Tag: Finance

MM Curator summary

A new expose shows how hospitals diverted money meant for nursing homes in a widespread, multi-year scandal.

 
 

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.

A tip about Indiana’s largest nursing home system leads an investigative team to expose how public hospital officials in Indiana exploited the Medicaid program’s lax oversight.

 
 

Annually, the Shorenstein Center on Media, Politics and Public Policy awards the Goldsmith Prize for Investigative Reporting to a stellar investigative report that has had a direct impact on government, politics and policy at the national, state or local levels. Six reporting teams were chosen as finalists for the 2021 prize, which carries a $10,000 award for finalists and $25,000 for the winner. The Journalist’s Resource is interviewing many of the finalists to offer a behind-the-scenes look at the processes, tools and legwork it takes to create an important piece of investigative journalism. The entry discussed here, “Careless,” was published in the Indianopolis Star. The Journalist’s Resource is a project of the Shorenstein Center, but was not involved in judging the Goldsmith Prize. The winner of the $25,000 will be announced on April 13.

What started as a tip about Indiana’s largest nursing home system led an investigative team at the Indianapolis Star to expose how public hospital officials in Indiana exploited the Medicaid program’s lax oversight to take billions of dollars in federal money meant to go to nursing homes and divert them to build shiny new hospital facilities. In some cases, hospital executives took home large compensation packages while diverting the money.

The journalists revealed that even though Indiana raked in more supplemental Medicaid funds for nursing homes than almost any other state, its nursing homes ranked among the worst in the nation. Most were understaffed, a problem that was exacerbated by the pandemic and led to hundreds of deaths that potentially could have been prevented, the reporters learned. 

What the county hospitals have been doing is not illegal. They’ve been taking advantage of a regulatory loophole in the Medicaid program. But the scheme has been marred with scandals and fraud. In 2016, federal officials prosecuted five people and recovered $15.5 million in taxpayer dollars in scandals involving the nursing homes. But there was more. With their in-depth investigative series, “Careless,” the reporters gained the trust of a source who shared a secret, 277-page report that claimed 20 more people were involved in a number of schemes to defraud Indiana’s nursing home system of at least $35 million. 

As a result of the stories, Indiana’s largest public hospital system, the Health & Hospital Corp. of Marion County, commissioned an outside review of its nursing home operations in May. In August, the hospital system’s long-time leader was forced to resign by the board. City officials, who oversee the hospital corporation’s budget, held a special hearing and budgeted additional tens of millions for its nursing home operations. At the state level, Gov. Eric Holcomb said in December that his office was working on reforms to the state’s elder care that could tie Medicaid payments to nursing home quality, according to the newspaper.

“What’s not being discussed is increasing Indiana’s minimum staffing ratios,” says Tony Cook, an investigative reporter at the Indianapolis Star, who received the initial tip in 2019.  

His editor, Steve Berta, known for looking at the bigger picture, suggested taking a close look at where the nursing home money was coming from. Cook teamed up with two colleagues, veteran investigative reporter Tim Evans, who was inducted to Indiana Journalism Hall of Fame last year, and data reporter Emily Hopkins. They set out to follow the money trail. 

Following the money

The nursing home industry is complicated and often secretive. The IndyStar investigative team, which faced pushback from local hospitals, had a steep learning curve. But that didn’t deter them from pursuing the story.

“There are layers and layers and it did take a while to really understand how it all worked,” Cook says. “The way we did it was just by trying to understand how the money flowed.” 

Medicaid is a state and federal public health program for low-income individuals, including seniors who need nursing home care.

The IndyStar team used an annual report compiled by the Medicaid and CHIP Payment and Access Commission, or MACPAC, to understand what types of Medicaid funds their state received and how it compared with other states. 

“The first step is to understand whether or not your state receives these types of funds,” says Hopkins. “Once you understand that they are receiving these funds, you can kind of go straight from there down to how much and who has received it at that level.” 

The team learned that in 2019, Indiana received $679 million in extra Medicaid payments for nursing homes, more than any other state. These extra payments, known as supplemental Medicaid funds, are meant for nursing homes owned by local governments. In Indiana’s case, that government entity was the county hospitals.

A decade earlier, Evans had been part of a team at IndyStar that reported on a scheme where a local county hospital was buying nursing homes to qualify for the supplemental Medicaid funds. He did the story and moved on.

“The first step is to understand whether or not your state receives these types of funds. Once you understand that they are receiving these funds, you can kind of go straight from there down to how much and who has received it at that level.” 

Emily Hopkins

The team found that since then, county-owned nursing homes had become the norm rather than the exception. By 2019, nearly two dozen county hospitals had bought up 93% of Indiana’s 534 nursing homes. A regulatory loophole allows the hospitals to spend the money on non-nursing home expenses, such as new hospital construction. Because Medicaid officials don’t track how the money is spent, the amount of money the hospitals divert remains a secret.

No one at the state or federal level knew how much Medicaid money had been siphoned away. 

The reporters asked the 22 county hospitals, which are public entities subject to records requests, how much money they had diverted from nursing homes. Only seven responded, acknowledging they had redirected between 66% and 70% of the supplemental Medicaid funds to the hospitals. The reporters determined that county hospitals had diverted at least $1 billion of the $4.5 billion in enhanced Medicaid funding they had received since 2003. They estimated that the true total could be as much as $3 billion.

The reporters also wanted to know how supplemental Medicaid funds compared with the regular Medicaid rate and how much money each Indiana nursing home received. They asked the state health department, which pointed them to an accounting firm that had done the calculations for the state. 

In Indiana, Medicaid pays nursing homes an average of $207.91 a day for each patient. But nursing homes owned by county hospitals get another $120.38, or 58% more, the reporters learned. They also learned how much additional Medicaid money each nursing home was generating. To get historic data, they filed a public records request with the state. 

Tip: Understand the structure of your local hospitals. Are they public, nonprofit or for-profit? Find out what financial documents they have to file with local or state authorities. And check free sites like EMMA to find their financial reports and public debt.

But the officials at the county hospitals wouldn’t say how they spent the money. County hospitals are funded by a variety of taxpayer funds, such as Medicaid, Medicare and sometimes local taxes. As public agencies, they must make public records available, but officials told the IndyStar that the information the reporters requested was a “trade secret” and exempt from public records laws. They denied their requests, which the IndyStar is appealing. 

“County hospitals are public entities but they operate and act a lot more like their private counterparts,” says Hopkins. “They’re not used to being held accountable or being transparent in the way that other agencies are. So I think they were very taken aback when they started to receive these [public records] requests.”

In Indiana, county hospitals have to file annual financial reports with the state. That helped the IndyStar team find out how much the county hospitals had come to rely on nursing home funding. For at least two hospitals, the nursing homes made up 40% of the money the hospitals brought in. 

Unraveling a complicated structure

The fraud tip that Cook had received in 2019 helped the investigative team learn that even though many Indiana nursing homes were owned by county hospitals, a private company oversaw them. 

The investigative team then asked the county hospitals for copies of their contracts with the nursing homes. Only a few provided them, however.

Cook, Evans and Hopkins learned that county hospitals set up contracts that brought nursing homes under their names. The state allowed the county hospitals to buy nursing homes outside their counties, too. Meanwhile, the private nursing homes continued to own the nursing homes’ buildings and managed their day-to-day operations. 

The reporters also learned that the hospitals gave almost all administrative control over the nursing homes to the private companies. For instance, county hospitals had no say on nursing home staffing decisions.

“One of the things that we were trying to drill into the readers’ minds was that these county hospitals really don’t have much to do with the nursing homes, except financially,” says Hopkins. “So you have these CEOs who technically, you know, should be responsible for this vast network of health facilities that are under their portfolio. But they kind of only focus on the hospital.” 

CEO salaries

County hospitals refused to disclose their CEO salaries. And the reporters could not retrieve the data from IRS Form 990s because public hospitals don’t file them. That’s unlike nonprofit hospitals, which are tax exempt, and must file Form 990 annually to provide information about their revenue, expenses and executive compensation.

But the IndyStar team realized that many hospital have foundations, which are nonprofits and have to file an IRS form 990 annually. Hospital foundations raise money for projects and services. The journalists found information about county hospital CEO compensation in a fraction of those tax filings.

“So we were really working with breadcrumbs,” says Hopkins. “But fortunately for us, from a storytelling standpoint, there was a really big breadcrumb in that we found that one hospital CEO for a small, rural county hospital was being compensated a multimillion-dollar package and there was no explanation for that.” 

He was making more than the CEO of Indiana University Health, the largest nonprofit hospital in Indiana, says Hopkins. 

“Just don’t take no for an answer. Because when we’re told, ‘Nope, you can’t get CEO compensation data,’ then you just have to say, ‘Well, how else can we get it?” 

Tony Cook

The journalists consulted data from the federal Bureau of Labor Statistics to find out how much a CEO for a local government-owned hospital earns in a year. The national average: a salary in the low six figures. That’s much lower than the seven-figure salaries of some county hospital CEOs in Indiana. 

Cook says that journalists sometimes have to look in multiple places to track down the information.

“Just don’t take no for an answer,” says Cook. “Because when we’re told, ‘Nope, you can’t get CEO compensation data,’ then you just have to say, ‘Well, how else can we get it?'” 

Calculating nursing home ratings

To find out how Indiana nursing homes ranked nationally, the investigative team didn’t rely on state or federal level star ratings, which are usually touted by the nursing homes. Instead, they zeroed in on staffing to create their own ranking system based on government data. 

The journalists explained their methodology as part of their first story in March 2020.They used data on nursing home staffing published by the U.S. Centers for Medicare & Medicaid Services.

The federal agency publishes a variety of data on staffing levels. The team used adjusted hours, which represent the reported hours adjusted for how sick the residents are. They compared the data across states and ranked Indiana 48^th.

“These are super vulnerable people who don’t have a lot of people advocating for them, so I would say dig into that data and find the worst nursing homes and write about them.”

Emily Hopkins

If you want to know about the quality of local nursing homes, focus on their staffing levels, advises Hopkins.

“Nursing home academic researchers as well as the federal government, which produces the stats, say staffing is the most important thing,” Hopkins says. 

Hopkins adds that aside from Medicaid funding, there are lots of stories about nursing home quality at the local and state level. All you have to do is look.

“It could be one really bad facility that stands out against the rest,” Hopkins says. “It could be a chain. There’s a story there and these are super vulnerable people who don’t have a lot of people advocating for them, so I would say dig into that data and find the worst nursing homes and write about them.”

Finding consumer voices: lawsuits and inspection reports

To find people who had been impacted by low staffing levels at Indiana nursing homes, the reporters began scouring civil lawsuits and nursing home inspection reports, also known as survey reports.

“We found the full picture exists in those wrongful death claims and the survey reports, where you read about the actual suffering of people rather than this calculated number or rating,” says Hopkins. 

The three journalists looked for lawsuits but didn’t find as many as they thought they would. The ones they found were filed against anonymous nursing homes.

They called the plaintiffs’ attorneys and learned that malpractice claims, including wrongful death claims, are first filed with the Indiana Department of Insurance. The cases then goes in front of a medical review panel before they become a lawsuit. Until there’s a judgement from the medical review panel, the nursing home cannot be named, they learned.  

Tip: Look for nursing home inspection reports, both at the state and federal level. “We found the full picture exists in those wrongful death claims and the survey reports, where you read about the actual suffering of people rather than this calculated number or rating,” says Hopkins. 

“So we learned that we had to look for these claims through the Department of Insurance, not through the court system,” says Cook. 

The team also scoured inspection reports available at the state and federal level. While different agencies are in charge of inspections at the state level, federal inspection reports are available on Medicare.gov’s Care Compare website.

Cook recommends journalists look at reports at both levels.

“Sometimes, they look kind of different because the state will include nursing homes’ responses but the feds won’t,” Cook says.

After their first story in March, they put out a call for people who wanted to share their experiences with Indiana nursing homes. 

“I think at this point, we’ve probably received more than 100 responses to that call out,” says Cook. 

Conducting a team project during a pandemic

The IndyStar investigative team started the project in person in 2019. But as their first story was published in March last year, COVID-19 had started to spread in the United States and they had to stay home.

For the remainder of the year, the trio worked remotely via Google Docs and Google Sheets. They held numerous conference calls via Microsoft Teams.

“There would be times where we would have a Google Doc up and we would all be on audio on Teams and just working through it and we would just leave the audio up for hours and hours so they would hear me yelling at my kids in the background,” Cook recalls. “So it was like we were all in a virtual conference room in a way, but with all these other distractions happening at the same time.” 

The three shared responsibilities and picked up the load when each had to go on furlough for three to six weeks at a time. Their editor, Berta, took a buyout last year. He edited all but one story in the series. 

“I got therapy at the end of year and it helped a lot. And I don’t think that any of us going through what we’re going through right now should be scared or ashamed of doing that.”

Emily Hopkins

“It was a challenge, especially on a big project like this, because of the pushback that you get from the people who don’t want you to report out these stories,” Cook says. “It’s very lonely work in a way. And to not be able to have the camaraderie of at least being with Tim and Emily every day in person and with our editor in person makes it more challenging to do this kind of work without that kind of moral and social support. Everyone’s schedule is thrown into flux because of virtual schooling with the kids or other things.” 

The trio is lucky to get along well, they say. But the pandemic, the isolation and witnessing nursing home deaths took a heavy mental toll.

“I got therapy at the end of year and it helped a lot,” says Hopkins. “And I don’t think that any of us going through what we’re going through right now should be scared or ashamed of doing that.”

Additional resources

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MM Curator summary

 
 

A proposed policy in MT would put 8% of the pot tax into a special fund for tribal healthcare and other services.

 
 

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.

 
 

MONTANA – Representative Jonathan Windy Boy’s HB 621 in the state legislature aims to give more money to tribal governments, courtesy of recreation marijuana sales taxes.

The bill plans to take just over 8% of recreational marijuana tax revenue and put it into a new account so tribal governments would have more money available for assistance programs. 

“Establishing a state special revenue account, provide a portion, distribution grants to tribal governments for public purposes – with the Indian Health Service and the BIA, funding on the federal level is anywhere between 50 to 60 percent of the total unmet need,” Windy Boy said.

If passed, HB 621 would give 8.4% of recreational marijuana tax revenue to a new revenue sharing account. Once there, the department of revenue could then give tribal governments grants for things like substance abuse, fire and police protection and disaster-related expenses. 

“There is a portion here that does assist law enforcement, so it’s kind of a catch-all situation with what’s being offered,” Windy Boy said.

It’s estimated that over $380,000 could go into the account starting in 2022, if the bill is passed; something tribes would like to see after cuts were made to healthcare in another bill.

“A lot of the Medicaid and Medicaid expansion has been eliminated from House Bill two,” Windy Boy said.

He thinks tribes didn’t get enough of the stimulus money that was given out in 2009, and that’s a big reason why he brought forth this bill.

“The tribes only got two million of that. So I want to get ahead of the curve here, and wanted to make this equal distribution,” Windy Boy said.

 
 

 
 

Clipped from: https://www.kulr8.com/news/bill-aims-to-give-marijuana-revenue-to-tribal-governments/article_0995958e-9100-11eb-98f5-93ac3dc88337.html

 
 

 
 

MM Curator summary

 
 

If WY expands Medicaid, it will get more money for the new population covered, AND more money for the population it already covers today.

 
 

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.

 
 

(AP) – The Wyoming House of Representatives passed a bill on a 32-28 vote Wednesday to expand Medicaid eligibility to low-income adults.

The bill would still have to pass the Senate and be signed by Gov. Mark Gordon before becoming law. The Senate killed a nearly identical bill on Monday when it missed a deadline for a hearing. The Senate floor leader will decide when the House version of the bill gets a hearing.

The House bill would allow the state to pursue a plan to expand the federal-state health insurance program to Wyoming adults whose income is at or below 138% of the federal poverty level — offering coverage for those who don’t qualify for Medicaid and don’t qualify for premium subsidies under the Affordable Care Act.

Wyoming is one of a dozen states that have not expanded Medicaid eligibility.

Supporters argue now is the time because there is increased federal funding available through the latest stimulus package as an incentive for those 12 states.

In Wyoming’s case, the offered 5% increase in federal funds for its traditional Medicaid program could bring in $120 million in each of the two years it’s offered. The federal government covers 50% of traditional Medicaid costs and 90% of the Medicaid expansion costs.

Wyoming’s health department estimates it would cover about 24,000 state residents in its first two years of Medicaid expansion with an estimated annual cost to the state of $20 million, a figure supporters say would be more than offset with the new subsidies.

“I voted no multiple times on this same issue … and I’m going to vote yes this time, because I haven’t seen any other solution,” said Republican House Speaker Eric Barlow of Gillette. “Nobody’s brought anything forward, and I’ve looked myself.”

Physician, hospital groups and others also supported the bill, saying it was a way to reduce uncompensated care costs while improving the health of those without insurance coverage.

Opponents raised budgetary concerns and argued it would provide free health coverage to those who are able to work.

“I haven’t heard once how our state is going to pay for this,” said Republican Rep. Chuck Gray of Casper.

 
 

Clipped from: https://www.blackhillsfox.com/2021/03/24/wyoming-house-passes-medicaid-expansion-bill-on-32-28-vote/

MM Curator summary

Oklahoma now will get a lot more federal funding than it originally planned when it chose to expand 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.

 
 

 
 

Two COVID-19 relief packages passed by Congress feature increases in Medicaid funding for the state of Oklahoma. (Pablo Angulo)

 
 

The Oklahoma Legislature’s appropriations chairmen are set to meet this morning with Oklahoma Health Care Authority staff about how additional federal Medicaid funding authorized by Congress and held by OHCA could affect next year’s state budget. The complicated situation stands as a potential X-factor for state leaders tasked with paying for Medicaid expansion, third-party managed Medicaid and a bevy of other budget items.

“It’s a significant amount of money,” OHCA chief financial officer Aaron Morris said. “I wouldn’t say we have completely sat on it. We’ve had a few initiatives we have introduced and continued to introduce. We’ve also returned funds to other state agencies that participate in the Medicaid program. We’ve returned funds to our hospital partners who pay SHOPP.”

The state’s Supplemental Hospital Offset Payment Program (SHOPP) charges certain hospitals a fee that is used to maximize the state’s drawdown of federal Medicaid dollars. Known as SoonerCare in Oklahoma, Medicaid is a federal-state partnership that provides health insurance to low-income children, families and disabled individuals. The portion of a state’s Medicaid program paid by federal money is determined by the Federal Medical Assistance Percentage, or FMAP, which changes annually in an inverse relationship to a state’s economic strength.

Since January 2020, states have received an additional 6.2 percent for its FMAP base rate under a provision of the Families First Coronavirus Relief Act. Between January and June 2020, Morris said that increase sent about $150 million to the Oklahoma Health Care Authority and other state agencies. Morris said he did not know how much money the boosted FMAP has brought in since July, but he said the OHCA’s cash on hand from the enhanced rate “likely exceeds $100 million.”

The 6.2 percent enhanced FMAP will continue for the duration of the federal public health emergency declaration, which currently runs through April.

“My guess is we will hear a decision either in late March or early April about whether that (public health emergency declaration) is renewed for another 90 days,” Morris said.

But wait, there’s more money

The Federal Medical Assistance Percentage, called FMAP, fluctuates annually in an inverse relationship to the strength of a state’s economy. (Kaiser Family Foundation)

Whether the 6.2 percent FMAP enhancement continues or not, Oklahoma is also poised to pick up a separate 5 percent FMAP bump starting July 1 when the state expands Medicaid to cover low-income adults. That provision was included in Congress’ latest COVID-19 relief package, the American Rescue Plan, and is specifically for states that have not yet adopted Medicaid expansion from the Obama-era Affordable Care Act.

While Oklahoma voters approved State Question 802 in 2020 to expand Medicaid, the constitutional amendment established a July 1 deadline for implementation, meaning Oklahoma will receive the 5 percent FMAP increase for eight financial quarters, or two years.

“That’s a 6.2 percent (increase) plus a 5 percent (increase) on top of our base FMAP,” Morris said. “So it’s an interesting time period that we’ve never really experienced before.”

Asked about the situation Tuesday, Gov. Kevin Stitt also used the word “interesting.”

“There could be some extra money inside of the Health Care Authority,” Stitt said. “So that’s interesting.”

The Legislature’s budget leaders are also intrigued.

“I just have a whole lot of questions,” said House Appropriations and Budget Chairman Kevin Wallace (R-Wellston).

Wallace, Senate Appropriations and Budget Chairman Roger Thompson (R-Okemah) and others met in Wallace’s office Tuesday to discuss the FY 2022 budget, which they must finalize before the end of May. Thompson noted that a state’s FMAP rate decreases when its economy performs better.

“The Oklahoma economy is doing very well, so I [expect] the FMAP to be going down in the next cycle,” Thompson said. “So I think we need to be saving some of this FMAP money we have today into our FMAP savings account so that when that rate drops, our (health care) providers are not hurt.”

Thompson rejected the notion that additional FMAP dollars could be used to fund Medicaid expansion, which will require about $164 million from the state Legislature. The federal government covers 90 percent of costs for a state’s expansion population.

“We’re still looking at the number. We’re still at $164 million until we find out otherwise,” Thompson said. “From a budgeting perspective, even though the feds are giving us extra money, whatever that number is it doesn’t matter. It’s still going to be one-time money, and our position is still we don’t use one-time money to pay for an ongoing expense. So we’ve got to figure out a way to pay that number with the funds that we have that would be reoccuring funds.”

Wallace agreed.

“We definitely don’t want to fund the expansion with one-time money,” he said.

Last year, lawmakers passed a bill that would have brought in about $134 million to fund Medicaid expansion by increasing the SHOPP fee, but Gov. Kevin Stitt vetoed the bill. It is unclear whether the Legislature intends to unveil and pass a similar SHOPP fee increase to fund Medicaid expansion this year.

“I would say all things are still in discussion,” Wallace said. “I don’t believe there are any final decisions that have been made yet.”

Wallace said it is important for lawmakers to have a good grasp of agency accounts because the Legislature is constitutionally tasked with the power of the purse.

“The last thing we want [an agency] to do is start some sort of programing where, when the federal dollars run out, they come back to the Legislature and say, ‘We need more money,'” Wallace said.

 
 

House Appropriations and Budget Chairman Kevin Wallace (R-Wellston) speaks to media Monday, March 9, 2020. (Tres Savage)

Managed care funding question looms as well

Complicating the Legislature’s decisions on how to fund Medicaid is the disagreement over third-party management of the state’s SoonerCare program. The OHCA has already signed contracts with a slate of private insurance companies that are expected to begin managing Medicaid patients’ care this summer, unless the Legislature takes some sort of action to block implementation, such as not funding the roughly $50 million estimated start-up cost.

Thompson said the additional FMAP dollars could come into play for that budget item.

“I don’t mind using $50 million of that federal money or what we are sitting on from the enhanced FMAP because that’s a one-time expense moving people over into that managed care,” he said.

House Speaker Charles McCall (R-Atoka) said the amount of FMAP money available is an important variable for legislative budget leaders.

“This is definitely something that very much will be a driver in terms of what the impact is on our budget that we’re crafting right now for health care,” McCall said. “We know we are going to fund [Medicaid expansion]. The people of the state of Oklahoma have mandated it. But if the amount that we have to come up with this year is lower because of the stimulus package, that’s great because it gives us a little more time to figure out the longterm funding of the program. In the short term, we’re going to be able to fund it. In the long term, there will be some tougher decisions to make down the road, I suspect.”

Another complicating factor for OHCA could turn into a difficult decision once the federal public health emergency declaration ends and the 6.2 percent FMAP increase terminates. In order to qualify for that increase during the pandemic, states had to agree not to disenroll Medicaid members for reasons other than death or relocation to another state.

As a result, Morris said Oklahoma’s Medicaid population has climbed from around 800,000 to about 960,000.

“Typically we’re looking at how they qualify,” Morris said. “If their income goes above the threshold, in a normal circumstance they would become ineligible for Medicaid, but during the public health emergency, as a stipulation of accepting the 6.2 percent advanced (rate), we can’t disenroll those folks.”

 
 

Clipped from: https://nondoc.com/2021/03/24/federal-relief-bills-will-send-oklahoma-more-medicaid-money/

MM Curator summary

 
 

Some Alabama officials are more open to expansion with the increased federal payouts under the COVID relief bill.

 
 

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.

 
 

Alabama Republicans for years have opposed expanding Medicaid eligibility. Now, they may be cracking the door.

Alabama Gov. Kay Ivey and legislative leaders said they are reviewing details of the nearly $2 trillion coronavirus relief package that includes new financial incentives for the states that have opted against expanding Medicaid to provide health coverage for more low-income Americans. A spokeswoman for Ivey said the governor is “open to the discussion” on expansion but that state leaders need additional information about the long-term cost projections.

“Ensuring every Alabamian has access to quality health care is important to the governor and always has been a priority of hers. However, as she has made clear, the problem has always been how to pay for it. She is open to the discussion, but right now, we simply do not have all the facts,” spokeswoman Gina Maiola said.

Alabama is one of 12 states that have taken no action toward expanding Medicaid eligibility under the Affordable Care Act. Previous studies have estimated that expansion would add around 300,000 people to state Medicaid rolls. Republican leaders have in the past expressed opposition to expanding Medicaid, at times citing both political opposition to the Affordable Care Act passed under former President Barack Obama and concerns about cost.

Medicaid expansion under the Affordable Care Act allows people with family incomes less than 138% of the federal poverty limit— or around $17,000 for an individual and $29,000 for a family of three to qualify for Medicaid. Currently, Alabama’s Medicaid program covers very few able-bodied adults.

“The bulk of the people who will gain coverage are people who are working,” said Jim Carnes, a policy analyst with Alabama Arise, an advocacy group for low-income Alabamians.

Already, the federal government would pick up 90% of the cost of the expansion. A 2019 study by a University of Alabama at Birmingham projected the state’s cost would be about $250 million per year, but that the state would see a resulting boost in economic activity.

The federal relief bill offers a new incentive by giving states a 5% boost to the federal match over the next two years for the people they currently cover.

Democrats in the Alabama Senate have estimated that would generate an additional $900 million for the state.

“I just want to say to Governor Ivey, if not now, when?” Senate Minority Leader Bobby Singleton said in the press conference. “I don’t care if we call it ObamaCare. We could call it Kay-Care. It could be Alabama Health Care. We need to expand Medicaid and the time to do it is right now,” Singleton said.

Dr. Don Williamson, president of the Alabama Hospital Association, said the calculations are complex because of the intricacies of how Alabama funds Medicaid. The cost will also depend on how many people are added to the rolls.

“To me, the most important thing that Medicaid expansion does is it absolutely improves health outcomes. You get earlier cancer diagnosis. You get lower infant mortality rates. You get earlier diagnosis if diabetes,” Williamson said.

State Rep. Steve Clouse, the chairman of the Alabama House of Representatives general fund budget committee, said state officials are trying to gather information about the incentives and what would be the state’s share of costs in the long run.

Sen. Greg Albritton, the chairman of the Senate budget committee, expressed some skepticism about the incentives. He said the incentives sound enticing but said the state has “got to have the answers” before making a commitment.

“I’m not surprised this would be the same old song, the same old dance. … Buying a new car now. Nothing down, but the payment is due in two years,” Albritton said.

Senate President Pro Tem Greg Reed said the analysis will continue over the coming weeks.

The 12 states that have held out against the Medicaid expansion are: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

 
 

Clipped from: https://www.modernhealthcare.com/medicaid/alabama-reviewing-medicaid-expansion-incentives

MM Curator summary

Some TN lawmakers are more open to expansion with the increased payouts offered in Biden’s COVID relief bill.

 
 

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.

 
 

 
 

Tennessee could offer TennCare coverage to hundreds of thousands of moderately poor residents while also saving as much as $900 million in state money over two years if lawmakers expand Medicaid under a sweetened deal proposed by the White House.

These new incentives, offered by President Joe Biden’s coronavirus stimulus law, have prompted at least one prominent Republican leader to reconsider expansion after his party opposed it for a decade.

Lt. Gov. Randy McNally, one of the two most powerful officials in the Tennessee General Assembly and who for years has stood by his conservative colleagues against Medicaid expansion, said the new incentives warrant a fresh look at the possibility of expansion.

“I think we’re going to take a very serious look at it and see what the federal government is offering, and also see what kind of flexibility, if any, the states have in expanding,” McNally, R-Oak Ridge, said Monday, adding a moment later: “I think that most of the legislators are probably willing to take a look and see what it would mean.”

 
 

While McNally’s statement falls miles short of support, it signals a rare crack in a near-insurmountable opposition that has kept Medicaid expansion out of Tennessee.

The state’s Republican majority has rejected all efforts to expand, turning away billions in federal funding that almost certainly would’ve improved the health of Tennesseans and could have bolstered struggling rural hospitals.

Biden’s strategy appears persuasive in Alabama and Wyoming, where conservative lawmakers are now reconsidering expansion, but the policy change still faces long odds in the Volunteer State despite the new financial incentives. Tennessee is not hurting for money: the state has raked in billions in surplus funding in recent years, including an unexpected $1 billion in tax revenue last year.

A spokesperson for Gov. Bill Lee signaled continued opposition to Medicaid expansion without addressing the issue directly. House Speaker Cameron Sexton said he was momentarily unconvinced because the new incentives only last two years, after which Tennessee must pay for a small portion of the cost of expanded TennCare enrollees.

“We’ll see what they have to offer. I’m not sure anything will pass,” said Sexton, R-Crossville. “You don’t do a policy just based off them trying to throw some money at you. That’s not the right direction to go.”

 
 

COVID-19 stimulus law will pay states to expand

Medicaid expansion, first allowed under President Barack Obama and the Affordable Care Act, allows states to offer government health insurance to residents who are not poor enough to otherwise qualify.

Under the terms of the original law, states can expand their Medicaid program to include residents who live within 138% percent of the poverty line, with the federal government covering 90% of the cost of insuring these new enrollees. Most states leapt at the opportunity to expand, and numerous studies show expansion has transformative impacts on the health of low-income residents.

 
 

Tennessee and 11 other states, all controlled by Republicans, have rejected Medicaid expansion largely because of its association with the Obama administration.

Public polling shows a majority of Tennesseans support Medicaid expansion, but numerous efforts to expand TennCare – mostly from Democrats and a few from Republicans – have failed.

Biden, who campaigned on a promise of bipartisanship, now seeks to woo states that haven’t expanded their Medicaid programs by offering a new deal. The American Rescue Plan Act, more commonly known as Biden’s coronavirus stimulus law, which took effect on March 11, offers billions in new incentives to expand Medicaid.

If the 12 non-expansion states choose to expand Medicaid under the new law, the federal government will still pay for 90% of the cost of the expansion population. But it will also increase its share of the cost of traditional Medicaid by 5% for a period of two years.

In Tennessee, expansion is estimated to extend TennCare to about 300,000 people, many of whom make too little money to afford private insurance. The state would be required to cover 10% of the cost of these enrollees, but this spending would be more than offset by additional federal funding from the new expansion incentives.

In summation, for two years TennCare would be able to insure many more people for less money. How much less? A lot.

If Tennessee expanded under the terms of the new law, the state is estimated to receive $1.26 billion in additional federal funding and be required to spend an additional $360 million in state dollars over the two-year span, according to an analysis by the Kaiser Family Foundation, a nonprofit health policy organization. The net gain to Tennessee would be approximately $900 million, the analysis states.

Brian Straessle and Mandy Pellegrin, two policy experts from the Sycamore Institute, a nonpartisan think tank in Nashville, said Tennessee would become responsible for some new costs in the third year after expansion, but it could potentially reinvest some of the new federal dollars to cover these costs for an estimated five to eight more years.

If Tennessee leaders have opposed Medicaid expansion out of fear of the cost, the Biden incentives should alleviate their concerns, at least for a while, they said. However, leaders opposed Medicaid expansion because they felt it was bad policy, the new incentives were unlikely to change their minds.

“If you are on the fence about the policy, then the additional money could potentially tip you over to be in favor of it,” Straessle said. “But if you just don’t think this is what a state government should be doing … then I don’t know if this is necessarily a slam dunk that is going to persuade everybody.”

Melinda Buntin, a health economics expert at the Vanderbilt Department of Health Policy, confirmed the new expansion incentives would allow TennCare to cover more people for less money for two years.

As Biden woos, Alabama and Wyoming are listening

If Biden’s plan was to offer an expansion deal that is too tempting to be ignored, it appears to be working.

In both Alabama and Wyoming, two deeply conservative states that have rejected Medicaid expansion for a decade, legislators are now reconsidering expansion in light of the new incentives.

A spokesperson for Alabama Gov. Kay Ivey said this week the state is “open to discussions” about expansion. Lawmakers in the Wyoming House of Representatives advanced a bill to expand Medicaid on Monday, according to the Casper Star Tribune.

Tennessee Democrats pleaded with Republicans to consider a similar change of heart on Tuesday. Senate Minority Leader Jeff Yarbro and Rep. John Ray Clemmons, both Nashville Democrats, said the state’s conservative supermajority is out of excuses not to entertain expansion. 

“If these conversations, looking at these dollar amounts that are on the table, are not being discussed on the first floor of the Capitol in the Department of Finance and Administration, in the Department of TennCare, then somebody’s not doing their job,” Clemmons said. “This is a win-win-win in all scenarios.”

After this story first published on Tuesday, several organizations that have long advocated for Medicaid expansion voiced support for the new incentives. 

The Tennessee Hospital Association said Biden’s stimulus law makes expansion a “better option” than before. The Tennessee Justice Center expressed gratitude McNally was willing to consider expansion, adding that “it would be unwise not to consider accepting billions of dollars from the federal government that would cover 300,000 Tennesseans, shore up rural economies, and keep healthcare providers in business.”

Sen. Richard Briggs, R-Knoxville, one of the few Republican lawmakers to support expansion, said this week he believed his colleagues could be convinced to expand TennCare if they viewed the proposal “objectively” and with “emotions aside.”

Briggs said he had not yet resumed discussions with other Republicans about expansion because he wanted them to consider the Biden incentives “gradually” and avoid a knee-jerk rejection.

“The incentives now are just so good, it’s hard to turn your back on them,” Briggs said. “If we’re ever going to do it, now would be the time to do it. It would take both the legislature and the governor’s support to do it.”

The Lee administration, which has vocally opposed expansion in the past, did not provide comment directly on the new Biden-backed incentives, but appeared to signal they are still against Medicaid expansion.

When asked about the new incentives this week, Casey Black, a spokesperson for Lee, said the administration is “currently focused on the successful administration of the block grant waiver” but ignored all questions about expansion.

The “block grant” is an effort to reshape TennCare that is often seen as a conservative alternative to Medicaid expansion, but is not technically mutually exclusive. In theory, the state could do both. The block grant gives state officials more authority over TennCare, including the power to stop covering some medications, and allows the state to keep about half of any money saved under its leadership.

The Lee administration proposed a block grant to the federal government in November 2019, and the proposal was approved in the final two weeks before President Donald Trump left office. Biden is expected to revoke this approval by the end of this year.

The Associated Press contributed to this report.

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman. Reach Natalie Allison at nallison@tennessean.com. Follow her on Twitter at @natalie_allison.

 
 

Clipped from: https://www.tennessean.com/story/news/health/2021/03/23/tennessee-could-expand-medicaid-save-900-m-biden-new-offer/4740068001/

MM Curator summary

Mississippi not expected to take the new COVID relief bill expansion incentives.

 
 

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.

 
 

MEMPHIS, Tenn. (WMC) – Mississippi is one of 12 states that has not expanded Medicaid.

But some new federal incentives are leading to renewed chatter at the State Capitol.

Around 300,000 Mississippians fall into a coverage gap.

Those people currently make too much money to qualify for Medicaid but not enough to afford private insurance.

The federal government is now offering an incentive to the states that haven’t expanded Medicaid coverage.

They’ll chip in an added five percent for folks already on the Medicaid rolls. Lawmakers are now saying that added money will make a difference.

“We’re having discussions. We’re having more discussions now than we’ve had before and it’s hard to not talk about it when you consider the federal government would give you a five percent bump to your existing Medicaid fund,” said Rep. Robert L. Johnson. “Which essentially would make us like 100 percent funded by the federal government.”

“It’s still from a Republican policy point of view, it is not something that’s very popular,” said Rep. Donnie Scoggin. “However, I am a nurse practitioner and as a nurse practitioner, Medicaid expansion I think would benefit the state tremendously.”

Governor Tate Reeves says his position has not changed; he is not interested in any form of expansion.

 
 

Clipped from: https://www.wmcactionnews5.com/2021/03/25/medicaid-not-expected-expand-mississippi/