VOLUME 3 - ISSUE 36
FEBRUARY 9, 2012



Welcome to the Medicaid Update eNewsletter
This issue sponsored by The Seventh Medicaid Congress



States Make their Case Against ACA to the Supreme Court
Here is the January 10, 2012 brief from the Attorney General of Florida et al asking the Supreme Court "Does Congress exceed its enumerated powers and violate basic principles of federalism when it coerces States into accepting onerous conditions that it could not impose directly by threatening to withhold all federal funding under the single largest grant-in-aid program, or does the limitation on Congress' spending power that this Court recognized in South Dakota v. Dole, 483 U.S. 203 (1987), no longer apply?" (BNA.com, January, 2012)

The Misleading Arguments in the States' Medicaid Coercion Brief
And here is a response from Sara Rosenbaum and Katherine Hayes on why the States' argument doesn't hold up. (Health Affairs Blog, January 19)

States Ease Barriers to Medicaid, CHIP Enrollment, Survey Says
The annual 50-state survey of Medicaid programs, conducted by the Georgetown University Center for Children and Families for the Kaiser Commission on Medicaid and the Uninsured, found that only two states -- Arizona and Nevada -- reduced eligibility for Medicaid and CHIP. (Kaiser Health News, January 18)

Health Reform Insurer Fee Will Cost Medicaid Programs $38.4B over 10 Years, Medicaid Health Plans Say
A Milliman report commissioned by Medicaid Health Plans of America has found that unless Medicaid health plans are exempted from the fee on insurance companies mandated to begin in 2014 under the ACA, States will essentially be taxed to the tune of $13.6 billion from 2014 to 2023 because State Medicaid programs will have to pay the fee for Medicaid managed care plans. The fees would cost the Federal government 24.8 billion over the same period, the report estimates. (InsideHealthPolicy.com, January 31)

It May Be Time 'To Take the Pain' on Medicaid
This is the message from Matt Salo, Executive Director of the National Association of Medicaid Directors, in a California Healthline piece on States' sometimes drastic efforts to curb Medicaid costs, including particularly draconian measures being considered in the State of Washington. Salo's message: get creative, and soon, because you cannot cut your way out of this problem and things are likely to get worse. (CaliforniaHealthline, January 18)


LePage Vows Veto If His Plan Not OK'd
And speaking of draconian cuts, Maine Governor Paul LePage has told lawmakers of both parties, now struggling to craft a budget in the face of severe shortfalls, that he will veto the budget if it does not contain his proposal of last December to eliminate altogether the coverage of 18,600 childless adults under MaineCare, the Maine Medicaid program. (KennebecJournal.com, February 8)

State's Incentives Aimed at Improved Health, Lower Costs
Ohio Gov. John Kasich announced last month that the State was rebidding all of its Medicaid managed care contracts to provide more choice and to include a withhold payment that would only be granted if a plan met certain performance standards. (ColumbusDispatch.com, January 12)

Key Report on Medicaid Calls for Big Change
A State-commissioned report by Navigant looked at Georgia's Medicaid and PeachCare programs and recommended three options for major change -- (1) restructuring the HMO-like structure so that payment is linked to health outcomes and expand managed care to include long term care and the disabled; (2) specifically directing individuals into managed care plans emphasizing prevention and wellness; and (3) and allowing the State to contract directly with medical homes and physician-hospital organizations. (Georgia Health News, January 20)

Panel: Idaho Medicaid Cuts Have Not Saved Money
The non-profit Idaho Center for Fiscal Policy, sponsored by disability groups in the State, released a report stating that the State's $35 million in Medicaid cuts have not saved the State any money because of lost jobs and increased costs to police services. (IdahoPress.com, January 19)

In Kansas, Governor Sam Brownback Drives a Rightward Shift
Among Kansas Governor Sam Brownback's aggressive conservative agenda to reduce government and its costs is a proposal to put all of the State's 330,000 Medicaid enrollees into private managed care plans. (Stateline.org, January 25)

Judge Tentatively Blocks 10% Cut to Medi-Cal Reimbursement Rates
Notwithstanding approval by CMS last October, a US District Court judge has blocked the State's plan to cut Medi-Cal reimbursement rates to providers by 10%. The cuts would have been retroactive to June 1, 2011. (CaliforniaHealthline, January 31)

State Medicaid Programs Face $141 Million Shortfall, Report Says
The nonpartisan Legislative Fiscal Bureau of the Wisconsin legislature has released a new report raising some concerns about whether Governor Scott Walker's plan to deal with a State Medicaid program shortfall of $141 million will be successful or not, despite some early gains. (JSonline.com, January 31)



Medicaid Home and Community-Based Services Expenditures Per Person Served, by state, 2008


Click above and go to Figure 5 (national map) on p. 7

Source: Kaiser Commission on Medicaid and the Uninsured and UCSF analysis of CMS Form 372 data and program surveys


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The Medicaid Landscape

Diane Rowland
Executive Vice President, Henry J. Kaiser Family Foundation, Executive Director, Kaiser Commission on Medicaid and the Uninsured, Washington, DC