MAY 16, 2012

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

NAMD, Former Governors Call for a Permanent Medicaid Waivers Path
Citing a consistent failure by CMS to move the concepts and practices of successful demonstration projects beyond the testing phase and into program-wide application the NAMD and a bi-partisan group of former governors have called for the creation of a pathway for states to adopt and apply the principles of beneficial programs. Presently the only avenue available is the CMS Center for Medicare and Medicaid Innovation, which this report says, has shown little interest in Medicaid projects other than those involving dual eligibles. (Inside Health Policy, May 11, 2012)

Medicaid Raise for Primary Care Could Include Subspecialists
CMS has proposed to increase Medicaid fees for primary care physicians AND primary care subspecialists (e.g., pediatric cardiologists). The increase is only for Evaluation and Management (E&M) and vaccine administration fees and would apply for FFYs 2013 and 2014 raising the Medicaid fees for these services to the Medicare levels. (Medscape Today, May 9, 2012)

Oregon Medicaid Demo Touted as Potential National Reform Model
HHS has approved a $1.9 billion demonstration plan for the delivery of care to Medicaid beneficiaries in Oregon through its newly created "Coordinated Care Organizations" (CCOs). The model is touted as a prototype for Medicaid nationally. The Oregon plan is expected to save $11 billion over the next decade. (Inside Health Policy, May 3, 2012)

Oregon's Idea for Fixing Medicaid Hits the National Stage
Two-time Oregon Governor John Kitzhaber, a former Emergency Room physician, has overseen the creation of Cooperative Care Organizations. These entities are designed to break-down competitive barriers in the delivery of services to the states Medicaid population (estimated at 16% of the state's total population and 39% of its children) and to focus on prevention and wellness. "We estimated that if every state Medicaid program in the country," say Kitzhaber, "were to adopt this model, the net savings would be about $1.5 trillion dollars over 10 years." This Oregon Public Broadcasting story provides more details. (OPB News, May 14, 2012)

The Affordable Care Act's Coverage Expansions Will Reduce Differences in Uninsurance Rates by Race and Ethnicity
This article in Health Affairs suggests that provisions of the Affordable Care Act will reduce uninsured rates among blacks and Hispanics bring them closer to the rates of uninsureds among comparable white populations. Reducing uninsurenance will depend on effective state policies. (Health Affairs, May 2012)

NAMD Releases Second White Paper in Series
The National Association of Medicaid Directors (NAMD) has released the second in a series of white papers. Entitled "Advancing Medicare and Medicaid Integration: An Update on Improving State Access to Medicare Data" the paper calls on CMS to give states access to not only Medicare Parts A and B data but also to Medicare Advantage data. (NAMC, April 2012)

GOP Says Block Grants Would Help Stem Medicaid Fraud, but Others Disagree
House Republicans continue to support Medicaid Block Grants to states. The most recent argument is to stem fraud and abuse. Those opposed to Block Grants contend that such grants would proliferate fraud and abuse and therefore Federal strings must be attached. Rhode Island, which has a capped Federal contribution, has seen no change in fraud and abuse. The debate continues. (Inside Health Policy, April 30, 2012)

Medicaid MCOs and Medical Loss Ratio (MLR) Requirements

SOURCE: Kaiser Family Foundation, April 2012

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The Medicaid Landscape

Diane Rowland, ScD
Executive Vice President, Henry J. Kaiser Family Foundation, Executive Director, Kaiser Commission on Medicaid and the Underinsured