MARCH 22, 2012

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

Why Obamacare's Medicaid Expansion Will Reduce Health Care Access
Avik S. A. Roy argues in The Atlantic that Medicaid expansion will simply lead to worsening underpayment of doctors, no increase in doctor visits, and replacement of private insurance, all of which will worsen access. (TheAtlantic.com, March 9)

Two (Very Different) Miami Hospitals Prepare For Health Law's Medicaid Expansion
A Kaiser Health News piece examines the very different perspectives of two Miami hospitals across the street from each other as they anticipate Medicaid expansion - the University of Miami Hospital, which sees a new market, and public safety facility Jackson Memorial Hospital, which sees a financial lifeline. (Kaiser Health News, March 20)

Medicaid Expansion Rule Fails to Finalize FMAP Methodology for Newly Eligible, State Pilot Tests Continue
HHS published the "final" rule governing the expansion of Medicaid as provided for in the ACA, but it still has not determined how it will treat three previous options under which States could identify newly eligible Medicaid recipients, who are subject to 100% Federal match for three years starting in 2014. (InsideHealthPolicy, March 16)

Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010
The actual rule schedule for March 23 publication in the Federal Register. (HHS)

Medicaid Computer System Glitches Costing States Millions
FierceHealthcareIT reports on computer glitches in Louisiana, Florida, Colorado and Maine which are causing everything from disappearing data and improper password recognition to improper payments and uncollected bills. (FierceHealthIT, March 21)

MACPAC Report to Congress
In a nearly 300-page document the Medicaid and CHIP Payment and Access Commission (MACPAC) presented its first report to Congress, covering issues and recommendations related to persons with disabilities, Medicaid, CHIP, payment, and program integrity. (MACPAC, March 2012)

Medicaid Patients Struggle to Get Primary Care, Visit ERs More
Twice as many people insured by Medicaid as by private insurance report barriers to primary care, and Medicaid patients are twice as likely to visit the emergency department as their privately insured counterparts, according to a new study published in the Annals of Emergency Medicine. (ACEP.org, March 14)

Medicaid Emergency Psychiatric Demonstration
A new CMS demonstration in 12 States will test whether Medicaid can support higher quality care at a lower total cost by reimbursing private psychiatric hospitals for certain psychiatric services for which Medicaid reimbursement has historically been unavailable. (CMMI, March 2012)

Medicaid Waivers Pave Way for Reform
A Politico piece looks at the mega-waivers granted to California and Texas. (Politico, March 5)

Toward a High Performance Health Care System for Vulnerable Populations: Funding for Safety-Net Hospitals
A new report, written on behalf of the Commonwealth Fund Commission on a High Performance Health System, suggests strategies to stimulate and reward safety net hospitals, including increasing Medicaid rates (in states that have unreasonably low rates) to safety-net hospitals with the highest shares of Medicaid and uninsured patients and lowest shares of privately insured patients, contingent upon meeting performance benchmarks; targeting Medicaid and Medicare disproportionate share hospital payments to hospitals that serve uninsured patients; and supporting safety-net hospitals' access to the capital they need to implement large-scale delivery system reforms. (CommonwealthFund.org, March 8)

Former Governors Propose Ways To Streamline Medicaid Waiver Process
A group of five former governors, both Republican and Democrat, came to DC to argue for greater flexibility, greater transparency, use of "template" waivers, and speedier and more consistent decision making by HHS in the granting of waivers to States. (InsideHealthPolicy, March 2)

THHSC Publishes Report on Medicaid Potentially Preventable Readmissions
The Texas Health and Human Services Commission (THHSC) released its FY 2010 report on potentially preventable readmissions (PPR) for Medicaid, with individual rates that each hospital can see confidentially. THHSC uses a 15-day window instead of Medicare's 30-day window and only classifies a readmission as a PPR if there is a "plausible clinical connection" between the initial admission and the readmission. (THA.org, March 8)

Improving Outcomes for Children in Child Welfare -- A Medicaid Managed Care Toolkit
The Center for Health Care Strategies has developed a new toolkit to help guide managed care programs serving children in the child welfare system (CHCS, February 2012)

Better State Budget Picture, but Medicaid Still in Jeopardy
A new report from the Center on Budget and Policy Priorities estimates total State budget shortfalls at $47 billion so far for the year ahead, far better than the $106 billion for the current year, but there is still substantial pressure to close budget gaps with cuts to Medicaid. (ModernHealthcare.com, March 2)

Hearing Examines Patient Care Under Medi-Cal Overhaul
At a recent State Assembly hearing, critics of California's expansion of managed care in Med-Cal told stories of compromised access, loss of position in the organ transplant queue, and delays in needed medications once individuals were transferred into managed care. (CaliforniaHealthline, March 9)

State Medicaid Coverage of Routine HIV Screening
This analysis from the Kaiser Commission on Medicaid and the Uninsured examines state Medicaid coverage of routine HIV screening and finds that about half of states cover routine screening under their Medicaid programs. (KCMU, March 21)

A Guide to the Medicaid Appeals Process
This background brief from the Kaiser Commission on Medicaid and the Uninsured provides a comprehensive look at the appeals process for the Medicaid program, which differs significantly from those available through the Medicare program and private health insurance. (KCMU, March 15)

A Mid-Year State Medicaid Budget Update for FY 2012 & A Look Forward to FY 2013
This Kaiser Commission on Medicaid and the Uninsured report, based on structured discussions with leading Medicaid directors in November 2011 and survey questions emailed to all 50 states and DC in December 2011 and January 2012, builds on findings from Kaiser's most recent comprehensive 50-state Medicaid budget survey. (KCMU, February 13)

People with Disabilities and Medicaid Managed Care: Key Issues to Consider
This issue brief from the Kaiser Commission on Medicaid and the Uninsured looks at issues related to the development and implementation of managed care programs with the capacity to serve Medicaid beneficiaries with disabilities. (KCMU, February 13)

Dollars Spent per Beneficiary

In a February 23 blog in The Incidental Economist, Aaron Campbell shows why it will be hard and painful to cut Medicaid.

Click above and see third chart ("Dollars spent per beneficiary")

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New Opportunities for Coordinating Care for Dual Eligibles

Melanie Bella
Director, Federal Coordinated Health Care Office, Centers for Medicare & Medicaid Services, US Department of Health & Human Services, Baltimore, MD