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Archive for Federal Medicaid issues

States Taking Different Paths to Pay for Medicaid Expansion

With the federal share of Medicaid expansion falling to 90 percent next year, states that expanded their Medicaid programs under the Affordable Care Act are now exploring new ways to raise the money to pay for the 10 percent for which they will soon by responsible. Some are implementing hospital or insurer taxes while others are increasing existing taxes on hospitals and health insurers.  New Hampshire is directing part of the proceeds from a liquor tax for this purpose and other states have introduced cigarette taxes.  Some are charging premiums to Medicaid beneficiaries and introducing work requirements for their Medicaid population so they can reduce overall enrollment.  Many are using money from their general revenues. This all comes at a … Read More

Posted in Affordable Care Act, Federal Medicaid issues

MACPAC: Slow Medicaid DSH Cuts

Slow the pace of scheduled cuts in Medicaid disproportionate share hospital payments (Medicaid DSH), the non-partisan agency that advises Congress and the administration will tell Congress in its next report of policy recommendations. The Medicaid and CHIP Payment and Access Commission voted 16-1 recently to recommend to Congress that Medicaid DSH cuts, mandated by the Affordable Care Act but delayed three times by Congress, be reduced in size and spread out over a longer period of time. Currently, Medicaid DSH allotments to the states are scheduled to be reduced $4 billion in FY 2020 and then $8 billion a year in FY 2021 through FY 2025.  MACPAC recommends that the cuts be reduced to $2 billion in FY 2020, $4 … Read More

Posted in Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP. Later that morning, the Commission discussed a study on performance and return on investment for state program integrity strategies. This session was originally scheduled for the December meeting. Following … Read More

Posted in DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments

Chatter About Medicaid Block Grants Grows

A week after a published report suggested that the Trump administration might be working on a plan to introduce Medicaid block grants, the Washington Post reports that those efforts are under way in earnest. According to the Post, A small group of people within the Centers for Medicare and Medicaid Services is working on a plan to allow states to ask permission for their federal Medicaid dollars to be provided in a single lump sum instead of the way they are currently awarded as a percentage of states’ total costs. While many, including members of Congress, insist that the administration cannot move forward with such a proposal without legislation, others suggest that the administration may offer states the opportunity to participate in Medicaid block … Read More

Posted in Federal Medicaid issues

Feds Urge States to Do More for Dually Eligible

In a formal guidance letter to state Medicaid directors, the Centers for Medicare & Medicaid Services has outlined ten ways that states can better serve individuals who are enrolled in both Medicare and Medicaid. Noting that such dually eligible individuals represent 20 percent of Medicare enrollees but 34 percent of Medicare spending while also constituting 15 percent of Medicaid beneficiaries but 33 percent of Medicaid spending, the letter from CMS administrator Seema Verma to state Medicaid directors explains that This letter describes ten opportunities – none of which require complex demonstrations or Medicare waivers – to better serve individuals dually eligible for Medicare and Medicaid, including through new developments in managed care, using Medicare data to inform care coordination and … Read More

Posted in Federal Medicaid issues, Medicare

Bill Would Overhaul Medicaid DSH

A new Senate proposal would change how the federal government allocates Medicaid disproportionate share money (Medicaid DSH) to the states. The State Accountability, Flexibility, and Equity (SAFE) for Hospitals Act, introduced by Senator Marco Rubio (R-FL), seeks to …create equity for all states by updating a metric used to determine how much each state is allotted, which has not been reformed since the early 1990s. A news release issued by Senator Rubio explains that the bill Gradually changes the DSH allocation formula so states’ allocations are based on the number of low-income earners living in the state, as a percentage, of the total U.S. population earning less than 100% of the Federal Poverty Level (FPL). Prioritizes DSH funding to hospitals … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals

MACPAC Looks at Medicaid DSH

Last week the federal Medicaid and CHIP Payment and Access Commission met in Washington, D.C. and one of the subjects on its agenda was Medicaid DSH. The Affordable Care Act mandated major reductions of Medicaid disproportionate share (Medicaid DSH) allotments to states and those reductions have been delayed by Congress several times but are now scheduled to begin in FY 2020. At the MACPAC meeting the commission’s staff presented three proposed recommendations that address Medicaid DSH allotments; these recommendations were based on a consensus reached by MACPAC commissioners at their October meeting.  Those recommendations are: Phase in Medicaid DSH reductions more gradually over a longer period of time. Apply reductions to unspent DSH funds first. Distribute reductions in a way … Read More

Posted in DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals

Medicaid to Help Pay for Food, Heat, Rent?

Maybe. At least that is what Department of Health and Human Services Secretary Alex Azar hinted during a recent symposium held in Salt Lake City. During the event, Azar said that HHS’s Center for Medicare and Medicaid Innovation seeks …solutions for the whole person, including addressing housing, nutrition, and other social needs. Azar hinted at future CMMI action, saying that What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea … I want you to stay tuned to what CMMI is up to. CMMI currently operates one major program that … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

HHS Gives States New Options for Medicaid-Covered Behavioral Health Treatment

The U.S. Department of Health and Human Services has informed state Medicaid programs that it is giving them new opportunities to pay for hospitalization to care for recipients with behavioral health problems. For years Medicaid has greatly limited the ability of state Medicaid programs to pay for inpatient care for many behavioral health problems – a limit commonly known as the IMD (institution of mental disease) exclusion.  Earlier this year the Centers for Medicare & Medicaid Services eased this long-time limit, announcing that it would make it easier for states to secure waivers from it.  CMS has announced in a formal guidance letter to state Medicaid directors that it is extending this policy, according to a CMS news release, which … Read More

Posted in Federal Medicaid issues

Medicaid Birthing Model Improves Outcomes

A federal program to improve birth outcomes among Medicaid-covered women has produced positive results:  lower rates of pre-term births, fewer low birthweight babies, fewer C-sections, lower delivery costs, and lower first-year health care spending. The “Strong Start for Mothers and Newborns” program was a four-year initiative established by the Affordable Care Act and developed by the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Innovation to employ patient education, nutrition, exercise, preparation for childbirth, breast-feeding, and family planning rather than strictly medical interventions and was delivered through three evidence-based prenatal care models:  Birth Centers, Group Prenatal Care, and Maternity Care Homes. The program, operated in 219 separate sites in 32 states (with one in Pennsylvania), served … Read More

Posted in Affordable Care Act, Federal Medicaid issues
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