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Low Obamacare Premiums to Soften Blow for Those Losing Medicaid

Ganny Belloni
March 16, 2023, 5:44 PM

CMS will take active role during Medicaid eligibility checks

All states required to take 14 months to complete checks

One-third of the millions of individuals expected to lose Medicaid coverage as eligibility checks resume this spring will qualify for Affordable Care Act coverage with low or no premiums, a top Medicaid official said.

The Department of Health and Human Services believes the majority of those whose Medicaid eligibility will be redetermined will remain eligible, and the government is actively collaborating with states to make sure beneficiaries don’t lose coverage because of administrative issues, Daniel Tsai, director of the federal Center for Medicaid and CHIP Services, said Thursday in an interview with reporters

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https://news.bloomberglaw.com/health-law-and-business/low-obamacare-premiums-to-soften-blow-for-those-losing-medicaid

#AffordableCareAct #DepartmentofHealthandHumanServices #CenterforMedicaidandCHIPServices #DanielTsai #Medicaid #CMS

Kathleen Sebelius: Medicaid expansion’s not ‘bait and switch’

Excerpt from: Politico (click for full article)

 

In a message targeted at states undecided about expanding Medicaid under the health care law, Department of Health and Human Services Secretary Kathleen Sebelius stressed Monday that the White House won’t back away from its promise to fund the expansions, even amid mounting battles over the federal budget.

Sebelius said states hesitant to sign up for the Medicaid expansion under the Affordable Care Act shouldn’t fear that the federal funding commitment will disappear when states boost their Medicaid rolls.

“This isn’t a bait and switch,” Sebelius told reporters Monday morning after addressing a health care conference in Washington. “We’re not saying come in, and we’re going to change the underlying framework.”

Medicaid math is tough when factoring loss of hospital funds

Excerpt from: Clarion Ledger (click for full article)

 

When we talk about Medicaid expansion, the question we should be asking is: Can the state afford to cover the loss of federal funds that pay for uncompensated care at hospitals?

The problem is we don’t have all the details from the Department of Health and Human Services to know exactly how much of Disproportionate Share Hospital payments will be cut. Those numbers are expected to be released this month, and the debate can begin in earnest.

But John Graves, a Vanderbilt University School of Medicine policy expert writing in the New England Journal of Medicine, used state and federal data to estimate the cuts to DSH payments in each state based on whether or not Medicaid was expanded there.

State ramps up crackdown on Medicaid fraud

Excerpt from: Star News (click for full article)

 

A North Carolina-wide crackdown on fraud has been intensified in recent months as state regulators took action against dozens of health care providers suspected of bilking the state's Medicaid program, including one in Wilmington, officials said.

Beginning in May, the N.C. Department of Health and Human Services started suspending Medicaid payments to certain outpatient behavioral health providers and placing 37 on prepayment review, a status where regulators scrutinize every incoming claim before approving reimbursement, said DHHS spokeswoman Chrissy Pearson.

Medicaid is a safety net for millions of lower-income Americans, particularly during a recession. But the inability of states to properly oversee the program has opened the door to abuse, with providers double-billing, submitted claims for services never rendered or, in some cases, billing for more hours than exist in a day. Such fraud drives up health care costs for every one and swindles taxpayers out of untold sums every year, experts say.

Recently heightened scrutiny already helped save the state millions of dollars. In the six months prior to being placed on prepayment review, those 37 providers collectively billed the state for $19.2 million in medical services. In the six months after regulators increased oversight, that group's total claim amounts plunged to just $138,000, a 99 percent reduction.