Tag: State News

 
 

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]: In which Maine considers stopping a provider tax scam. I have never heard of this happening, and am doubly amazed that CMS actually put it in its sights a few years ago. Wonders never cease!

 
 

Clipped from: https://www.maine.gov/dhhs/blog/tackling-long-standing-financing-issue-mainecare-2023-05-10

May 10, 2023

Among other provisions, the Governor’s budget change package proposes to eliminate a disputed tax that funds Medicaid (i.e., MaineCare) services, to limit the State’s liability going forward and clear the path for payment rate reform. This reflects Governor Mills’ commitment to responsible State budgeting and support for MaineCare which provides vital services to residents with health and long-term service and supports needs. 

Maine’s Service Provider Tax was created in 2004 and applies to some health providers, among other entities. Some of the revenue supports MaineCare services. According to KFF’s State Health Facts, 48 states had at least one provider tax as a financing source for Medicaid in 2022. 

In a September 2018 letter, the federal Centers for Medicare & Medicaid Services (CMS) raised concerns about the Service Provider Tax’s application to private non-medical institutions (PNMI) and similar home- and community-based providers in Maine. CMS asserted that this health care tax was an impermissible source of the non-federal share of funding that is used to finance Medicaid services. CMS relied, in part, on a July 25, 2014 State Health Official letter (PDF), that cautioned states against selectively taxing Medicaid managed care organizations (“MCOs”). However, the affected providers in Maine are not MCOs. Additionally, Maine’s Service Provider Tax is not on the federal government’s list of either prohibited or permitted provider taxes and the Department has argued that it meets the tests set forth for other types of permissible provider taxes. 

As Maine sought clarification, in November 2019, the Trump Administration proposed the Medicaid Financial Accountability Regulation (MFAR) that would have made major changes to provider taxes and supplemental payments – preventing Maine from developing a path forward in light of the uncertainty, as explained in a report to the Legislature (PDF). Although the federal government withdrew this proposed rule in the fall of 2020, in December 2020, CMS initiated a compliance action on the State of Maine by “deferring” or delaying payment of federal funds associated with the questioned tax effective back to July 1, 2020. Such deferrals, which are the first step toward a penalty or “disallowance,” continued quarterly and totaled $28.5 million as of April 2022.  

The Department appealed the deferrals. If a disallowance is issued, Maine could also appeal it. However, few administrative appeals are successful and the process is lengthy. Without repealing the Service Provider Tax on health providers, the potential disallowance from the federal government could be over $100 million through this fiscal year, with approximately $34 million more each subsequent year.  

As such, the change package proposes to repeal the Service Provider Tax on health providers and remove all documented add-on amounts associated with the tax that are built into MaineCare reimbursement, effective January 1, 2025. The change package would use nearly $20 million in ongoing general funds from the updated May 2023 revenue forecast to replace the lost revenue that supports MaineCare services. Additionally, the change package would add a one-time $6.5 million to the Medicaid Stabilization Fund in the event that CMS issues a disallowance for past use of the tax, bringing the total in that Fund to $29 million.  

Repealing the health components of the Service Provider Tax would solve a dispute that dates back years. Consistent with facilitating re-certification of the Riverview Psychiatric Center and paying the federal disallowance incurred under the previous administration, Governor Mills is addressing this long-standing issue, not passing it along to future administrations. The change package would improve fiscal responsibility and the financing of MaineCare.  

It is also consistent with Maine’s award-winning comprehensive rate reform system. Under PL 2021, Chapter 639, MaineCare is working toward rates that are based on adequate, equitable and data-driven reimbursement; reward quality, cost-effective care; promote accountability for cost and performance; and reduce administrative burden. The providers currently paying this tax have had or are scheduled for a comprehensive review and update of how MaineCare reimburses them. The proposed change takes another step toward rates that meet the reform law’s goals. 

 
 

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 NY Medicaid budget will hit $100B for the first time. To infinity and beyond!

 
 

Clipped from: https://www.empirecenter.org/publications/budget-deal-increases-state-share-medicaid-spending-by-14-percent/

(This post has been updated to correct errors.)

Albany’s newly enacted budget appears to increase the state share of Medicaid spending by $4.2 billion or 13 percent, continuing a trend of explosive growth for the safety-net health plan in the aftermath of the pandemic.

Governor Hochul’s initial proposal in January had called for an unusually large increase of $2.9 billion or 9 percent. Her final deal with the Assembly and Senate – approved this week – would add another $1.3 billion, according to projections in a “scorecard” prepared by the Budget Division.

Overall spending on Medicaid, including federal aid and funding from New York City and the 57 counties, is expected to break $100 billion for the first time in the year ahead.

The program’s outlays dropped during the pandemic’s first wave in fiscal 2021, but bounced back sharply after that – in part because of a big increase in enrollment during the public health emergency (see chart). The state’s share is on track to be 53 percent higher in 2024 than it was in 2019, which compares to 10 percent growth in the five years before 2019.

 
 

This trend has pumped billions more into what was already a costly health-care system by national and international standards. New York spends more per capita on Medicaid – and on health-care generally – than any other state.

Here are some of the key Medicaid- and health-related provisions of the new budget:

Across-the-board rate increases: The bulk of the added spending will go toward higher fees for various groups of providers that treat Medicaid recipients.

Hospitals are due to receive bumps of 7.5 percent for inpatient care and 6.5 percent for outpatient care, which will cost the state an estimated $395 million in the first year.

Nursing homes and assisted living providers were allocated a 6.5 percent increase, at a cost of about $217 million, with the option of a 7.5 percent increase if approved by the health commissioner, the budget director and federal officials.

The budget also includes a 5 percent cost-of-living adjustment for workers in group homes and other facilities funded by the Office of Mental Health and the Office for People with Developmental Disabilities.

Distressed hospitals: The final deal added back $500 million in supplemental funding for financial distressed and safety-net hospitals, partially restoring a $700 million reduction in Hochul’s original proposal.

Pharmacy ‘carve-out’: After three years of delay, the final budget allows the state to move ahead with a restructuring of Medicaid’s pharmacy benefit that was approved in 2020.

Under this so-called “carve-out,” which took effect April 1, prescription drug costs will be directly reimbursed by the Health Department rather than by the insurance plans that process most other claims under Medicaid managed care.

The state expects this will save $410 million, mostly through additional rebate payments from drug manufacturers. However, most of that savings is to be paid back out to safety-net providers – to compensate them for lost revenue they have been generating through a federal drug-discount program called 340B. 

Cost-shift to counties: Lawmakers agreed to phase out an aid-sharing arrangement that reduces the Medicaid tab for New York City and the other 57 counties – effectively ending a freeze on the local contribution that has been in place for eight years.

As a result, the city and counties will pay $219 million more in this fiscal year, rising to an estimated $808 million by 2027.

For counties outside New York City, that additional cost is equivalent to 4 percent of their property tax revenues in 2021.

Home health compensation: In an unexpected last-minute provision, the budget calls for cutting wage supplements for downstate home health aides by $1.55 per hour.

At the same time, a $1 hike in the enhanced minimum wage for home health aides, which was due in October, would be replaced by a $1.55 hike in January. In New York City, Long Island and Westchester County, that would precisely offset the $1.55 cut to the wage supplement – meaning the downstate workers’ total minimum compensation would stay flat in the new year.

The wage supplements, instituted in 2016, require that downstate home health aides receive extra compensation on top of the minimum wage which can be provided either in the form of benefits, such as health insurance, or as straight wages.

The hourly amounts are currently $4.09 in New York City and $3.22 in Nassau, Suffolk and Westchester counties, and would drop to $2.54 and $1.67, respectively, as of Jan. 1.

This change was backed by the union 1199 SEIU because part of the savings would go to a subsidy for home health agencies that offer health insurance for their workers. This would mean more revenue for an 1199-operated benefit fund that has been losing money for several years.

However, most aides currently receive all or most of the supplements in the form of wages rather than benefits – and the policy change amounts to a net reduction for the affected workers as a group.

Over the first two years, the state projects that it will save $584 million on wage supplements while allocating just $157 million for enhanced subsidies – for a net reduction of $427 million compared to the baseline. The total impact for workers would be larger, because the reduction in wage supplements affects their compensation from all payers, including Medicare and private sources.

Health-care capital grants: The budget allocates another $1 billion for capital grants to health-care institutions – allowing hospitals, nursing homes and other providers to expand or renovate their facilities at taxpayer expense.

Lawmakers have previously approved similar pots of money seven times over the past 10 years – allocating a total of $5.4 billion, less than half of which has been spent.

Extension of HCRA taxes: In what has become a routine step, the budget extends a pair of multi-billion-dollar taxes on health insurance for another three years, to March 2026. 

The taxes have been levied under the so-called Health Care Reform Act since 1996. Together, they bring in about $5.2 billion per year, making them the state’s third-largest source of revenue after income and sales taxes.

They also add hundreds of dollars per year to the cost of health insurance for the average family – which is one reason New York has some of the highest premiums in the contiguous 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]: More details on the current left wing Medicaid expansion offensive.

 
 

 
 

Clipped from: https://www.politico.com/news/2023/05/09/medicaid-for-undocumented-immigrants-democrats-00095949

The intra-party debate comes as the Biden administration and Democrats at the national level grapple with how to expand health care access for noncitizens.

 
 

“It frustrates me because it’s not based on any kind of policy decision other than dollars,” said Connecticut state Rep. Jillian Gilchrest, a Democrat who is spearheading a bill to expand Medicaid to all undocumented kids this year. “The budget document outlines your priorities as a state. As we’re looking at all the various things we need to fund, this should be top of mind.”

The intra-party debate comes as the Biden administration and Democrats at the national level grapple with how to expand health care access for noncitizens — who make up just 6 percent of the U.S. population but 23 percent of the uninsured — in a divided Congress.

Hopes of a public health insurance option, a hallmark of Biden’s presidential campaign, were dashed during debates over what became the Inflation Reduction Act. Instead, House Republicans just passed legislation that would add work requirements to Medicaid — a move that could leave an additional 600,000 Americans uninsured, according to the Congressional Budget Office.

Against that federal backdrop, progressive state lawmakers are trying to take up the mantle, using their own dollars to push policies for undocumented immigrants that were until recently outside mainstream Democratic thinking and inch toward universal coverage.

“The idea that health care is something everybody should have access to has shifted in the last decade or so,” said Kelly Whitener, an associate professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families. “How to get there is the hard part — and I think the cost barrier is a real one.”

In Nevada, Democrats have slashed a $300 million proposal to expand Medicaid to all undocumented immigrants to a $90 million policy that would cover those up to age 26 — with further cuts on the table. Even if legislators can agree on the price tag, Republican Gov. Joe Lombardo has not said whether he will sign it into law.

In Minnesota, where Democrats control the governor’s mansion and both chambers of the legislature for the first time in a decade, lawmakers are debating whether to extend state-funded Medicaid coverage to undocumented children or spend an extra $39 million to cover all undocumented immigrants as they balance a host of other priorities, such as K-12 schools, affordable housing and child care.

And in Connecticut, lawmakers in 2021 expanded Medicaid coverage for undocumented children up to age 8. Last year, they expanded the program to age 12. While a bill was introduced this year that would have allowed coverage up to age 26, costing the state about $15 million a year, it was whittled down to age 15, at a cost of $3 million.

Immigrant advocates — frustrated with the state’s incremental approach to expanding coverage — are pushing in the final weeks of the legislative session for an extra $5 million they say would allow them to cover all kids up to age 18. Connecticut Gov. Ned Lamont, a Democrat, said during a Wednesday forum that he was comfortable with extending the program to age 15.

“Well, the advocates are saying, ‘Not enough,‘” Lamont said. “I get it. That’s their job, but I think we’re making progress every day.”

Democrats who favor incremental coverage expansion argue they are being methodical and chafe at the accusation that it signals a lack of political will.

“That’s just flat out nonsense,” said Connecticut state Sen. Cathy Osten, the Democrat who co-chairs the legislature’s appropriations committee. “We just want to roll out the program correctly.”

Illinois offers a cautionary tale for those concerned about costs. The number of undocumented adults who have signed up for Medicaid under the state’s coverage expansions exceeded the actuarial firm Milliman’s projections, according to the Department of Healthcare and Family Services. And, according to the state’s most recent public data, between March 2022 and February 2023, the program paid nearly twice — $189 million more — in claims for covered adults than Milliman projected, the department said.

“There’s historically been an assumption that takeup would be slow and low, that people won’t necessarily know that coverage is available, or if they are aware that coverage is newly available, they might be reluctant to enroll,” Whitener said. “But it is not playing out that way in every state.”

Beyond Illinois, California, Maine, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Vermont and Washington state have all expanded Medicaid to undocumented children. Some of those states also provide benefits to adults, either through Medicaid or the state health insurance exchange. Undocumented immigrants, as well as legal immigrants who have been in the country for less than five years, do not qualify for federal Medicaid money.

And Utah’s GOP legislature this year passed a bill expanding health coverage to undocumented kids through its Children’s Health Insurance Program after it was amended to include a $4.5 million cap, data review requirements and a sunset clause. Rep. Jim Dunnigan, a Republican, said he helped kill the proposal last year, but after extensive conversations with the bill’s Democratic sponsor, he co-sponsored the legislation this spring and shepherded it through the House, where it passed 64-7, with 52 Republicans in support.

“Some of my more conservative colleagues said … ‘If you structure it properly, we have a heart. We have a heart for kids,'” Dunnigan said. “Frankly, I was surprised at some of them. But I give them credit because they were willing to listen to what the bill was actually trying to accomplish.”

Proponents of the policies argue that while undocumented coverage expansions require significant ongoing funding, the dollars represent only a small part of their state’s budget and will save money in the long run by encouraging people to receive preventive care and keep people out of emergency rooms, reducing uncompensated care costs. They also argue the move will bring equity to mixed-status families where some people are eligible for health care and others are not, and that immigrants pay taxes that go to fund these types of programs.

But some lawmakers — in addition to having concerns about the cost — fear that opening up coverage will lead to an influx of undocumented immigrants from surrounding states, though several studies examining the so-called “magnet effect” of health care benefits have found that people move primarily for better housing, family reasons and jobs. They also argue that expanding the program too quickly could burden the state’s health care infrastructure and create problems that could leave people without coverage.

In Maryland, Democratic leadership scuttled a bill this year that would have allowed undocumented immigrants to purchase plans through the state’s health insurance exchange, saying the issue needed more study.

“What you have is a group of people who have identified a solution to a part of the problem and, I think because of their passion and their desire to see the health care needs met, they don’t necessarily understand why we want to look at all of the options available to us,” Maryland Senate Finance Committee Chair Melony Griffith, a Democrat, told reporters last month. “We want to make sure we’re meeting the needs of the most vulnerable, and getting the most out of the investments the state makes.”

 
 

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 state is dropping copays. Well for members anyway. Docs will get the copays from the state moving forward.

 
 

Clipped from: https://mississippitoday.org/2023/05/02/no-more-copays-mississippians-medicaid/

Mississippians who are insured by Medicaid no longer have to make copayments for health care services, the state’s Division of Medicaid announced.

The policy change, which went into effect May 1, includes copays for prescription medications as well as hospital and doctor’s office visits.

The Medicaid division will keep paying providers for their services, including copays — the only change is that beneficiaries will no longer be responsible, according to communications officer Matt Westerfield.

Copays are a form of cost sharing in health insurance plans. Insurance companies pay a portion of the bill, while the patient is responsible for a certain out-of-pocket amount. 

Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform, said copayments in Medicaid create problems for both policyholders and providers. 

 
 

Copays can discourage people from getting the care they need because they cannot afford it, which can snowball into a worse, even more expensive health care issue, “which means the Medicaid program would end up paying more overall,” Miller said. 

“For example, if an asthmatic child doesn’t get an inhaler because their parents can’t afford the copayment, they could end up in the hospital,” he said. “Sometimes people stretch out medications to reduce the number of refills, and that can cause problems.”

And then providers have to try and collect the copays.

“If the person can’t afford the copayment and the provider sees the patient anyway, the provider just gets paid less, and that can discourage physicians from taking on Medicaid patients,” Miller said. “In theory, the copayment discourages people from getting services they don’t need, but on balance, the problems they create by discouraging necessary care likely outweigh the advantages.”

In a month, Medicaid plans to submit a state plan amendment in pursuit of the change to the Centers for Medicare and Medicaid, which is required when a state plans to revise its policies. If approved, it will be retroactively effective to May 1. The amendment will be posted on the Medicaid agency’s website upon its submission. 

“We are always looking for opportunities to increase access to services while reducing administrative burdens on members and providers,” Westerfield said.

 
 

Republish our articles for free, online or in print, under a Creative Commons license.

 
 

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]: After decades of waiting, I/DD members in Nevada can now get basic dental care. Meanwhile, far-left wing activists want to make sure we don’t remove one single un-eligible Chad-the-otherwise-healthy-27-year-old bartender with an ACA card.

 
 

Clipped from: https://www.kolotv.com/2023/05/02/nevada-medicaid-gets-25-million-expand-dental-services-disabled/

 
 

Those with intellectual and developmental disabilities can now take advantage of six new services(WBNG)

CARSON CITY, Nev. (KOLO) – In a first for Nevada, the state’s Medicaid has received $2.5 million to expand dental services for adults with intellectual and developmental disabilities.

The money comes from the American Rescue Plan Act and a Federal 19 Title Grant.

“Caregivers and people with disabilities face day-to-day challenges with activities that we take for granted,” said Nevada State Dental Officer Dr. Keith Benson. “Simply brushing teeth in the morning can be a monumental challenge for patients and caregivers.”

Many people with intellectual and developmental disabilities are not able to sit for a dental visit without needing sedation or anesthesia. The following services will now be made available:

• Root canals
  
• Preventative Care
  
• Multiple doctor’s appointments
  
• Fillings
  
• Cleaning
  
• Sedation
  

“I have seen stress, effort, and cost place a huge burden not only on patients but also on loved ones and caregivers,” Dr. Benson said. “I applaud the dentists in our state that have stepped up to the challenge to serve this population.”

 
 

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]: Providers screeching for a rate increase upon the news of a 7% bump- “Yay!” Big Union Bosses at SEIU with tentacles in the NY Medicaid program- “… not so fast.”

 
 

Clipped from: https://spectrumlocalnews.com/nys/central-ny/ny-state-of-politics/2023/04/27/tentative-deal-would-raise-medicaid-spending-for-hospitals–nursing-homes

Hospitals and nursing homes in New York could receive a higher reimbursement rate under a tentative agreement in the state budget. 

But a broader deal for a state spending plan was not finalized on Thursday, and state lawmakers have left Albany for the next several days as issues addressing climate change are yet to be locked down. 

A source Thursday said Medicaid reimbursement rates will increase for hospitals by 7.5%. For nursing homes, the rate will increase by 6.5%. 

The health care workers union 1199SEIU called the tentative plan not nearly enough. 

“Providers serving the most vulnerable New Yorkers are emerging from the pandemic considerably weakened by soaring costs, the end of dedicated Federal funding and a decade of flat Medicaid rates,” said the union’s president George Gresham. 

Health care networks have pointed to financial complications in the wake of the COVID-19 pandemic and had sought reimbursement rates of 10% in the budget. Gov. Kath Hochul’s initial proposal called for 5% increases. 

New York’s Medicaid program is the second largest in the country and health care spending is the biggest item in the state budget. 

Even as framework deals are reached on issues like the child tax credit, other provisions remained unresolved. 

Democrats in the state Assembly met for several hours on Thursday in a closed-door meeting and wrestled over policies addressing climate change including measures for all-electric construction. A proposal to align the state’s utility regulations with the goals of a sweeping climate law is off the table, a source said. 

Hochul on Tuesday told reporters she was optimistic for a deal before the week was over. But Assembly Democrats are not expected back until Sunday to discuss budget details.