“MADISON, Wis. — Nearly 26,000 adults who lost Medicaid coverage through Wisconsin’s BadgerCare Plus program after being kicked off earlier this year will have more time to sign up for private subsidized insurance, the federal government announced Thursday.
The U.S. Centers for Medicare and Medicaid Services said it was establishing a special enrollment period through Nov. 2 for those people to sign up under the federal exchange created under the health overhaul law.
The Wisconsin Department of Health Services estimates that about 25,800 out of 63,000 adults who lost that coverage had yet to sign up for subsidized insurance plans under the federal law.
They lost coverage after Gov. Scott Walker and the Republican-controlled Legislature tightened income eligibility for the state’s Medicaid coverage from 200 percent of poverty to 100 percent. That made the income cutoff for coverage $11,670 for an individual and $23,850 for a family of four.”
“Dive Brief:
•In an effort to reduce the backlog of contested Medicare claims, the Centers for Medicare and Medicaid Services has offered to pay hospitals 68% of what they say they are owed for short-term inpatient stays.
•The system of hearings on challenged claims has been on hold since December, when the HHS Office of Medicare Hearings and Appeals temporarily suspended most new requests for administrative law judge hearings on payment denials by recovery audit contractors.
•Hospitals will have 60 days to decide whether to accept CMS’ offer, which does not apply to any short-term hospital admission that occurred after October 1, 2013.”
“NORTHPORT, Maine – By the time Laura Tasheiko discovered the lump in her left breast, it was larger than a grape. Tasheiko, 61, an artist who makes a living selling oil paintings of Maine’s snowy woods, lighthouses and rocky coastline, was terrified: She had no health insurance and little cash to spare.
Laura Tasheiko, 61, sits in her home in Northport, Maine (Photo by Joel Page for USA TODAY).
But that was nearly six years ago, and the state Medicaid program was generous then. Tasheiko was eligible because of her modest income, and MaineCare, as it is called, paid for all of her treatment, including the surgery, an $18,000 drug to treat nerve damage that made it impossible to hold a paintbrush, physical therapy and continuing checkups.
But while much of America saw an expansion of coverage this year, low-income Maine residents like Tasheiko lost benefits. On Jan. 1, just as the Affordable Care Act was being rolled out nationwide, MaineCare terminated her coverage, leaving her and thousands of others without insurance.
Maine Gov. Paul LePage’s decision to shrink Medicaid instead of expanding it was a radical departure from a decade-long effort to cover more people in this small rural state of farmers, lobstermen, craftsmen and other seasonal workers, which at least until recently, boasted one of the lowest rates of uninsured in the nation.”
“Republicans vying to wrest the Kentucky House from Democratic control for the first time in nearly a century promised Tuesday to try to repeal the state’s Medicaid expansion and rein in other parts of the federal health care overhaul.
House Republican leaders made stops in western Kentucky as part of a multi-day tour to promote their legislative agenda, called the “Handshake with Kentucky.” They said they would push for legislation prohibiting mandatory participation in a workplace union and for a revamped state tax code and creation of medical expert panels to review proposed medical malpractice claims before they could be pursued in court.
“If the people of Kentucky entrust us with the majority, we are committing to immediately begin debate with the intention of passing each of these pieces of legislation,” House GOP Floor Leader Jeff Hoover said.
State Democratic Party Chairman Dan Logsdon called them “warmed over” ideas repackaged to get Republicans to the polls.
“It’s not leadership,” he said. “It’s pandering to their base.”
Republicans have not had a majority in the Kentucky House since 1920. Democrats have been whittled to a 54-46 majority, putting the GOP within striking distance of consolidating power in the Kentucky General Assembly. Republicans have solid control of the state Senate.”
“Utah Gov. Gary Herbert isn’t backing down from insisting on a work requirement in his Healthy Utah alternative to Medicaid expansion, even though Pennsylvania’s governor dropped the same mandate to win federal approval.
“We’re always keeping an eye on what’s happening in other states that are in a similar situation. That said, we’re not always reactive,” Herbert spokesman Marty Carpenter said Tuesday. “It’s still a very important element of the deal to the governor.”
Last week, the Obama administration announced it had signed off on Pennsylvania Gov. Tom Corbett’s plan to use the money available under the Affordable Care Act to provide health care coverage to low-income uninsured residents.
Corbett’s Healthy PA plan is close to what fellow Republican Herbert has proposed, except that the Pennsylvania governor dropped a requirement that able-bodied recipients look for a job.”
“Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday.
Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast.
Despite the long-term projected drop, federal spending for major health care programs will jump this year by $67 billion — or about 9 percent — the agency estimated. The largest increase will be for Medicaid, which is projected to grow by $40 billion, or 15 percent. Most of this short-term increase is attributable to the Affordable Care Act, including its Medicaid expansion and the financial assistance to help people purchase health insurance.”
“If you get health insurance through your workplace, you’ll probably have a chance this fall to make important decisions about your coverage and costs.
Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for making elections online, as well as updates on changes to their plans required by the Affordable Care Act. Some 55% of Americans have employer-based coverage, according to Mercer, a human-resources consultant.
“From the employee perspective, if there is any year to pay attention to the information, this is the year,” says Brian Marcotte, president and chief executive of the National Business Group on Health, a nonprofit representing large employers.
Starting next year, one change could be an ACA provision requiring some large employers—generally those with 50 or more full-time or equivalent workers—to offer affordable, adequate coverage to employees working more than 30 hours a week.”
“Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department.
The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies.
First reported by the newsletter Inside Health Policy on Thursday, the clarification worries immigration advocates, who say many residents are facing website difficulties and other barriers to meeting the deadline to submit additional details. Those who don’t know about the deadline, or can’t meet it because of glitches, could be deemed ineligible for subsidies and lose their coverage.
“We’re very concerned about the implications of this on hundreds of thousands of low-income individuals who are likely eligible, but have encountered significant difficulties with the website, uploading or sending documents,” said Mara Youdelman, managing attorney at the National Health Law Program.
If found ineligible, residents could owe thousands of dollars.”
“When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers.
But with an $8 billion tax on insurers due Sept. 30 — the first time the new tax is being collected — the industry is getting help from an unlikely source: taxpayers.
States and the federal government will spend at least $700 million this year to pay the tax for their Medicaid health plans. The three dozen states that use Medicaid managed care plans will give those insurers more money to cover the new expense. Many of those states – such as Florida, Louisiana and Tennessee – did not expand Medicaid as the law allows, and in the process turned down billions in new federal dollars.
Other insurers are getting some help paying the tax as well. Private insurers are passing the tax onto policyholders in the form of higher premiums. Medicare health plans are getting the tax covered by the federal government via higher reimbursement.”
“Thursday’s announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court’s 2012 decision making the expansion a voluntary program, there are still 23 states that haven’t expanded public health insurance to all of their low-income residents.
The expansion in Pennsylvania will add about 500,000 low-income to adults to the Medicaid rolls. According to numbers from the Kaiser Family Foundation, about 281,000 of those people were falling into what’s known as the “coverage gap”— people who don’t qualify for Medicaid but also don’t get subsidies for purchasing insurance on their own, either. About 4.5 million people across the country fall into this coverage gap, according to Kaiser.”