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

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

see full article at :

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

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

CMS Chief Expresses Optimism About Federal Exchange Enrollment

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

 

But other signs, such as the number of insurance carriers applying to sell policies in Illinois' health insurance marketplace, suggest cause for concern. Meanwhile, Modern Healthcare reports on the downside of the Obama administration's shorter application form for purchasing insurance through the exchanges.

National Academy of Elder Law Attorneys Supports National Healthcare Decisions Day

Excerpt from: NAELA (click for full article)

 

National Healthcare Decisions Day is April 16. The National Academy of Elder Law Attorneys (NAELA), along with other national, state, and community organizations, is leading a massive effort to highlight the importance of advance health care decision-making—an effort that has culminated in the formal designation of April 16 as National Healthcare Decisions Day (NHDD). As a participating organization, NAELA members provide information and tools for seniors and individuals with special needs to talk about their wishes with family, friends, and healthcare providers, and execute written advance directives (healthcare power of attorney and living will) in accordance with state laws.

 

How Will Consumers Navigate New Health Care Options?

Excerpt from: Kaiser Family Foundation (click for full article)

 

With the open enrollment period for health insurance exchanges less than six months away, consumers are already asking questions about their new health care options under the Affordable Care Act (ACA). Even in the age of digital information, hands-on consumer assistance could play a key role in helping people understand their insurance choices come 2014 — a recent Kaiser Family Foundation poll showed that two thirds of the uninsured and a majority of Americans overall say they have too little information to know how the ACA will affect them.

On Thursday, April 18 at 9:30 am ET, the Kaiser Family Foundation and the Robert Wood Johnson Foundation hosted a forum to examine what consumers are already asking about their new health coverage options; what progress states are making and challenges they are facing to develop consumer assistance plans; and what role the federal government and other private sector entities might play in order to help consumers navigate the new health care landscape.

Long-term care nurses gain power through physician assessment tool: expert

Excerpt from: McKnight's (click for full article)

 

Long-term care nurses should embrace a physician assessment tool in INTERACT II as a way to reduce hospital readmissions, a compliance expert emphasizes.

While all of INTERACT II is helpful, the SBAR (Situation, Background, Assessment and Request) component provides a way for nurses to communicate with physicians in discussing a resident's condition. It prompts the nurse to use sentences such as “Things that make the condition worse are _____.”

“It's a way to empower nurses,” said Sheila Capitosti, vice president of clinical and compliance services at Functional Pathways. In the past, nurses who called physicians, especially after hours, would often lead to the resident being sent to the hospital emergency department.  That's changing, according to Capitosti and others attending “Therapy Services: Impact on Avoiding Hospitalizations” a session at the American College of Health Care Administers convocation Monday in Orlando.

The SBAR section “conserves documentation,” Capitosti says, as many nurses would be recording vital signs or other notes within a medical record. In the six months since the Centers for Medicare & Medicaid Services began penalizing hospitals that readmit patients with certain conditions, she says she has seen a difference in how nursing homes approach hospitalizations.

WEBINAR: The California Coordinated Care Initiative: What Advocates Need to Know – Basics

Excerpt from: NSCLC (click for full article)

 

The state of California is moving forward with implementation of the Coordinated Care Initiative (CCI), including the recently federally-approved dual eligible demonstration project, now known as Cal MediConnect.

The CCI is currently set to begin on October 1, 2013. The CCI fundamentally changes the way that Californian dual eligible beneficiaries and other low-income seniors and persons with disabilities get their health care.  NSCLC is providing a webinar training series to inform and educate advocates of the upcoming changes and help them understand how their clients will be impacted by the CCI.

The series will begin with a number of Basics webinars that will cover:

• What is the CCI?
• Who is affected by the CCI?
• How are beneficiaries affected by the CCI?
• How does enrollment work?
• What can advocates do to help their clients?

Register for the date and time most convenient for you. More dates for the Basics webinar will be released in the future. Attend as many as you like, but they will all cover the same material.

Managing the gaps with transitional care

Excerpt from: McKnight's (click for full article)

 

The Medicare Payment Advisory Commission (MEDPAC) presents costs associated with 30-day hospital readmissions as an estimated $15 billion annually in Medicare spending. The churning of these patients in and out of hospitals comes at a high price to the healthcare system in the form of adverse events, patient dissatisfaction and cost. Of particular threat are patients with complex needs including the vulnerable populations; during transitions throughout the continuum of care these patients are at risk for medical errors, lack of responsiveness to critical labs, or other overlooked symptom indicators. In addition, many other life-threatening elements go unnoted and fall through the cracks during the transition from hospital to sub-acute or long term care.  It is anticipated that the prevalence of disjointed care will increase as health care providers continue the move to single practice settings where we no longer have primary providers synchronizing the patient care needs. Taking an aggressive proactive approach is needed to prevent the challenges that face the health care fluctuations anticipated for our vulnerable populations at present and in the near future.    

Private Medicaid Plans Get Push

Excerpt from: Wall Street Journal (click for full article)

 

A pair of states are proposing to use new Medicaid funding to help the poor buy private health insurance, a new twist in how to implement the 2010 federal health-care law that is winning support from some Republicans.

Arkansas Gov. Mike Beebe, a Democrat, wants U.S. health regulators to let the state use federal dollars intended to expand eligibility for the Medicaid program to instead buy private insurance policies for low-income people. Ohio Republican Gov. John Kasich is pushing for a similar deal.

Mooching Off Medicaid

Excerpt from: New York Times (click for full article0

 

And despite some feeble claims to the contrary, privatizing Medicaid will end up requiring more, not less, government spending, because there’s overwhelming evidence that Medicaid is much cheaper than private insurance. Partly this reflects lower administrative costs, because Medicaid neither advertises nor spends money trying to avoid covering people. But a lot of it reflects the government’s bargaining power, its ability to prevent price gouging by hospitals, drug companies and other parts of the medical-industrial complex.

For there is a lot of price-gouging in health care — a fact long known to health care economists but documented especially graphically in a recent article in Time magazine. As Steven Brill, the article’s author, points out, individuals seeking health care can face incredible costs, and even large private insurance companies have limited ability to control profiteering by providers. Medicare does much better, and although Mr. Brill doesn’t point this out, Medicaid — which has greater ability to say no — seems to do better still.

Case Study: Michigan’s Money Follows the Person Demonstration

Excerpt from: Kaiser Family Foundation (click for full article)

 

Since 2008, Michigan’s Money Follows the Person (MFP) rebalancing demonstration has servedas a catalyst that enhances existing Medicaid transition services,resultingin over 6,000Medicaid beneficiaries returning to community living.In Michigan, the MI Choice home and community-based services (HCBS) waiver program provides transition services to eligible Medicaid beneficiaries transitioningfrominstitutions back to the community. In addition to MI Choice transition services, the MFP program funds enhanced outreach activities and individualized assistance to locate housing. MFP beneficiaries enroll in the MI Choice program with enhanced federal funding for the first year and remain in the waiver program as long as they are eligible. Funding for Michigan’s MFP demonstration totals $67.8 millionand runs through 2016.1

Money Follows the Person: A 2012 Survey of Transitions, Services and Costs

Excerpt from: Kaiser Family Foundation (click for full article)

 

The Affordable Care Act extended the Money Follows the Person (MFP) demonstration grant program through 2016, giving states further options to transition Medicaid beneficiaries living in institutions back to the community. Enacted into law in 2006 as part of the Deficit Reduction Act (DRA), the MFP demonstration provides states with enhanced federal matching funds for twelve months for each Medicaid beneficiary transitioned from an institutional setting to a community-based setting.

A total of 45 states and the District of Columbia have received federal grant money under the program to transition Medicaid individuals living in institutions back into their homes or the community. As of August 2012, 25,000 individuals nationally had been transitioned since the program’s inception, up from 17,000 individuals by 2011. These findings and others in the report are derived from a Kaiser Commission on Medicaid and the Uninsured survey of state MFP programs conducted in August 2012. The latest survey is a follow-up to surveys conducted in 2011, 2010 and 2008.