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MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. to review a number of Medicaid- and CHIP-related issues. MACPAC members heard presentations on and discussed the following issues: Multistate Collaboration: Panel on State Perspectives Themes from Interviews on the Development of Hospital Payment Policies DSH Payments: Policy Changes and Policy Options Operational Considerations for Work and Community Engagement Requirements Medicaid Coverage of New and High Cost Drugs Managed Care Oversight Oversight of UPL Payments: Additional Analyses and Policy Options Mandated Report: Therapeutic Foster Care Find outlines of these subjects and additional materials by clicking the links above and go here for a transcript of the two days of public meetings. MACPAC is a non-partisan legislative branch … Read More

Posted in Federal Medicaid issues

Battle Over Medicaid Work Requirements Not Over

The Secretary of Health and Human Services is not accepting a recent federal court ruling as the final word on Medicaid work requirements. Although the court ruled against a federally approved plan to permit the state of Kentucky to implement a work requirement for some able-bodied Medicaid recipients, HHS Secretary Alex Azar insists that his department will continue to support work requirements for Medicaid beneficiaries. Azar told a Heritage Foundation audience that We suffered one blow in district court in litigation, but we are undeterred.  We’re proceeding forward…We’re fully committed to work requirements and community participation in the Medicaid program…we will continue to litigate, we will continue to approve plans, we will continue to work with states.  We are moving … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid

GAO Looks at Medicaid Managed Care Spending

The federal government should do more to help states ensure the accuracy and integrity of their payments to Medicaid managed care organizations and the payments those Medicaid managed care organizations make to health care providers. This is the conclusion reached in a new study of Medicaid managed care performed by the U.S. Government Accountability Office at the request of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs. The GAO study identified six payment risks among various transactions between state governments, Medicaid managed care organizations, and health care providers.  The two biggest risks, the GAO concluded, were: incorrect fee-for-service payments from MCOs, where the MCO paid providers for improper claims, such as claims for … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs. According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible. Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it. Despite this, the authors note, access to care did improve as a result of the Affordable Care Act’s Medicaid expansion. Learn more about the studies, their results, … Read More

Posted in Affordable Care Act, Federal Medicaid issues

Proposed Federal Reorganization Could Affect Health Care

Aspects of a proposed reorganization of the federal government could affect the agencies that administer key health care programs. In its 132-page Delivering Government Solutions in the 21st Century:  Reform Plan and Reorganization Recommendations proposal, the White House calls for consolidating many social safety-net programs in a new Department of Health and Public Welfare.  This department would retain responsibility for Medicare and Medicaid but also would assume responsibility for some food aid programs, including food stamps (now the Supplemental Food Assistance Program, or SNAP). In addition, the proposal would: consolidate all health research programs in the National Institutes of Health, including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, and the National Institute … Read More

Posted in Federal Medicaid issues, Medicare

Verdict: Medicaid Expansion Improved Care and Access

A new review of studies published since the Affordable Care Act’s Medicaid expansion has concluded that expansion improved care, access to care, and coverage in states that expanded their Medicaid programs. Among the improvements cited by studies are: greater use of primary care more preventive health visits more behavioral health care shorter hospital stays fewer avoidable hospital admissions reduced access problems reduced reliance on hospital ERs as a primary source of care improved monitoring and compliance rates for patients with diabetes and hypertension higher rates of screening for prostate cancer and Pap smears In addition, hospitals provided less uncompensated care and had better margins. Learn more in the Health Affairs study “The Effects Of Medicaid Expansion Under The ACA:  A … Read More

Posted in Affordable Care Act, Federal Medicaid issues

Hospitals, Others Oppose Easing Medicaid Access Requirements

Hospital groups and other health care interest organizations have expressed strong opposition to a Centers for Medicare & Medicaid Services proposal to ease requirements that states ensure adequate access to care for their Medicaid population. Under current federal Medicaid law, states must periodically review their Medicaid provider networks to ensure that Medicaid recipients have adequate access to care.  Under a March CMS proposal, that requirement would exempt states from performing such reviews if at least 85 percent of their Medicaid population is enrolled in a managed care plan and similarly exempt them from reviewing the impact on their provider networks of rate cuts of less than four percent during a single state fiscal year or six percent over two consecutive … Read More

Posted in Federal Medicaid issues

CMS Rejects Bid to Impose Lifetime Limit on Medicaid Services

The Centers for Medicare & Medicaid Services has denied a request from the state of Kansas to impose a lifetime limit on the Medicaid benefits individuals may receive. In a move that the agency appeared to signal last week and that appears to have national implications, CMS administrator Seema Verma explained that  We have determined that we will not approve Kansas’ recent request to place a lifetime limit on Medicaid benefits for some beneficiaries…We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them. Medicaid advocates feared that benefit limits would follow in the … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

A Look at Medicaid Managed Care

With 74 million people enrolled in Medicaid managed care plans – roughly 71 percent of the U.S. Medicaid population – the Health Affairs Blog has taken a broad look at Medicaid managed care, addressing the question of how it works, whether it’s working, and what its future may be. The two-part report notes that some Medicaid managed care companies are highly profitable and that this profitability has increased in recent years.  It also notes that the manner in which these companies serve their members varies greatly, that their medical loss ratios vary considerably from state to state, and that the reserves managed care companies hold vary greatly as well. In addition, the two-part report seeks answers to a number of … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid policy

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP issues, met publicly in Washington, D.C. last week. The following is MACPAC’s own summary of its two days of meetings. The April 2018 meeting began with session on social determinants of health. Panelists Jocelyn Guyer of Manatt Health Solutions, Arlene Ash of the University of Massachusetts Medical School, and Kevin Moore of UnitedHealthcare Community & State discussed state approaches to financing social interventions through Medicaid. In its second morning session, the Commission reviewed a draft chapter of the June 2018 Report to Congress on Medicaid and CHIP on the adequacy of the care delivery system … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments
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