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Boehner, Obama meet amid optimism on 'fiscal cliff'
Los Angeles Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
House Speaker John A. Boehner returned to the White House to meet with President Obama as talks continue over the year-end budget crisis. Boehner made a substantial shift during the weekend by offering to raise tax rates on those making more than $1 million a year, a significant change from Republican orthodoxy against higher tax rates. Aides described it as an optimistic overture, even though the White House did not accept the proposal. More

Report: Decrease in federal funding forces more Medicaid burden on states
McKnight's Long Term Care News    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A drop in enhanced federal funding for Medicaid made states increase outlays for the program by an estimated 16.2 percent in fiscal 2012, according to a new joint report by the National Association of State Budget Officers and National Governors Association. To counteract the change, 33 states said they would enact Medicaid funding increases in fiscal 2013. Ohio ($1.2 billion) and Florida ($685.4 million) top the list. A group of 12 states will institute cuts for the same time period led by Texas ($3.5 billion) and California ($893 million). More

Bella offers Rockefeller assurance on duals demonstration oversight    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The director of CMS' Medicare-Medicaid Coordination Office reaffirmed that the agency will not let states participating in the duals demonstration program lock beneficiaries into health plans or programs, and also told Sen. Jay Rockefeller, D-W.Va., that CMS will conduct a readiness review — an example of which was sent to stakeholders on Nov. 28 — of all participating managed care plans in each state prior to their demo's implementation. Rockefeller has long voiced concerns about the initiative's impact on quality of care, worrying in particular that a vulnerable dual eligible could be forced into a plan by way of passive enrollment and then be unable to leave at a later date. More

Medicaid trumps 'fiscal cliff' as top state budget concern
Pew Center on the States    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The so-called fiscal cliff talks in Washington, D.C., might be getting all the attention, but for states, Medicaid is still the biggest budget worry for the coming year, according to a new survey of state legislative directors to be released soon. Nowhere is the problem larger than in Texas, which faces a $4.3 billion Medicaid deficit. Nine other states likewise are reporting spending overruns for Medicaid and other health care programs for the current 2013 fiscal year, compared with six at this time last year, says the National Conference of State Legislatures. Maine, for example, is seeing Medicaid caseloads go down, but costs rising. More

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As state budgets rebound, federal cuts could pose danger
The New York Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
After years of budget cuts and sluggish recovery, states expect to see their revenues climb back to prerecession levels this year for the first time since the financial crisis hit. But even as some states hope to restore some of the deep spending cuts they have made, they face a new threat. Washington's efforts to tame the federal deficit, state officials fear, could end up further whittling away the federal aid that states depend upon and weakening the economy as it slowly mends. More

Medicaid source rejects GOP assertion HHS 'blended rate' reversal is bad for states    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A source close to state Medicaid directors says states are reassured by the administration's decision to scrap support for its earlier Medicaid "blended rate" funding proposal, rejecting assertions by key GOP lawmakers that the move is a "bait and switch" effort to pressure states to expand Medicaid. U.S. Sen. Orrin Hatch, R-Utah, and U.S. Rep. Fred Upton, R-Mich., criticized the administration for reversing course on a proposal included in the president's fiscal 2013 budget that would have blended the federal matching rates for existing and newly eligible Medicaid beneficiaries, saying the reversal shows the White House is not serious about Medicaid reform and is simply trying to pressure wary states to take up the health law's Medicaid expansion. More

Court: California can cut Medicaid payments
The Hill    Share    Share on FacebookTwitterShare on LinkedinE-mail article
A federal appeals court ruled Thursday that California can move ahead with a 10 percent cut to providers in its Medicaid program, Medi-Cal. The decision from the U.S. Court of Appeals for the 9th Circuit affirmed the power of the federal Health secretary, Kathleen Sebelius, to weigh in on states' decisions to cut Medicaid rates. More

Providers weigh legal options after court says California can impose Medi-Cal rate cuts    Share    Share on FacebookTwitterShare on LinkedinE-mail article
California providers are meeting to discuss their next legal steps in the wake of a 9th Circuit three-judge panel's decision to lift an earlier court ban on 10-percent rate cuts to the Medi-Cal program, a provider source says. Providers have 45 days to ask the full court of nine judges for a new hearing and remain hopeful the state won't proceed with the cuts, but a California health official says the state will craft a plan to implement the approved cuts and collect retroactive payments after reviewing the ruling. More

Healthcare crisis: Not enough specialists for the poor
Los Angeles Times    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The blurry vision began early last year. Roy Lawrence ignored it as long as he could. But after falling off a ladder at his construction job, he knew he had to see a doctor. He went to a community health clinic in South Los Angeles, where doctors determined he had diabetes and cataracts. The clinic could manage his illness but referred him early this year to the county health system for eye surgery. Nearly a year later, Lawrence, a Jamaican immigrant without insurance, still is waiting for the operation. Lawrence, 49, and patients like him are posing a crucial challenge for the planned overhaul of the nation's healthcare system. More

Options fewer as Arizona weighs Medicaid decision
The Associated Press via Stamford Advocate    Share    Share on FacebookTwitterShare on LinkedinE-mail article
It's almost a case of starting over for Arizona Gov. Jan Brewer as she weighs whether to ask legislators to provide government-paid health coverage to hundreds of thousands of additional low-income Arizonans. A new Obama administration pronouncement eliminated a middle option that was seen as potentially palatable for Brewer and at least some cost-conscious majority Republican legislators. The state's policymakers are now faced with what could be an all-or-nothing decision with big ramifications for the state treasury and people lacking healthcare coverage. More

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New Colorado Medicaid program helps middle class with long-term issues
The Denver Post    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Colorado will expand Medicaid in July to allow middle-class families of children with severe, ongoing disabilities to "buy in" to the insurance traditionally for the low-income. For a $90-a-month premium, Susan Hogarth now has covered the therapies, the pricey speech equipment and the specialized prescriptions that keep her son Jake on a path to improvement from his rare Angelman syndrome, a lifelong genetic disorder that affects his learning, speech, judgment and relations with others. More

Milwaukee's nonprofit health systems ducking Medicaid issue
Milwaukee Journal Sentinel    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The nonprofit health systems in the Milwaukee area are quick to state their support for access to care and to note the costs they incur from people who don't have health insurance. But that doesn't mean they are urging Gov. Scott Walker to expand the Medicaid program under the Affordable Care Act, even with the federal government paying 100 percent of the cost through 2016, before declining to 90 percent in 2019. The governor's decision will determine whether 125,000 to 150,000 people in the state gain health insurance in 2014. So far, the five health systems that treat adults in the Milwaukee area are ducking the issue. More

Feds to assume key role as only 17 states, DC say they'll run exchanges    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Only 17 states and the District of Columbia have either established or declared to HHS that they will operate a full state-based exchange in 2014, a conclusion that means the federal government will be involved — perhaps significantly — in the majority of the health reform law's new health insurance marketplaces during the first year of their operation. More

Aetna names new Illinois Medicaid plan CEO
Business Wire    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Aetna has announced the selection of Sanjoy Musunuri as chief executive officer in Illinois for Aetna Better Health, Aetna's Medicaid health plan. The plan, which has administered benefits for Medicaid enrollees in the Illinois Integrated Care Program for more than a year, recently was selected by the Illinois Department of Healthcare and Family Services to participate in the state's Medicare Medicaid Alignment Initiative as well. More

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Free webinar by LexisNexis 'Why Identity Management Matters to Medicaid' | 1 p.m. EST Jan. 9
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The challenges of identity risk management can be boiled down to these two words: "Who's there?" At its core, this is the essence of security. Government efforts are driving much of the focus on identity management — a primary concern for the healthcare industry. Medical identity theft or improper access to sensitive records, as well as liability issues, are of paramount concern. Patients want to know what steps are being taken to ensure their privacy. As a Medicaid plan, you should not just be addressing the "what" of identity management — the technical side — but also the question of "who?" How do you know people are who they claim to be and what risks do they pose for the environments and systems they are attempting to enter? Clint Fuhrman, director of Government Health Care Programs for LexisNexis Risk Solutions, addresses these issues in a FREE 60-minute webinar. More

Free webinar: 'Optimizing Pharmaceutical Care and Measuring Outcomes in a Collaborative Drug Therapy Management Program' | 2 p.m. EST Jan. 30
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medication-related problems and medication mismanagement are massive public health problems in the U.S. Experts estimate that 1.5 million preventable adverse events occur each year that result in $177 billion in injury and death. In response to these problems, PerformRx, in collaboration with the AmeriHealth Mercy Family of Companies, successfully have developed a collaborative Drug Therapy Management program that has demonstrated significant reductions in emergency room visits and inpatient admissions, as well as significant costs savings. More

Insights webinar: 'Proper Capitation Rates for Hemophilia Patients' | 11 a.m. EST Jan. 23
Baxter    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The webinar will cover the uniqueness of the hemophilia disease state and the difficulties to apply an appropriate capitation for this disease. Also on the agenda: considerations for managed healthcare plans to ensure that states understand this unique disease state and that adequate reimbursement is received for hemophilia patients to receive the needed care. For details, click here. More

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Watch, listen to the Sept. 18 webinar, 'Importance of Coordinated Care in the Management of Members with Hemophilia,' free on MHPA's website
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
The presentation on coordinating care in hemophilia and how to improve outcomes and reduce costs by Jeff Januska, PharmD, pharmacy director at CenCal Health and Dr. Steven Pipe, associate professor, Department of Pediatrics and the Department of Pathology, University of Michigan, now is available on MHPA's website.

Insights webinar: 'Reduce Outsourcing Risk by CGS' | 11 a.m. EST Dec. 20
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Refine your outsourcing process and reduce ongoing operational risk by implementing a vendor qualification and review tool. The CGS presentation, "Reduce Outsourcing Risk with a Vendor Qualification and Review Process," demonstrates how to qualify a supplier during the selection process using a defined set of scoring criteria and how to use the same criteria to manage the supplier during ongoing operations. More detail and registration here.

Free webinar: 'Getting to know the 30 million newly insured: New patients equals new challenges' | 2 p.m. EST Feb. 6
PwC    Share    Share on FacebookTwitterShare on LinkedinE-mail article
In the wake of the Supreme Court's ruling to uphold the Affordable Care Act, approximately 30 million uninsured Americans under age 65 stand to gain coverage under the law. States are making two crucial decisions: Whether to expand Medicaid coverage, and which type of health insurance marketplace to create — state-run, state-federal run, or federally facilitated. As decisions are made and plans put in place, one thing is certain: When the exchange population is combined with the new Medicaid beneficiaries, the result will be a distinctly different customer base for the health sector, bringing with it many new challenges and opportunities. More

MHPA CEO Thomas Johnson to speak at Strategic Solutions Network's 4th Annual 'Medicaid Innovations Forum' | Feb. 5-7 | Orlando, Fla.
MHPA    Share    Share on FacebookTwitterShare on LinkedinE-mail article
Medicaid Innovations is designed to be the meeting place for all participants in the Medicaid universe who want to participate, share and learn about innovations that promote quality improvement, cost reduction and transformation in the face of reform. Use discount code MHPA when registering to receive a $200 discount off the current rate. For complete agenda and to register, click here.

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