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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Through its regime of subsidies, penalties, and federal regulations, the Affordable Care Act (ACA) made health insurance affordable to millions of people who were uninsured because they earned too little or had preexisting conditions. But it also made insurance more expensive for millions who used to be able to afford it. Between December 2013 and January 2017, average premiums more than doubled, and individual markets were in turmoil.
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On February 21, 2018, the District of Columbia (D.C.) moved one step closer toward becoming the second in the nation, behind Massachusetts, to adopt an individual health insurance mandate. The Executive Board of the D.C. Health Benefit Exchange Authority (Authority) approved a resolution recommending the adoption of a District-level mandate as well as a number of other policy proposals. The resolution will have to be approved by the D.C. Council before going into effect.
D.C. would be the first to adopt its own mandate in the wake of repeal of the Affordable Care Act’s (ACA’s) individual mandate, but it joins at least eight states considering or studying their own individual mandate.
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Riding a wave of enthusiasm from progressive Democrats, supporters of single-payer have effectively made it a front-and-center issue in California’s 2018 elections. It’s been discussed in virtually every forum with the candidates running for governor, emerged as a point of contention in some legislative races, and will likely be a rallying cry at the upcoming California Democratic Party convention. Advocates of the single-payer system know that it’s not going to happen now, it’s not going to happen tomorrow, but long-term, they hope to make single-payer a reality.
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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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Georgia families face some of the biggest increases in health care premiums in the country this year. For many families, health care is rapidly becoming unaffordable – a necessity that is becoming a luxury. Candidates running for Governor and the Legislature would be wise to take note of other states’ successes in granting patients the right to shop for health care to lower health care costs.
Data show that the primary reason premiums are going up is the escalating costs of treatments and procedures. Consumers’ deductibles and copays are going up, too. In other words, patients are paying more but getting less. At a time when the internet is making more and more information available online – just think of Yelp or Angie’s List – consumers face real obstacles in knowing ahead of time how much a procedure will cost and how much they will have to pay from their own pockets.
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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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Alex Azar, the new secretary of health and human services, said Thursday that he would closely scrutinize a plan by Idaho to allow the sale of insurance that does not comply with the Affordable Care Act, an early test of how he will enforce a law he opposes. But he said it was too early to know what action he might take. “We’ll be looking at that very carefully and measure it up against the standards of the law,” Mr. Azar said at a hearing of the Senate Finance Committee. The plan presents Mr. Azar with a choice that he could face frequently in his new job: whether to try to shore up the health law or to “let Obamacare fail.”
People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states. “Members have difficulty finding–and in many cases cannot find–medical providers,” who will accept patients covered under policies sold by Centene, according to the lawsuit filed in federal court in Washington State.
“People signed up for insurance and they ‘discovered there were no doctors,”’said Seth Lesser, a partner at the law firm of Klafter Olsen & Lesser who is representing some of the policyholders.
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Idaho has a maverick plan to let insurers sell plans that don’t meet Obamacare coverage rules and patient protections to give more health insurance options to citizens who can’t afford the expensive Obamacare policies. Gov. Butch Otter issued an executive order to authorize a state-level version of the “Cruz amendment,” which Senator Ted Cruz (R-TX) offered to the Better Care Reconciliation Act during efforts to repeal the ACA last year. The amendment would have allowed insurers to offer non-ACA-compliant plans in the individual market so long as they also offered plans through the marketplace. Other conservative states are keeping a close eye on the option. HHS Secretary Alex Azar said he would closely scrutinize Idaho’s plan, but he said it was too early to know what action he might take.
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