JUNE 6, 2012

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

State Officials: CMS Might Launch Second Innovation Initiative, This Time for States
The Center for Medicare and Medicaid Innovation (CMMI) Director Richard Gilfillan, MD, said last week that work is underway on an initiative to assist states in the overhaul of their delivery and payment systems. State officials believe this is a reference to a state-based health care intiative through CMMI. References have been made to aggressive programs undertaken by a few states such as Arkansas, Oregon, Maryland, Massachusetts and Rhode Island. At a Center for American Progress conference, Gilfillan referred to states as "laboratories for testing new ideas." (Inside Health Policy, May 30, 2012)

Large Swathe of Physicians Shun Medicaid, Medicare Patients
According to a survey by Jackson Healthcare, 39% of physicians are not accepting new Medicaid patients, and 26% see no Medicaid patients. The survey also revealed a lower degree of physician disenchantment regarding Medicare. Further, 17% of respondents said they are not accepting new Medicare patients while 10% have closed their practice to Medicare entirely. (MedScape Today, May 24, 2012)

Medi-Cal at a Crossroads: What Enrollees Say About the Program
This report from the California Healthcare Foundation presents the results from the largest survey of Medicaid enrollees; Medi-Cal is the Medicaid program in California. Significant findings include positive results on application ease, a low rate (3only 31%) of enrollees who report being delayed in seeking care as the result of cost. A surprising 79% report that it is easy to find a primary care physician but only 43% say finding specialists is easy. (California Healthcare Foundation, May 2012)

Advocates Seek Voice in Duals MOU Process, but CMS Says Pacts Won't Include Surprises
Patient advocates are concerned about a lack of stakeholder input in the memoranda of understanding between CMS and the states that will cement details of demonstration programs to align the financing and care for beneficiaries dually eligible for Medicare and Medicaid. A CMS official said the agreements should not contain any real surprises for advocates as they will follow the state plans and the stock MOU previously released by CMS. (Inside Health Policy, June 1, 2012)

Update: Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges, General Guidance on Federally-facilitated Exchanges
The Department of Health and Human Services has released its draft Blueprint for Approval of Affordable State-based Exchanges (SBEs) and State Partnership Exchanges (SPEs) as well as General Guidance for Federally Facilitated Exchanges (FFEs). The Blueprint process has been developed in a manner that insures SPEs and SBEs can be approved by January 1, 2012 and begin providing coverage by January 1, 2014 for qualified health plans (QHPs). (Health Reform GPS, May 25, 2012)

Vermont Seeks to Switch Duals' Drug Benefit to Medicaid
Vermont has raised the ire of the pharmaceutical industry with its plan to switch dual eligible beneficiaries out of their existing Medicare Part D drug plans and into the state's existing Medicaid pharmacy benefit, which includes a preferred drug list and potentially substantial drug maker rebates. The drug industry is telling state officials that the proposed policy is inconsistent with federal law and would undermine Part D. (Inside Health Policy, May 30, 2012)

Medicaid Cuts Threaten Nursing Home Reforms, Advocates Say
Lawmakers in Illinois have agreed to $1.6 billion in Medicaid cuts. Some angry lawmakers contended this will undercut two-year old nursing home reforms. Last week nursing home operators agreed to a reduction in reimbursement and the state established lower than desired levels of care for registerd nurses. (Chicago Tribune, May 28, 2012)

Realigning Health with Care

The Stanford Social Innovation Review, a periodical worth the radar space for health executives, provides excellent critique of healthcare worthy of attention.

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Medicaid Health Plan Performance

Douglas Sherlock, CFA
The Sherlock Company, North Wales, PA