OCTOBER 16, 2012

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

Medicaid Chiefs Blast CMS for Lack of Anti-Fraud Collaboration with States
In a strongly worded letter to CMS, the National Association of Medicaid Directors (NAMD) claim the agency is undermining anti-fraud efforts through its poor communication and lack of collaboration with the states, citing the lack of state participation in a newly unveiled public-private anti-fraud partnership. (Inside Health Policy, October 15, 2012)

Medicaid's High Marks on Preventive Care Contrary to Its Stingy Image
According to a recent study Medicaid programs are doing an above-average job in providing needed preventive care services. The Kaiser Commission on Medicaid and the Uninsured found that most Medicaid programs covered the bulk of 42 recommended services for adults, particularly for cancer and sexually transmitted infection screenings as well as pregnancy care. Many of these services, such as screenings, are being bundled with other services. (amednews.com, October 8, 2012)

Florida Medicaid Program in Limbo
Gov. Rick Scott and the Republican-led Legislature, in an effort to cut costs, want to privatize Medicaid even though Florida has some of the most stringent eligibility requirements in the country. A five-county pilot program showed little or no savings but advocates are pushing a revamped version of the program statewide. The Obama administration is seeking to make more Floridians eligible for Medicaid for a program that already costs more than $21 billion a year. Both need the other's consent to proceed. The sides have been negotiating but neither is prepared to comment. (examiner.com, October 8, 2012)

Medicaid Fraud in the Billions
Penny Thompson, Deputy Director for the Centers for Medicare and Medicaid Services (CMS), told the House Oversight and Government Reform Committee, chaired by Rep. Darrell Issa (R-Calif.), that federal payments made to New York state-run development centers were "excessive and unacceptable," exceeding the entire Medicaid budget of 14 states. She went on to admit that the overpayments, estimated to be $15 billion, were inexcusable and "suggests an institutional failure and a pattern of irresponsible actions that have cost the taxpayers billions." This article's author concludes, "Simply put, bureaucrats in New York have been milking the system for decades, but Thompson claims she just found about it a few months ago." Medicaid fraud includes not simply providers but also state agencies such as New York's that were involved in this "scam." For the HHS Office of Inspector General's report on the matter go to: https://oig.hhs.gov/oas/reports/region2/21101029.pdf. Issa's staff prepared a report on Medicaid abuse in April entitled "Uncovering Waste, Fraud and Abuse in the Medicaid Program." Lawrence Huntoon, MD, a board-certified neurologist from Buffalo, New York, and Editor-in-Chief of the Journal of American Physicians and Surgeons, reviewed Thompson's statements and concluded: "Now we have indisputable evidence that government itself is a major source of fraud in government-run medical programs." (The New American, October 8, 2012)

Court Strikes Down Indiana's Medicaid Dental Cap
A federal Appeals Court has ruled that Indiana's social services agency cannot cap payments for Medicaid recipients' dental services (set at $1,000) if they are determined to be medically necessary, finding such a cap to be a violation of state and federal Medicaid law. The state has responded by saying it may drop dental coverage entirely if the cap is no longer in place, which would likely require the approval of Indiana's General Assembly. (SFGate, September 29, 2012)

Kids' Prescriptions Often Going Unfilled
According to a recent study in Pediatrics of 4,833 pediatric patients receiving nearly 17,000 prescriptions over 26 months, 22% of the prescriptions went unfilled. All of the patients were on Medicaid. The reasons for the unfulfilled prescriptions are not known, although the researchers suggest convenience may be a factor, citing studies in which adults are shown to be more likely to fill their prescriptions when they are transmitted to the pharmacy electronically. Rachael Zweigoron, MD, the study's principal author, says that parents don't always know why a pediatrician has prescribed a medication or supplement. "Are we, as pediatricians, doing a good enough job of explaining the importance to parents?" Zweigoron asked. (Reuters, September 25, 2012)

California Plans, Providers Behind Talk of Capping Medicaid Spending Per Person
California's Medicaid program, Medi-Cal, pays providers less than most states which is prompting an interest by payers, providers and California officials in pursuing a per-person cap on Medicaid spending. How a per-capita plan would affect California depends in large part on its design. Bruce Lesley, president of First Focus, argues for rates being based on current payment levels so that states like New York with higher provider payments won't be the only ones penalized. California's Democratic Govorner Jerry Brown sees capitation as a way to avert Medi-Cal cuts. (Inside Health Policy, October 12, 2012)

Daschle Backs Medicaid Per Person Caps as Alternative to Block Grants
As a compromise to block grants proposed by some Republicans, former Sen. Tom Daschle, (D-SD), is advocating for federal funding of Medicaid on a capped, per person basis. Daschle said he is "vehemently opposed" to block grants. He believes capitation would give states an incentive to improve. He went on to say, "That's another key factor here: We're guaranteeing benefits on the Medicaid program." (Inside Health Policy, October 4, 2012)

Medicaid Patient Shift Squeezes Home Caregivers
Thousands of Medicaid managed care patients in South Texas were forced to change plans from Molina Healthcare after it announced a 10% cut in reimbursement rates. This put severe financial strain on home health providers, resulting in their inability to continue providing services. 11,400 patients have switched from Molina to one of four other plans. Home health providers require an indication from a health practitioner that home care is medically necessary, and securing those documents during this transition is proving difficult. (New York Times, October 4, 2012)

Grover Norquist Prods Georgia Legislators to Drop Hospital Tax Used to Raise Funds for Medicaid
Grover Norquist, the Washington-based anti-tax activist, has sent a letter to Georgia legislators urging them to not renew the hospital tax used to fund Medicaid, which is set to expire next July. He called the tax "a bed tax," saying it would kill jobs. The tax is based on revenues not beds. Ted Sweeny of the Georgia Budget and Policy Institute says the underfunded Medicaid program needs the revenue. Georgia raises more than $200 million per year from the tax which is doubled through matching federal funds. Georgia is one of 40 states to use such a tax, which results in winners and losers. "Georgia's policymakers should stand up to Norquist and, more importantly, focus on what's in Georgia's best interest," he said. (Kaiser Health News, October 6, 2012)

How Will the Election Change Medicaid?

Phil Galewitz of Kaiser Health News, in conjunction with PBS Newshour, discusses his views on how the results of the election may impact Medicaid.

(Click above to play video)

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Medicaid Challenges and Opportunities in the States
A Medicaid Directors Roundtable Discussion

Matthew Eyles
Public Affairs & Policy, Coventry Health Care, Inc., Bethesda, MD

Bruce Goldberg, MD
Oregon Health Authority, Salem, OR

Mary Mayhew
Department of Health and Human Services, Augusta, ME

Mark Schaefer, PhD
Medical Care Administration, Hartford, CT