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SPN Medicaid Exchange - Issue 131

Published on Thursday, February 16, 2012


SPN Medicaid Exchange - Issue 131

What's New in Medicaid
And Other Health Care Issues

States Grapple with Budget Shortfalls, Health Reform
Ten states have reported new Medicaid cuts, according to Most states, however, according to a recent Kaiser Commission report, are on track with their Medicaid budget and enrollment trends for fiscal year 2012 and do not anticipate the need for significant mid-year cuts. States will continue to face the dual challenges of implementing health reform and coping with another year of budget shortfalls heading into fiscal year 2013.

Obama Administration Lawyers Defend Medicaid Expansion
Administration lawyers are defending the part of President Barack Obama's health care law that expands the Medicaid program for the poor and disabled and are insisting that Congress has the power to set the terms under which it will disburse funds to the states, reports Reuters.

Taxpayers Paying More for Medicaid Expansion than Revealed
The costs borne by taxpayers as a result of the new health care law is greater than the Obama administration has claimed, with one-sixth of the total fee being paid by Medicaid managed care plans. According to Benjamin Domenech of the Heartland Institute, states will pay $13 billion and the federal government about $24.8 billion due to the state-federal Medicaid matching formula.

ObamaCare Deadlines Put States under Pressure
A successful rollout of the new health care law hinges on critical decisions that states must make - and take quick action on - this year. KaiserHealthNews reports that key pieces of how-to guidance from the federal government are missing and that states are competing for a limited pool of information technology vendors to help them get started.

Medicaid and Medicare

Obama Budget Barely Touches Entitlement Spending
President Obama's budget proposal leaves largely unchanged the biggest drivers of future government spending: the Medicare, Medicaid and Social Security programs, reports the Wall Street Journal. In 2022, if no changes are made, the government will spend just under $3 trillion on these programs, or 54 percent of the expected federal budget.

Saving Medicaid through Comprehensive Reform
The Medicaid program is failing and the Affordable Care Act is not helping the health care situation. The Heritage Foundation's Nina Owcharenko argues Congress needs to start over by repealing the new health care law and put Medicaid on a federal budget, mainstream working families into private coverage, and preserve a true safety net for the most vulnerable in society.

Just Repealing ObamaCare Is Not Enough
Serious political debate in Republican circles over the substance, scope and scale of what should "replace" the new health care law has been more or less frozen in suspended animation since its enactment in March 2010. Thomas P. Miller of the National Journal argues that repealing the health law is a necessary, but not a sufficient part of fixing our health care system after the Supreme Court announces its decision later this year.
Challenge to ObamaCare Involves a Series of Complex and Interrelated Legal Questions
How the Supreme Court views a series of complex and interrelated legal questions, including the constitutionality of the law's individual mandate and Medicaid expansion, will trigger a cascade of related decisions. A Kaiser Health News diagram shows how the various decisions related to each of the posed questions could potentially interact.

Medicaid ACO Demo Targets Poorest Patients
Two different accountable care organizations tasked with driving down the cost of health care differ significantly, reports FierceHealth care. Unlike the Medicare ACOs, the Medicaid ACO project is committed to reinvesting every dollar of shared savings back into Medicaid beneficiaries

Performance of Managed Care Linked to Contract Specifics
There is a wide range of intensive and specialized medical and long-term care needs facing Medicaid beneficiaries with disabilities. According to the Kaiser Commission, the actual performance of managed care in serving Medicaid enrollees with disabilities will depend heavily on the specifics of states' managed care contracts and on many program design and oversight issues.

Keep the Safety Net, but Improve It
A strand of conservative domestic policy is emerging that embraces the idea of a safety net, and a shift in the conversation about the public sector from inputs to outcomes, argues Reihan Salam. In his National Review column, Salam argues that many on the left and right will agree that the diffusion of accountability is a serious problem that makes Medicaid less effective, and less cost-effective, than it might otherwise be.

Greater Use of Managed Care in Medicaid Likely to Continue
Greater use of managed care in Medicaid is likely to continue, fueled by interest in improved care delivery and payment systems, among other things. In addition, according to the Kaiser Commission, states are positioning themselves to participate in the large new markets created by the Medicaid expansion as well as the new health insurance exchanges.

State News

Connecticut: The governor's new budget proposes to raise the eligibility threshold for low-income adults to apply for health insurance through Medicaid.

Florida: Federal officials have blocked the state's attempt to expand its Medicaid privatization program, refusing to allow the state to impose $10 monthly premiums on Medicaid beneficiaries.

Georgia state officials are creating two task forces to gather input on a consulting firm's report that calls for adopting an enhanced managed care system that would cover aged, blind and disabled Medicaid beneficiaries.

Illinois Governor Pat Quinn said he plans to cut the state's Medicaid spending by $2 billion as a necessary way to attack the state's budget crisis.

Illinois Governor Pat Quinn said that the state must make changes to its pension system and to Medicaid this year, while insisting that spending cuts alone will not fix the state's budget. A financial watchdog group recently forecasted that Illinois' pile of unpaid bills will quadruple to $35 billion in five years.

Kansas: An influential lawmaker has said that fear of change should not prevent the state from overhauling Medicaid.

Kentucky: Company executives hired to run Medicaid's new managed care system are trying to address a growing number of complaints and explain to legislators how they cover prescription costs.

Louisiana: More than 180,000 southeast Louisiana residents, most of them children, are being shifted from the state-run insurance program to private insurance networks as part of Governor Bobby Jindal's Medicaid overhaul.

Maine's governor wants to go further than most states and cut some 65,000 Medicaid enrollees to close budget gaps in the program.

Vermont: Politicians are pushing to allow small businesses to offer lower premium health insurance plans until the state can implement its single payer health care system.

Washington: A state senator says she has enough bipartisan support to pass a bill that would reform the way that Medicaid fraud is detected in the state.

Washington: Starting April 1, Medicaid will no longer pay for any medically unnecessary emergency room visits, even when patients or parents have reason to believe they're having an emergency.

Be Prepared

Order a copy of the NCPA Handbook on State Health Care Reform here.

Sign up for John Goodman's health policy blog at:

Take Advantage of the NCPA's Medicaid Service Center. The Medicaid Service Center can help state-based think tanks with commentaries, policy papers and speakers for briefings. Those interested in exploring further should contact Devon Herrick at (972) 308-6470.

Links of Interest

What the Other Side Says

The NCPA welcomes submissions of Medicaid-related research for inclusion in future editions.


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