Patti's Blog - Advocate for Elders, People with Disabilities and Their Families

Medicaid Gets a Rehab

Excerpt from The Wall Street Journal: (click for entire article)

If you're having trouble affording medical care, Medicaid might be an option you haven't considered.

"A lot of people have perceptions about who is eligible and who is not that aren't quite right," says Cindy Mann, director of the federal Center for Medicaid. "It's a much broader program than people think."

Medicaid, the state and federally run health-insurance program for the poor, is getting a rehab under the Affordable Care Act, with some changes phasing in now. For many people who qualify that means free health care.

Fake doctors ran Medicaid schemes

Excerpt from Watchdog Bytes: (click for entire article)

Medicaid scam of the day: Forget about licenses.

You might call it unnecessary regulation, but Medicaid insists that people providing health-care services actually be qualified.

Fake doctors have treated patients, with Medicaid footing the bill, though.

You might even want to check credentials on the school nurse.

How is the Affordable Care Act Changing Medicaid Today? State Adoption of Five New Options

From The Kaiser Family Foundation:

A new brief from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured examines how states in every region have responded to five key opportunities available under the health reform law to help them prepare for the significant expansion of Medicaid in 2014. The options covered in the brief include incentives for states to get an early start on the Medicaid coverage expansion; increased federal funding to upgrade Medicaid eligibility systems; money to improve care for beneficiaries with chronic conditions by providing “health home” services; special funding for chronic disease prevention; and help in developing service delivery and payment models that integrate care for beneficiaries who are dually eligible for Medicare and Medicaid.

The new brief is available online.

Medicaid costs could rise if home care budget cut, study says

Excerpt from My Suburban Life: (click for entire article)

A new study warns that state government’s costs could actually rise if Illinois reduces Medicaid funding for home care services in order to balance next year’s budget.

The Chicago-based Health and Medicine Policy Research Group said that people who receive home care services could be forced into nursing homes or other institutions if Medicaid funding for home care is reduced.

“It is cheaper for the state to pay for home-based services than to pay for more expensive institutional-based services,” Lisa Hardcastle, president of the Illinois HomeCare and Hospice Council in a statement. “This study shows states that invested in home care programs achieved savings for taxpayers while states that cut home care suffered from increases in long-term care costs.”

News bites: Medicare, Medicaid overhauls unlikely this year, and more

Excerpt from The Hill: (click for entire article)

Don't expect a grand bargain to overhaul Medicare and Medicaid in the lame duck session, Modern Healthcare [registration required] reports.

A Food and Drug Administration panel backed the first rapid, at-home HIV test, The Associated Press reports.

Soda sales are in decline for Pepsi and its competitors, forcing the companies to focus on "flat" drinks and bottled water, the New York Times reports.

Nursing Home Transition Initiative (NFTI) in Jeopardy

Excerpt from Area Agencies on Aging Association of Michigan: (click for entire article)

The Nursing Home Transition Initiative (NFTI) is part of the MI Choice Medicaid Waiver program. NFTI is a cutting edge program that has gained national attention for successfully transitioning people in nursing homes who want to leave but face barriers. Barriers can include losing their home, not having an accessible home, and needing services and supports to stay at home. Last year, over 1,600 people were transitioned; data suggest that every year about 3,000 people in nursing homes are candidates for NFTI.

NFTI saves the state money because it targets people on Medicaid who cost an average of $172/day in a nursing home, compared with an average of $60/day in their own home. It is estimated that $25 million will be needed next year to transition another 1,600 people.  The Governor’s budget allocates $11 million to serve people on the MI Choice waiting list, but only $3.1 million for NFTI, enough to continue the program for only two months. This would mean over 1,000 people would be forced to remain in nursing homes when they could live in the community at a much lower cost to the state. An additional $22 million is needed for NFTI in fiscal year 2013.

Michigan Medicaid Program Non-Emergency Medical Transportation Services

Excerpt from the attached information sheet:

Assistance with transportation to receive medical care may be covered by Medicaid –

• Payment for transportation may only be authorized –

o   to receive a Medicaid covered service
o   if it is not otherwise available at no cost
o   for the least expensive available transportation that is suitable to the individual’s needs

• Individuals that can provide their own transportation or receive transportation from a family member, relative or friend are expected to do so without reimbursement. Reimbursement is only approved in cases of extreme circumstances or hardship.

• The physician or other health care provider may be required to verify the medical appointment and need for transportation.

Download Medicaid Transportation Services

Lawsuit Challenges Medicaid Managed Care Decision In Missouri

Excerpt from Kaiser Health News: (click for entire article)

Which marketplace is better: a crowded one with lots of choices or a streamlined one with just a few options? Those competing ideals are the backdrop of a legal battle playing out this month in Missouri, where the state’s efforts to winnow contracts for its Medicaid managed care business are being challenged by one of the companies left out in the cold.

Molina Healthcare is suing the state arguing that Missouri changed the rules in the midst of a competitive bidding process. Molina is one of five companies currently managing care for about 430,000 of the state’s Medicaid beneficiaries, who are mainly low-income children and pregnant women.

Molina’s contract was not renewed for next year. Instead Missouri awarded contracts to two insurers already active in the state and one new company.

Medicaid payments to primary care doctors will rise under new regulation

Excerpt from The Washington Post: (click for entire article)

Primary care doctors could get a pay raise next year for treating Medicaid patients, under a rule announced by the Obama administration Wednesday.

The proposed regulation implements a two-year pay increase included in the 2010 health-care law. The increase, effective in 2013 and 2014, brings primary care fees for Medicaid, which covers indigent patients, in line with those for Medicare, which insures the elderly and some disabled patients.

Although Medicaid is jointly funded by states and the federal government, the pay boost would be covered entirely with federal dollars totaling more than $11 billion over the two years it would be in effect.

How to Navigate Medicare/Medicaid With Cancer

Excerpt from The Huffington Post: (click for entire article)

When someone is diagnosed with cancer, they are so deluged with information about their health and how to treat the disease so that managing their Medicare or Medicaid coverage gets overlooked.

"The paperwork becomes overwhelming for people," said Cheryl Berger-Israeloff, who works as a volunteer patient navigator for the American Cancer Society at Nassau University Medical Center. "They have to figure out what is covered, what they need, what is not covered."

Ms. Berger-Israeloff is not just working with people who are over age 65 and therefore automatically eligible for Medicare, but also indigent people, illegal immigrants, and what she calls the "working-class poor."