Tag: Medicaid Reform

[MM Curator Summary]: A new change in the NY budget process will allow older members to make more money and have more in assets and still have Medicaid coverage. It will also give non-citizens over 65 Medicaid coverage, but those members will have to be paid for using zero federal dollars.

 
 

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.

 
 

New York State Department of Financial Services

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Bronx nursing home resident James Galbert receives his first dose of the COVID-19 vaccine in December 2020.

Reaction to the 2023 New York State budget continues, and older adult advocates are pleased that the $220 billion plan passed by lawmakers earlier this month expands Medicaid eligibility.

Starting in 2023, older, disabled and blind New Yorkers can make up to 138% of the federal poverty level and still qualify for taxpayer-funded health care coverage. That would increase the maximum monthly income for those groups from $934 a month to $1,563 a month.

“So what this is going to do is massively expand the reach of the Medicaid program for folks, specifically in the age, blind and disabled categories of eligibility,” said attorney Kelly Barrett Sarama with the Center for Elder Law and Justice, a Buffalo nonprofit legal agency.

In addition, the maximum assets those groups can have and still qualify for Medicaid will nearly double, from $16,800 to $28,134. For couples, the allowable maximum assets will increase from $24,600 to $37,908.

Under the current limits, Sarama said many people have to spend down much of their assets in order to qualify for Medicaid. Plus, she said, many younger Medicaid recipients, who are not subject to an asset test, lose their coverage once they move into the older, disabled or blind categories.

“What this increase will do is help protect folks who do have a bit of a retirement savings and who have a little bit of resources in their account from completely being forced to deplete their income and assets in order to qualify for Medicaid,” she said.

The budget also makes Medicaid available to undocumnted immigrants 65 and older, as well as extends postpartum coverage for Medicaid-eligible mothers from 60 days after they give birth to one year after they give birth.

One in three New Yorkers, 7.4 million people, are currently on Medicaid, including over 280,000 in Erie County. That number has increased by about 1 million since the COVID-19 pandemic began, as the economic recession made more people eligible and federal laws barred states from terminating coverage for most enrollees during the public health emergency.

Gov. Kathy Hochul’s office did not immediately respond to an inquiry about how many more New Yorkers are expected to be on Medicaid once eligibility expands next year. In December, the state Division of Budget had projected Medicaid enrollment to return to pre-pandemic levels of just over 6 million by 2024.

New York already has the second-largest Medicaid budget of any state in the nation, with total spending at $72.8 billion in 2020. Only Californida, with a $97.8 billion Medicaid budget, spent more.

The funding is crucial, Sarama said, as it’s the primary payer of long-term care in the state. Medicaid accounts for nearly 80% of New York nursing homes’ revenue and determines the wages of the state’s home care workers.

“As you age, you’re more likely to end up needing some care in your home in order to sustain your lifestyle and to remain living in your home, and so this increase will help more folks access the Medicaid program, access long-term care in New York State,” Sarama said.

 
 

 
 

 
 

Clipped from: https://www.wbfo.org/health-wellness/2022-04-24/new-york-state-budget-expands-medicaid-eligibility-for-older-adults

 
 

[MM Curator Summary]: She doesn’t really emphasize that expanding to non-citizens will have to be paid 100% by state taxes.

 
 

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 bill that would expand Medicaid coverage to otherwise ineligible noncitizens is now awaiting Gov. JB Pritzker’s approval.

That provision was part of an “omnibus” Medicaid bill, House Bill 4343, that passed through the General Assembly on the final day of the session.

And while Medicaid bills are traditionally worked out in a bipartisan “working group,” this one drew strong opposition from Republicans because the language about noncitizens had never been discussed in any public hearing or working group meeting.

“We had a bipartisan group for the last three months, getting up at 7 o’clock in the morning for these meetings with the agreement that all Medicaid expansions and increases were going to be working through this group,” Sen. Dave Syverson, R-Rockford, said during floor debate in the Senate. “And then you turn around a couple hours after this agreement, and you change the bill.”

More:What’s in Illinois’ $46 billion budget package? Here’s a detailed look

Sen. Ann Gillespie, D-Arlington Heights, who chairs a Medicaid subcommittee, defended the process and said there were other provisions of the bill that were negotiated outside the working group.

“We used this bill to add on the Medicaid omnibus, but it was never exclusively the Medicaid omnibus,” she said.

She said the bill clarifies statutory language to help providers and meets a goal of expanding health care coverage amid the pandemic to “make sure that we’re taking care of as many people as we can.”

In 2020, Illinois became the first state to offer coverage for undocumented noncitizens by extending it to those 65 and older who would otherwise qualify for Medicaid if not for their immigration status. In 2021, lawmakers lowered the age limit to 55. This year’s bill lowers the age limit even further to 42.

In addition, Illinois does not apply a citizenship requirement for children under age 18 or pregnant women, including up to 60 days postpartum.

Medicaid is a government-funded health care program for low-income individuals and families. It is jointly funded with state and federal dollars and is administered by the state under federal guidelines.

Under federal rules, certain categories of noncitizens can qualify for Medicaid if they are lawfully present in the country. Among those are green card holders, asylees, refugees and members of federally recognized Native American tribes who were born in Canada. Those individuals typically must be U.S. residents for five years before they become eligible.

But federal rules do not allow for coverage of those who are not lawfully present in the U.S., which means the federal government will not reimburse for their care and all costs of covering those individuals must be paid solely with state dollars, estimated at $68 million a year for the latest expansion.

More:How the top Illinois governor candidates are outpacing others in fundraising and spending

Covering noncitizens

Supporters of covering noncitizens regardless of their immigration status argue that it’s actually cheaper than the alternative, which is forcing them to get all of their care in emergency rooms.

“These are people that would have otherwise ended up in the emergency room because of their diabetes, or because of high cholesterol in the midst of a pandemic,” said Rep. Delia Ramirez, D-Chicago, who sponsored a separate bill, House Bill 4437, that would have extended coverage to all noncitizens age 19 and over. “And the cost of not insuring them was 3-to-1 to insuring them right now.”

But Syverson rejected that argument and said there is a bigger danger in providing an inducement for people to come into the country illegally with the offer of taxpayer-funded free health care.

“If the word’s out that Illinois is the place to go, they’re going to come here, and like I said before, we can’t adequately take care of our disabled and our seniors,” he said in an interview. “And yet, we’re going to provide better care for undocumenteds than we do for our own families. And it’s going to drive up the cost of health care for working families, because again, the more people that are on government health care that reimburses at a much lower rate to hospitals and doctors, the more that gets shifted over to private-pay people.”

Gillespie said during a separate interview that the idea of expanding coverage for more noncitizens grew out of a feasibility study directed by the governor’s office through the Departments of Healthcare and Family Services and Insurance.

That study examined several options for reducing the number of uninsured people in Illinois and making coverage more affordable.

The report, released in April 2021, led to the formation of another working group focusing on health care expansion, Gillespie said, and that was the group that came up with the language to expand coverage to more noncitizens.

“So the base of House Bill 4343 was the results coming out of that group,” she said. “And then we added the Medicaid working group provisions, agreed provisions, onto that bill. So the bill itself had two separate geneses, if you will.”

Expanding Medicaid coverage to more noncitizens was also a top priority of the Legislative Latino Caucus.

Speaking at an April 5 news conference to promote her own bill, Ramirez argued that providing universal coverage was the morally right thing to do.

“This would finally ensure that every single low-income person in our state has access to health care coverage, regardless of their immigration status,” she said. “Health care must be a human right. Everyone should be able to access a doctor to treat their diabetes or manage a chronic condition regardless of their immigration status.”

Ramirez’s bill was never voted on by a committee, but discussions about expanding coverage for more noncitizens continued until the cutoff age of 42 was agreed upon.

“And that’s where the budget discussions came in. It really came down to what was it that we could afford to do this year,” Gillespie said.

Working groups

The process by which the bill passed the General Assembly highlights a little-known and often obscure aspect of the General Assembly, informal “working groups.”

Under the Illinois Constitution, all meetings of committees, joint committees and legislative commissions must be open to the public. Committee meetings may be closed if two-thirds of the members of that chamber determine that it’s in the public interest to do so. Closing joint committee and legislative commission meetings requires a two-thirds vote in both chambers.

In recent years, however, lawmakers have gotten around that by forming informal “working groups” that operate much like committees in that they study issues, hear testimony and recommend the passage of legislation. But their meetings are not open to the public and even their membership is not publicly known.

Lawmakers on both sides of the aisle have defended the working group process, saying it allows for more free discussions and that ultimately it leads to bipartisan legislation.

“Over the past several years, the Medicaid work group has been a really productive and collaborative experience for members of all four caucuses and the administration, no matter which party was in control the governor’s office, to work through complicated issues in the Medicaid space, and to evaluate a wide range of options that were brought before the House,” Rep. Tom Demmer, R-Dixon, said during debate in the House.

Demmer said bills crafted through that process have often received unanimous support.

“Unfortunately, the bill that we see before us today has many items we did talk about and reach consensus on, but others that were simply added at the last minute and for that reason, I urge a no vote,” he said during debate.

Capitol News Illinois is a nonprofit, nonpartisan news service covering state government and distributed to more than 400 newspapers statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.

 
 

Clipped from: https://www.sj-r.com/story/news/state/2022/04/25/illinois-gov-jb-pritzker-has-law-would-expand-medicaid-coverage/7414341001/

[MM Curator Summary]: Legislators are one step closer to allowing voters to vote on Medicaid expansion each 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.

 
 

A constitutional amendment asking Missourians to let lawmakers decide year-to-year whether the state will offer Medicaid to working-age adults moved closer to passage Wednesday.

By an 8-5 vote, the Senate Appropriations Committee sent the House-passed proposal to the full Senate for debate. Only Sen. Lincoln Hough, R-Springfield, voted with Democrats to oppose the measure, which is seen by critics as an effort to roll back voter-approved Medicaid expansion.

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If approved in the Senate, the measure would appear on the August or November election ballot.

Since Oct. 1, just more than 100,000 people have enrolled in the program that provides medical coverage for people with incomes less than 138 percent of the federal poverty limit. In the budget for the fiscal year that begins July 1, the cost of expansion is pegged at $2.5 billion.

The House-passed budget plan does not use any general revenue to pay the cost. Instead, it taps extra federal funds being sent to Missouri because it expanded eligibility to pay a part of the state’s 10 percent match.

The amendment debated Wednesday is intended to give future lawmakers options when the state hits tough economic times, committee Chairman Dan Hegeman, R-Cosby, said after the vote.

“I have always had the concern that at some point in time, in the future, we will be pitting other general revenue-source expenditures against the expanded Medicaid because there was no other funding mechanism included,” he said.

In August 2020, Missouri voters approved a constitutional amendment requiring the state to offer Medicaid coverage to 19- to 64-year-olds.

A single person is eligible with earnings up to $18,754 a year, or about 32 hours a week at the current minimum wage. For a household of three, the limit is $31,781 per year, or what a person working full time would earn at $15.29 per hour.

Prior to passage, only very low-income adults with children were eligible for coverage and no working-age adults without children could enroll.

Making the coverage optional for the state budget would break faith with the voters who passed the expansion program, said state Sen. Lauren Arthur, D-Kansas City.

“It seems pretty clear this is an attempt to undo what the voters did on Medicaid expansion,” she said. “It is disrespectful to the people who have spent hours on line trying to enroll.”

That view was echoed by Sen. Karla May, D-St. Louis, who said ending Medicaid expansion would hurt rural Missourians who have limited access to health care providers.

“We should not be in a hurry to deliver this piece of legislation to the floor whatsoever,” May said.

An attempt to block the expansion program last year by withholding funds was overturned in July by the Missouri Supreme Court. Opponents argued lawmakers had the option to refuse to pay for the expanded population’s care because of a constitutional provision that bars initiatives that appropriate funds.

The high court, however, ruled the amendment only set eligibility standards and did not directly appropriate money and therefore was constitutional.

Missouri is sitting on a record general revenue surplus that could reach $3 billion or more in the coming fiscal year. The state treasury is so flush with cash that the Missouri House is considering a bill to provide $1 billion in tax rebates.

The extra cost of expansion is expected to push the entire Medicaid budget to $16.6 billion in the coming year. The increasing cost is unsustainable, said Sen. Bill Eigel, R-Weldon Spring.

If the program is insolvent, it will hurt people more than denying coverage to the expansion group, he said.

The amendment, Eigel said, “asks for more clarification from the people of this state who were lied to by an out-of-state, special interest campaign.”

The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.

HJR 117: Medicaid eligibility, requirements

https://bit.ly/3uECUVj

Sponsor: Rep. Cody Smith

 
 

Clipped from: https://www.newstribune.com/news/2022/apr/14/bill-could-overturn-missouri-medicaid-expansion/

[MM Curator Summary]: CMS will resume TX DSRIP payments, and make backpayments- but is now auditing the underlying financing mechanism used to generate the state share.

 
 

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.

 
 

Texas got a temporary reprieve on Medicaid funding from the federal government. But that won’t solve underlying problems with high numbers of uninsured Texans and the plight of hospitals in the state — especially those in rural areas.

 
 

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Texas got some breathing room when the federal government decided last week to continue sending Medicaid money for health care for some of the state’s residents without private insurance.

But it’s not a permanent fix, and the state still has to work out solutions for uninsured Texans, the state of rural hospitals and other issues.

Texas is one of a dozen states that hasn’t expanded its Medicaid program under the federal Affordable Care Act. It’s a financially attractive federal match — the state would get roughly 90 cents for every dime invested — that has been the bane of Republicans in Texas from the moment of its inclusion in what some of them still refer to as Obamacare.

It’s also the state with the highest number of uninsured residents: 4.9 million, according to the latest American Community Survey data for 2020 from the U.S. Census Bureau. That was 17.3% of the population — also the highest in the country.

Texas found a way to bring in more Medicaid money without signing up for expansion. As The Texas Tribune’s Karen Brooks Harper described it, “Texas had come up with its own mechanism known as the Local Provider Participation Funds, in which private hospitals set up taxing districts and sent that money through local and state governments to the U.S. Centers for Medicare and Medicaid Services.”

CMS halted those payments to Texas — about $7 million a day — in September, questioning whether the state’s scheme was legal. For now, it has decided to restore the payments, so the good news is that there is no bad news — at the moment. And it also agreed to make the decision retroactive, so all of the money denied to the state since September is now coming in.

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That’s good news for hard-pressed hospitals that provide health care under Medicaid, with the caveat that CMS is still auditing the Texas Medicaid plan that makes it possible, and it could still come back and shut things down.

That so-called 1115 Medicaid waiver has brought about $30 billion in federal funds into the state for uncompensated care provided by hospitals to people who aren’t privately insured, for mental health and similar programs.

In the meantime, the state is suing to prevent the feds from cutting off the waiver.

Texas voters want to expand it. Their representatives in Austin do not.

Medicaid expansion has been proposed by legislators from both parties in every legislative session since the Affordable Care Act was passed in 2010. But a succession of state leaders have opposed it, often arguing that it would pull Texas into an expensive federal entitlement program.

Other states started with similar objections, but most have come around and expanded their Medicaid coverage. Last year, advocates argued that bringing Texas in would insure more than 1 million people who aren’t insured now, lowering the cost of treatment, pumping money into the medical economy of the state and lowering the overall cost to taxpayers. They even said it would bring $75 million to $125 million into the state budget every two years.

It’s part of a bigger health care plight for the state where slightly more than half of rural hospitals are deemed “vulnerable” by the Chartis Center for Rural Health and where the population of uninsured residents is larger than the populations of 25 states.

The momentary crisis — the federal government turning off this part of the state’s Medicaid money — is over. The health care problem remains: Nearly 5 million Texans remain uninsured, getting their medical help in the state’s expensive and inefficient workaround.

The state caught a break. But the feds remain at work, challenging the Texas waiver. Texas lawmakers thought they had a 10-year agreement, written in the last weeks of the Trump administration. It might not last another year.

 
 

Clipped from: https://www.texastribune.org/2022/03/30/texas-medicaid-uninsured/

[MM Curator Summary]: TX providers are losing $7M a day because of the decision by the Biden CMS to un-approve its DSRIP waiver.

 
 

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.

 
 

Since last year, Texas and Joe Biden’s White House have been in a Medicaid funding feud that has been costing Texas hospitals about $7 million a day. State and federal officials have imposed a deadline over the dogfight for this Friday. 

Last April, the Biden administration revoked a 10-year waiver renewal approval of billions in future Medicaid dollars for Texas.

According to The Houston Chronicle, the money, funneled through an 1115 waiver, has brought more than $30 billion to Texas since 2012, accounts for nearly one third of the state’s Medicaid budget, and funds emergency care to patients without government or private insurance.

After being denied the waiver, Republican state leaders sued to reinstate it. A federal judge ordered both sides to negotiate. A year later, they still have nothing to show for it, except the loss of millions of dollars.

Under the initial plan, payments to hospitals would have already begun, but instead, the stalemate is costing hospitals $7 million dollars a day and could force some to roll back medical services or increase charges if the waiver expires this fall, according to John Hawkins, President and Chief Executive of the Texas Hospital Association.

Since the Biden administration’s reversal last year, hospital and patient advocates assumed the waiver would shrink as Texas expanded Medicaid under the Affordable Care Act. Since Republicans have refused to expand, millions of low-income Texans are left without Medicaid or any other coverage.

Texas has both the biggest uninsured population and the highest uninsured rate of any state. The state also has historically low reimbursement rates for providers, including hospitals.

Sarah Rosenbaum, a health law and policy professor at George Washington University, said it’s possible that federal officials are trying to pressure Texas into contributing more toward indigent care.

“They’re now in a game of chicken with the administration,” Rosenbaum said of the state’s position.

The Centers for Medicare and Medicaid Services said the agency is “committed to ensuring a strong and vibrant social safety net across the nation, including in Texas.”

“This includes making sure that providers in Texas receive all Medicaid payments for providing services to Medicaid beneficiaries to which they are entitled,” it wrote, as reported by The Houston Chronicle.

 
 

Clipped from: https://www.reformaustin.org/healthcare/texas-feud-over-medicaid-is-costing-7-million-a-day/