Over a 6-month period, the OIG found in California:
For our sample of 150 beneficiaries, California made Medicaid payments on behalf of 112 eligible beneficiaries. However, for the remaining 38 beneficiaries, California made payments on behalf of ineligible beneficiaries (e.g., a woman who did not meet eligibility requirements for the newly eligible group because she was pregnant) and potentially ineligible beneficiaries (e.g., a beneficiary who may not have met the residency requirement). On the basis of our sample results, we estimated that California made Medicaid payments of $738.2 million ($628.8 million Federal share) on behalf of 366,078 ineligible beneficiaries and $416.5 million ($402.4 million Federal share) on behalf of 79,055 potentially ineligible beneficiaries. (These estimates represent Medicaid payments for fee-for service, managed-care, the drug treatment program, and mental health services.) These deficiencies occurred because California’s eligibility determination systems lacked the necessary system functionality and eligibility caseworkers made errors. We also identified a weakness in California’s procedures related to determining eligibility of individuals who may not have intended to apply for Medicaid.
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Kentucky Gov. Matt Bevin (R) is countersuing to stop a lawsuit filed by critics of the state’s plan to institute Medicaid work requirements.
The administration filed a lawsuit in federal district court in Kentucky on Monday seeking a ruling that the state’s Medicaid waiver fully complies with federal law.
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Ohio will soon ask the federal government to waive an Obamacare requirement that nearly everyone in the state get health insurance coverage.
It will also ask permission to make some Medicaid recipients work 20 hours a week, go to school or take on similar activities. The state announced both these actions today, anticipating it will submit separate applications to Washington in about a month, after holding public hearings.
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Galen Institute Senior Fellow Doug Badger has written a paper, published by the Taxpayers’ Budget Office of the National Taxpayers Union Foundation, in which he analyzes CBO’s expectation that the Center for Medicare and Medicaid Innovation (CMMI) would reduce Medicare spending by $45 billion over ten years. The forecast is flawed, Badger concludes, as CBO “ascribes unobserved and unobservable savings to projects that CMMI has not yet undertaken (and may never undertake).” He says the CBO’s judgements “are in some cases questionable, in others mistaken and in still others rendered obsolete.”
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Gov. Holcomb (R-IN) joined U.S. Health and Human Services Secretary Alex Azar at Eskenazi Hospital on Friday to announce Indiana gained federal approval to continue its Healthy Indiana Plan (HIP).
The plan, which the state calls a successful alternative to traditional Medicaid, has been approved through Dec. 2020.
This will allow the state to continue health coverage for more than 400,000 low-income adult Hoosiers.
The Healthy Indiana Plan was created in 2007 under Gov. Mitch Daniels. The program was expanded in 2015 by then Gov. Mike Pence with a federal waiver to implement HIP as an alternative to traditional Medicaid expansion.
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Americans are among the most generous people in the world. While this nation was founded on the pursuit of a shared dream, the moral pledge of the American people has been to never leave behind our most vulnerable fellow citizens.
When we created Medicaid in 1965 as part of President Lyndon B. Johnson’s War on Poverty, we formalized that commitment and wove a fabric of care that has provided health services for seniors in need, pregnant mothers, low-income children and parents, and people with disabilities. Johnson affirmed the nation’s safety net, saying, “Our aim is not only to relieve the symptoms of poverty, but to cure it and, above all, to prevent it.”
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A growing number of mostly Republican-led states are rushing to follow Kentucky’s lead in requiring thousands of people on Medicaid to work or lose health coverage.
The governors of South Dakota, Alabama, Louisiana and South Carolina have said in recent weeks that they plan to pursue work requirements for their Medicaid programs, following the Trump administration’s release of guidelines for the concept in January.
“Whenever possible, we should always endeavor to help South Carolinians in need find their path to gainful employment and away from temporary assistance of government,” South Carolina GOP Gov. Henry McMaster tweeted Jan. 11, the same day federal officials announced the new guidance.
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A House committee voted Tuesday to impose work requirements on Medicaid recipients, something Republicans are seeking as a precondition to expanding the health-care program to more low-income, uninsured Virginians. It was not clear how many of the state’s 1 million Medicaid recipients would be affected if the bill becomes law because the majority are children, the elderly, pregnant women and people with disabilities, all of whom would be exempt under the plan because they are considered to face some barrier to work.
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Across plans and states, the expansion population experienced high disenrollment rates, indicating that, as in other Medicaid eligibility groups, there is substantial churn in this population.
• Even after adjusting for age and gender, claims costs increased steadily over time, suggesting that expansion enrollees have complex and/or chronic conditions.
— For some enrollment cohorts, average claims costs decreased modestly in the second half of the first year of enrollment, suggesting some initial pent-up demand for services, though claims costs increased steadily from that point forward.
• Across enrollment groups, per member per month spending on prescription drugs increased with enrollment duration.
— Among enrollees who remained enrolled the longest, inpatient claims initially made up the largest share of claims costs, but were surpassed by prescription drug claims by month 8 of enrollment, on average.
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Americans are familiar with the horrors of the opioid crisis, and government at every level has tried to respond with spending on treatment programs and more. But one area that deserves more scrutiny is how government programs may be contributing to the epidemic.
Wisconsin Senator Ron Johnson released a report this month from the Senate Homeland Security and Governmental Affairs Committee that connects the dots between Medicaid and the opioid epidemic. The report doesn’t claim too much, conceding that everything from too many prescriptions to drug marketing contributed to the epidemic.
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