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Modern Healthcare
Given her extensive experience reforming state Medicaid agencies, the next CMS administrator could lead efforts to make Medicaid patients more financially responsible for their insurance coverage. President-elect Donald Trump Tuesday announced that Seema Verma, the president, CEO and founder of SVC, a national health policy consulting company that has helped craft Medicaid expansion plans in Indiana, Iowa, Kentucky, Michigan and Ohio, would work under Rep. Tom Price, who currently is a congressman from Georgia but has been nominated for HHS secretary.
Verma is likely to focus on overhauling CMS' efforts to coordinate care for people dually eligible for Medicaid and Medicare. Demonstrations aimed at better serving an often chronically ill population has lacked participation. Verma has said health plans should have more tools at their disposal to boost participation, according to Jeff Myers, CEO of Medicaid Health Plans of America.
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Inside Health Policy (Subscription required)
Lobbyists and consultants say the Medicaid managed care rule could be pulled back if lawmakers move Medicaid to a block grant, per-capita caps or other capitated payment system, as the rule could be seen as limiting state flexibility to run their programs. Jeff Myers, president and CEO of Medicaid Health Plans of America, told Inside Health Policy that in any type of Medicaid capitated pay model, it's pretty clear that a number of regulations that have been finalized don't make a lot of sense, and lawmakers would likely move to redo the regulatory state underlying the program. Both the Medicaid managed care regulation and mental health parity regulation could come under scrutiny, Myers said, as well as a Medicaid supplemental pay regulation.
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AIS
Donald Trump's shocking victory on Nov. 8 will spell big changes for all facets of the healthcare industry, as the president-elect and congressional Republicans — which retained control of both the House and Senate — are expected to repeal much of the Affordable Care Act (ACA).
"Because there is no detail and we're a week into [Trump] positioning himself as president-elect, it's hard for me to say what it means for Medicaid plans, or what it means for states," said Jeff Myers, president and CEO of the Medicaid Health Plans of America (MHPA). "But MHPA has always been supportive of a Medicaid program that allows states to have flexibility to provide access and care to their most disadvantaged. States are different, they have different patient populations and the health systems in those states are different, so trying to make a nationalized system in Medicaid doesn't make a lot of sense. And in this type of block-grant scenario, the states would have a significant amount of control over the program that many state governors believe they do not have today."
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The Hill
A medical cures bill cleared its first Senate hurdle on Monday, as Vice President Joe Biden made a rare appearance in the chamber to preside over the vote. The Senate voted, 85-13, to end debate on the proposal. Sixty votes were needed to overcome the procedural test.
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The Hill
Republicans in Congress are planning to strike a direct blow against Obamacare in the early weeks of Donald Trump's presidency, the House's No. 2 leader said on Monday. A budget document that paves the way for Obamacare's repeal is expected to come up in the Senate the first week of 2017, according to House Majority Leader Kevin McCarthy.
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Arkansas Online
Less than a month before the federal waivers of Arkansas' private option are set to expire, state and federal officials are still trying to reach an agreement on how to restructure the state's expanded Medicaid program. Gov. Asa Hutchinson, on a trip to the nation's capital, met with U.S. Health and Human Services Secretary Sylvia Burwell on Monday in an effort to reach agreement.
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The Atlanta Journal-Constitution
Georgia lawmakers are readying for a brutal — and potentially early — debate over whether to extend a tax that plugs a gaping hole in the state Medicaid system in the opening days of next year's legislative session. Donald Trump's election — and his vows to gut Obamacare — have sidelined talk about a Medicaid expansion under the imperiled Affordable Care Act. Most lawmakers talk of a wait-and-see approach toward health policy after Trump's election.
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Casper Star Tribune
Hopes for Medicaid expansion, the program intended to bring health coverage to thousands of low-income adults, have died in Wyoming. The four-year effort to expand Medicaid in the Cowboy State expired unceremoniously in the wake of Donald Trump's successful White House bid. The president-elect has said he will overhaul or replace the Affordable Care Act, of which growth of the Medicaid program was a key component.
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The New York Times
Excluded from the Affordable Care Act because of politics, thousands of poor Americans grapple with the toll — physical and psychological — of being uninsured. According to the most recent census data, the uninsured portion of the United States population has fallen to 9 percent, with the sharpest drop registered among those living in households with incomes of less than 200 percent of the federal poverty level (which, translated into dollar terms, is the equivalent of an income of $48,600 a year for a family of four, or $23,760 for a single person).
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Kaiser Health News
New Hampshire, along with 30 other states and the District of Columbia, expanded eligibility for the state-federal low-income health insurance program under the Affordable Care Act. Roughly 1.6 million Americans have had access to substance abuse services. But a study published Monday in the journal Health Affairs found significant disparities in coverage among the states.
Researchers sought to determine the number of substance treatment services available in each state in 2014. They analyzed coverage for the four tiers of services recognized by the American Society for Addiction Medicine, which are classified as outpatient (including group and individual therapy as well as recovery support services), intensive outpatient, short- and long-term residential inpatient and intensive inpatient care for detoxification. Data was collected from the annual National Drug Abuse Treatment System Survey and state Medicaid directors.
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Kaiser Health News
Most of the state prison systems in the 31 states that expanded Medicaid have either not created large-scale enrollment programs or operate spotty programs that leave large numbers of exiting inmates — many of whom are chronically ill — without insurance. Local jails processing millions of prisoners a year, many severely mentally ill, are doing an even poorer job of getting health coverage for ex-inmates, by many accounts. Jail enrollment is especially challenging because the average stay is less than a month and prisoners are often released unexpectedly.
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Kaiser Health News
People with a history of incarceration are typically much sicker than the general population, especially returning inmates. Studies done primarily in Ohio and Texas have found that more than 8 in 10 returning prisoners have a chronic medical condition, from addiction to asthma. Dr. Reggie Egins says a lot of it has gone untreated for a range of reasons — because the healthcare system is tough to navigate, because they're homeless and don't have insurance, or because they don't trust doctors.
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Kaiser Health News
By funding the expansion of state Medicaid programs beyond the traditional populations of poor mothers and children, the law has brought coverage to tens of thousands of previously uninsured shooting victims, often young African-American men, who, once stabilized in emergency rooms, missed out on crucial follow-up care and have endured unremitting effects of nerve injuries, fractured bones, intestinal damage and post-traumatic stress disorder.
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