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CBO: Court ruling cuts cost of healthcare law, but leaves 3 million more uninsured
The Washington Post    Share    Share on FacebookTwitterShare on LinkedinE-mail article
President Barack Obama's signature health initiative will cost a bit less than expected thanks to last month's Supreme Court ruling, but the court's decision also is likely to leave millions of poor people without access to health insurance, congressional budget analysts said. In its June 28 ruling, the court upheld the bulk of Obama's Affordable Care Act, but struck down its plan to require states to expand their Medicaid programs to cover poor people who earn as much as 138 percent of the federal poverty level. More



US poverty on track to reach 46-year high; suburbs, underemployed workers, children hit hard
The Associated Press via The Washington Post    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The ranks of America's poor are on track to climb to levels unseen in nearly half a century, erasing gains from the war on poverty in the 1960s amid a weak economy and fraying government safety net. Census figures for 2011 will be released this fall in the critical weeks ahead of the November elections. The Associated Press surveyed more than a dozen economists, think tanks and academics, both nonpartisan and those with known liberal or conservative leanings, and found a broad consensus: The official poverty rate will rise from 15.1 percent in 2010, climbing as high as 15.7 percent. More

Working poor stand at center of Medicaid debate
The Associated Press via Yahoo News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Nowhere did President Barack Obama's healthcare law hold more promise than in Texas, which leads the nation in the portion of its population that is uninsured. A quarter of Texans have no coverage, many of them families like who are considered the working poor. Without a Medicaid expansion, the state's working poor will continue relying on emergency rooms — the most costly treatment option — instead of primary care doctors. The Texas Hospital Association estimates that care for uninsured patients cost hospitals in the state $4.5 billion in 2010. More

Hospitals meet with HHS on Medicaid expansion, including link to ACA payment cuts
InsideHealthPolicy.com    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Heads of several hospital groups met with HHS Secretary Kathleen Sebelius on Monday to discuss Medicaid expansion issues that have emerged as a result of the Supreme Court's ruling, including "the connection between coverage and payment reductions," according to the American Hospital Association. The discussion appears to be a continuation of industry's message that the reform law's payment cuts to hospitals can only be sustained if the coverage expansions scheduled for 2014 are fulfilled. More

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Wisconsin defends duals demo proposal in letter to MedPAC
InsideHealthPolicy.com    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Wisconsin is defending its proposal for the CMS dual eligible demonstration that aligns Medicare and Medicaid financing, writing in a letter this week to the Medicare Payment Advisory Commission that the state has a proven track record in caring for medically complex people in managed care. The state also points out that the demonstration is not seeking to include all of the states' duals. MedPAC and others have voiced concerns about the size of the CMS initiative, with states collectively proposing more than 2.8 million duals to be included. More

Illinois likely to expand Medicaid under federal insurance law
The State Journal-Register    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Illinois probably will enact an 18-percent expansion of the Medicaid program in 2014, with the federal government paying almost the entire bill for the first three years as part of the Affordable Care Act. But the expansion, which is expected to add about 500,000 people to a program that already covers 2.7 million of the state's 12.8 million residents, may not come without vigorous debates in the Illinois House and Senate, lawmakers said. More

Healthcare Medicaid expansion spurs debate in Florida
Tampa Bay Times via The Miami Herald    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medicaid is about to take a starring role in the national healthcare debate. Today, only certain people qualify for the health insurance program for the very poor: the elderly, the disabled, pregnant women and children. Under its proposed expansion, any poor American could qualify — a key part of healthcare reform. But because of the recent U.S. Supreme Court ruling, decisions about expanding Medicaid have been left to the states. And Florida Gov. Rick Scott was the first governor in the land to declare he wouldn't do it. More



West Virginia delays plan to transfer Medicaid patients
Charleston Daily Mail    Share    Share on FacebookTwitterShare on LinkedinE-mail article
West Virginia has delayed plans to turn over the care of 57,000 elderly or disabled Medicaid patients to three health insurance companies. The Department of Health and Human Resources said in May it would move patients who receive Supplemental Security Income into managed care insurance plans starting in December. The three companies — Carelink, The Health Plan and Unicare — would get money from the state to insure SSI patients for whom the state currently handles claims. Managed care, like a private sector HMO, attempts to coordinate healthcare while controlling costs. The three companies already manage care for 170,000 Medicaid recipients. More

Alabama governor waiting until after election to decide on Medicaid expansion
Tuscaloosa News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Alabama Gov. Robert Bentley won't say whether he'll expand Medicaid and accept the federal money that comes with it, although governors in other states, including Texas Gov. Rick Perry and Louisiana Gov. Bobby Jindal, already have said they would refuse to take the money and expand their state's Medicaid programs. "We're going to wait until we see what the landscape is after the election to make a final decision," Bentley said. "If [former Massachusetts] Gov. [Mitt] Romney wins and we [Republicans] take over the Senate, that changes the whole landscape." More

Wyoming governor expresses grave concerns over Medicaid expansion
Star-Tribune    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Gov. Matt Mead has "grave concerns" about the financial impact of expanding Medicaid in Wyoming, he wrote in a letter sent to the Obama administration's top health official. In the letter, Mead asks U.S. Health and Human Services Secretary Kathleen Sebelius for more details related to the federal health reform law and Wyoming. "Without additional information, the [law] and the Medicaid expansion appear to only add to the unsustainable debt while taking away the states' prerogative to make the best decision for our citizens," he wrote. More

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New Mexico governor lobbied to support Medicaid expansion
The Associated Press via KFDA-TV    Share    Share on FacebookTwitterShare on LinkedinE-mail article
More than 50 organizations are urging New Mexico Gov. Susana Martinez to support expanding Medicaid to cover more uninsured New Mexicans. The groups sent a letter to the Republican governor, saying the expansion of Medicaid under a federal healthcare law is a "win-win for New Mexico." Among those signing the letter are health care groups such as the New Mexico Pediatric Society and religious organizations including the New Mexico Conference of Catholic Bishops. More

Hearing on Connecticut Medicaid rules changes
The Associated Press via WTNH-TV    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Two legislative committees will discuss whether to push ahead with plans to tighten eligibility rules for Connecticut's 2-year-old Medicaid health insurance program for needy adults. The Appropriations and Human Services Committee have scheduled a public hearing today to learn more about the state's application for federal approval to change the eligibility rules. It is meeting afterward and could vote on whether to give Connecticut Gov. Dannel P. Malloy's administration the go-ahead to file the application. More

Maine GOP: DHHS ends state fiscal year 2012 without significant shortfall in Medicaid program
Pharmacy Choice    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Maine Department of Health and Human Services Commissioner Mary Mayhew informed the Legislature that the projected $12.5 million shortfall was all but eliminated in the final five weeks of State Fiscal Year 2012. In late May, DHHS officials met with Legislators to share that the preliminary year-end analysis showed the possibility of a $12.5 million shortfall in the Medicaid program. This estimate was based on claims payment projections over the final five funding cycles coupled with money owed to the department from other areas of state government. More

Missouri's newest managed-care contractor develops partnership with health centers
St. Louis Beacon    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Shannon Bagley has a passion for crunching numbers and for seeking good care for the medically needy. These interests come from her training as a CPA and growing up in central Illinois where her mother worked for the Illinois Department of Children and Family Services. She is combining her knowledge of healthcare economics and medical services in her job as president and CEO of Home State Health Plan. A subsidiary of Centene Corp., Home State was one of three companies that won contracts to handle managed care for Mo HealthNet, Missouri's Medicaid program. The managed-care component serves about 410,000 people. More


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Free webinar: A Coventry Health Care Story — How One Plan Built the Ultimate Cost-Containment Solution | 1-2 p.m. EDT July 25
Verisk Health    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Free webinar on how Coventry Health Care unveiled the next-generation of claims editing and fraud prevention solutions and improved their claims payment accuracy. Topics to be discussed include Prepayment Fraud Prevention; Real-Time Editing; and Clinical Validation. For more information: webinars@veriskhealth.com. Register here.

Insights webinar: State Oversight in the Medicare and Medicaid Arenas: The Different Impact of Federal Preemption in Each Program and Potential Changes in the Years Ahead | 11 a.m. EDT July 30
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
State regulators play crucial roles in oversight of plans operating in both the Medicaid managed care and Medicare managed care environments, but the scope of regulatory oversight is very different, based on the express federal preemption that applies to Medicare plans, but not to Medicaid plans.
  • The webinar first will review preemption under federal Medicare law and look at recent pushback against this preemption by state regulators and the implication for Medicare plans.
  • We'll next examine the role of conflict preemption in the Medicaid program. While there is no express preemption in Medicaid law, courts in recent years have invalidated some state statutes and regulations because they conflict with federal Medicaid laws.
  • The webinar will conclude with a discussion of the limits on federal power in Medicaid arising from the U.S. Supreme Court's opinion on the Affordable Care Act and a preliminary discussion of the opinion's implications.
Register here.


Insights webinar: 'How Can We Get Risk-Based Capital Relief' by Summit Reinsurance Services Inc. | 11 a.m. EDT Aug. 13
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medicaid enrollment is expected to grow by an estimated 14 million to 16 million lives due to the expanded Medicaid eligibility provisions of the Patient Protection and Affordable Care Act. As a result, many Medicaid health plans have legitimate concerns about meeting risk-based capital requirements. Summit Reinsurance Services Inc. will be presenting information on quota-share reinsurance solutions for risk-based capital relief. Click here to register.

Free webinar from MHPA partner Verizon: Fraud Waste and Abuse — The Next Generation | 2 p.m. EDT Sept. 12
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Understanding the patterns of fraud, where to find it, how to detect, and when to act. The old pay-and-chase model of fraud management is inefficient and costly. Connie Schweyen, Debra Faulkner, MBA, MHA; and David Botsko, Ph.D., CFE, managing principals at Verizon Connected Healthcare, will show you how to catch crime before it happens and how a near real-time fraud management solution can ensure near-time results. More



Agenda available for MHPA's 2012 Annual Meeting | Oct. 24-26
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The agenda for the MHPA 2012 Annual Meeting at the Hyatt Regency Washington on Capitol Hill in Washington, D.C., is now online at MHPA's website. The meeting agenda for A Pivotal Time for Medicaid Health Plans includes keynote speeches from Tim Engelhardt, director of models and demonstrations at the CMS Medicare-Medicaid Coordination Office; Charlie Cook, political analyst and publisher of The Cook Report; Donna Brazile, political strategist and commentator; and Robert Brownstein, political director for Atlantic Media Corp. Also read about our new pre-conference, "Developments in the States" as well as other informative sessions and presentations at this three-day event. View the full agenda and register here.

2012-2013 Best Practices Compendium submissions due by July 31
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Click here for details.

Job Opportunity: Supervisor of Advertising and Production at Health Partners (Philadelphia)
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
For more details and to apply online, click here.

Dual Eligibles Best Practices Summit | July 30-31 | Orlando, Fla.
Healthcare Education Associates    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Thomas Johnson, president and CEO of MHPA, participates as a faculty member of the 2012 Dual Eligibles Best Practices Summit. Learn how to execute a well-run dual eligibles plan, from outreach campaigns to managed long-term care and everything in between. Members of MHPA are entitled to a 15 percent discount. Mention HMP122 during registration to enjoy this offer. For more information, click here or contact Theresa Powers at 704-341-2437 or tpowers@healthcare-conferences.com. More

MHPA on Twitter, LinkedIn and Facebook
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