SEPTEMBER 11, 2012

Welcome to the Medicaid Update eNewsletter
Editor: Philip L. Ronning
This issue sponsored by the Dual Eligibles Summit

Opting in to the Medicaid Expansion under the ACA
While only a few states cover non-disabled, non-pregnant parents with income up to 138% of the federal poverty level (FPL), the Affordable Care Act (ACA) could swell that number by as much as 15.1 million according this Robert Wood Foundation analysis. The report details the likely demographics of these new beneficiaries including estimates on a state-by-state basis. (Robert Wood Johnson Foundation, August 2012)

There Is No 'I' in 'Safety Net'
This blog post uses the experience of a patient combined with the author's own experiences in caregiving to elaborate the importance of collaborative efforts in providing care, not simply services. The author includes links to several resources -- including Improving Chronic Illness Care (ICIC) -- to encourage collaboration in the business of caring. (Huffington Post's The Blog, September 6, 2012)

2 Campaigns Differ Sharply on Medicaid, Seeking Vast Growth or Vast Cuts
This New York Times article provides a take on the Obama and Romney campaigns' differing approaches to Medicaid, suggesting that the outcome of the election will have more of an effect on Medicaid than on Medicare. The Obama campaign is based largely on implementation of the Affordable Care Act while the Romney campaign is seen to follow Ryan's backing of block grants. The author summarizes the approaches by saying, "In pure dollar terms, the difference comes down to this: As chairman of the House Budget Committee, Mr. Ryan has proposed cutting federal spending on Medicaid by $810 billion over 10 years. Mr. Obama's expansion plan, by contrast, would cost an additional $642 billion over the same period, according to the most recent estimate from the Congressional Budget Office." (New York Times, August 31, 2012)

Nursing Homes View Clinton's Spotlight on Medicaid as Boost in Their Bid to Stop Pay Cuts
Former President Bill Clinton put Medicaid in the spotlight during his speech at the Democratic Convention. The nursing home industry sees this as good support in their fight to stave off state budget cuts as well as an estimated $65 billion in Medicare cuts over the next 10 years. (Inside Health Policy, September 6, 2012)

Implementing the ACA's Medicaid-Related Health Reform Provisions after the Supreme Court's Decision
This brief by the Kaiser Family Foundation speaks to issues that will arise from the June 28, 2012 Supreme Court decision upholding the constitutionality of the affordable Care Act but limiting the Secretary of Health and Human Services from enforcing Medicaid expansion. The 2014 implementation of Medicaid's expansion raises many questions and this policy brief examines them in light of the Supreme Court's decision. (Kaiser Family Foundation, August, 2012)

A Guide to the Supreme Court's Decision on the ACA's Medicaid Expansion
The Kaiser Family Foundation has also released a brief (as a companion piece to the brief described above) examining the Supreme Court's ruling on the Affordable Care Act's expansion of Medicaid. In this brief you will find details regarding the decision. Although a majority of the court found the Medicaid expansion unconstitutionally coercive, a different majority of the Court held that this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary's enforcement authority. "The practical effect of the Court's decision makes the ACA's Medicaid expansion optional for states because, if states do not implement the expansion, states can lose only ACA Medicaid expansion funds. The Court ruled that the Secretary may not withhold all or part of a state's matching funds for the rest of the Medicaid program if a state does not implement the expansion." (Kaiser Family Foundation, August, 2012)

Texas Counties Consider Going It Alone on Medicaid Expansion
In spite of Texas Gov. Rick Perry's opposition to the Affordable Care Act's (ACA) expansion of Medicaid some of the State's largest counties are discussing banding together to proceed with the ACA's planned expansion. Many Texas counties have offered free or low-cost healthcare for residents with incomes as much as three times the federal poverty level (FPL) of about $57,000 annually for a family of three. This policy costs them an estimated $2 billion a year. Expanding Medicaid could help these cash-strapped counties. Bexar County, for example, would save $53 million annually. The plan being considered would require approval from Washington as well as the Texas legislature. (Washington Post, August 26, 2012)

Minnesota Seeks OK to Change Medicaid Health Plan
Minnesota's Gov. Mark Dayton is asking the Department of Health and Human Services for permission to make changes to its Medicaid program which could save the state an estimated $151 million over five years. The proposal involves efforts to keep more people in need of care out of institutions and at home and to make personal care attendants and counseling for nursing home care faster and easier. (Sacramento Bee, August 28, 2012)

Deal: No Medicaid Expansion for Georgia
Gov. Nathan Deal of Georgia said he "would not have any intention" of expanding Georgia's Medicaid rolls with federal money from the Affordable Care Act but went on to say he would wait until November to decide. He said his reason for waiting until December is "...to see whether or not there are going to be legislative changes at the federal level. And we do have a time frame for making the decision that I think, especially on the exchanges, we have just a few days after the election in order to make a final determination on that." (Atlanta Journal Constitution, August 28, 2012)

State Innovation Models Initiative
The State Innovation Models Initiative is a $275 million competitive funding opportunity for States to secure grant monies to support the design and testing of multi-payer payment and delivery models. Information, including access to the CMS August 28, 2012 webinar, is available by clicking this link. (CMS, September 10, 2012)

Duals' Advocates Concerned about Medicaid Cuts while Demo Is Ongoing
CMS and the State of Massachusetts are involved in a demonstration project regarding dual eligibles. Beneficiary advocates have raised concerns that the project's memorandum of understanding does not prevent Medicaid cuts during the demonstration. Advocates fear this will impact the patients of duals who have high levels of need for long-term care services. (Inside Health Policy, September 7, 2012)

State Variation in Primary Care Physician Supply: Implications for Health Reform Medicaid Expansions

The Affordable Care Act is likely to expand Medicaid coverage to as many as 16 million more beneficiaries. States with the fewest PCPs relative to population have the highest Medicaid reimbursement rates (close to or exceeding Medicare rates) and will therefore see little impact from increased Medicaid rates. This Robert Wood Johnson Research Brief provides details.

(Click chart to see full version on p. 4 of document)

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Medicaid ACO Payment Reform Strategies

Tricia McGinnis, MPP
Senior Program Officer, Center for Health Care Strategies, Hamilton, NJ