Tag: Medicaid Reform

 
 

MM Curator summary

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

 
 

[MM Curator Summary]: Forbes kindly points out that the 18M are no longer eligible and have lots of protections to help them as they exit the program for which they are… no longer eligible.

 
 

Clipped from: https://www.forbes.com/sites/theapothecary/2023/05/02/cleaning-up-medicaid-rolls-after-covid/?sh=4371c5f83003

Today, Paragon Health Institute released a new report, Pandemic Unwinding: How States Should Clean Up Their Medicaid Rolls.

Medicaid is a welfare program for low-income Americans. But, because of policies related to the COVID public health emergency, more than 20% of Medicaid enrollees no longer meet the criteria for program eligibility. States have not conducted redeterminations of Medicaid enrollees’ eligibility in more than three years.

States have an obligation to move as quickly and smartly as possible to begin cleaning up their Medicaid rolls. Doing so would represent an important first step toward rebuilding public trust, protecting taxpayers, and preserving resources for the country’s most vulnerable.

I coauthored this report with Gary Alexander, who led two state health and human services departments, and research fellow Nic Horton. The importance of Medicaid redeterminations was evidenced by yesterday’s Wall Street Journal op-ed by Arkansas Governor Sarah Huckabee Sanders entitled, “Arkansas Gets Medicaid Back to Normal.” The Paragon report provides a case study of Arkansas’s approach to redeterminations and contains seven steps that states should take to perform expedited and efficient redeterminations.

According to the Congressional Budget Office, roughly 20 million Americans have multiple sources of coverage with the most common being employer coverage and Medicaid. As a result, taxpayers are making sizeable payments to health insurers for many Medicaid enrollees who have other sources of coverage and who should not be on welfare. Moreover, public resources are being expended for people who likely need the program less than others who rely on it to pay their health care expenses.

Here are the five key takeaways from the paper:

1. The continuous enrollment requirement for Medicaid during the COVID-19 public health emergency has led to upwards of 18 million Medicaid enrollees who do not meet eligibility requirements for the program.

2. As of April 1, 2023, states have resumed regular eligibility redeterminations to preserve Medicaid for those who truly need the program and to protect taxpayers. States should prioritize resources and start with reviews of those most likely to now be ineligible.

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3. States have an incentive to act expeditiously, as enhanced federal COVID funding for Medicaid has already begun winding down and will be gone by the end of 2023.

4. The vast majority of people enrolled in Medicaid who are ineligible already have other sources of coverage or will transition to other sources of coverage when their Medicaid enrollment ends. For example, a study from the Urban Institute found that only one percent of removed enrollees would not qualify for other forms of subsidized coverage.

5. There are numerous protections for people who are removed from the program and who are still eligible, including retroactive Medicaid coverage that pays for three months of past medical expenses.

Even before the pandemic, improper Medicaid enrollment was the leading cause of improper payments in federal health programs, including Medicare. This was a problem emanating from the excessive federal reimbursement of state expenditures on Medicaid recipients enrolled under the Affordable Care Act (ACA). With University of Kentucky economist Aaron Yelowitz, I wrote about how the ACA led to significant improper enrollment and spending in Medicaid in two Wall Street Journal pieces (“ObamaCare’s Medicaid Deception” and “Why Obama Stopped Auditing Medicaid“) as well as a Mercatus research paper. Thus, there were many ineligible Medicaid enrollees when the COVID continuous coverage requirements commenced.

In the report, we discuss how rules from both the Obama and Biden administration made it more likely for ineligible people to stay on Medicaid and more difficult for states to remove ineligible recipients from Medicaid, in part by reducing the frequency of state eligibility redeterminations. Importantly, much of the media’s focus on Medicaid redeterminations fails to appreciate how easy it is for people who are eligible for Medicaid to enroll or re-enroll in the program. As we discuss in the report, two major protections are retroactive eligibility and hospital presumptive eligibility.

• Retroactive eligibility: Individuals who qualify for Medicaid can enroll and have their medical expenses covered by taxpayers retroactively so long as they were eligible when the services were received. If individuals are incorrectly removed, they can re-enroll in the program and still have their expenses covered, with up to three months of expenses paid by Medicaid.

• Hospital Presumptive Eligibility (PE): PE is an expedited Medicaid application process through the hospital that permits a Medicaid determination based on only a few questions about income and household size and without verification. If individuals meet these basic and initial requirements, they are immediately presumed Medicaid eligible. They receive temporary coverage pending completion of a full eligibility review. This means that a person who is disenrolled often finds it easy to get back on the program through PE when receiving medical services.

 
 

MM Curator summary

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

 
 

[MM Curator Summary]: Turns out the Aace in the hole used by far left-wing activists to force Medicaid expansion is really a Joker.

 
 

Clipped from: https://www.wsj.com/articles/medicaid-expansion-wont-save-rural-hospitals-obama-care-fraud-dependency-e9ad20c7

But it has disastrous consequences for state budgets and fosters high levels of dependency.

Democrats think they’ve found the key to convincing Republican states to expand Medicaid and cover millions more able-bodied adults in the government-run health-insurance program. Over the past few years, Democrats have claimed that refusing to accept ObamaCare’s central policy will force the closure of rural hospitals, hurting GOP states and voters the most. This tug-at-the-heartstrings message has swayed Republican-dominated states such as South Dakota, Missouri and, as of late March, North Carolina to expand Medicaid. But it’s a lie.

I have analyzed every hospital closure since 2014 when ObamaCare went into effect. Medicaid expansion has failed to halt rural hospital closures, and in some cases it contributes to them. The reason is simple: Medicaid is so poorly run that it often adds financial burdens to hospitals. The 10 Republican-led states that haven’t adopted this policy would be wise to hold their ground, given that Medicaid expansion also has disastrous consequences for state budgets and fosters historic levels of government dependency.

 
 

Here are the facts. Since 2014, dozens of hospitals have closed in states that haven’t expanded Medicaid. Yet their stated reasons almost always have nothing to do with Medicaid expansion. Damage from natural disasters, declining business and fraud, among many other factors, have caused hospitals to close. Only four hospitals in nonexpansion states directly attributed their closures to a lack of Medicaid expansion. Two of them later were alleged to have engaged in wide-scale fraud and financial mismanagement, casting doubt on their earlier statements.

Even more telling is what happened in the nearly 40 states that did expand Medicaid before the start of this year. Despite the assurances of liberal activists, nearly 50 hospitals have closed in these states since expansion passed, including more than a dozen in rural areas. Missouri voted to expand Medicaid by ballot initiative in August 2020, with implementation beginning a little more than a year later. Yet two rural hospitals closed in September 2022, well after expansion took effect.

 
 

The situation will surely worsen. According to data from the Center for Healthcare Quality and Payment Reform, 1 in 4 rural hospitals in expansion states are still at risk of closure. A 2019 Navigant study found that the top five states at risk of losing community-essential rural hospitals are all expansion states.

This is exactly what Medicaid expansion was supposed to prevent, yet expansion itself is driving this crisis in rural and urban hospitals alike. The program’s reimbursement rates are about 60% of what private health insurance pays, often leaving hospitals with large losses on Medicaid patients. Nationwide, more than 18 million able-bodied adults and counting have enrolled in the program due to expansion, and each new recipient potentially adds red ink to a hospital’s balance sheet.

Rural hospitals typically struggle financially as it is, and Medicaid expansion can push them into insolvency. But the problem isn’t limited to rural hospitals. Pennsylvania expanded Medicaid in 2015 and Philadelphia’s Hahnemann Hospital closed in 2019 because of what the Philadelphia Inquirer called a “heavy reliance on Medicaid.”

Despite these closures, hospital advocacy groups have joined Democrats in vigorously demanding expansion. The promise of federal money in the short term—and the resulting bonuses and pay bumps for hospital executives—is apparently more important than future stability.

Democrats won’t stop until they convince all 50 states to expand Medicaid. As one activist told the New York Times in March, “this argument about rural hospital closures has been an incredibly compelling argument to voters.” That same story, which focused on Mississippi, was titled “A State’s Choice to Forgo Medicaid Funds Is Killing Hospitals.” Mississippi and Alabama are likely the next two states in Democrats’ sights.

The remaining Republican-led states shouldn’t fall for it. By not expanding Medicaid, they are likely saving rural hospitals from even worse financial pressure, while protecting taxpayers from enormous losses and saving able-bodied adults from government dependence. In these states, at least, the truth about Medicaid expansion still prevails.

Mr. Dublois is data and analytics director at the Foundation for Government Accountability.

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From <https://www.wsj.com/articles/medicaid-expansion-wont-save-rural-hospitals-obama-care-fraud-dependency-e9ad20c7>

MM Curator summary

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

 
 

[MM Curator Summary]: Welcome the next cohort of MACPAC(kers).

 
 

https://www.gao.gov/press-release/gao-makes-macpac-appointments,-designates-vice-chair-0

 
 

 
 

Press Release WASHINGTON, D.C. (May 1, 2023)—Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of six new members to the Medicaid and CHIP Payment and Access Commission (MACPAC). He also named the Commission’s Vice Chair.

“I’m pleased to announce the newest members of this important health care commission,” Dodaro said. “These outstanding individuals are exceptionally well-qualified to serve and provide Congress with expert advice on both Medicaid and the Children’s Health Insurance Program (CHIP).”

The newly appointed members are Timothy Hill, Carolyn Ingram, Patti Killingsworth, Adrienne McFadden, and Jami Snyder. Their terms will expire in April 2026. In addition, John B. McCarthy was newly appointed to serve out the remaining term of Laura Herrera Scott, which will expire in April 2024. Current member Robert Duncan has been named the Commission’s Vice Chair.

The Children’s Health Insurance Program (CHIP) Reauthorization Act of 2009 established MACPAC to review Medicaid and CHIP access and payment policies and to advise Congress on issues affecting Medicaid and CHIP. The Act directs the Comptroller General to appoint MACPAC’s members. Brief biographies of the new commission members and the Commission Vice Chair follow.

New Commission Members:

 
 

 
 

Timothy Hill, MPA, is Vice President for Client Engagement at the American Institutes for Research (AIR), where he provides leadership and strategic direction across a variety of health-related projects. Prior to joining AIR, Mr. Hill held several executive positions within the Centers for Medicare & Medicaid Services (CMS), including as a Deputy Director of the Center for Medicaid and CHIP Services, the Center for Consumer Information and Insurance Oversight, and Center for Medicare. Mr. Hill earned his bachelor’s degree from Northeastern University and his master’s degree from the University of Connecticut.

 
 

Carolyn Ingram, MBA, is an Executive Vice President of Molina Healthcare, Inc., which provides managed health care services under the Medicaid and Medicare programs, as well as through state insurance marketplaces. Ms. Ingram is also the Plan President for Molina Healthcare of New Mexico and the Executive Director of the Molina Healthcare Charitable Foundation. Previously, Ms. Ingram served as the Director of the New Mexico Medicaid program, where she launched the state’s first managed long-term services and supports program. She also held prior leadership roles, including Vice Chair of the National Association of Medicaid Directors and Chair of the New Mexico Medical Insurance Pool. Ms. Ingram earned her bachelor’s degree from the University of Puget Sound and her master of business administration from New Mexico State University.

 
 

Patti Killingsworth is the Senior Vice President of Long Term Services and Supports (LTSS) Strategy at CareBridge, a value-based healthcare company dedicated to supporting Medicaid and dual eligible beneficiaries receiving home and community-based services. Ms. Killingsworth is a former Medicaid beneficiary and lifelong family caregiver with 25 years of Medicaid public service experience, most recently as the longstanding Assistant Commissioner and Chief of LTSS for TennCare, the Medicaid agency in Tennessee. Ms. Killingsworth received her bachelor’s degree from Missouri State University.

 
 

John B. McCarthy, MPA, is a Founding Partner at Speire Healthcare Strategies, which helps public and private sector entities navigate the healthcare landscape through the development of state and federal health policy. Previously, he served as the Medicaid Director for both the District of Columbia and Ohio, where he implemented a series of innovative policy initiatives that modernized both programs. He has also played a significant role nationally, serving as Vice President of the National Association of Medicaid Directors. Mr. McCarthy holds a master’s degree in public affairs from Indiana University’s Paul H. O’Neill School of Public and Environmental Affairs.

 
 

Adrienne McFadden, MD, JD, is the Chief Medical Officer of Medicaid at Elevance Health, where she serves as the strategic clinical thought leader for the Medicaid line of business. Previously, Dr. McFadden was the Chief Medical Officer at Buoy Health, a virtual health service created to support patient decision making. After beginning her career in emergency medicine, Dr. McFadden has held multiple executive and senior leadership roles including Vice President for Medicaid Clinical at Humana, Inc.; Director of the Office of Health Equity at the Virginia Department of Health; and inaugural Medical Director of the South University Richmond Physician Assistant Program. Dr. McFadden received her medical and law degrees from Duke University.

 
 

Jami Snyder, MA, is the President and Chief Executive Officer of JSN Strategies LLC, where she provides health care-related consulting services to a range of public and private sector clients. Previously, she was the Arizona cabinet member charged with overseeing the state’s Medicaid program. During her tenure, Ms. Snyder spearheaded efforts to stabilize the state’s health care delivery system during the public health emergency and advance the agency’s Whole Person Care Initiative. Ms. Snyder also served as the Medicaid director in Texas and as the President of the National Association of Medicaid Directors. Ms. Snyder holds a master’s degree in political science from Arizona State University.

Commission Vice-Chair:

 
 

Robert Duncan, MBA, is Executive Vice President and Chief Operating Officer of Connecticut Children’s. Previously, he served as Executive Vice President of Children’s Wisconsin and the President of Children’s Service Society, a large social service agency that provides foster care and adoption, mental health, and parental support services to children and families across the state. Earlier, he served as both the Director of the Tennessee Governor’s Office of Children’s Care Coordination and the Director of CoverKids, Tennessee’s CHIP program. Mr. Duncan received his master of business administration from the University of Tennessee at Martin.

For more information about MACPAC, contact Kate Massey, MACPAC’s executive director, at (202) 350-2000. Other questions should be directed to Chuck Young in GAO’s Office of Public Affairs at (202) 512-4800. 

 
 

From <https://www.gao.gov/press-release/gao-makes-macpac-appointments,-designates-vice-chair-0>

 
 

MM Curator summary

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

 
 

[MM Curator Summary]: We sort of don’t have a plan to keep Medicare/Medicaid integration going.

 
 

 
 

Clipped from: https://healthpayerintelligence.com/news/how-to-protect-integration-progress-as-medicare-medicaid-plans-sunset

With Medicare-Medicaid plans set to sunset by the end of 2025, states, CMS, Congress, and other stakeholders must take steps to protect the Medicare-Medicaid integration progress.

Source: Getty Images

 
 

By Kelsey Waddill

May 03, 2023 – As CMS sunsets the Medicare-Medicaid plan model, Congress and the agency will need to take steps to expand the Medicare-Medicaid Coordination Office (MMCO) oversight capabilities and protect the previous years’ Medicare-Medicaid integration progress, researchers explained in a Health Affairs article.

CMS is sunsetting the Medicare-Medicaid plan model nationwide. The agency found that the program was inconsistent. In some cases it increased utilization while in other cases it decreased utilization. The Medicare-Medicaid plan will be dissolved nationwide by the end of December 2025.

States will have to determine how to transition their Medicare-Medicaid plan populations into meaningfully integrated dual eligible special needs plans, such as highly integrated dual eligible special needs plans (HIDE SNP) and fully integrated dual eligible special needs plans (FIDE SNP).

There are 11.5 million individuals with access to a dual eligible special needs plan or Medicare-Medicaid plans. Less than half are enrolled in one of these options (5.1 million). The sunsetting of the Medicare-Medicaid plan model in one state (California) drove down enrollment in meaningfully integrated programs.

Some states have models that will provide a more natural transition into meaningfully integrated plans. For example, eight states offer a capitated Medicare-Medicaid plan and certain counties in two of these states offer parallel Medicare-Medicaid plans and FIDE SNPs. By expanding the FIDE SNPs, the plans could absorb Medicare-Medicaid plan beneficiaries.

Most states will have to design a pathway from Medicare-Medicaid plans to meaningfully integrated plans.

Also, the sunsetting of the Medicare-Medicaid plan model may require CMS to rethink the role of the MMCO.

The researchers pointed out that the MMCO’s functions extend beyond the Medicare-Medicaid plans. The office should continue to be responsible for overseeing Medicare-Medicaid integration and it is the only office that is dedicated to both programs, as opposed to other oversight bodies that focus on either Medicare or Medicaid.

“As the end of the MMP nears and the future of MMCO is uncertain, it is important to ensure Medicare-Medicaid integration successes are not lost,” the researchers underscored.

They suggested four administrative and regulatory changes that could support integration of Medicare and Medicaid as CMS sunsets the Medicare-Medicaid plans.

First, policymakers should address the role of MMCO and the extent of its authority. MMCO leaders have expressed that they do not have the power to engage more broadly in Medicare-Medicaid integration. But the researchers urged Congress to formalize MMCO’s authority over the Financial Alignment Initiative, dual eligible special needs plan endeavors, and other related programs.

Second, as states are required to sunset their Medicare-Medicaid plans, they should also be required to set up integrated programs.

“States face competing priorities and political pressures that inhibit a shift to an integrated program. Absent a mandate, dual eligible individuals in many states and counties will continue to lack access to an integrated option,” the researchers stated.

States can use dual eligible special needs plan State Medicaid Agency Contract (SMAC). Additionally, they should be required to formulate an integration plan and should receive planning grants and technical assistance, with MMCO oversight.

Third, policymakers should remove the financing and payment barriers to integration. Funds should be fungible between Medicare and Medicaid services and siloes should be disintegrated. States should be allowed to participate in Medicare savings that are a result of integration investments.

Finally, lawmakers and CMS should create training of enrollment support providers so that they can share the value of integration. There should also be incentives for enrolling dual eligibles in meaningfully integrated programs.

“CMS should work with the Administration for Community Living (ACL) and states to ensure the aging and disability network (including SHIPs) is equipped to serve dual eligible individuals, and Congress should ensure sufficient resourcing,” the researchers added.

For payers who are considering entering the dual eligible market during this sunset period, separate research has outlined five factors to keep in mind.

 
 

 
 

MM Curator summary

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

 
 

[MM Curator Summary]: Let’s try this maybe in a way that doesn’t rely on CMS or SCOTUS.

 
 

 
 

Clipped from: https://www.washingtonpost.com/business/2023/04/11/gop-medicaid-food-stamps-work/

The demand from House Speaker Kevin McCarthy comes as the White House rejects talks on policies that could cut benefits to low-income Americans

House Speaker Kevin McCarthy (R-Calif.) at a bill-signing ceremony in March. GOP leaders are looking at proposals to require recipients of some federal aid to work. (Jabin Botsford/The Washington Post)

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House Republicans are eyeing new work requirements for millions of low-income Americans who receive health insurance, money to buy food and other financial aid from the federal government, reprising the party’s historic crusade against welfare as some lawmakers seek new ways to slash spending.

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In recent weeks, the GOP has focused its attention on two anti-poverty programs: Medicaid, which enrolls the poorest families in health insurance, and food stamps, which provide grocery benefits to those in need. Top lawmakers including House Speaker Kevin McCarthy (R-Calif.) have publicly endorsed rules that could force some enrollees to find a job and work longer hours — or risk losing the government’s help entirely.

The demands largely come in the context of a brewing fight over the federal budget. Many Republicans have said that federal aid programs offer a way for policymakers to boost U.S. workforce participation while saving Washington money — a stance that infuriates Democrats, aid workers and others, who say such changes could harm vulnerable families still reeling since the coronavirus pandemic.

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The debate in some ways resembles the Republican-led campaign against so-called welfare queens in the 1990s, when a politically resurgent GOP — then under the leadership of House Speaker Newt Gingrich — secured a dramatic restructuring of the government’s social safety net. The resulting overhaul, enacted by President Bill Clinton, slashed cash benefits for millions of Americans in ways that GOP leaders now cite as a model.

“I don’t think hard-working Americans should be paying for all the social services for people who could make a broader contribution and instead are couch potatoes,” Rep. Matt Gaetz (R-Fla.), a member of the far-right House Freedom Caucus, said at a news conference last month.

At the center of the standoff is the debt ceiling, the statutory limit on how much the U.S. government can borrow to pay its bills. Lawmakers must raise that cap as soon as June or risk a federal default — an economic calamity that GOP leaders have tried to exploit in hopes of advancing their agenda.

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In a letter published late last month, McCarthy called on President Biden to negotiate and spelled out his party’s latest demands. That included steep spending cuts and new policies “strengthening work requirements for those without dependents” — a reference to children — citing the fact that Biden supported the welfare-to-work approach adopted under Clinton in the ’90s.

Biden has refused to haggle over the debt ceiling and instead demands that Republicans raise it and preserve the country’s credit without conditions. The president has expressed a willingness to discuss broader fiscal issues with McCarthy, but White House aides have outright rejected any changes to food stamps and Medicaid that reduce enrollment.

“The President has been clear that he will oppose policies that push Americans into poverty or cause them to lose health care,” White House spokesman Michael Kikukawa said in a statement. “That’s why he opposes Republican proposals that would take food assistance and Medicaid away from millions of people by adding burdensome, bureaucratic requirements.”

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Still, top Republicans have unveiled a battery of proposals, including one targeting Medicaid, hoping to deliver on a long-sought conservative goal to add work requirements to the insurance program.

In February, Gaetz released legislation that would deny benefits to able-bodied adults unless they work for 120 hours per month, volunteer or participate in a work program for 80 hours, or participate in a combination of those activities. The congressman did not respond to a request for comment.

It is unclear whether other Republicans would support that approach. Gaetz’s bill does not yet appear to have any co-sponsors, but the hard-right bloc to which he belongs, the House Freedom Caucus, generally endorsed work requirements in its own demand letter last month. The group didn’t specify any programs, but Rep. Scott Perry (R-Pa.), the caucus’s chairman, later told The Washington Post that he wants nationwide work requirements for Medicaid.

The new conservative push is especially potent because Republicans’ razor-thin House majority gives its hard-right faction powerful leverage. It also arrives at a tumultuous time for Medicaid, which saw enrollment balloon by about 30 percent at the height of the pandemic.

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During the crisis, lawmakers enacted temporary rules that essentially prevented states from culling their Medicaid rolls. But those prohibitions expired on April 1, opening the door for state health officials to begin reevaluating eligibility. Approximately 15 million low-income Americans are ultimately expected to lose their coverage as a result, including 6.8 million who still qualify for the program, according to federal estimates in August.

At the White House, Biden has leaned into health care as a campaign message ahead of a potential 2024 reelection bid. In an interview last month, his Medicaid chief criticized work requirements.

“On work requirements, I think the administration’s position is really clear about being very much concerned about putting up barriers to people getting coverage,” said Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services. “It’s critical that we have coverage in this country … and there are other ways to really address making sure that people are able to find employment.”

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The two parties have previously battled over work requirements in the safety net program. In 2018, the Trump administration issued optional guidance for states to implement work rules in Medicaid for the first time, contending it would incentivize healthy people to find employment. Democrats seized on the issue, arguing the policy would hurt vulnerable Americans and was designed to curtail Medicaid enrollment.

Thirteen states adopted such rules under President Donald Trump. Once Biden took office, however, his Medicaid agency quietly began to send letters rescinding states’ Medicaid work requirements, which already faced a flurry of legal challenges and weren’t in effect. Only one state, Arkansas, imposed a work requirement for a significant period. Over more than nine months, about 18,000 adults lost coverage for failing to comply with the rules, and only about 1,900 re-enrolled in the program before a federal judge blocked the work rules.

Since then, the state’s new governor, Sarah Huckabee Sanders (R), has said she will try again under different rules — while a work requirement in Georgia is slated to begin this summer. Nationally, Republicans have argued that such mandates could increase labor force participation, even as the unemployment rate remains low.

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“This is the perfect time to have work requirements because people are needed, they’re wanted,” said Rep. Brett Guthrie (R-Ky.), chairman of the House Energy and Commerce health subcommittee. “Wages are rising because there’s a shortage of workers, so it’s a good opportunity for people to better themselves moving forward.”

For some Republicans, though, the push doubles as an opportunity to reduce the federal debt, which exceeds $31 trillion. At a House hearing in early April, Rep. Darin LaHood (R-Ill.), the new chairman of the House Ways and Means subcommittee on work and welfare, stressed that lawmakers had to ensure more “accountability for federal taxpayer dollars.”

In doing so, Republicans have signaled their focus could be broad in scope, potentially including the benefits the government provides for housing, child care and other key services.

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“We should be exploring every possibility to get our fellow Americans back into the labor force, including strengthening work requirements across all government programs,” added Rep. Jason T. Smith (R-Mo.), the leader of the House Ways and Means Committee.

Tasked to prepare a spending blueprint for the 2024 fiscal year, the House Budget Committee last week specifically called attention to what it described as a “culture of government dependency,” citing an uptick in spending in Medicaid and other federal programs, including food stamps, unemployment insurance, disability benefits and tax credits for low-income parents with children.

The panel’s chairman, Rep. Jodey Arrington (R-Tex.), said in a previous interview that Republicans are “going to look at health care” with the goal of reducing costs, stressing that decisions “haven’t been made” about what to propose on Medicaid. Broadly, though, Arrington long has endorsed work requirements on aid programs, especially in the case of food stamps.

Formally known in Washington as the Supplemental Nutrition Assistance Program, or SNAP, food stamps provide lower-income households with an average of more than $230 each month for groceries, often paid through a debit card. Approximately 41 million people are currently enrolled in the program, according to the government.

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Under existing law, SNAP already requires many adults without children to seek employment and training. But GOP leaders argue that the rules are too lax, exempt too many beneficiaries from work and open the door for states to make too many exceptions.

One key bill from Rep. Dusty Johnson (R-S.D.), a top ally of McCarthy, would rewrite some of the program’s rules, chiefly by subjecting Americans without children between the ages of 49 and 65 to SNAP work requirements. (Current rules for these adults only apply up to 49.) The proposal, which has more than three dozen GOP co-sponsors, also would limit states’ ability to waive some of those rules.

“This is not about balancing the budget on the backs of anyone,” Johnson said in an interview, adding that there is “no reliable pathway out of poverty” that doesn’t involve work, education and training.

But the changes could force more than 10 million people off food stamps, according to the left-leaning Center on Budget and Policy Priorities, which estimates the cut would affect 1 in 4 SNAP recipients. Even those who retained monthly food aid could face additional hardship, because they could be forced to work longer hours in ways that affect their ability to care for their children, CBPP found.

Johnson disputed that analysis. Still, it could be the second blow to SNAP recipients in recent months, after Congress allowed a pandemic benefit program to expire in March, slashing millions of families food benefits by an average $82, according to the Food Research and Action Center. Some Republicans still have signaled discomfort over targeting SNAP in the ongoing budget debate.

Democrats, meanwhile, have pledged to oppose any such changes, setting up a clash that could come to head even if the GOP does not pursue changes in talks around the debt ceiling. Lawmakers also must act by Oct. 1 to approve legislation known as the Farm Bill, which authorizes a bevy of federal farm and nutrition-related programs.

 
 

 
 

MM Curator summary

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

 
 

[MM Curator Summary]: Who knew what when?

 
 

 
 

Clipped from: https://oversight.house.gov/release/comer-requests-gao-review-improper-payments-in-medicaid-program/

WASHINGTON—House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) is requesting U.S. Government Accountability Office (GAO) Comptroller General Gene L. Dodaro initiate a review of the high number of improper payments in the Medicaid program. Chairman Comer is also requesting GAO review actions the Centers for Medicare and Medicaid Service (CMS) can take to coordinate with state auditors and improve Medicaid program integrity.

“We are writing to request the Government Accountability Office (GAO) initiate a review of improper payments in the Medicaid program. GAO has previously made more than 750 recommendations and designated Medicare and Medicaid programs as a ‘high risk area’ since 1990 due to high rates of improper payments. The size and complexity of the Medicaid program make it vulnerable to improper payments. Improper payments totaled an estimated $98.7 billion in fiscal year 2021, meaning more than one of every five Medicaid expenditures were improper. The Committee is continuing our larger oversight of CMS due to unresolved concerns about billions of dollars in wasted taxpayer funds each year,” wrote Chairman Comer.

GAO has produced multiple reports identifying weaknesses in the processes Medicaid agencies use to identify improper payments and identified necessary steps to strengthen program integrity, yet CMS has failed to take necessary action. Pandemic-era changes to Medicaid eligibility determinations drastically increased the rate of improper payments. The Oversight Committee is seeking information to ensure that GAO and CMS coordinate to take necessary steps to reduce waste, fraud, and abuse in Medicaid programs and recoup improper payments.

“During the COVID-19 pandemic, the Medicaid program suspended enforcement of eligibility reviews, resulting in millions of people receiving Medicaid benefits for which they were not eligible. While the suspension was important to ensure state’s ability to respond to the COVID-19 pandemic, according to GAO, the lack of eligibility determination audits will likely increase improper payments due to the lack of oversight. Suspending eligibility verifications prevented states from removing ineligible enrollees, compounding existing improper payment abuses,” Chairman Comer continued.

Read the letter to GAO Comptroller General Gene L. Dodaro here.

READ MORE: Comer & Oversight Republicans Press CMS on Medicaid Redeterminations to Reduce Improper Payments

MM Curator summary

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

 
 

[MM Curator Summary]: Directed payments is Latin for “yet another opaque way to siphon taxpayer money to providers- this time thru MCOs”.

 
 

 
 

 
 

Clipped from: https://www.route-fifty.com/health-human-services/2023/04/special-medicaid-funds-help-most-states-prompt-oversight-concerns/385000/

 
 

Grady Memorial Hospital in Atlanta. Frank Mullen via Getty Images

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This story was first published by Kaiser Health News. Read the original article here. 

Emanuel Medical Center in rural Georgia racks up more than $350,000 a month in losses providing health care for low-income and uninsured patients. But a new state funding proposal could significantly reduce those deficits, not just for the 66-bed Swainsboro facility but for most rural hospitals in Georgia, according to state Medicaid officials.

It’s not Medicaid expansion, which Georgia Republican leaders have rejected. Instead, the state Department of Community Health is using an under-the-radar Medicaid funding opportunity that has been rapidly taken up by more than 35 states— including most of the states that have expanded the government insurance program.

The extra federal money comes through an obscure, complicated mechanism called “directed payments“—available only for states that hire health insurers to deliver services for Medicaid.

In 2020, these special funding streams, which are approved by federal health officials, sent more than $25 billion to states, according to the Medicaid and CHIP Payment and Access Commission (MACPAC), which advises Congress.

The Centers for Medicare & Medicaid Services, when asked for an updated total, referred KHN to individual states for their spending figures. “CMS has not publicly published total spending related to state directed payments,” said agency spokesperson Bruce Alexander.

But the Government Accountability Office, Congress’ watchdog agency, and MACPAC say federal health officials should do more to monitor directed payments and evaluate whether states meet the program’s goals, which include improved access and quality of care. More transparency is needed, these agencies said.

A MACPAC report last year found that fewer than 25% of directed payment plans running for at least a year had evaluations available for review.

Federal health officials “are getting a lot of questions” on directed payments from GAO and MACPAC, said Debra Lipson, a senior fellow at consulting firm Mathematica, which has studied the issue. “It’s a lot of money.”

CMS hasn’t yet released reports on quality metrics for the program, Lipson added.

Alexander, the CMS spokesperson, said the agency “takes our role in oversight and transparency seriously, and we are working collaboratively with our federal and state partners to improve our oversight and transparency” of directed payments.

Medicaid is the government health insurance program for low-income and disabled patients. It’s jointly financed by the states and the federal government.

CMS launched the directed payments program in 2016. Georgia officials estimated the state will net $1 billion in federal funds this fiscal year for hospitals and other medical providers through its directed payment programs.

California estimates it brought in more than $6 billion just last year in new federal funds through directed payments. Arizona received $4.3 billion between 2018 and 2022. Florida netted more than $1 billion over a 12-month period ending in September.

This special Medicaid funding may indirectly help patients by strengthening financial stability for hospitals, along with offering the potential for capital improvements from the added cash infusions.

But patient advocates and Democratic lawmakers in Georgia said providing insurance coverage for the medical needs of the uninsured by adopting Medicaid expansion is more urgent. Hospitals, like Emanuel Medical Center, would benefit from Medicaid reimbursements for patients who now often rack up unpaid bills for care.

The uninsured “are not going to get preventive care, and that drives up health care costs,” said state Sen. Elena Parent, an Atlanta-area Democrat. “The state should have expanded Medicaid.”

That expansion is not going to happen in Georgia in the short run, as Republican Gov. Brian Kemp is set to launch new limits on Medicaid enrollment for low-income adults, with work requirements attached.

Under directed payments, added funding for hospitals and other Medicaid medical providers flows through different avenues, including minimum fees for services, a general reimbursement increase, and pay hikes based on quality of care.

Payments are based on the volume of services delivered. If one hospital served more Medicaid patients than another, its reimbursements would be higher, Lipson said.

“CMS initially was surprised by the volume of states’ directed payment proposals,” said Lipson. Some states have 25 or more, she added. They must be renewed annually. Often states finance their portion through hospital assessments or money transferred from public funds, such as hospital authorities, county governments, and state agencies.

Georgia has five such directed payment plans. Their goals include boosting Medicaid pay for hospitals and doctors, strengthening the health care workforce, and improving health outcomes and equity, said Caylee Noggle, commissioner of the state Department of Community Health, which runs Medicaid in Georgia.

Grady Memorial Hospital in Atlanta, a large safety-net provider, said it expects to gain $139 million across four of the Georgia programs.

“It’s a tremendous benefit for us,” said Ryan Loke, Grady’s chief health policy officer. “Without this money, Grady would be in a lot worse position.”

Grady is seeing more Medicaid and uninsured patients who formerly used nearby Atlanta Medical Center, which closed last year.

State Sen. Ben Watson, a physician and Savannah-area Republican, pointed out that such safety-net hospitals, which serve a large portion of people who lack health coverage, are getting higher pay through Medicaid directed payments, thus helping them cover some losses.

Georgia plans to use these funding streams as a base for extending extra help to rural hospitals.

With the extra payments, Grady and other hospitals will approach or reach their normal funding limit for hospitals that serve a “disproportionate share” of indigent patients. The state would take about $100 million of this excess money and send it to rural hospitals.

The Georgia Hospital Association said the directed payment money is helpful but won’t cover costs of charity care for the uninsured.

“They’re not looking at [hospitals’] bad debt,” said Anna Adams, an executive with the group. “An insured patient is a healthier patient. We’d love to see as many people covered as possible.”

Officials at rural hospitals in Georgia, meanwhile, are looking forward to the projected boost in Medicaid funds.

“It’s going to put cash in the coffers of rural hospitals that are struggling,” said Jimmy Lewis, CEO of HomeTown Health, an association of rural hospitals in the state.

Damien Scott, CEO of Emanuel Medical Center, said he’s “cautiously optimistic” about the coming allocation. On his wish list: attracting a pediatrician to his county — it has none currently — and gaining the space to move the hospital’s lone MRI machine from a truck into the hospital building.

As it is, he said, “we struggle every month for our survival.”

This story can be republished for free (details).

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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MM Curator summary

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

 
 

[MM Curator Summary]: A tiny fraction of Medicaid members get residential treatment for opioid use disorder- but it the difficulty in getting non-residential treatments (ie MAT) is probably a bigger problem.

 
 

 
 

Clipped from: https://www.upi.com/Health_News/2023/04/12/rehab-opioid-addition/9341681306196/

 
 

The United States is in the middle of an opioid crisis, yet new research shows that only about 7% of Americans on Medicaid who have opioid use disorder receive residential treatment.

This means that many people who could potentially benefit from what is more commonly known as “rehab” aren’t getting the care they need to help them with their addiction.

“We know residential care is important when it’s done right … and when it’s evidence-based. We know it’s incredibly important to engaging people in their recovery from opioid use disorder,” said study corresponding author Lindsay Allen. She is a health economist and assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, in Chicago.

“And Medicaid is a major payer. It’s the biggest payer of opioid use disorder treatment nationally because so many individuals with OUD [opioid use disorder] are covered by Medicaid,” Allen continued.

Making direct comparisons of access to residential OUD treatment can be difficult because states code or define programs differently.

But the researchers used a research network that standardized data for nine states that represent about 14.9 million people, including 20% of all Medicaid enrollees.

Using an apples-to-apples comparisons of data, the investigators discovered that usage of residential treatment for OUD varied widely, depending on the state.

RELATED Overdose deaths among seniors soar over past 2 decades, UCLA study finds

While some states provided residential treatment for up to 14.6% of Medicaid enrollees with OUD, others only allowed 0.3% to access rehab.

Allen said the differences were disconcerting.

Among the benefits of having standardized data is providing information about where and what policies need to be targeted, she said.

RELATED Anti-addiction drug buprenorphine may cut risk of fatal overdose

The states that were part of the study were Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia and West Virginia. Dr. Sarah Wakeman, medical director for substance use disorder at Mass General Brigham, in Boston.

Yet, there isn’t convincing evidence that residential treatment is best for treating OUD, she said, noting that many residential programs don’t offer medication to treat OUD, or even prohibit them.

What is best is treating a patient with an opioid agonist, such as methadone and buprenorphine, Wakeman said, comparing this to providing insulin to someone with diabetes. The medications are misunderstood and deeply stigmatized, she said.

“They restore normal functioning. They allow a person to feel well again, to not experience cravings or an urge to want to use opioids, to not experience withdrawal and to just get on with their life,” Wakeman said. “And they’ve been shown in literally hundreds of studies over decades to reduce the recurrence of opioid use disorder and reduce both overdose-specific mortality and all-cause mortality.”

Residential treatment may be helpful for someone who has experienced significant consequences from their opioid disorder, who has not successfully stabilized in an outpatient treatment setting or who is also addicted to other substances, said Dr. Larissa Mooney, director in the division of addiction psychiatry at UCLA’s David Geffen School of Medicine in Los Angeles.

However, even in residential treatment, medication for OUD needs to be offered, Mooney said.

“The most robust treatments for opioid use disorder are FDA-approved medications, which include buprenorphine, methadone and extended-release naltrexone,” Mooney said.

Managing co-occurring psychiatric disorders, such as depression or anxiety, is also an important part of addiction recovery, she said.

“With support and access to medication treatment, many people can achieve remission from opioid use disorder. Individual paths to recovery vary widely, so we need to ensure access to as many treatment options as possible,” Mooney said.

More information

The U.S. Department of Health and Human Services has more on the opioid crisis in the United States.

MM Curator summary

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

 
 

[MM Curator Summary]: The annual pretending that we will ever cut Medicaid dons its 2023 costume.

 
 

Clipped from: https://www.politico.com/news/2023/03/08/house-democrats-republicans-medicaid-00086136

Republican House and Senate leadership have been adamant that they will not cut Social Security and Medicare, but have said less about Medicaid.

 
 

“No one’s interested in doing anything other than saving it to make it more solvent for those that might need it down the road,” Sen. Mike Braun (R-Ind.) told POLITICO. “If you want to save [Medicaid] for future generations, it’s never too early to look at how to do that.”

Biden, who is expected to release his budget on Thursday, has spent much of the year castigating Republicans for proposals to cut Medicare, Social Security, Medicaid and the Affordable Care Act part of a broader effort to paint the GOP as a threat to popular health programs. Though Democrats, who control the Senate, will almost certainly reject big cuts to Medicaid, Republicans’ desire to rein in federal spending portends a drawn out political fight over a program that now insures more than one-in-four Americans.

Republican House and Senate leadership have been adamant that they will not cut those two entitlement programs, but have said less about Medicaid, which insures more than 90 million Americans. That number swelled during the Covid-19 pandemic, when states were barred from removing people who were no longer eligible.

Asked if assurances by GOP leaders that Medicare and Social Security are off the table have put more pressure on lawmakers to find savings in Medicaid, Rep. Michael Burgess (R-Texas) quipped: “It doesn’t take much imagination to figure that out.”

Some Republicans want to revive a 2017 plan to phase out the enhanced federal match for Medicaid and cap spending for the program — an approach the Congressional Budget Office estimated would save $880 billion over 10 years and increase the number of uninsured people by 21 million.

“If you remember back to the American Health Care Act, we proposed that we make some significant changes to Medicaid. I think you’re gonna find that some of those same ideas are going to be revisited,” said Rep. Buddy Carter (R-Ga.), a member of the House Budget Committee and the conservative Republican Study Committee, a group now working on its own budget proposal to pitch to GOP leadership.

Carter added that there is also interest in the caucus in abolishing Obamacare’s Medicaid expansion, arguing that the majority of states that have opted to expand the program over the last decade might have “buyer’s remorse.”

“Medicaid was always intended for the aged, blind and disabled — for the least in our society, who need help the most,” he said. “Trying to get back to that would probably be beneficial.”

Carter and many other Republicans are also pushing for Medicaid work requirements, though the one state that implemented them saw thousands of people who should have qualified lose coverage.

“For the people who are on traditional Medicaid — the pregnant, children and disabled — there’s no sense in talking about work requirements,” Burgess said. “But for the expansion population, able-bodied adults who were wrapped in under the Affordable Care Act, yeah, that has to be part of the discussion.”

Other Republicans want to make narrower reforms. Rep. Brett Guthrie (R-Ky.), who chairs the Energy and Commerce Committee’s Health Subcommittee, is looking at changes to value-based payments in Medicaid so that states aren’t “on the hook for treatments that don’t work.” Still others are weighing potential changes to areas within Medicaid, including provider taxes and how to handle coverage for people who are eligible for both Medicare and Medicaid.

The GOP members are spurred on by outside conservative groups like the Paragon Institute, which has been holding monthly briefings for Capitol Hill aides and backchanneling with members.

“If you look at what’s driving the debt, it’s federal health programs,” Brian Blase, the president of Paragon, who worked at the White House’s National Economic Council under the Trump administration, told POLITICO. “Either Congress will reform federal health programs or there will be a massive tax increase on the middle class.”

Democrats, for their part, are working to make any proposal to cut Medicaid as politically risky for Republicans as threats to Medicare.

“I worry that my Republican colleagues have, I guess, heard from the public about their desire to cut Social Security and Medicare [and] are looking elsewhere, and obviously poor people have very little representation in Congress, so that’s an easy target,” said Sen. Bernie Sanders (I-Vt.), who chairs the Health, Education, Labor and Pensions committee.

Democrats hoping to shield Medicaid in the upcoming budget negotiations are emphasizing how many red states have voted to expand the program since Republicans last took a run at it in 2017. They’re also stressing that the people covered by Medicaid aren’t solely low-income parents and children.

“Right now at least 50 percent of Medicaid goes to seniors, and a lot of that is for nursing home care,” Rep. Frank Pallone (D-N.J.), the top Democrat on the Energy and Commerce Committee, told reporters. “People don’t realize that Medicaid is the ultimate payer for nursing home care once you run out of money or once your Medicare runs out.”

In a speech in late February, President Joe Biden excoriated Republicans for pushing deep cuts to Medicaid, arguing that doing so would threaten the finances of rural hospitals that are barely able to keep their doors open today.

“Many places throughout the Midwest, you have to drive 30, 40 miles to get to a hospital. By that time, you’re dead,” he said. “Entire communities depend on these hospitals. Not getting Medicaid would shut many of them down.”

Two people familiar with White House plans tell POLITICO that Biden is expected to include a federal expansion of Medicaid in the remaining holdout states in the budget he will submit to Congress later this week.

Adam Cancryn contributed to this report.

MM Curator summary

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

 
 

[MM Curator Summary]: A mean ole’ big bad right wing extremist GOP bad thinker is scaring people.

 
 

 
 

Clipped from: https://truthout.org/articles/trumps-former-budget-director-is-advising-gop-to-cut-medicaid-by-2-trillion/

Russ Vought is urging House GOP to gut many federal programs that low-income people rely on to meet basic needs.

 
 

Acting Director of the Office of Management and Budget Russ Vought presses the button that starts the machine that will print copies of US President Donald Trump’s proposed budget for the U.S. Government for the 2021 Fiscal Year on February 6, 2020, in Washington, D.C. Samuel Corum / Getty Images

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The right-wing official who served as budget director for the Trump administration is reportedly playing a significant advisory role for House Republicans as they seek to leverage a fast-approaching debt ceiling crisis to enact spending cuts that would disproportionately impact low-income households.

According to
The Washington Post, former Office of Management and Budget chief Russ Vought “has emerged as one of the central voices shaping the looming showdown over federal spending and the national debt.”

“As Republicans struggle to craft a strategy for confronting the Biden administration over the debt ceiling, which limits how much the government can borrow to pay for spending Congress has already approved, Vought has supplied them with a seemingly inexhaustible stream of advice: suggestions for negotiating with the White House, briefings about dealing with the media, a 104-page memo that proposes specific spending levels for every federal agency,” the Post reported Sunday.

 
 

More specifically, Vought has suggested that the GOP sideline efforts to cut Social Security and Medicare and instead focus on a “push to obliterate almost all other major forms of federal spending, especially programs that benefit lower-income Americans, and dare Biden to stand in the way.”

Vought’s agenda, the Post noted, proposes $9 trillion in federal spending cuts over the next 10 years, targeting thousands of domestic programs including Medicaid and the Supplemental Nutrition Assistance Program (SNAP).

If adopted, Vought’s proposal would inflict $2 trillion in cuts to Medicaid, potentially compromising coverage for millions across the United States — and compounding the impact of lapsing pandemic protections.

Vought’s proposed cuts to SNAP — a food aid program long attacked by Republicans — would amount to $400 billion. A recent survey found that 64% of respondents said affording food is one of the biggest challenges they’re facing amid elevated inflation.

Tens of millions across the U.S. are currently facing what advocates have dubbed a “hunger cliff” as pandemic-related emergency boosts to SNAP funding expire.

SNAP accounts for a tiny fraction of the federal government’s overall spending.

“At a moment when food distribution centers are seeing increases in demand as American families struggle to feed their children, Republican lawmakers are putting families in their political crossfire by threatening to dramatically decrease spending on essential programs like SNAP. The timing of this could not be worse,” said Ailen Arreaza, executive director of ParentsTogether. “Further cuts to essential policies helping families to keep food on the table would be unconscionable — and those politicians responsible will pay a political price.”

Vought, who is also urging Republicans to cut Labor Department funding in half and slash the Affordable Care Act, presents such austerity as needed to rein in an out-of-control federal bureaucracy. But as the Post notes, Vought “oversaw enormous increases in the national debt as Trump’s director of the Office of Management and Budget,” making clear to critics that his priority is gutting programs that low-income people rely on to meet basic needs.

“The Republican playbook is always to drive more people deeper into poverty, while giving kickbacks and tax breaks to their super-rich friends,” said progressive organizer and former congressional candidate Melanie D’Arrigo.

Last week, more than 70 House Republicans introduced legislation that would make 2017 Trump tax cuts for individuals permanent, a major giveaway to the rich that would cost the federal government around $2.2 trillion in revenue through 2032.

The Biden White House and congressional Democrats have indicated that they would oppose federal spending cuts as part of any deal to raise the debt ceiling and prevent a catastrophic default, which could come as soon as this summer if lawmakers don’t act.

“The only thing more odious than pushing for $3 trillion of unpaid-for tax cuts is pushing for $3 trillion of tax cuts and $3 trillion in cuts to healthcare and nutrition for low- and middle-income families,” tweeted Brendan Duke, a senior adviser to Sen. Michael Bennet (D-Colo.).

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