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NY counties continue to pay increasing Medicaid costs that they cannot directly impact.

 
 

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.

 
 

Genesee County is on track to spend more than $9 million on Medicaid this year and New York State is doing very little to help alleviate this local obligation, according to the director of the county’s Department of Social Services.

Presenting his departmental review at Monday’s Genesee County Legislature Human Services Committee meeting, David Rumsey (photo above) said the county has little input over the government-financed health insurance program for eligible people.

Approximately 3,000 county residents are on Medicaid, he said, and that number continues to increase.

“The transition of Medicaid administrative functions from the county to the state remains unchanged. There has been no additional movement by the state to take over the Medicaid administrative functions,” he said.

Rumsey also mentioned the inordinate amount of time spent on determining people’s eligibility in light of the required five-year lookback period for chronic care (nursing home) cases.

“The Medicaid assistance programs have the greatest burden to the county, but for which we have little control,” he added, reporting that projected spending by the county for Medicaid in 2021 is $9,052,134.

In his report, Rumsey touched upon other programs and services offered by DSS as well as its budget status.

2021 BUDGET STATUS

Anticipated 20 percent cuts in state aid did not occur, he said, keeping the DSS budget on track for 2021.

“The pandemic continued to bring uncertainty about the projected funding streams and allocations, and it still does,” he said.

Rumsey said he is monitoring state training school expenses since the number of youths currently in detention will need to be budgeted for in 2023 (two-year billing cycle). 

He also reported that required training for new employees hired over the last year was put on hold at the state level.

“The state is currently formulating a plan to move the virtual training back to in-person, but this plan is reliant on the continued safety for the trainees that attend,” he said.

PROGRAMMING

— Temporary Assistance (Public Assistance): This unit provides cash assistance to individuals or families, with benefits provided based on eligibility and on-going case monitoring.

“The overall monthly caseload is trending downward with a decrease in both Family Assistance and Safety Net,” he said. “There has not been a significant increase in homelessness noted yet.  The eviction moratorium is extended through January 15, 2022 which may change this trend.”

— Emergency Rental Assistance Program (ERAP):  This was rolled out by the Office of Temporary and Disability Assistance to assist renters and landlords, but the start was “slow and not successful,” Rumsey said.

He said most of the funds went to renters, while assistance to landlords lagged behind.

“A lot of landlords had property damaged,” he said. “Now, they are getting a few more rights.”

— Fraud: The DSS Fraud Department has been very busy, Rumsey said, with its two investigators following up on Font End Detection System referrals, Intentional Program Violations, prison matches, and allegations of welfare fraud.

— Child Support: Federal guidelines strive for a minimum collection rate of 80 percent; DSS is at 78.94 percent, well above the state average of 67.20 percent, Rumsey said.

“This unit continues to work to ensure right sized orders are established and appropriate modifications to existing orders is occurring,” he said. “The COVID-19 pandemic caused delays in the operations of this unit as the Child Support Court was temporarily closed.”

Other programs include Home Energy Assistance and Supplemental Nutritional Assistance.

SERVICES

— Family First: In a move that will save the county money, the state is requiring the local DSS offices to reduce the number of residential placements by 12 percent.

“The Family First initiative is also requiring us to have at least 30 percent of our total foster care population in a certified Kinship (relative) foster home, and we are currently meeting both requirements,” Rumsey reported.

He also said that the Family First Prevention Act reforms federal financing to prioritize family-based foster care, preferably with kin, over residential care by limiting federal reimbursement for certain residential placements.

— Foster Care: The DSS foster care unit has certified nine new foster homes this year, with three more pending by the end of the year, Rumsey said. Of the nine, three were “kinship” and six were regular foster care. DSS also was able to certify one new cluster foster home, increasing that number to four.

Rumsey said the county saved money this year through a reduction in voluntary agency therapeutic foster care placements and utilizing certified county foster homes.   

— Preventive Services: Mandated preventive services are provided to assist families and children in meeting their needs and keeping the youth out of foster care placements. Rumsey said that through August, DSS has worked with 222 children with only five being placed outside of the home.

— Child Protective Services: Through August, DSS has handled 646 cases of suspected child abuse and maltreatment, he said, with investigations taking place within 60 days as mandated by New York State. For September, there were 32 more CPS cases compared to September 2020.

“Moving forward these cases will be harder to determine because there is the movement from needing just credible evidence to having a preponderance of the evidence, which is a higher standard that must be met,” Rumsey advised.

— Adoptions: DSS assisted in the adoption of four children with expectations that another three will be finalized by the end of the year.  Of the 54 youth in foster care, 10 are freed for adoption, he said.

Rumsey said that 115 children are currently receiving adoption subsidy payments.

The current annual adoption subsidy rates are basic $7,800, special $9,358 and exceptional $12,453.

“The other concern is that once a foster family adopts children, they rarely continue as foster parent resources for other children who are placed,” he said. “Permanency for children often results in shortages of foster parents.”

— Adult Services: Currently, DSS has 155 Adult Preventive and Protective Services for Adults cases, with 33 of those personal care cases being monitored.

“DSS continues to partner with the Office for the Aging, the District Attorney, the Sheriff and Lifespan in a coordinated Enhanced Multi-Disciplinary Team to work together to assist our elderly Genesee County residents in combating elder abuse and financial exploitation,” he reported.

— Detention: In 2021, five youths were placed into OCFS State Training Schools, which are very costly to the county, Rumsey said. The current detention rate is $468.17/day.

Photo by Mike Pettinella.

 
 

Clipped from: https://www.thebatavian.com/mike-pettinella/dss-director-no-relief-in-sight-from-new-york-state-to-alleviate-countys-medicaid

 
 

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Miami is now operating a “provider tax” program to maximize federal dollars for hospital Medicaid revenues.

 
 

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.

 
 

 
 

Miami-Dade County now has a Medicaid Hospital Directed Payment Program (DPP) to give local hospitals financial relief made necessary by unreimbursed Medicaid costs.
The ordinance by Commissioner René García, unanimously approved Sept. 1, would take effect in ten days. The program would provide financial relief to Miami-Dade hospitals, which incur $524 million in unreimbursed Medicaid costs each year. Currently, Miami-Dade has nearly 17% of the state’s Medicaid enrollees, a memo from Chief Financial Officer Edward Marquez says.
The DPP is a Medicaid matching program funded through local non-ad valorem special assessments on local hospitals. The revenue generated through this special assessment is placed in a local provider participation trust fund and is matched with federal funds to provide hospitals with supplemental Medicaid reimbursement.
“The passage of this ordinance will ensure that our community’s low-income patients benefit from enhanced healthcare services, and hospitals are able to improve their facilities and patient care through the creation of this program, which ensures Miami-Dade County and its residents receive their fair share of federal Medicaid funding,” said Commissioner García in a press note.
Commissioner Rebeca Sosa expressed similar sentiments at the meeting. “When hospitals face staggering losses, they cannot provide the care necessary for the population, those losses prevent or delay upgrades to facilities and staff, and they can create pressure on public facilities. So, it’s a pleasure to join our senator Rene García and all my other colleagues in this item.”
At the July 8 commission meeting, four representatives from local hospitals spoke in favor of the now-approved ordinance. Gino Santorini, CEO of Mount Sinai, said Medicaid comes at a loss in terms of covering the costs, so “this is an opportunity to unlock some federal funds, which would bring about $300 million down to offset that which will really help to benefit all the hospitals, the employers and the county health in general.”
Dawn Javersack, chief financial officer (CFO) of Nicklaus Children’s Health System, said “seven out of every 10 patients that we see are Medicaid beneficiaries and they represent some of the most vulnerable population… This is really important in terms of the care that’s provided to those patients.”
Sanjay Shetty, president of Steward Health Care North America, and Dawn White, vice president of Government and Community Relations for Baptist Health, also expressed support for the creation of the program.
“I am so pleased that the county commission unanimously supported this innovative mechanism for drawing down more funding to cover the costs of care for our low-income residents,” said Mayor Daniella Levine Cava in a press release. “Our local hospitals treat patients with professionalism and compassion. They deserve our support so they can meet the healthcare needs of Miami-Dade families.”

 
 

Clipped from: https://www.miamitodaynews.com/2021/09/07/county-throws-lifeline-to-hospitals-drowning-in-medicaid/

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GA budget officials are notifying the Governor that Medicaid spending needs to go up while state employee benefit funds are decreasing.

 
 

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 agency that provides health care to about 2 million Georgians is requesting an increase of almost $500 million in its state budget over the next year and a half.

Enrollment growth in Medicaid — the state-federal health care plan for the poor and disabled — and rising usage and costs will continue to put a bigger dent in government coffers, officials said Thursday,

Meanwhile, Lisa Walker, chief financial officer of the Department of Community Health, said the health care plan for more than 650,000 teachers, state employees, retirees and their dependents could see two-thirds of its reserve drained by 2024 as expenses outpace revenue from premiums and government subsidies.

Both have become common scenarios for the government programs that fund health care for about a quarter of the state’s population: Heath care costs continue to rise in Medicaid, and that means a larger infusion of taxpayer money into the system. The State Health Benefit Plan for teachers and state employees is regularly projected to run a shortfall in coming years.

Gov. Brian Kemp last month told state agency directors not to request spending increases in the coming year, but he made exceptions for programs that expected to see a rise in usage and expenditures. As in past years, a vast majority of that increase will be in k-12 schools, colleges and the Department of Community Health, which runs the Medicaid and State Health Benefit Plan programs.

Enrollment in some health plans run by the DCH spiked during the initial months of the COVID-19 pandemic as Georgians lost jobs both during and after the economic shutdown.

At the same time, many of those in the program delayed care due to the fear of infection or other reasons. DCH officials expected Medicaid recipients to return to the doctor for treatment this year as COVID-19 vaccinations became more available.

The federal government pays for the majority of the DCH’s $17 billion budget, although the state also chips in several billion dollars. The DCH’s budget, when including federal funding, is the largest part of the state government’s spending.

The DCH has to ask for a big increase in funding pretty much every year as health costs rise. Walker said the department is requesting $122 million more in the midyear budget — which runs through June 30 — and $359 million more in fiscal 2023, which begins July 1.

The agency’s request now goes to Kemp, who will decide what to include in the budget proposal he will deliver to the General Assembly in January.

Besides presenting the DCH budget proposal, Walker on Thursday gave the agency’s board a briefing on the financial status of the State Health Benefit Plan.

Money for the program comes from employee/retiree premiums and the government.

The Community Health board earlier this month froze premiums for members for the third time in four years.

Walker said expenses outpaced revenue by $89 million last fiscal year and would do so by about $337 million this year.

The program currently has about $3 billion in reserve, but that could fall to $1 billion by the end of fiscal 2024 as losses escalate. The trend could be reversed by higher premiums, increased government subsidies, reduced expenditures or changes in the heath coverage.

The teachers, state employees and retirees on the program keep a close eye on its finances because lawmakers raided the reserve during the Great Recession to help the state balance its books. That led to higher premiums and attempts to change benefits to build back the reserve.

DCH officials have projected massive shortfalls in the past, so teacher groups have expressed skepticism about the estimates.

 
 

Clipped from: https://www.ajc.com/politics/georgia-medicaid-agency-requesting-nearly-500-million-more-in-health-spending/ZJVT5X34NJCHBMRZYPRBGOHEFM/

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Florida budget analyst release the first look at what the impact of ending the additional 6.2% in pandemic funding.

 
 

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 estimates show an anticipated $417 million deficit in Medicaid for the current fiscal year, which will end June 30, and a $1.434 billion deficit in the 2022-23 fiscal year.
 

Florida’s swelling Medicaid rolls are expected to help create a nearly $1.9 billion deficit in the safety-net health care program over the next 22 months, according to new estimates drawn up by a state panel.

The estimates, posted Friday, show an anticipated $417 million deficit in Medicaid for the current fiscal year, which will end June 30, and a $1.434 billion deficit in the 2022-23 fiscal year.

In 2022-23, economists estimate the state will need to spend $35.4 billion to keep the Medicaid program operating at current levels. During that year, economists project that lawmakers will need an additional $1.1 billion in general revenue to fund the state’s portion of Medicaid, which is jointly financed with the federal government.

Along with facing increased enrollment amid the COVID-19 pandemic, the state will need to boost spending because of an anticipated loss of enhanced federal Medicaid funding.

Congress agreed in March 2020 to beef up the amount it spends on Medicaid by 6.2 percentage points to help states during the pandemic. The more the federal government contributes to the costs of the program, the less the state has to pay.

The Biden administration has extended the increased funding through this calendar year, but state economists did not plan on any of the additional funding beyond Dec. 31.

Economists assumed an average 1 percent rate increase in payments to Medicaid long-term care plans and an average 3.6 percent increase in payments to Medicaid managed “medical assistance” plans, effective Oct. 1.

Managed medical assistance plans provide managed care to the broadest group of Medicaid beneficiaries.

The new forecast came after recent estimates that more than 5 million residents will be enrolled in Medicaid between now and June 30.

 
 

Clipped from: https://health.wusf.usf.edu/health-news-florida/2021-08-25/florida-medicaid-could-face-hefty-deficits

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The exit of a major health system from the MO provider tax scheme threatens to weaken the overall success of the arrangement.

 
 

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.

 
 

Truman Medical Centers in Kansas City will stop contributing to a financial pooling arrangement that helps maintain political support for a tax that pumps hundreds of millions of dollars into Missouri’s Medicaid program every year. 

 
 

The move, which lawmakers began learning about last week, has raised concerns that other providers could follow Truman’s lead — and could ultimately doom the provider tax and the funding it has provided the state for nearly three decades. 

The provider taxes were first enacted in 1992, but a bitter political fight over contraceptive coverage and Planned Parenthood pushed an extension of the taxes into a special legislative session in late June. House Budget Committee Chairman Cody Smith, R-Carthage, who guided the bill through the House, said the pooling arrangement has helped maintain support for the taxes from hospitals that do not serve a large number of Medicaid clients. 

Truman’s decision “is a big blow to the concept, I would think, as they are the largest Medicaid provider,” Smith said. 

TMC has two campuses – one at Hospital Hill in Kansas City and the Lakewood campus, which is a major health-care provider in Eastern Jackson County.

Pulling out of the pool wasn’t an easy decision, Keith King, spokesman for Truman Medical Centers, wrote in an email to The Independent. But he said it is necessary for the hospital’s financial stability.  

“As a safety-net hospital and largest single provider of uncompensated care in our region, Truman Medical Centers/University Health operates on a lower operating margin than most Missouri hospitals,” King wrote. 

The special session extended the provider taxes through 2024. 

Hospitals pay a tax of about 5.75 percent on patient revenues that produces about $1.7 billion annually to support the Medicaid program. Called the federal reimbursement allowance, or FRA, the money finances payments for hospital care and other services provided by Medicaid. 

There are similar taxes on nursing homes, pharmacies and ambulance services. 

For hospitals like Truman that serve a large Medicaid clientele, the tax is paid by deducting what is owed from Medicaid payments. Hospitals that have a limited number of Medicaid patients remit cash to the state. 

The pool is a voluntary arrangement managed by the Missouri Hospital Association. Participating hospitals that receive more in Medicaid payments than they pay in FRA taxes contribute to the pool and hospitals that pay money to the state receive funds to offset the taxes. 

The pool handles about $80 million annually, said Dave Dillon, spokesman for the association. 

“Hospitals that serve a significant number of uninsured may gain more financially by walking away,” Dillon wrote in an email. “That’s why we work so hard to maintain the pooling arrangement — because it levels the playing field between potential winners and losers in the FRA, and keeps everyone in the tent.” 

SSM Health, which operates nine hospitals in Missouri, pulled out of the pooling arrangement during 2019, when it was enduring financial stress that led it to put three hospitals up for sale. 

The action by Truman Medical Centers comes as the state is imposing cuts on hospital payments. Gov. Mike Parson vetoed a $50 million appropriation intended to offset cuts to payments for outpatient services, and the hospital association is suing over plans to cut payments for inpatient services. 

“The move to managed care, outpatient fee schedules and other factors have destabilized hospitals’ 30-year relationship with the state in the FRA,” Dillon wrote in an emaicl. “Like the game Jenga, the more parts of the structure that are removed, the less stable the whole platform.” 

Neither Truman nor the hospital association would say how much Truman contributes to the pool.  

“But here’s the bottom line: This is a tough year all around, and we’ve been looking at every expense to see what we can cut to potentially meet that small margin we talked about earlier,” King wrote in the email. “These kind of cuts are never easy, but we make them to ensure we can continue to take care of our patients at the level they deserve.” 

The full impact of Truman’s withdrawal from the pool may not be known until the FRA is up for renewal again in 2024. Support from providers for the taxes is vital to the regular passage of extensions. 

“This is about goodwill, it is about having a wider view of this program,” Dillon said in an interview. “It is what underpins the kind of collaborations necessary to do the FRA.” 

Rudi Keller covers the state budget, energy and the legislature. He’s spent 22 of his 30 years in journalism covering Missouri government and politics, most recently as the news editor of the Columbia Daily Tribune. Keller has won awards for spot news and investigative reporting. 

 
 

Clipped from: https://www.examiner.net/story/news/2021/08/11/tmc-leaving-medicaid-provider-tax-pool/5568537001/