medicaid work requirements before then.  On the other hand, the Biden Administration may want to allow the case to go forward in order to prevent an adverse decision that would hinder the flexibility that the Secretary of HHS has to issue Medicaid waivers.  A decision strictly interpreting the Secretary’s waiver authority may limit the ability of the Biden Administration to use waiver authority to implement its own healthcare priorities.

[1] Later in 2020, the D.C. Circuit struck down New Hampshire’s work requirements.

 
 

 
 

Clipped from: https://www.jdsupra.com/legalnews/outgoing-hhs-secretary-files-supreme-6138680/

 
 

 
 

 
 

 
 

 
 

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Medicaid pays $6.6 billion for HCBS for older adults through Section 1915c waivers – News – McKnight’s Senior Living

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HCBS spending decreased 26% in 2018 compared to 2017.

 
 

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.

 
 

Expenditures for home- and community-based services for Medicaid-eligible older adults and disabled individuals through Section 1915(c) waivers, used by some assisted living providers and others, topped $6.6 billion in 2018, according to a report released this week by the Centers for Medicare & Medicaid Services.

The amount was a 26% drop from the outlay of $8.9 billion in 2017, but it represented 7.1% of overall spending for long-term services and supports in 2018.

Twenty-nine states used Section 1915(c) waivers to cover services in residential care settings in 2016, according to separately reported data from the Medicaid and CHIP Payment and Access Commission.

Other highlights from the Medicaid report:

  • During 2017 and 2018, all states except Arizona, Rhode Island and Vermont operated at least one section 1915(c) waiver program.
  • In 2017, 80 programs in 41 states targeted older or disabled individuals.
  • Older or disabled individuals accounted for the majority of total LTSS spending in 2017 and 2018, representing approximately 55% to 56% of total expenditures in these years.
  • Section 1915(c) waiver programs for older or disabled individuals accounted for approximately 22.1% of total Section 1915(c) expenditures in 2017 and 22.4% in 2018. 
  • In 2017, states spent $56.1 billion for LTSS for older or disabled individuals, with 33.7% of total Medicaid LTSS expenditures devoted to HCBS. In 2018, states spent $50.8 billion, with 32.9% of total LTSS for HCBS.

In a separate report also released this week, CMS said that there were 2.24 participants per 1,000 residents in Section 1915(c) waiver programs for older or disabled individuals in 2016 and 2.23 per 1,000 in 2017. Average waiver expenditures per older or disabled individual were $13,543 in 2016 and increased approximately 10% to $14,949 in 2017.

For section 1915(c) waiver programs serving older or disabled individuals, Minnesota, Illinois, Oregon, Mississippi and Idaho served the greatest number of participants as a proportion of their populations, exceeding six per 1,000 residents in both years.

Other highlights of that report:

  • Forty-one of the 47 states (87%) with Section 1915(c) waiver programs in 2016 and 2017 provided services for older or disabled individuals. Delaware, Florida, Hawaii, New Mexico, Tennessee and Texas did not operate any waiver programs for this LTSS population in 2016.
  • The number of older or disabled waiver program participants per 1,000 state residents in 2016 ranged from less than one (Virginia and Colorado tied for lowest) to almost 10 (Minnesota).
  • Six states served fewer than one older or disabled 1915(c) waiver program participant per 1,000 state residents (Virginia, Colorado, California, Wisconsin, North Dakota and Utah) in 2016. Twenty-five of the 41 states (61%) had higher rates than the U.S. rate (2.2) that year.
  • States in the lowest quartile in 2016, with fewer than 1.5 participants per 1,000 residents, were Virginia, Colorado, California, Wisconsin, North Dakota, Utah, Nevada, Louisiana, North Carolina, New York, Maine and Michigan. Those in the highest quartile (where participants were greater than or equal to 4.5 per 1,000 residents) were Kansas, Connecticut, Pennsylvania, Oklahoma, Washington, Ohio, Idaho, Mississippi, Oregon, Illinois and Minnesota.
  • In 2016, average waiver expenditures per Section 1915(c) waiver program older or disabled participant ranged from $913 in Oregon to $37,321 in Kansas. Washington, which had the second-lowest average expenditure, spent $3,857 more per participant on average than Oregon in 2016 (or a total of $4,770 per older or disabled individual). States in the lowest quartile of average waiver expenditures per waiver program participant were Oregon, Washington, Missouri, Nevada, New York, Iowa, California, Idaho, Alabama, Wyoming and Kentucky.
  • In 2016, 18 of 41 states (44%) had average waiver expenditures greater than the U.S. total average. Among those in the highest quartile of average waiver expenditures were Connecticut, Wisconsin, North Carolina, Michigan, Maine, Louisiana, Minnesota, Colorado, Pennsylvania, Alaska and Kansas.
  • In 2017, seven states served fewer than one older or disabled waiver program participant per 1,000 state residents (Virginia, Colorado, New York, Wisconsin, California, North Dakota and Utah). Similar to 2016, 25 of the 41 states (61%) had higher rates than the U.S. rate in 2017 (2.2).
  • In 2017, average waiver expenditures ranged from a low of $1,061 in Oregon to a high of $53,987 in Kansas in 2017, and 19 of 41 states (46%) had average waiver expenditures greater than the U.S. total average.
  • The states in the lowest quartile of average waiver expenditures per older or disabled individual remained the same in 2017 as in 2016, except for the addition of Illinois and Oklahoma to the lowest quartile in 2017, replacing Kentucky and New York. 
  • The state with the largest decline in average waiver expenditures per older or disabled adult Section 1915(c) waiver program participant between 2016 and 2017 was Washington, which was a 69% decline. Among the states with the largest increases from 2016 to 2017 were Wisconsin (12%), California (14%), Connecticut (15%), Oregon (16%), Pennsylvania (17%), Iowa (18%), Virginia (41%), District of Columbia (44%), Kansas (45%) and New York (700 %).

 
 

Clipped from: https://www.mcknightsseniorliving.com/home/news/medicaid-pays-6-6-billion-for-hcbs-for-older-adults-through-section-1915c-waivers/

 
 

 
 

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WI Submits Medicaid Demonstration Waiver, Health Savings Account Program

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Wisconsin has asked CMS to put all of the premium payments made by Medicaid members into an HSA regardless of whether they achieve healthy behavior requirements.

 
 

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.

 
 

The Medicaid demonstration waiver, submitted to CMS in late December, seeks to leverage health savings accounts for childless Medicaid enrollees.

 
 

Source: Getty Images

 
 

By Hannah Nelson

January 21, 2021 – The Wisconsin Department of Health Services (DHS) has submitted an amendment to their section 1115 Medicaid demonstration waiver “BadgerCare Reform” for Centers for Medicare & Medicaid Services (CMS) approval to leverage a Medicaid health savings account (HSA) program for childless adults in the state.

Submitted on December 21, the amendment proposes that the full amount paid in premiums by individuals within the Medicaid/BadgerCare Plus program be deposited into a Medicaid HSA. Individuals could use then use the funds from their Medicaid HSA toward health expenses upon disenrollment from the BadgerCare Plus program.

This amendment would apply to enrollees aged 19 to 64 with incomes between 50-100 percent of the federal poverty line. Additionally, qualified members must not be pregnant or have dependent children under the age of 19 living in their home.

The federal public comment period will span from January 7, 2021 to February 6, 2021.

Under Wisconsin’s existing approved waiver, enrollees who fulfill healthy behavior incentives are charged lower premiums. However, this amendment would deposit additional funds to these enrollees’ HSAs so that regardless of whether an enrollee fulfills the healthy behavior incentives or not, the same amount of money would be deposited.

HSAs are considered an experimental approach in Medicaid programs. According to a 2018 Health Affairs study from Harvard T.H. Chan School of Public Health, there may be unintended consequences of an HSA program since these accounts are not commonly used. For instance, enrollees could be confused by the HSA program which may dissuade some people from enrolling.

“There’s been a lot of recent research showing that expanding Medicaid leads to improved access to care and better quality of care—which suggests that any expansion will be better for public health than not expanding. But our findings suggest that some of the benefits of expanding Medicaid may be at least partially compromised by some of the current innovations in use,” said Benjamin Sommers, associate professor of health policy and economics at Harvard T.H. Chan School and lead author of the study.

Under the Trump Administration, which prioritized increased state flexibility for Medicaid programs, some states have experimented with new approaches.

The researchers assessed views about new Medicaid policies approved by CMS in Ohio, Indiana, and Kansas through a telephone survey of 2,739 low-income adults. The survey gathered responses related to health savings accounts, financial well-being, access to care, experiences with the Affordable Care Act (ACA), work requirements, and private vs. public insurance coverage.

In 2015, Medicaid coverage was expanded in Indiana, but enrollees are required to pay premiums and contribute to HSAs, similar to what Wisconsin is proposing in their Medicaid demonstration waiver. On the other hand, Ohio expanded Medicaid coverage without premiums and with minimal cost-sharing.

The researchers found that cost-related barriers to care were more prevalent in Indiana, where enrollees were required to contribute to HSAs.

According to the survey respondents from Indiana, the health savings accounts caused confusion. Nearly 40 percent of those interviewed said they had never heard of the required accounts, and only 36 percent made regular required payments. This means that two-thirds of beneficiaries were at risk of losing benefits or coverage.

“For both work requirements and health savings accounts, the policies may operate as intended for modest numbers of Medicaid beneficiaries who understand or react to the incentives. But there’s a real risk that even greater numbers of low-income adults will be adversely affected because they don’t understand the new policies, can’t afford them, or get tied up in administrative complexity. For these reasons, it’s critical that there be ongoing independent monitoring of these approaches,” Sommers said.

 
 

Clipped from: https://healthpayerintelligence.com/news/wi-submits-medicaid-demonstration-waiver-health-savings-account-program

 
 

 
 

 
 

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Nevada lawmakers told Medicaid will require nearly $12 billion over 2 years

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Medicaid now consumes more than 33% of the Nevada budget, and will spend $2B next year than the year before.

 
 

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.

 
 

Lawmakers were told Thursday that the total Medicaid budget will consume $11.87 billion over the coming two-year budget cycle, more than a third of the total state budget for the coming two years.

That is an increase of $2.3 billion over the current budget, largely the result of the economic collapse caused by the pandemic.

Medicaid Administrator Suzanne Bierman told members of the Senate Finance and Assembly Ways and Means committees the reason is that the number of people receiving Medicaid coverage increased 128,139 since February 2020. By the end of the coming biennium, officials predict Medicaid will be serving 788,000 Nevadans — more than a quarter of the state population.

The federal government is currently covering 68 percent of that amount through the enhanced federal contribution that historically pays most of Medicaid for the states. Bierman said projections are that the percentage will decrease to 63 or 64 percent in the coming two years.

Officials are hoping the enhanced match percent will be extended but that decision hasn’t yet been made.

The total budget proposed by Gov. Steve Sisolak is $31.4 billion for the coming two years. While Medicaid is the majority of HHS spending, the department’s total budget is fully half the entire state budget at just over $15 billion when its other divisions are added in.

The proposed Medicaid budget does restore the 6 percent Medicaid provider rate reduction enacted by the special legislative session last summer. But Bierman said clearing that reduction through the Centers for Medicare and Medicaid Services takes time and it has not yet been authorized.

She said, however, her division is in contact with hospitals and other providers, advising them that, if and when the reductions are approved, the payments to those providers will be reduced retroactively back to August. Providers, she said, are still getting paid at the pre-reduction rates.

Several lawmakers questioned some of the reductions in other parts of the department.

There will be reductions in other divisions including Child and Family Services, Behavioral Health, Aging and Disability Services and Welfare that officials concede could impact clients in a long list of programs to achieve the necessary budget reductions and extend some waiting lists for different services. Dozens of positions will remain vacant in fiscal 2022 but the proposed budget says most will be restored and filled in 2023 as the state continues to recover.

HHS provides all those social, mental health and health services relied upon by the poor, mentally and physically disabled, the medically frail, children and the elderly including those in all categories in long-term care facilities.

In most cases, department officials say there won’t be a reduction in services in most cases but it may take longer for new clients to get services.

Lawmakers expressed concerns about holding some professional positions vacant in the northern and southern Nevada Mental Health facilities but division officials said they are having extreme difficulties filling those posts because private facilities pay significantly more for doctors, nurses, mental health professionals and other medical and psychiatric professionals.

The legislative briefings continue Friday with overviews of the K-12 and the Nevada System of Higher Education budgets along with the military department budget.

 
 

 
 

Clipped from: https://www.nevadaappeal.com/news/nevada-lawmakers-told-medicaid-will-require-nearly-12-billion-over-2-years/

 
 

 
 

 
 

 
 

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State senators argue over plans to move Medicaid onto managed care contractors (Oklahoma)

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Lawmakers do the normal “big bad managed care” dance on the eve of managed care coming to Oklahoma.

 
 

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.

  
 

OKLAHOMA CITY (KFOR) – Oklahoma lawmakers are duking it out over plans to move Medicaid patients to managed care contractors. On Thursday, a group of Republican state senators joined ranks with those who oppose the change.

As the state heads toward expanding Medicaid, Gov. Kevin Stitt is seeking a managed care contractor who will take on those new patients and others.

OKDHS announces retroactive rate adjustment for Medicaid Waiver providers

But on Thursday, State Sen. George Burns and eight other state senators sent him a letter urging him to change course. The letter pointed out that the move won’t save the state money, and that those Sen. Burns knows who are familiar with managed care companies said they only benefit out-of-state insurance companies and their stockholders.

Their objections fall in line with those of several state healthcare associations who point out that while the current Medicaid program run through the Oklahoma Health Care Association works with about 3 percent overhead, a managed care company requires something closer to 12-15-percent for administrative costs.

But a different Republican lawmaker, State Sen. Kim David, is a big believer in making the change.

“We’re 48th in the nation and we have been forever,” she said. “Forty-eighth in the nation for healthcare outcomes.”

State representatives talk what’s next for Oklahoma’s Medicaid expansion funding following SQ814 failure

After years of researching solutions to Oklahoma health outcome issue, she said she’s confident managed care will provide something our current healthcare system lacks: hands-on help to navigate healthcare for Oklahomans.

“[Someone who] helps people get those appointments with those primary care providers, make those appointments, make sure they have a ride to the doctor, make sure they get prescriptions filled,” she said.

Sen. David insists this will improve patient outcomes.

As for the money issue, she said that’s not where the focus should be.

“Money does not equate health outcomes,” Sen. David said. “What they like is they like the fact that we pay in two weeks.”

Dr. Mary Clarke with the Oklahoma State Medical Association agrees that managed care does typically reimburse providers more slowly, sometimes taking several months to pay a doctor for their care.

“We may not get paid for months and that’s hard to keep the small rural practices open,” Dr. Clarke said.

Medicaid expansion leads to battle over TSET funds in SQ 814

She argued that not only did managed care not work in Oklahoma in the 1990s, but that the higher cost of the care will result in patient claims being denied.

“It’s easy to think this is going to save money and improve quality, but we have lots of historical research that will show that it does not. Trying it again is not going to come out with a different outcome,” Dr. Clarke said.

The OHCA also advocates for making the move to managed care.

Gov. Stitt was not available for an interview, but sent KFOR the following statement Thursday:

“Our state is stuck near the bottom of the list in almost every major health outcome. Oklahomans hired me to bring a fresh set of eyes to all areas of state government, and as governor, I can’t stand by and continue with business as usual when the system isn’t working. Moving to a managed care model will deliver better health care for Oklahomans and provide the cost certainty needed to protect our investment in other priorities like education and transportation.”

GOV. KEVIN STITT

Clipped from: https://kfor.com/news/local/state-senators-argue-over-plans-to-move-medicaid-onto-managed-care-contractors/

 
 

 
 

 
 

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Amazon surpasses Walmart for most Nevada employees and dependents on Medicaid

MM Curator summary

 
 

7,892 Amazon employees are on Nevada Medicaid now, up from 4,040 last year.

 
 

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.

  
 

Amazon has surpassed Walmart to become the employer with the most employees and dependents on Medicaid in Nevada, according to a new report from the state. 

The number of Nevada Amazon employees and dependents on Medicaid nearly doubled year over year, increasing from 4,040 to 7,892, despite statements on the company’s website that they offer medical, prescription drug, dental, and vision coverage to all of their employees, regardless of their level or position. Amazon reports having more than 10,500 full and part time jobs in the state.

The massive jump in Amazon employees and dependents covered by Medicaid came alongside a significant jump for Integrity Staffing Solutions, a job placement company that has two of its three listed Nevada offices located at Amazon fulfillment centers.

Integrity Staffing Solutions was the fifth-largest Nevada employer of Medicaid-covered employees and dependents in the 2020 fiscal year, increasing from less than 500 in the previous year to 1,746.

Walmart, the leading employer of Nevada Medicaid recipients in the last three fiscal years, fell behind Amazon, but its number of Medicaid-covered employees and dependents also continued to rise, increasing about 11 percent from the previous year to 7,725 in the last fiscal year.

Nevada Medicaid Recipients Employed by Employers with 50 or More Employees
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Of the nearly 8,000 Nevada Walmart employees and dependents on Medicaid, 3,429 were company employees. The company reports having 14,548 employees in the state. Amazon would not indicate how many people it employs in the state.

Quentin Savwoir, the political director of Make It Work Nevada, a progressive non-profit and advocacy group, sees a problem with these increasing numbers. 

“If these corporations like Walmart, like an Amazon, invested in things like paying families quality, affordable childcare, or even just paying their employees equal pay, that would go a long way to making the lives of the women and families we work alongside a little bit better,” said Savwoir. “They wouldn’t have the need to rely on the social safety net.”

When asked for comment, Walmart’s communications department offered information about the pay and health care coverage provided to employees, including that the average total compensation and benefits for its hourly employees, both full- and part-time, is more than $18 an hour as of last January — and that eligible full- and part-time employees can receive medical coverage beginning at a cost of $30.50 per biweekly pay period. It also stated that the company’s goal is “moving people beyond entry-level jobs.”

An Amazon spokesperson said that the figures in the report are misleading because they include part-time workers and people who were only employed by Amazon for a short time, including seasonal employees.

“We have hundreds of full-time roles available, however, some prefer part-time for the flexibility or other personal reasons,” an Amazon spokesperson said.

In Nevada, households with annual incomes of up to 138 percent of the federal poverty level — $16,753 per year for an individual or $34,638 per year for a family of four — may qualify for Medicaid. A single adult with three children would have to earn almost $17 per hour while working 40 hours per week to no longer be eligible for Medicaid.

That means that even full-time employees working for companies like Amazon and Walmart could qualify. Amazon pays its employees a minimum wage of $15 per hour, and Walmart employees in Nevada earn an average wage of $14.84 per hour.

The report from the Department of Health and Human Services’ Office of Analytics, which was mandated by a bill the Legislature passed in 2017, comes on the heels of a nationwide report released last November by the Government Accountability Office (GAO) that showed some similar trends.

The GAO report found that across the 11 states studied, Walmart was consistently one of the top employers of Medicaid and SNAP recipients. The report also showed that Amazon was among the top employers of workers on Medicaid. 

Sen. Bernie Sanders of Vermont, who commissioned the GAO report, called the findings “morally obscene.”

“U.S. taxpayers should not be forced to subsidize some of the largest and most profitable corporations in America,” Sanders said in a press release.

The growth in Medicaid recipients from employers with 50 or more employees resulted in an increased cost to Nevada Medicaid of $2.8 million from the 2019 to 2020 fiscal year.

That increase was much less than the combined increase for Amazon and Walmart employees — which in 2020 was nearly $12 million more than the previous year. However, that was offset by the decrease in the number of employees and dependents covered by Nevada Medicaid at other companies, including Clark County School District, Smith’s Food and Drug and Wynn Resorts.

During the 2020 fiscal year, Amazon and Walmart employees and dependents’ cost to Nevada Medicaid was more than $43 million. In that same period, the cost to Nevada Medicaid from companies with 50 or more employees was approximately $737 million.
As of November, more than 761,000 Nevadans were enrolled in Medicaid, which was 120,000 more than the 2019 Legislature had predicted. To account for that growth, Nevada will spend an additional $153.5 million on Medicaid in fiscal year 2022, according to the latest state budget proposal.

 
 

Clipped from: https://thenevadaindependent.com/article/amazon-surpasses-walmart-for-most-nevada-employees-and-dependents-on-medicaid