Tag: State News

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KANSAS- Audit reveals KDHE mistakenly paid $1.3 million to Medicaid contractors for care of dead people

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A new audit finds various issues with payment integrity in KS Medicaid, some of which have been addressed, some have not.

 
 

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.

 
 

Review shows agency caught $19.2 million in overpayments over 2-year period

 
 

A state inspector general discovered the Kansas Department of Health and Environment didn’t detect overpayment of $1.3 million to private companies contracted to deliver services under Medicaid. (Illustration by Kansas Reflector)

TOPEKA — An expansive audit of Kansas Department of Health and Environment’s payments to companies contracted to deliver services under the state’s Medicaid program found $1.3 million in inappropriate compensation for care of people who had actually died.

Steven Anderson, the state’s Medicaid inspector general, said the examination found 25 instances from 2015 to 2020 in which KDHE cut checks for beneficiaries who were deceased. When the report was issued last week, KDHE hadn’t yet recouped the cash from the managed-care companies handling KanCare. Approximately 360,000 Kansans are Medicaid recipients.

In addition, analysis by Anderson of the period from July 2019 and July 2021 showed KDHE had identified $19.2 million improperly paid to the contractors that was subsequently recovered by docking future payments. The mistakes caught by KDHE involved 632 cases in which the state continued making payments after a death. In 56 of those cases, the inspector general’s report said, inappropriate payments had continued for five or more years after the beneficiaries’ demise.

Anderson’s office reviewed the length of time overpaid funds were in possession of MCOs and determined the miscue was equivalent to giving those for-profit companies a $1.5 million cash loan.

The report from the inspector general recommended KDHE “review quality control measures and staff training protocols to ensure they are sufficient to confirm staff members know how to effectively and efficiently identify and process cases involving death of a beneficiaries.”

Apparently many of the mistakes occurred when the company Maximus was under contract from 2016 to 2020 to operate the state’s Medicaid clearinghouse for processing claims. KDHE should consider feasibility of taking legal action against Maximus to recover funds, Anderson’s report said.

In Kansas, KDHE is responsible for administering Medicaid, also known as KanCare. KDHE contracts with three companies to coordinate health care for individuals enrolled in KanCare. The Medicaid inspector general, housed in the attorney general’s office, is responsible for independent and ongoing reviews of the program.

“We have worked hard, in cooperation with the Legislature, to revitalize the office of Medicaid inspector general into a professional, independent reviewer that can promote efficiency in the Medicaid program,” said Attorney General Derek Schmidt. “These audits are products of that important work to reduce fraud and identify cost savings within the Kansas Medicaid, MediKan and State Children’s Health Insurance programs.”

 
 

MediKan benefit woes

The inspector general also released a July 30 report outlining challenges facing Kansans interested in reporting Medicaid fraud and recommended ways of improving access to the proper points of contact.

In a third report, also released on July 30, Anderson said 912 MediKan beneficiaries who exceeded the 12-month lifetime eligibility limit between January 2018 and April 2021. Providing benefits beyond the maximum period resulted in the state paying $1.6 million for medical claims for adults 18 to 64 years of age who were  ineligible for the program, the audit said. MediKan is a state-funded initiative providing medical services for people with physical or mental disabilities who wouldn’t qualify for Medicaid.

Kristi Zears, spokeswoman for KDHE, said 457 of the ineligible recipients of MediKan benefits were discontinued before release of the inspector general’s audit. The other 455 improper recipients had been discontinued by July 29, she said.

“We appreciate the work of the Medicaid inspector general and welcome the opportunity to further improve state medical assistance programs,” said Zears, who indicated KDHE’s reporting system would guarantee timely discontinuation of ineligible people.

The inspector general, who is required by state law to report on fraud, waste, abuse and illegal contact, presented the information to Schmidt, KDHE secretary Lee Norman, KDHE Medicaid director Sarah Fertig and the House and Senate members on the KanCare oversight committee. The joint legislative oversight committee’s meeting Tuesday was called off with a tentative plan to convene lawmakers during September.

Under KanCare, the managed-care companies receive a monthly payment from the state for each eligible beneficiary enrolled with that company regardless of whether the person incurred medical costs that month.

Sunflower State Health Plan and United Healthcare Community Plan of Kansas have worked in the privatized Medicaid system since implemented in 2013 during the administration of Gov. Sam Brownback. Amerigroup’s contract was allowed to expire by KDHE in 2018 and that troubled company was replaced by Aetna Better Health of Kansas.

 
 

Clipped from: https://kansasreflector.com/2021/08/11/audit-reveals-kdhe-mistakenly-paid-1-3-million-to-medicaid-contractors-for-care-of-dead-people/

 
 

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Feds to nix Montana’s Medicaid work requirement

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Montana may not continue its expansion program if Biden rejects their request to include work requirements.

 
 

 
 

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.

 
 

Federal health officials will likely reject Montana’s request to include work requirements for beneficiaries of its Medicaid expansion program, which insures 100,000 low-income Montana adults, state officials said.

 
 

Three years after the Trump administration encouraged states to require proof that adult enrollees are working a certain number of hours or looking for work as a condition of receiving Medicaid expansion benefits, the Centers for Medicare & Medicaid Services has reversed course under Democratic President Joe Biden.

“CMS has communicated to [the Montana Department of Public Health and Human Services] that a five-year extension of the Medicaid expansion waiver will not include work/community engagement requirements,” health officials wrote in a Medicaid waiver amendment application out for public review.

It’s unclear what that means for the future of the Montana program. In 2019, Montana lawmakers approved extending the 2015 program — the Supreme Court made the Medicaid expansion provision in the Affordable Care Act optional for states — as long as it included work requirements. Those requirements were a key condition for the moderate Republicans who joined Democratic lawmakers to muster enough votes to pass the 2019 bill over the objections of conservative GOP legislators.

The state’s position officially remains that it wants “to condition Medicaid coverage on compliance with work/community engagement requirements,” according to the amendment application. If state negotiators are proposing an alternative, they have not disclosed it.

If CMS does not approve the waiver with the work or community engagement requirements, the state health department will operate Medicaid expansion according to what is approved and await legislative review of the program, said department spokesperson Jon Ebelt.

The Montana Medicaid expansion program is scheduled to end in 2025 if the legislature doesn’t renew it. State lawmakers meet every other year, giving them the 2023 and 2025 sessions to consider changes to the popular program, which enrolls 10% of the state’s population.

Meanwhile, Republican-led lawmakers and Republican Gov. Greg Gianforte’s administration have proposed other measures designed to trim the Medicaid expansion rolls and defray costs, including raising the premiums some enrollees pay and ending a provision that allows 12 months of continuous eligibility regardless of changes in income. Those proposals are also pending federal approval, and it was in the state’s application for the 12-month continuous eligibility waiver that the status of the work requirement negotiations was disclosed.

In June, the number of Montanans enrolled in the expansion program passed 100,000 for the first time in its 5½-year history. The program provides health insurance coverage to adults who earn up to 138% of the federal poverty level, which is $26,500 for a family of four.

The negotiations between state and federal health officials involve what’s called a Section 1115 waiver amendment application to CMS, which is made when a state Medicaid program seeks to deviate from federal requirements. CMS’ deadline for acting on the application, originally submitted in 2019, was extended to Dec. 31, 2021, because of the covid-19 pandemic.

The Trump administration approved work requirement waivers in 12 other states, though no states are implementing those requirements, either because of the pandemic or lawsuits, according to research by KFF. (KHN is an editorially independent program of KFF.)

Since Biden took office, CMS has withdrawn the Trump administration’s approval of work requirement waivers in Arizona, Arkansas, Indiana, Michigan, New Hampshire and Wisconsin.

Asked to comment about the Montana negotiations, CMS officials said Medicaid is a lifeline for millions of Americans who would be put at risk by work requirements.

“The pandemic and uncertainty surrounding its long-term social, health, and economic effects exacerbate the risks associated with tying Medicaid eligibility to requirements that have been demonstrated to result in significant coverage losses and substantial harm to beneficiaries,” an unattributed CMS statement said.

Montana health department officials said in their waiver application that they expect negotiations with CMS to be finalized in the fall and the Medicaid waiver to be extended for five years starting in January. That Jan. 1, 2027, end date of the waiver, presumably without work requirements, would be subject to the state’s own 2025 sunset.

The 2019 state law granting a six-year extension to the Medicaid expansion included the condition that work and community engagement be part of it. The law states beneficiaries must work at least 80 hours each month or be engaged in a job search or volunteer work, unless they are exempt for specific reasons, such as pregnancy, disability or mental illness.

State Rep. Ed Buttrey (R-Great Falls), who sponsored both the 2019 bill and the 2015 bill that created the original Montana Medicaid expansion program, said lawmakers added the 2025 sunset so that they could assess and revise the program, if needed.

“So in a couple sessions we’ll have to take another look at the program and the federal rules and find out how things are performing and how we want to move forward.” Buttrey said.

He defended work requirements, saying the goal of Medicaid expansion has always been to create a healthy workforce to improve Montana’s economy.

State Rep. Mary Caferro (D-Helena) said work requirements can cause unnecessary hurdles for people who qualify for the Medicaid expansion program. She said that 7 in 10 Montanans who gained Medicaid coverage under the expansion are already working and that the rest can’t for various reasons, such as they are caregivers, have an illness or are going to school.

“Work requirements don’t make sense for our particular population,” Caferro said.

The disclosure of the ongoing work requirement negotiations was made in an application that seeks to eliminate 12-month continuous eligibility for Medicaid expansion beneficiaries plus a separate group of Medicaid beneficiaries with severe disabling mental illnesses.

Currently, those people are enrolled in the Medicaid expansion program for a full year regardless of changes in income or assets. The proposed change, included in the state budget passed by lawmakers earlier this year, would kick enrollees out of the program if their income rises — even if only temporarily because of a one-time payment or seasonal work.

The state also proposes increasing premium payments for certain expansion beneficiaries to up to 4% of their household income in the same waiver application that proposes work requirements.

Buttrey said the goal was to offset the costs of Medicaid so that the people benefiting from it bore some of the costs, and hopes CMS will approve the proposal.

The public comment period for the state’s waiver applications is open until Aug. 31. A legislative committee is scheduled to meet Tuesday to review the proposals.

 
 

Clipped from: https://montanafreepress.org/2021/08/05/feds-to-nix-work-requirements-in-montana-medicaid-expansion-program/

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Feds withdraw approval for Ohio Medicaid work requirements

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The Biden CMS has reneged on another approved CMS-state agreement.

 
 

 
 

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

 
 

 
 

The Ohio Statehouse

Credit: Laura A. Bischoff

The federal government has withdrawn its approval for Ohio Medicaid to create the program’s first ever work requirements.

The decision is the latest update in a more than five year effort by conservative lawmakers to require those covered through Medicaid expansion to document they either have a job, are in school or have an exemption.

Two years ago, the U.S. Centers for Medicare and Medicaid Services under the Trump administration approved Ohio’s request to make the changes, which hadn’t been implemented due to the ongoing pandemic. This week, the Biden administration withdrew support for the requirements.

Ohio Gov. Mike DeWine on Wednesday called the decision “extremely disappointing.”

ExplorePREVIOUS COVERAGE: Work rules approved for Ohio Medicaid expansion

“Ohio’s reasonable approach provided individuals with options while supporting them on their way to self-sufficiency,” DeWine said. “The Biden Administration’s decision was short-sited and contrary to our statewide effort to improve public health.”

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About 3.2 million Ohioans are covered by the joint state-federal insurance program, including just under 800,000 covered by the expansion of the program under the Affordable Care Act.

This includes around 43,200 people in Montgomery County, 24,300 in Butler County, 11,000 in Clark County, 8,400 in Greene County and 7,000 in Warren County covered by the expansion of Medicaid eligibility as of June, which is the latest state Medicaid data available.

Work requirements have been hailed by some conservative lawmakers as a way to encourage self sufficiency and has been years in the making.

Ohio Medicaid had requested federal permission to create work requirements under the direction of the Republican-majority Ohio General Assembly during former Gov. John Kasich’s administration.

At the same time, courts have struck down other requirements, and some studies have shown the work requirements lead to people falling off the rolls because they don’t know about the paperwork requirements or don’t keep up with the forms correctly.

“There’s no evidence that work requirements do anything other than disenroll people,” said Loren Anthes, who researches Ohio Medicaid for Cleveland-based Center for Community Solutions.

Anthes said studies since Medicaid was expanded have demonstrated that it’s a key tool in fighting against addiction and infant mortality, and that it helps rural providers stay open.

ExploreMedicaid work requirement ruling could affect Ohio

When submitting the original application, state officials had estimated that about 95% of those covered by the expansion would already either meet the work requirement or be exempt. Some of the exemptions include being age 50 or older, participating in drug or alcohol treatment, being pregnant, or complying with work requirements associated with other programs like SNAP, also known as food stamps.

The Biden administration, however, estimated between 121,000 and 163,000 beneficiaries could lose coverage in the first 12 months of implementation, based on what happened with Arkansas work requirements and with Ohio adding work requirements for SNAP.

The administration noted that people could lose coverage because of documentation errors or lack of awareness.

Additionally, the administration highlighted Ohio’s problems with the computer system used to determine eligibility. State audits have found serious issues with the system and with backlog, including one report indicating that the error rate for determining Medicaid eligibility in the state was 43%, more than double the national average.

ExploreOhio Medicaid director said DeWine administration inherited ‘mess’

“Thus, the introduction of an administratively complex program like the community engagement requirement presents a serious risk of beneficiary disenrollment due to technical errors,” the administration stated in a letter withdrawing support for work requirements.

Republican Ohio Sen. Rob Portman expressed disappointment at the decision, saying the requirements would have “provided greater well-being and self-sufficiency to individuals who are able to work.”

Democratic Ohio Sen. Sherrod Brown commended the move. “We should be making it easier for Ohioans to access care, not harder – especially at a time when Ohioans are fighting against the COVID-19 global pandemic,” Brown said.

 
 

Clipped from: https://www.daytondailynews.com/business/feds-withdraw-approval-for-ohio-medicaid-work-requirements/5CBST6PC5RCW3ALXTILETYTYRA/

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Democrats oppose changes to Medicaid expansion eligibility

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Fiscal conservatives want to be able to remove people whose incomes have grown beyond Medicaid eligibility more often than every 12 months.

 
 

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.

 
 

HELENA, Mont. (AP) — Democratic lawmakers in Montana said they are opposed to a plan to end 12-month continuous eligibility for people who qualify for Medicaid expansion or another program that provides health coverage for those with a disabling mental illness.

The Department of Public Health and Human Services is seeking federal permission to eliminate the continuous eligibility provision for Medicaid expansion at the direction of the Legislature, the agency said in a draft application to the Centers for Medicare and Medicaid Services.

It is seeking the same change for the mental health program because it would reduce the administrative burden to have consistent eligibility requirements, said Darci Wiebe, the administrator of the health department’s Health Resources Division.

About 100,000 Montanans are covered under the Medicaid expansion program that provides health insurance for people who are not eligible for traditional Medicaid coverage, but do not qualify for federal subsidies on policies sold under the Affordable Care Act.

 
 

Republican lawmakers reduced the state’s Medicaid expansion appropriation and included a statement in the budget bill saying: “The Legislature intends that the Department of Public Health and Human Services eliminate the policy of 12-month continuous eligibility for the Medicaid expansion population.“

However, other efforts to pass a standalone bill to end the 12-month eligibility policy failed during the 2021 Legislature, Democrats noted.

“The legislative intent in my view is ambiguous at best and again, DPHHS can do this if they wish, but I don’t think they can put it on the backs of the Legislature,” Democratic Rep. Ed Stafman of Bozeman said Tuesday. “That is what they claim several times in the petition.”

The Children, Families, Health and Human Services Committee discussed the proposals, which must be approved by the federal Centers for Medicare and Medicaid Services. The Medicaid expansion proposal has been the subject of two public hearings. Public comment is being taken through the end of August. Committee members said they plan to include their individual comments on the proposal.

Under Montana’s current Medicaid expansion program, people remain eligible for coverage for a full year, even if their income increases and they no longer meet the financial requirements. Republicans want to be able to move people off the program when they are no longer financially eligible, rather than wait for the end of that 12-month term, arguing it would save the state money.

Opponents counter it will cycle people on and off the program and disrupt continuous care for those with chronic conditions, such as high blood pressure or diabetes, and will lead to higher medical costs through the use of emergency rooms rather than primary care providers.

“The department’s proposal represents a threat to the health care of thousands of Montanans,” Stafman, chair of the committee, said in a statement. “It makes zero sense to take an effective program and make it less efficient, less fair, and more bureaucratic. If the department moves forward with this misguided proposal, they will damage Montanans’ health and hurt the bottom lines of businesses that rely on Medicaid to cover their employees.”

Opponents to ending continuous Medicaid eligibility for people suffering with severe disabling mental illness argued the Legislature did not request changes for that program, which covers about 1,000 people.

There are already fraud and abuse measures within the Medicaid system, said Kristin Page-Nei, whose brother is covered under the program. “We do not need another layer of red tape putting up another barrier.”

Separately, the waiver application notes Montana expects a pending August 2019 Medicaid expansion application that sought to add work requirements and increase premiums for some will be rejected by the Centers for Medicare and Medicaid Services. The Biden Administration has overturned work requirements in several states whose programs were approved under the Trump Administration.

“This is not the time to experiment or test policies that risk a substantial loss of health coverage or benefits, especially for individuals and communities significantly impacted by COVID-19 and other health inequities,” CMS said in a February statement.

No one can lose Medicaid expansion coverage during the public health emergency caused by the coronavirus, which is expected to last at least through the end of the year.

 
 

Clipped from: https://www.theintelligencer.com/news/article/Democrats-oppose-changes-to-Medicaid-expansion-16380932.php

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California to offer vaccine incentive to Medicaid population

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Callifornia is offering MCOs another $250M in incentives to increase Medicaid vax rates.

 
 

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.

 
 

 
 

SACRAMENTO, Calif. (AP) — California announced another round of coronavirus vaccine incentives on Friday, offering up to $50 apiece to more than 11 million people in the state who get their health insurance through Medicaid.

The money is part of a new $350 million plan to get more of the state’s Medicaid population vaccinated as the state is seeing a surge of new cases attributed to the delta variant, a more contagious and dangerous version of the coronavirus. Medicaid is the joint state and federal health insurance program for people who are disabled or have low incomes.

Many states have used tax dollars to entice people to get the coronavirus vaccine. States like Massachusetts, Michigan and Ohio offered up to $1 million in a lottery-style drawing among those who had received the vaccine.

In California, Gov. Gavin Newsom’s administration doled out $116.5 million in incentives earlier this year, including $1.5 million each for 10 people and $50,000 payments for another 30 who had received the vaccine. The state is handing out $50 gift cards to grocery stores to people who got vaccinated between May 27 and July 18, plus free tickets to Six Flags theme parks.

California is among the states with the highest vaccination rates, with about 76% of residents 12 and over having received at least one dose of the vaccine. However, only 45% of the state’s Medicaid population has been vaccinated.

 
 

FILE — In the July 26, 2021 file photo Gov. Gavin Newsom speaks at a news conference in Oakland, Calif. (AP Photo/Jeff Chiu, File)

“We’re working extremely hard to improve vaccination rates, but we believe we can do better, and must do better, to prevent further disparities in COVID-19 infection and death among persons served by (Medicaid),” state Medicaid Director Jacey Cooper said.
 

California’s Medicaid program is the largest in the country with more than 13.8 million people. But the incentives announced Friday will apply to about 11.7 million people who get their health insurance from private companies, who are then paid by the state.

California is offering those companies $250 million in incentives if they increase the vaccination rates among their members. The state has also set aside $100 million for incentive payments to people, which can’t exceed $50 each. Coper said most likely those payments would be in the form of grocery store gift cards.

Several groups of Medicaid beneficiaries have low vaccination rates, including people who are homebound, have multiple chronic diseases, people of color and people between the ages of 50 and 64 and 12 and 25, Cooper said.

The goal of the incentives, Cooper said, is to spur the private insurance companies who manage the bulk of the state’s Medicaid plans to get more of those people vaccinated. That could include having more primary care doctors offer the vaccine at their offices and partnering with community organizations and food banks.

“We need to work through harder to reach beneficiaries and figure out how we can make it more convenient,” Cooper said.

Clipped from: https://fox28media.com/news/nation-world/california-to-offer-vaccine-incentive-to-medicaid-population

 
 

 
 

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ARKANSAS- The governor said only 4% of traditional Medicaid recipients have been vaccinated. That’s not correct.

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Arkansas Medicaid members are not getting vaccinated, but its not as bad the number based on submitted claims for vaccinations.

 
 

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.

 
 

 
 

VAXXED: A patient receives a COVID shot at UAMS clinic (file photo) Brian Chilson

At a press briefing yesterday, Governor Hutchinson announced the state will begin increasing the amount it pays doctors and other medical providers who vaccinate Medicaid beneficiaries against COVID, from $40 per shot to $100. The reason, the governor said, is that vaccination rates among recipients of traditional Medicaid are very low:

In fact, only 27,000 traditional Medicaid clients age 12 and up have been vaccinated. Now, to put that in perspective, we have 627,000 recipients on traditional Medicaid [who are 12 and up]. That means that 4.3% of traditional Medicaid recipients are vaccinated. That is extremely, extremely low, and a very vulnerable and at-risk population, and it’s a challenge for us.

Increasing the reimbursement rate for shots may be a good idea. It’s one of several ways Hutchinson is trying to increase immunizations in under-vaccinated Arkansas, where hospital ICUs are brimming with COVID patients. But the tiny numbers he gave for vaccine uptake were likely a big undercount.

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It turns out the state has received 27,000 claims for COVID shots for Medicaid recipients, according to the Arkansas Department of Human Services. (DHS is the state agency that administers Medicaid.) A claim is the request for payment that a doctor submits to Medicaid or other insurer after providing a medical service. It’s almost certain that many thousands more people on Medicaid — especially nursing home residents — have actually received shots.

“We don’t have a specific number in terms of clients who have ‘gotten vaccinated.’ We can tell you how many vaccination claims have been billed, and that was the 27,000 number the Governor mentioned yesterday,” DHS spokeswoman Amy Webb wrote in an email.

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Medicaid, a joint state-federal program, provides insurance to over a million Arkansans, or roughly one in every three people in the state. As of June, the “traditional Medicaid” program referenced by Hutchinson included about 450,000 children on ARKids and about 266,000 adults, who are generally disabled and/or elderly.

(In addition to traditional Medicaid, there’s also “Medicaid expansion,” which covers another 321,000 beneficiaries who are low-income, non-disabled, working-age adults. Medicaid was “expanded” to cover this population under the Affordable Care Act, former President Obama’s health care reform package; in Arkansas, Medicaid expansion is called Arkansas Works. The governor was not including this group in the numbers he gave yesterday.)

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The 4% figure stated by Hutchinson was surprising in part because it seems at odds with the high rate of vaccinations reported among nursing home residents. Federal agency data indicates something like 80% of nursing home residents in Arkansas have been vaccinated against COVID, and an industry group representing nursing homes has reported similar numbers. How could that be, considering about two-thirds of all nursing home residents in Arkansas are on traditional Medicaid?

Apparently, many Medicaid beneficiaries in nursing homes have gotten COVID shots that don’t show up in the state’s Medicaid billing system. That’s because most nursing home residents are also on Medicare, the federal health insurance program for the elderly. For thousands of so-called “dual eligible” beneficiaries, Medicaid pays for the cost of a nursing home (or “long term care,” in the parlance of health care), but Medicare pays for most other medical costs, such as hospital stays, doctor visits — and vaccinations.

“Medicaid is the payor of last resort, so they probably would bill Medicare first,” Webb said in a phone call. “That’s why they wouldn’t show up [in the Medicaid claims.]”

DHS is working on getting a more precise figure that takes into account dual eligible people and other factors, Webb said. “To be clear, we still think the numbers are low based on what we have now,” she wrote.

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It’s also likely that others have gotten vaccinated without showing up in the Medicaid billing system. Though COVID shots are free to all patients, regardless of whether they have insurance, doctors and other medical providers usually ask for insurance information so that they can get reimbursed afterwards. But if a person doesn’t have that information, they’ll usually be given the shot anyway.

“We know that clients could have gotten any vaccination site and not shown their card,” Webb wrote. “We also know that providers have a while to bill so there could be vaccines we don’t know about yet. Either way, the billed number is still low, which is why we are changing the rate.”

Hutchinson said yesterday he hopes boosting the reimbursement from $40 to $100 will incentivize doctors and other providers to “engage with the beneficiaries on the vaccines and to answer questions, consult with them at length and to encourage vaccinations.”

 
 

Clipped from: https://arktimes.com/arkansas-blog/2021/08/11/the-governor-said-only-4-of-traditional-medicaid-recipients-have-been-vaccinated-thats-not-correct

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MISSOURI- DSS needs additional employees and two months to implement Missouri Medicaid expansion

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After being forced to expand Medicaid without funding for it, the Medicaid agency is letting the legislature know they are not staffed to implement the expansion.

 
 

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.

 
 

Missouri’s Solicitor General says the state Department of Social Services (DSS) needs two months to implement voter-approved Medicaid expansion.

 
 

Cole County Circuit Judge Jon Edward Beetem views a slide presentation from attorney Chuck Hatfield during a June 21st hearing in Jefferson City on Missouri’s Medicaid expansion lawsuit (file photo courtesy of News-Tribune” pool photographer Julie Smith)

D. John Sauer made his comments Friday afternoon to Cole County Circuit Judge Jon Beetem, saying DSS needs more employees and computer upgrades for implementation. Attorney Chuck Hatfield, who represents the three low-income women suing Missouri, disagrees.

“They believe that they need another two months, and I’m not sure I said it this way in there (Cole County Circuit Court), we don’t think they’re (the state) entitled to another two months of not complying with the law. They need to comply with the law now,” Hatfield told Capitol reporters Friday, outside the Cole County Courthouse.

Counselor Hatfield wants the judge to issue a final order quickly.

“What we asked the court to do today is to say that the state may not deny applications of folks who are eligible for Medicaid, under the (Missouri) Supreme Court’s decision. And the Supreme Court pretty clearly said that the provisions of the (state) Constitution that expanded Medicaid are valid and now in effect,” Hatfield says.

The Missouri Supreme Court issued a unanimous decision on July 22, ruling that Missouri’s Medicaid expansion ballot measure was constitutional. The court sent the case back to Judge Beetem for him to enter a judgment for Hatfield’s three clients. Hatfield expects a ruling within a few business days.

Hatfield’s three clients are Stephanie Doyle of St. Louis, Melinda Hille of Fenton and Springfield’s Autumn Stultz. They suffer from diabetes and various skin conditions. Hatfield tells Capitol reporters that his clients “don’t care about computers. Do it (process applications) by paper if you need to. They want their health care.”

Hatfield also notes that Governor Mike Parson (R) called for implementation of Medicaid expansion during his January State of the State address, and says it was six weeks away from implementation in May. That’s when the GOP-controlled Legislature decided not to fund the expansion.

53 percent of Missouri voters approved Medicaid expansion in August 2020. However, it failed in 107 of Missouri’s 114 counties. The opposition to Medicaid expansion this year primarily came from rural GOP lawmakers who represent those districts. They say Missouri cannot afford Medicaid expansion.

While Hatfield wants the judge to issue a final order quickly, Solicitor General Sauer is requesting another hearing in Cole County Circuit Court to give a Missouri Medicaid representative an opportunity to testify on DSS’ needs. Sauer also says a representative from DSS’s Family Support Division should testify.

Medicaid is a federal and state program that assists with medical costs for residents with limited incomes. Medicaid expansion supporters say it would help the working poor across the state. They say it will provide healthcare to Missourians who earn less than $18,000 annually.

DSS statistics show that 1,089,379 Missourians are currently receiving Medicaid benefits. That number has increased for 11 straight months.

 
 

Clipped from: https://www.missourinet.com/2021/08/09/sauer-dss-needs-additional-employees-and-two-months-to-implement-missouri-medicaid-expansion/

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TMC leaving Medicaid provider tax pool

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

 
 

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

 
 

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

 
 

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

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

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

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

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

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

The special session extended the provider taxes through 2024. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
 

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

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With 13K new members in Central Oregon, Medicaid will carry pandemic lessons

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Oregon is getting ready to begin the disenrollment process for those no longer eligible once the pandemic is declared over, but is hoping to make the application process easier moving forward.

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.

More Oregonians than ever before are using the state’s free health care during the pandemic — but for many, that could change in a few months.

A set of changes to federal law are expiring next year, potentially causing thousands to lose their access to the Oregon Health Plan, the state’s Medicaid program, which provides health and dental benefits to low-income Oregonians.

“Enrollment in (Central Oregon) has grown since the pandemic started. That’s pretty consistent with what’s happening across the state,” said Lindsey Hopper, a vice president with PacificSource who oversaw Medicaid in Central Oregon for much of the pandemic.

In June, there were about 13,000 more people in Deschutes, Jefferson and Crook counties covered by the state’s Medicaid program than there were at the start of the pandemic last March, according to an analysis of Oregon Health Authority data.

As economic turmoil forced hundreds of thousands of layoffs statewide, more people lost their employers’ coverage and couldn’t afford their own, causing a spike in applications last spring.

But most of the increased enrollment comes from a mundane change to the annual renewal process: In the first pandemic relief package from March 2020, Congress asked states to keep Medicaid members on the rolls during the pandemic, even if their incomes rose or they missed their renewal paperwork.

“We think all of those things contribute to what happens to enrollment in the Oregon Health Plan,” Hopper said.

Oregon’s Medicaid enrollment is expected to keep growing to more than 1.4 million next summer, up from around 1.1 million prior to the pandemic.

Despite Central Oregon seeing more than a 20% increase in health plan members compared to before the pandemic, it’s actually been easier for some agencies to help people get covered during the pandemic.

“So our traffic is down, but every person we get stays on (the plan) until the end of the pandemic,” said Sean McAnulty, who supervises a small team of insurance enrollment assisters with Mosaic Medical.

McAnulty’s team helps Central Oregon residents figure out what low- or no-cost health insurance options are available to them.

Now, the continuous enrollment rules have reduced their caseload by about half.

The rules for showing proof of income were also relaxed, and the ability to work through applications over the phone has allowed Mosaic’s team to spend more time helping clients actually use their coverage once they’re enrolled.

“We’re providing a higher level of assistance as we have more time for each case,” McAnulty said. “There’s a lot of navigation after. Getting someone benefits doesn’t mean they end up using them.”

That means doing things like helping members set up their first appointments once they’re covered.

Changes on horizon

Once the pandemic ends — or, at least, the federal government’s public health emergency declaration expires — the pandemic eligibility rules go away.

That means the state will again begin reevaluating the eligibility of those on the plan, and anyone whose income has risen above the Medicaid threshold since they got on the plan or who hasn’t kept up with their paperwork will receive a notice that their coverage could expire.

“Whenever there’s going to be something like this, there’s always going to be people who fall off,” McAnulty said. “This is why we’re here, is to help people navigate that.”

Since the change is dependent on the federal declaration, precise timelines aren’t yet set in stone. Projections from the Oregon Health Authority suggest the declaration will likely expire in January 2022, and re-enrollment eligibility will be determined over the next six months .

An estimated 200,000 members statewide will lose their coverage when rules change. Some of those people will be losing coverage because they’re no longer eligible, such as if they returned to their jobs and now make more than the income requirement.

But many will be part of what Lori Coyner, Oregon’s former Medicaid director, calls the “churn population,” those who frequently are off-and-on with the state’s insurance policy as their incomes fluctuate or they miss their paperwork.

That churn, all but eliminated by the pandemic’s enrollment rules, makes it harder for people to access the health care they might be eligible for.

“We do know that when people stay on, they keep their doctors, they keep their providers, where to get their prescriptions filled and all of that,” Coyner said. “When they drop off and then come back on, they have to re-establish all of that.”

Pandemic’s impact could be here to stay

Coyner’s goal now is to avoid some of those on-and-off relationships by making some of the pandemic’s lessons permanent fixtures of the Oregon Health Plan.

It’s a perfect time: The state’s renegotiating its five-year agreement with the federal government laying out exactly how Medicaid in the state will operate outside of typical federal rules.

Coyner, now a policy advisor heavily involved in designing the agreement, said the state hopes to make permanent the pandemic provisions reducing how often people have to reapply and reducing the amount of financial paperwork they have to submit.

“We learned that it’s much faster for people to apply and get their application in, and then we can do the income verification later instead of having to have them get a check stub right at the front end,” Coyner said.

Those changes to the plan still have to be approved by the federal agency that oversees Medicaid, and wouldn’t be finalized until the new agreement takes effect next summer.

Aside from all the technical hoops temporary rules may have eliminated, the pandemic “shined a light” on disparities in access to care, added Dana Hittle, now the state’s interim Medicaid director.

“For all of the flexibilities, or a good number of the flexibilities, that we were able to put into place because of the pandemic that we want to continue,” Hittle said, “the goal is to make it as easy as possible for people to have access to health care and remove those barriers.”

Clipped from: https://www.bendbulletin.com/localstate/with-13k-new-members-in-central-oregon-medicaid-will-carry-pandemic-lessons/article_e96de250-ee35-11eb-8f51-d7280945f893.html

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Pritzker Administration Expands Medicaid Coverage for Critical Diabetes Prevention and Management Programs

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Illinois is seeking approval for 2 new programs to help Medicaid members improve their diabetes management

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.

For Immediate Release – August 2, 2021

Pritzker Administration Expands Medicaid Coverage for Critical Diabetes Prevention and Management Programs

SPRINGFIELD – The Illinois Department of Public Health (IDPH) and Illinois Department of Healthcare and Family Services (HFS) today announced the Diabetes Prevention Program and the Diabetes Self-Management Education and Support Program, nationally-recognized diabetes prevention and management programs, will be newly eligible for Medicaid coverage in Illinois, upon final federal approval.

Diabetes is the seventh leading cause of death in Illinois.  An estimated over 1 million adults in Illinois have Type 2 diabetes, and a significant share of those individuals may not know it. It is estimated that many more Illinoisans have prediabetes, a condition where blood-sugar levels are high, but not high enough to warrant a Type 2 diabetes diagnosis.  The federal Centers for Disease Control and Prevention (CDC) estimates that 34% of the adult population in the U.S. currently has prediabetes, yet 80% of people are unaware of that diagnosis.

“Diabetes is both chronic and costly,” said Illinois Department of Healthcare and Family Services Director Theresa Eagleson. “Targeting prevention and stopping the progression for those most at risk of developing diabetes is at the heart of these programs. We know that rates of diabetes are higher within communities of color, and this initiative reflects HFS’ focus on making equity central to what we do. Providing this coverage allows us to meet our customers where they are on their healthcare journey and is key to putting many eligible Illinoisans on a path to a healthier future.”

The Diabetes Prevention Program (DPP) involves a yearlong, evidence-based lifestyle change aimed at reducing the risk of adults with prediabetes progressing to Type 2 diabetes. Developed by the CDC, the program’s Diabetes Prevention Lifestyle Change curriculum focuses on increased physical activity, healthy eating, and stress management.

CDC-recognized DPP organizations can enroll as Illinois Medicaid providers to deliver the program to eligible participants by administering services during regular sessions over the course of the year, including dietary and nutritional counseling, fitness assessments and educational sessions on how to prevent Type 2 diabetes.

A CDC-conducted evaluation of the DPP has found a 58% reduction in the risk of developing Type 2 diabetes.

To be eligible to enroll in the DPP program, individuals must be aged 18 to 64, be enrolled in the Illinois Medicaid program, have a Body Mass Index (BMI) that exceeds a certain level and either have elevated blood-glucose levels or a history of gestational diabetes mellitus. Enrollees who were previously diagnosed with Type 1 or Type 2 diabetes or who are currently pregnant are not eligible to participate in the program.

“Diabetes is a serious, chronic condition that can lead to heart disease, stroke, blindness, kidney failure, leg amputation, and even early death,” said Illinois Department of Public Health Director Dr. Ngozi Ezike. “The rate of new cases of diabetes among children and adolescents continues to grow and diabetes-related complications are increasing among those ages 18-64 years.  But with improved eating, more physical activity, and behavioral supports, we can slow or stop the growth.  And now with Medicaid coverage for diabetes prevention and management programs in Illinois, our goal is to get more people the help and support they need to live healthier lives.”

Health care providers and Illinois Medicaid Managed Care Organizations (MCO) are able to refer participants to the program, but a referral is not required to participate. Eligible enrollees can directly enroll with a fee-for-service or an MCO’s in-network, CDC-recognized DPP provider by supplying blood test results from within the past year indicating a diagnosis of prediabetes or gestational diabetes mellitus.

The second program, Diabetes Self-Management Education and Support (DSMES) provides services to prevent the progression of diabetes, thereby prolonging the life of the participants and promoting a healthier lifestyle.

DSMES must be recommended by a medical provider or a practitioner licensed to work with individuals to halt the progression of diabetes. Services may include counseling on long-term dietary changes and nutrition, increased physical activities, skills for diabetes self-care and behavioral strategies for weight control. Services can be offered via telehealth, in-home or in a health clinic or outpatient facility.

In order to be eligible for DSMES, individuals must be aged 18 to 64 and have a documented diagnosis based on certain criteria of Type 1, Type 2, or gestational diabetes. Participants must also receive a written referral from a qualified provider, which could be a physician, physician assistant, nurse practitioner or advanced practice nurse.

Participants are eligible to receive up to 18 hours of services during a 12-month period.

HFS and IDPH are collaborating with the Illinois Public Health Institute, with support from federal partners the CDC and the National Association of Chronic Disease Directors, on a Medicaid State Plan Amendment to add coverage for these two programs.

Combined, the DPP and DSMES programs are estimated to cost under $1 million the first year they are offered in Illinois. The state’s share of the cost is estimated at roughly $300,000 for the first year, and the remainder will be covered by federal funding.

For services provided under the fee-for-service delivery setting, HFS has requested an effective date of Aug. 1, and services may start to be administered upon approval by federal Centers for Medicare & Medicaid Services.

Clipped from: https://www.myradiolink.com/2021/08/03/pritzker-administration-expands-medicaid-coverage-for-critical-diabetes-prevention-and-management-programs/