In the Medicaid and the Children's Health Insurance Programs, where eligibility changes depending on income and family size, churning is not uncommon. Adding subsidized health insurance on the exchanges to the process expands the possibilities for churn. According to an analysis by Matthew Buettgens, a senior research associate at the Urban Institute, 7 million people could churn between Medicaid and exchange coverage annually.
Although most physicians contacted in 2013 were accepting new patients with any type of insurance, they seemed to prefer patients with private insurance or Medicare, rather than Medicaid, according to a National Center for Health Statistics survey. Nationwide, an average of 84.7% of physicians were accepting new privately insured patients, followed closely by Medicare with 83.7%; that latter figure jumps to 88.8% if pediatricians are excluded.
The Supreme Court said Medicaid providers can't sue states claiming they were underpaid for medical services to the poor, ruling such disputes should be resolved instead by HHS. Federal law gives states discretion in setting Medicaid rates, as long as they follow a broad set of factors intended to ensure health services remain available to the poor without encouraging the "unnecessary utilization of such care." In Idaho, several companies that provide home care for intellectually disabled people sued state officials claiming reimbursement rates set by the state were too low.
Medicare spent $4.5 billion last year on new hepatitis C treatments - more than 15 times what it spent the year before, previously undisclosed federal data shows. The outlays will be borne largely by federal taxpayers, but the expenditures will also mean higher deductibles and maximum out-of-pocket costs for many of the 39 million seniors and disabled enrollees, who pay a smaller share of its cost, experts and federal officials said. Sovaldi accounted for more than $3 billion of the spending, while Harvoni hit $670 million even though it came on the market only in October.
Doctors in New York's economically depressed neighborhoods are in an experiment to transform New York's healthcare services into coordinated networks of doctors, hospitals and other practitioners. Medicaid officials hope to inspire these providers to work together on a coordinated care approach. New York, which has the country's largest Medicaid budget, is committing more than $1 billion a year for five years to the experiment. If it works, more could follow.
Florida health officials want to remove Medicaid's 30-day wait period so people can automatically enroll for health insurance once they're deemed eligible, The Bradenton Herald reports. The proposed amendment would also get patients information more quickly about their plan options to encourage them to choose their own plan instead of being automatically enrolled in one. Health officials will host two meetings to get the public's input on April 7 in Tampa and April 14 in Tallahassee.
In the states that have chosen not to expand their Medicaid program, there are hundreds of thousands of uninsured, low-income Hispanics who are lagging behind on key measures of access to healthcare, according to a report from Families USA. To explore how expanding Medicaid can mitigate these disparities in healthcare, researchers compared how insured and uninsured low-income Hispanics in three states fare in terms of access to healthcare and preventive health services.
Sen. Rob Portman (R-Ohio) introduced an amendment to the Republican budget that would boost Medicaid funding for "medically complex" children. The amendment would create a deficit neutral fund that would focus on increasing integrated and coordinated care for children on Medicaid who have multiple, serious, rare or chronic illnesses. Sen. Bernie Sanders (I-Vt.), the ranking member of the Budget Committee, said, while Portman's amendment "touches upon a serious issue," it's a bigger problem that the Republican budget would repeal Obamacare and cut Medicaid.
Quest Diagnostics reports that people in states that expanded Medicaid under the ACA are far more likely to be newly identified with diabetes than in states that have not expanded the program. A Quest analysis of de-identified test results of 434,288 people with newly identified diabetes found that newly identified diabetes jumped 23% in Medicaid-enrolled patients in states that expanded Medicaid, compared to a 0.4% increase in states that did not expand.
As more baby boomers need hip replacements, health insurers like Humana and WellCare are turning into hot merger targets, according to Bloomberg. Both providers are generating record revenue as aging U.S. baby boomers drive an increase in enrollment in the government-sponsored program for the elderly. Insurers are also benefiting from expanded Medicaid coverage for the poor under Obamacare. Larger insurers such as Aetna and Anthem would like to continue expanding beyond coverage that's paid for by employers, and could be interested buyers.
Sens. Patty Murray (D-Wash.) and Sherrod Brown (D-Ohio) introduced a bill that would boost payments to Medicaid doctors to equal those paid to Medicare doctors. Physician groups have lobbied hard for higher payments for treating Medicaid patients. The bill would also bump up payments for doctors and nurses who specifically treat women and children, such as OB-GYNs, nurse practitioners and physician assistants. The Medicaid bump alone would cost the federal government at least $11 billion, according to CMS.
The GOP-controlled Florida Senate unanimously approved a bill that would accept federal dollars under ObamaCare to expand eligibility for Medicaid. The passage of the bill, which has been eyed by other GOP state lawmakers who have resisted the expansion, sets up the second showdown in the House in as many years. The Senate previously pushed through a Medicaid expansion bill in 2013, though it was rejected by the House. Florida Gov. Rick Scott, a Republican who was narrowly reelected last fall, has said he would support Medicaid expansion if the bill reached his desk.
New Hampshire is the sixth state to earn approval from the federal government to launch its own version of the ACA's Medicaid expansion. The plan will help about 35,000 uninsured people to buy private insurance plans. The program was negotiated by Gov. Maggie Hassan (D) and the state's GOP-controlled legislature. The state is the sixth to earn a waiver from the federal government for the Medicaid expansion, just weeks after Indiana Gov.