The HHS lacks transparency in how it makes approval decisions about billions of dollars in experimental projects in the Medicaid program, according to a report from the Government Accountability Office. The GAO report concerns so-called 1115 waivers that the federal government grants to allow states to run test programs that would not otherwise be allowed under Medicaid. For example, states could alter the eligibility or benefits under Medicaid.
NPR looks at the ongoing debate surrounding the expansion of Medicaid. Twenty-four states and the District of Columbia said yes to the expansion when the ACA went into effect. Since then, just six more have signed on. States that say yes get billions of additional federal dollars, but many Republican lawmakers are loathe to say yes to the Obama administration. NPR looks specifically at states like Montana, Wyoming, Utah and Alaska. For example, Montana's approach is now on its way to the federal government, which will have the last word on whether it's legal under the ACA. In Alaska, Gov.
The House Finance Committee in Alaska is slated to set to work on a Medicaid expansion and reform bill, after three days of budget overviews. The committee announced four meetings in Anchorage to hear Gov. Bill Walker's Medicaid bill, one of three bills the governor put on the special session agenda. With a third of the special session over, the Legislature held a handful of meetings on the budget, but none on the Medicaid bill so far.
About 5% of Medicaid beneficiaries account for almost 50% of program spending, according to a report from the nonpartisan Government Accountability Office. The report found a small number of "super-utilizers" consume much of healthcare spending, reporting that, from 2009 to 2011, 5% of enrollees in Medicaid made up 48% of costs, while the most expensive 1% made up 25% of costs. The report notes that Medicaid costs are expected to increase as more people are covered under Obamacare's expansion of the program.
Michigan's health policy experts say the number of people who enrolled int he expanded Medicaid program in its first 100 days was what planners had expected for the entire first year. University of Michigan statisticians estimated 328,000 people enrolled in the first three months. One year after the Healthy Michigan Plan launched, they estimated that number at 603,000.
Maine's attorney general, Janet Mills, is urging state budget writers to give her more resources to combat Medicaid fraud and elder abuse. Mills wants to add a third attorney to her office's HealthCare Crimes Unit, which investigates and prosecutes Medicaid fraud and patient abuse and neglect in healthcare facilities. She contends the addition would bring in more revenue for the state while improving the integrity of Maine's healthcare programs. Since 2010, the unit has recouped nearly $61 million in state and federal tax dollars.
Rhode Island's Reinventing Medicaid Working Group, created by Gov. Raimondo to identify Medicaid savings, issued recommendations including a 5% rate cut in Medicaid reimbursements for hospitals and 3% cut for nursing homes. The working group says its recommendations would cut $85.5 million in state expenditures, close to the $90 million goal included in Raimondo's budget. Documents show the total reductions would be worth $158.6 million, including federal funds.
In this brief, The Commonwealth Fund examines the requirements of State Innovation Waivers and explores how states might utilize the waivers. It concludes the waivers involve a balancing act: providing states with latitude to experiment with alternative coverage mechanisms while requiring they continue to meet the coverage and affordability goals of the ACA.
In this Health Affairs piece, the co-chairs of The Partnership for Medicaid, Bruce Siegel, Margaret Murray and Dan Hawkins, are proposing a framework for Medicaid designed to allow for true state-to-state comparisons, enable states to learn from each other and provide policymakers the tools to improve quality for Medicaid recipients and reduce costs for taxpayers, states and the federal government. It also aims to provide an information source for health services researchers.
For more than 20 years, federal law has allowed states to recover almost all Medicaid costs if recipients are 55 or older when they die, a rule that now applies to many of the 11 million people who joined Medicaid since the ACA's expansion of the program in 28 states. As a result, some families are discovering they may have to sell a home or other assets of a deceased relative to reimburse the government. Prior to Medicaid expansion, in fiscal 2011, states recovered almost $498 million from the estates of Medicaid recipients who died, according to a report by the OIG.
If Congress does not extend federal funding for the Children’s Health Insurance Program (CHIP), Massachusetts would incur an additional cost of $166 million in fiscal year 2016 to continue insurance coverage for 130,000 children currently enrolled in the program, according to a report authored by a health policy expert from UMass Medical School and released April 7 by the Massachusetts Medicaid Policy Institute of the Blue Cross Blue Shield of Massachusetts Foundation.
Rachel Gershon, an associate with the Center for Health Law and Economics at the University of Massachusetts Medical School, talks to CT Latino News about an analysis of proposed changes to Connecticut's Medicaid program. Gershon co-authored the analysis, which was released by the Connecticut Health Foundation.
State Medicaid programs spent $1.33 billion on hepatitis C therapies through the third quarter of last year, or nearly as much as the states spent in the previous three years combined a Wall Street Journal analysis of federal data shows. The growth was primarily driven by Gilead's Sovaldi, which has a wholesale cost of $84,000 per person over the course of treatment.
Federal officials released a rule proposing how the mental health parity law, ensuring benefits for mental health and addiction treatment were on par with what they received for medical and surgical care, should protect low-income Americans insured through Medicaid managed care and the Children's Health Insurance Program plans.