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Inside Health Policy and Modern Healthcare
CMS on Nov. 18 proposed preventing increases in pass-through payments and new pass-through payments in states that use private managed care to deliver Medicaid benefits. Congressional Republicans this week asked the Obama administration to freeze regulations so the Trump administration could review them, and Medicaid Health Plans of America President and CEO Jeff Myers criticized CMS for not heeding the GOP's request.
Read about it here:
Inside Health Policy
Modern Healthcare
The New York Times
The expansion of Medicaid, a central pillar of the Affordable Care Act, faces immense uncertainty next year, with President-elect Donald J. Trump and top Republicans in Congress embracing proposals that could leave millions of poorer Americans without health insurance and jeopardize a major element of President Barack Obama's legacy. But influential figures in surprising quarters of the new administration might balk at a broad rollback of Medicaid's reach, favoring new conditions for access to the government insurance program for the poor but not wholesale cutbacks.
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CNNMoney
Donald Trump likely won't let Medicaid collapse, but he will vastly change the health insurance program for low-income Americans.
Think less federal funding, more state control, fewer participants and higher costs for those in the program. Here's how Medicaid works now: Nearly 73 million Americans are on Medicaid or the related Children's Health Insurance Program (CHIP). The programs cost $509 billion in fiscal 2015, with the federal government shouldering 62 percent of the bill and states paying 38 percent.
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Modern Healthcare
Florida wants to pilot a program that would reimburse managed-care plans for residential placement and other services for Medicaid enrollees with severe mental illness or substance use disorders. If approved by the CMS, Medicaid beneficiaries in Florida would be eligible to receive services such as help searching and applying for a rental home and assistance finding ways to subsidize rent.
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Kansas Health Institute
Anticipating significant changes in federal healthcare policy, Kansas officials are slowing their timeline for renewing KanCare, the state's privatized Medicaid program. Some of the health policy changes favored by President-elect Donald Trump and Republican congressional leaders would significantly alter the way Medicaid is funded and relax rules that dictate who and what states must cover. But it isn't yet clear which of those changes will be included in promised legislation to repeal and replace Obamacare.
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Forbes
Several states led by Republican governors appear to be putting Medicaid expansion under the Affordable Care Act on hold given talk by the incoming administration of Donald Trump to scrap the law or move to federal block grants to cover poor Americans. State-elected officials in Idaho, Nebraska and South Dakota and political pundits in Georgia are saying talk of expanding Medicaid before the election has now subsided at least for the 2017 legislative sessions. That means more than 500,000 Americans will have to wait for health benefits.
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Kaiser Health News
Kentucky Gov. Matt Bevin, who was elected in 2015, has argued Kentucky cannot afford Medicaid in its current form. Obamacare permitted states to use federal funds to broaden Medicaid eligibility to all adults with incomes at or below 138 percent of the federal poverty level, now $11,880 for individuals. Kentucky’s enrollment has doubled since late 2013 and today almost a third of its residents are in the program. That's led to the one of the sharpest drops in any state's uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier.
Kentucky's achievement owed much to the success of its state-run health insurance exchange, Kynect, in promoting new coverage options under the health law. Kynect was launched under Bevin's Democratic predecessor, Steve Beshear, and dismantled by Bevin this year.
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Modern Healthcare
South Dakota Gov. Dennis Daugaard's decision to abandon plans to seek Medicaid expansion could be because Vice President-elect Mike Pence cast doubt over the future of federal matching funds through the Affordable Care Act. On Tuesday, Daugaard, a Republican who had been supportive of expanding Medicaid eligibility in his state, said he would not recommend it to the state's Legislature this year after hearing the incoming administration's plans for repealing or reforming the ACA.
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The Salt Lake Tribune
The federal government likely will have some changes to the state's small-scale Medicaid expansion plan, which currently is awaiting approval. And that means the state will not be able to begin enrolling individuals by Jan. 1, the originally projected start date, said Nate Checketts, the Utah Department of Health's deputy director. The plan, projected to cover 9,000 to 11,000 people, targets childless adults who are chronically homeless, involved in the justice system or in need of mental-health or substance-abuse treatment. It also expands coverage of low-income parents with dependent children previously not covered by Medicaid.
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WRAL-TV
A report released Tuesday by the North Carolina legislature's internal oversight agency recommends changes in how the state's Medicaid program goes after fraud and waste. The report noted that North Carolina is spending millions of dollars on claim reviews that are not fraudulent, and attorneys aren't able to follow up on many that are. In the 2013-14 fiscal year, for example, the state paid contractors $3.7 million to hunt out fraudulent claims, but the state was able to recover less than $500,000.
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The Hill
The embattled manufacturer of the EpiPen will not testify at a hearing next week by the Senate Judiciary Committee, its chairman announced Monday. Sen. Chuck Grassley (R-Iowa) said executives at Mylan turned down his request to appear at a Nov. 30 hearing set to focused on the company's potential settlement with the Obama administration over a Medicaid pricing dispute.
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