Physicians Health Plan appeals committee recommendation on Medicaid Health Plan LANSING, MI - Physicians Health Plan (PHP) has announced it is appealing the recommendation of the Michigan Department of Health and Human Services (MDHHS) Joint Evaluation Committee to discontinue the PHP Medicaid Health Plan in Region 7 (Ingham, Eaton and Clinton counties). If the appeal is successful, the Lansing-based health insurer, which has offered Medicaid Managed Care coverage to the mid-Michigan region since 1998, will continue to be an option for Medicaid-eligible individuals and families.. On Aug. 3, 2015, PHP submitted a comprehensive and competitive Medicaid Health Plan proposal to the MDHHS Joint Evaluation Committee in response to a Request for Proposals, with the goal of continuing to serve Medicaid-eligible individuals throughout Ingham, Eaton and Clinton counties.. The MDHHS Joint Evaluation Committee recommendations were announced Tuesday, Oct. 13 and the deadline for the appeal is Tuesday, Oct. ...
This article originally appeared on heartland.org.. A new study by the Office of Inspector General for the Department of Health and Human Services found half of all providers listed in Medicaid managed care plan are not available to new Medicaid patients, either because they are not at the listed location or they are but aren ??t accepting new Medicaid patients.. For doctors who are accepting new Medicaid patients, the average wait to get an appointment is two weeks, with a quarter of patients having waits of one month or longer.. The study ??s findings come as enrollment in Medicaid continues to grow, largely from the expansion in eligibility through the Affordable Care Act and also as a result of a lackluster economy.. Devon Herrick, a senior fellow and health care researcher for the National Center for Policy Analysis, says the fees state Medicaid programs pay are often only about half of what private insurers pay for the same service. As a result, doctors are reluctant to participate in ...
October 16, 2015. The Affordable Care Acts Medicaid expansion resulted in record increases in Medicaid enrollment and spending nationally in fiscal year 2015, with both rising an average of nearly 14 percent. This is just one finding in the 15th annual 50-state Medicaid budget survey by the Kaiser Family Foundations Commission on Medicaid and the Uninsured.. Released Oct. 15, this report provides an in-depth examination of the changes taking place in state Medicaid programs across the country. Health Management Associates conducted the survey of Medicaid directors across the country. The survey shows big differences across states driven largely by the states decisions on the Medicaid expansion and also provides an examination of state Medicaid policy and program changes across the country. HMA Managing Principals Vernon K. Smith, Kathleen Gifford and Eileen Ellis authored the report along with Robin Rudowitz, Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.. Two additional ...
A substantial body of research has investigated effects of the Medicaid expansion under the Affordable Care Act (ACA) on coverage, access to care, and various economic measures. These findings can inform understanding of the broader effects of the ACA and ongoing debate over ACA repeal, including the Medicaid expansion.. This issue brief summarizes findings from 153 studies of the impact of state Medicaid expansions under the ACA published between January 2014 (when the coverage provisions of the ACA went into effect) and June 2017.1 It includes peer-reviewed studies as well as freestanding reports, government reports, and white papers published by research and policy organizations, using data from 2014 or later. This brief only includes studies that examine impacts of the Medicaid expansion; it excludes studies on impacts of ACA coverage expansions generally (not specific to Medicaid expansion alone) and studies investigating potential effects of expansion in states that have not (or had not, ...
Medicaid premium assistance, where Medicaid acts as wrap-around coverage for a private health insurance plan, is administratively complex for states and may not work well. In an issue brief, the Kaiser Family Foundation (KFF) considered what is known about wrap-around Medicaid coverage, and looked at financial implications of such a program.. Wrap arounds. According to KFF, states with Medicaid premium assistance programs use Medicaid funds to purchase private coverage for Medicaid beneficiaries. Federal law requires these programs to make the purchased private coverage on par with what the states Medicaid program would cover, but private insurance generally covers less than Medicaid and requires more out-of-pocket payments. Therefore, states with these programs must provide supplemental benefits and cost-sharing protections, known as wrap arounds, to insure that cost sharing does not exceed Medicaid limits. In general, states with these programs have low enrollment rates, and therefore, ...
Purpose. This was a Data Capacity-Building Project, to build a robust comparative effectiveness research infrastructure, agenda, and collaborative partnerships focused on eliminating health disparities. Specifically, a database was built comprised of all Medicaid enrollees and claims in the states that share in common both adverse minority health outcomes and the historical roots of racial health disparities in the South. Setting and Participants. A 100 percent sample of four years 2004-2007 of Medicaid Analytic Extract (MAX-file) data (plus Medicare-linked claims for dual-eligibles) from fourteen southern states, representing 3.8 to 5.4 million persons each year (one-third of all United States Medicaid enrollees, nearly half [48 percent] of African American and 21 percent of Latino Medicaid enrollees in the United States) was obtained from the Centers for Medicare and Medicaid Services (CMS). This region is the epicenter of the Black-White health disparities epidemic, and has also experienced a ...
Medicaid expansion, which took effect as the opioid epidemic ballooned, provided insurance coverage to people at highest risk of opioid use disorder (OUD) - lower-income, younger adults. Because Medicaid covers the overdose-reversal drug naloxone, the expansion gave Harvard Medical School professor Richard Frank an opportunity to compare how Medicaid expansion impacted naloxone prescribing in expansion and non-expansion states.. In a recent study published in the journal Addiction, Frank found that expansion states dramatically increased their Medicaid-covered naloxone prescriptions. In 2016, states that did not expand Medicaid averaged 83.1 Medicaid-covered prescriptions per 100,000 enrollees, while expansion states averaged nearly four-times that amount - 215.6 per 100,000 enrollees. On average, naloxone (Narcan) saves one life for every 14 prescriptions written, which means expansion states saved an additional 22.7 lives per year per state.. Franks study suggests Medicaid expansion has been ...
Katie Baldwin-Johnson is with the Alaska Mental Health Trust, which is helping spearhead Medicaid reform and pay for some costs of expansion. She says Andis story is pretty typical. Low-income earners cant afford to look after themselves, so they arent as healthy.. Theyre not taking care of themselves, she says. So having access to a primary care provider, for example, where maybe someone did not previously, certainly could help with stabilization in a work placement.. Medicaid expansion started in Alaska in 2015 to provide health care to low-income adults who dont have dependent children. The fight over it went all the way to the state Supreme Court. It was so controversial because Medicaid is one of the most expensive items in the state budget. But, for Medicaid expansion, the federal government pays more than 90 percent of the cost.. Katie says Medicaid expansion has been especially important for people with mental health issues. Access to medical providers helps catch illnesses ...
Among the conclusions of the June 2013 MACPAC report is that more research is needed on how nonphysician practitioners could improve access to care for Medicaid enrollees with disabilities. The Medicaid and the State Childrens Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) released its Report to the Congress on Medicaid and CHIP last week. The report, issued annually, includes a chapter on access to care for adults with disabilities. Based on large-scale population surveys, provider and stakeholder data, consumer interviews and other qualitative data, and state Medicaid program data, MACPAC reported that access to health care among Medicaid-only enrollees with disabilities is comparable to that of other insured persons with disabilities; that unmet need among Medicaid-only enrollees with disabilities is lower than that of individuals with disabilities covered by private insurance or Medicare only; and that preventive services are underused among Medicaid enrollees with ...
The Trump Administration has issued guidance permitting state Medicaid programs to apply for waivers to institute work requirements as a condition of Medicaid eligibility, a departure from the programs history. To date, 20 states have sought approval for such waivers, which remain controversial and face challenges in court.1 (For up to date information on state status of Medicaid work requirement waivers, see the Kaiser Medicaid Waiver Tracker.). A separate KFF analysis of data on the general Medicaid population found that most (63%) non-dual, non-SSI, non-elderly Medicaid beneficiaries were already working and many others faced barriers to work that could make them exempt from the requirements.2 Additionally, large numbers of beneficiaries could face difficulties demonstrating that they were in compliance with or exempt from work requirements and as a result could lose coverage. For example, early state experience with work requirements has resulted in significant disenrollment from the state ...
Im sure everyone thats reading this knows better, but I cant let it go unaddressed.. LePage is absolutely wrong about the costs of Medicaid expansion. And its not free. The people of Maine are already paying for Medicaid expansion right now even if they cant access it. The federal government currently covers 95 percent of the cost of Medicaid expansion and will still cover 90 percent of the cost in 2020 and beyond. Federal taxpayers who live in Maine are already paying for it.. LePage claims Medicaid expansion will cost the state $100 million per year, which is a relatively small number in the grand scheme of things, but hes also wrong about that. The current cost to the state will be roughly half that or around $55 million according to the Maine Office of Fiscal and Program Review (the states version of the non-partisan Congressional Budget Office).. We should be clear that LePage is picking a fight with all of his constituents, not just heathen liberals.. I followed the vote live last ...
As Clock Ticks, Medicaid Expansion Dwindles By Becca Aaronson and Aman Batheja, The Texas Tribune May 8, 2013 As Clock Ticks, Medicaid Expansion Dwindles was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans - and engages with them - about public policy, politics, government and statewide issues. Updated, May 8, 1:40 p.m.: With the prospect of Medicaid expansion on life support, protesters gathered at the Capitol on Wednesday to urge state leadership to expand coverage to poor adults, and state Democrats announced that theyre still searching for a legislative vehicle to expand coverage. It appears as if we are going to miss an opportunity and that is to the detriment to the people below the poverty level who work and dont have health care, state Rep. Garnet Coleman, D-Houston, said at a news conference held by Democrats, noting that the legislation that would have offered an alternative to Medicaid expansion, House Bill 3791 authored by ...
Correspondence issued by the Government Accountability Office with an abstract that begins Spending on prescription drugs in Medicaid--the joint federal-state program that finances medical services for certain low-income adults and children--totaled $15.2 billion in fiscal year 2008. State Medicaid programs do not directly purchase prescription drugs; instead, they reimburse retail pharmacies for covered prescription drugs dispensed to Medicaid beneficiaries. The federal government provides matching funds to state Medicaid programs to help cover a portion of the cost of these reimbursements. For certain outpatient prescription drugs for which there are three or more therapeutically equivalent versions, state Medicaid programs may only receive federal matching funds for reimbursements up to a maximum amount, which is known as a federal upper limit (FUL). FULs were designed as a cost-containment strategy and have historically been calculated as 150 percent of the lowest published price for the
This presentation provides an overview of the Medicaid program, including the history of Medicaid, Medicaid eligibility and benefits, Medicaid populations and expenditures, and Medicaid managed care. It profiles the role of Medicaid today and the role of Medicaid in health reform.
The one-year deadline for nursing home residents on Medicaid to spend down their first round of stimulus checks is here, but they may have a little extra time.. In March 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act authorized $1,200 stimulus checks to most Americans, including Medicaid recipients. Another round of $600 checks was authorized in December 2020, and $1,400 checks were ordered in February 2021. The stimulus checks are not considered income for Medicaid recipients, and the payments have been excluded from Medicaids strict resource limits for 12 months.. While the one-year deadline for spending down the first round of checks is here, another COVID-19 bill gives beneficiaries more time. The Families First Coronavirus Response Act passed in March 2020 provides that if you were enrolled in Medicaid as of March 18, 2020, the state cannot terminate a recipients benefits even if there is a change in circumstances that would normally cause the benefits to be stopped. ...
Eligible Medicaid members will begin to receive letters on Monday, March 15 from the North Carolina Department of Health and Human Services (NCDHHS) notifying Medicaid beneficiaries of open enrollment which will now include the EBCI (Eastern Band of Cherokee Indians) Tribal Option. The EBCI Tribal Option, the first Indian Managed Care Entity in the nation, is a health plan created by the Cherokee Indian Hospital Authority available to members of federally recognized tribes, or those who are eligible for Indian Healthcare Services. This health plan will offer tailored medical, behavioral health, pharmacy, and support services for Medicaid members. Right now, Medicaid members use NC Medicaid Direct, the current healthcare program in North Carolina, said Karen Kennedy, Tribal Option director, CIHA is now able to offer Medicaid services through the EBCI Tribal Option as a source to meet the primary care needs of tribal members who are eligible. Gwynneth Wildcatt, Tribal Option Member Services ...
Jzanus helps our clients determine Medicaid eligibility for the patients they provide service to and recover revenue lost due to uncompensated care. Our team of Certified Application Counselors (CAC) and trained Medicaid Eligibility staff assist patients in the five boroughs of New York, and Nassau, Suffolk, and Westchester Counties. We also assist patients on the Federal Exchange in the state of New Jersey. We serve as patient advocates and financial counselors to navigate the complex application processes for federal, state and community based programs. These professionals provide assistance throughout the eligibility process in a dignified and respectful manner and help get indigent patients the financial help they urgently need. There are also other revenue enhancement services addressing the needs of the medically underserved population who may not meet the stringent state Medicaid guidelines.
Downloadable (with restrictions)! The authors provide direct evidence on the effect of health insurance on health outcomes by examining the dramatic increases in the eligibility of pregnant women for the Medicaid program between 1979 and 1992. They find that the 30-percentage-point rise in Medicaid eligibility significantly lowered the incidence of low birth weight and infant mortality. Targeted changes in Medicaid eligibility that were restricted to specific low-income groups had much larger effects on birth outcomes than broader expansions of eligibility to women with higher income levels because of much lower take-up of this entitlement by the latter group. Copyright 1996 by University of Chicago Press.
Relevance. Medicaid patients are characterized by clinical and social complexity -- the very characteristics which often exclude them from clinical trials and yet drive health disparities. This Medicaid-based dataset populates studies that help users understand how local area, provider-level, and patient-level differences in treatment (natural experiments in comparative effectiveness) influence clinical and economic outcomes. Variation implies that disparities are not inevitable. The comparative impact of this natural variation can be measured in meaningful outcomes such as emergency department visits, hospital admissions, inpatient bed-days, deaths, and total Medicaid expenditures, as well as community-level disparity rate-ratios. Medicaid data allow users to follow a complex patient (e.g., comorbid diabetes and schizophrenia or COPD and CHF) from treatment to outcomes through every billable service in the health care system (i.e., from doctors visit to lab tests to prescriptions to emergency ...
The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that has important implications for Medicaid beneficiaries who require rehabilitative and habilitative services and devices. In the rule, CMS proposes changes to provide states more flexibility to coordinate Medicaid and the Childrens Health Insurance Program (CHIP) eligibility notices, appeals, and other related administrative procedures with similar procedures used by other health coverage programs authorized under the Affordable Care Act (ACA), such as coordination of benefits between Medicaid and health plans offered in the health insurance exchanges (Exchanges). Specifically, CMS is soliciting comments on whether the habilitative benefit should be offered in parity with the rehabilitative benefit under the Medicaid program (as they must be under the Exchanges). Additionally, CMS requests input on whether the state defined habilitative benefit definition for the Exchanges should apply to Medicaid or ...
Reports suggest that the Medicaid population includes a higher percentage of smokers than the general population. A high prevalence of smokers in a population is likely to lead to a higher burden of chronic obstructive pulmonary disease (COPD). Few studies have evaluated the economic burden of COPD in a Medicaid population. The objective of this observational, retrospective cohort study is to estimate the economic burden of COPD in subjects with a COPD diagnosis who are enrolled in Medicaid and are receiving maintenance treatment covered by Medicaid.. Specifically, the null hypothesis for the primary outcome measure is that no difference is observed in all-cause costs between subjects with and without COPD. The test hypothesis is that there is a difference in all-cause costs between subjects with and without COPD.. Secondary outcomes to be evaluated include all-cause resource use and COPD-related costs for the COPD cohort.. The study uses a medical and pharmacy administrative claims database ...
Medicaid provides 1/4 of all funding for mental health care.. Doesnt the Medicaid program cost a lot of money? Yes it does. But its a good deal if you consider that the average annual Medicaid spending per child is $2,422 and $7,683 for each adult and that the costs per enrollee is growing more slowly than premiums from employer based coverage (4.6% vs 7.7%).. Medicaid costs are going up because millions more are are needing it in these difficult times. Medicaid would be your safety net if you were to lose a job or experience a sudden drop in income.. For community health centers like mine, Medicaid is a lifeline. 37% of health center patients are covered by Medicaid. And this money is well spent. Community health centers have been shown to provide high quality cost effective care its 23 million patients.. Medicaid has its faults but few would argue that it is a lynch pin for our health care system and represents our nations moral commitment to help low income communities.. Attempts to make ...
Medicaid is a nationwide program that is administered not only by the federal government but also the government of each individual state. Types of assistance programs and eligibility requirements vary from state to state. Utah Medicaid is administered by the Utah Department of Health. At your local Medicaid office, you can fill out an application and find out more about the eligibility requirements and verifications youll need to provide before your application can be processed. You will also be assigned a case worker who will serve as your point of contact regarding your Medicaid application and/or coverage. There are Medicaid programs for children and Medicaid programs for adults. Children whose parents meet income requirements can qualify for one of the various programs. Medicaid for Newborns is a program for children from birth to age six whose parents meet the income requirements. Newborn Plus is for children ages six to eighteen, which certainly are not newborns but do fall under this ...
The term long-term services and supports (LTSS) refers to care provided to individuals with functional limitations and chronic illnesses who need help completing activities of daily living. Activities of daily living include activities such as bathing, dressing, preparing meals, and administering medication. Under a managed long-term services and supports (MLTSS) system, state Medicaid programs choose to finance and manage institutional care and/or home- and community-based services (HCBS) through at-risk managed care financing arrangements, rather than fee-for-service (FFS) financing arrangements. Currently, there are 21 states with 26 Medicaid MLTSS programs. Overall, these programs serve . . . ...
The leader of the largest trade group for Medicaid health plans wants states to think twice before enacting work requirements for beneficiaries of the public insurance program. If states choose to go that route, they could end up facing higher costs in the long run, Jeff Myers, president and CEO of Medicaid Health Plans of America, tells FierceHealthPayer.
Given the extraordinarily negative public reception to Governor Pat McCrorys idea to privatize the NC Medicaid program and the way it fell flat in its first presentation at the NC General Assembly, you might be forgiven in thinking that this particular Medicaid reform was dead in the water in NC. Unfortunately you would be wrong.. Today Governor McCrory issued a press release saying he would be coordinating with the Senate and House to require the Governors Department of Health and Human Services to request a Medicaid waiver from the federal government. This federal waiver would allow NC to make unspecified changes to Medicaid and create a predictable and sustainable Medicaid program for taxpayers.. Let me translate this for you. The only reason for NC to get a federal waiver to change its Medicaid program in this way would be to give NC the option to sell parts of the Medicaid program off to private companies - which has been the plan here all along. Why? Because if you sell off part of ...
Four months is all it took. In April, when Iowa governor Terry Branstad handed over the states Medicaid program to private insurance companies, many questioned his motives. Recent large-scale transitions to privatized Medicaid in states like Florida and Kansas havent fared well. The Des Moines Register warned, The health care of a half million people and $4 billion in public money are at stake.. Now, just four months later, billing problems are piling up.. Hundreds of Iowas Medicaid providers say the insurance companies arent paying them on time. For many, administrative costs have gone up. The privatized program, which Branstad claimed would modernize care, is actually making it harder for many doctors, hospitals, clinics, and nonprofits to provide care.. A state senator says the program is in a state of emergency. If providers continue to go unpaid, many may be forced to stop taking Medicaid patients or close their doors all together.. By handing over control of Medicaid to ...
Medicare and Medicaid to Revise Reimbursements for Prescription Drugs. (4/5/07)- The 2005 Deficit Reduction Act seeks, amongst other things, to reduce the joint federal-state Medicaid program by $8.4 billion over 5 years. The savings would come mainly through changing how the government calculates reimbursement to pharmacies and PBMs. The CMS put forth the proposal in December, and is required by law to finalize the new rule on Medicaid reimbursement by July 1.. The controversy over the new rule centers on the definition of an average manufacturer price, which is used to calculate the reimbursements to pharmacies for generic drugs. Under the proposal the generic price would take into account the rebates that PBMs receive, even for generic drugs. Most pharmacies do not receive these rebates, so they are paying a higher price for a generic drug than is the average PBM.. The government pays for Medicaid prescriptions in two ways: The federal government reimburses the pharmacy for the cost of the ...
Ive once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law. For the various enrollment data, Im using data from Medicaid.govs Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, theyve only published enrollment data
Medicaid law imposes a penalty period if you transferred assets within five years of applying, but what if the transfers had nothing to do with Medicaid? It is difficult to do, but if you can prove you made the transfers for a purpose other than to qualify for Medicaid, you can avoid a penalty.. You are not supposed to move into a nursing home on Monday, give all your money away on Tuesday, and qualify for Medicaid on Wednesday. So the government looks back five years for any asset transfers, and levies a penalty on people who transferred assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid. The penalty period is determined by dividing the amount transferred by what Medicaid determines to be the average private pay cost of a nursing home in your state.. The penalty period can seem very unfair to someone who made gifts without thinking about the potential for needing Medicaid. For example, ...
By advancing equity in oral health, we can ensure each child gets the support they need to grow up healthy and reach their dreams, without dental disease creating a barrier to their success. The CMS guidance was an outgrowth of a 2016 federal report that found three in four kids enrolled in Medicaid faced barriers to receiving the full breadth of dental care they needed. The report was based on a four-state sample of Medicaid programs. The central problem was a conflict in state Medicaid policies. States Medicaid dental periodicity schedules, which outline the minimum set of services kids should receive, were not aligned with their payment policies, called fee schedules. When the periodicity and fee schedules dont match, it presents a roadblock to care for children and families.. CDHP has long urged for Medicaid and CHIP programs to better align their periodicity and payment policies to better reflect clinical guidelines for preventing and managing tooth decay. The clarifying guidance promotes ...
The U.S. Department of Justice estimates that 1.3 million individuals with mental illness were in state or Federal prisons or local jails in 2005. More than half of all prison and jail inmates showed symptoms of a mental disorder, and about a quarter had mental health problems diagnosed within the past 12 months. For many adults with mental illness, Medicaid is the primary source of health care coverage when they reenter their communities after a stay in a public institution. Many states suspend Medicaid eligibility for adults while they reside in public institutions, since Medicaid regulations preclude the use of federal Medicaid dollars to pay for health services for most persons in state institutions. In addition, applying for federal disability benefits can be complex and requires coordination among local institutions, state agencies and federal agencies.. This publication, Establishing and Maintaining Medical Eligibility upon Release from Public Institutions may be downloaded or ordered at ...
Hilltop Senior Policy Analyst Laura Spicer, MA, gave a presentation at the National Academy for State Health Policy (NASHP) 25th Annual State Health Policy Conference held October 15-17, 2012, in Baltimore. In the presentation, Impact of Medicaid Expansion on a States Economy: The Hilltop Health Care Reform Simulation Model, Spicer gave an overview of the Hilltop Health Care Reform Simulation Model, a financial modeling tool developed by Hilltop Director of Economic Analysis Hamid Fakraei, PhD, that projects the costs and savings to states as they implement the provisions of the Affordable Care Act (ACA). Spicer discussed the economic impacts of the ACA and how the model was used in Maryland to isolate the impact of Medicaid Expansion and inform the decision by Maryland policymakers to expand Medicaid in 2015 ...
Medicaid is a public health insurance program for low income children and adults that is financed by the state and federal governments. As of Fiscal Year 2012, Medicaid spending consumed nearly 15 percent of total state own-source revenues (revenue generated by taxes and fees levied by Michigan). This share has grown five percentage points over the previous decade and when combined with Michigans decade long recession, is squeezing out appropriations for other state programs. The fundamental challenge for policymakers is that there is a structural imbalance between Medicaids revenue base and expenditure growth rate. There are several factors driving Medicaid cost growth. First, Michigans enrollment increased nearly 60 percent between 2001 and 2010, with accelerated growth of up to 11 percent per year during the most recent national recession. Second, the type of cases and the changing case mix influence costs. The elderly and disabled Medicaid populations make up approximately one quarter of ...
Many people who do not fall into the low-income category reject the idea of going on Medicaid as they age, become frail, and in need of home and health services that Medicaid programs provide.. Medicaid is a federal health-care program for the poor, and elderly people who work all their lives often dont believe its for them. In fact, many of them are insulted when anyone suggests that they apply for it. And the idea of applying for Medicaid, public assistance, or government aid doesnt make it any better when they learn that Medicare -- the federal health-care program for the aged -- does not pay for the long-term care needs of aging citizens.. For anyone who does not have private funds or insurance to pay for long-term care, Medicaid pays the bill. And senior citizens who worked all their lives and who may have a little money saved can still apply to Medicaid to get help with their personal and home care.. Northwest Ohio Area Office on Aging officials say that its unfortunate for senior ...
Access to affordable medical care is especially important during a global health crisis. You should be aware that federal law prevents the states from terminating Medicaid benefits while the coronavirus health emergency continues.. The Secretary of Health and Human Services has declared a nationwide public health emergency for COVID-19. In light of the public health emergency, the Families First Coronavirus Response Act provides that if you were enrolled in Medicaid as of March 18, 2020, the state cannot terminate your benefits even if there is a change in your circumstances that would normally cause your benefits to be stopped. The law states that your Medicaid coverage must continue through the end of the month in which the Secretary declares that the public emergency has ended. The only exceptions to this non-termination rule are if you choose to terminate your benefits yourself or you move to another state. States that already terminated a Medicaid recipients benefits should be contacting ...
data.medicaid.gov , Last Updated 2019-12-06T22:22:54.000Z. Total Medicaid Enrollees - VIII Group Break Out Report Reported on the CMS-64 The enrollment information is a state-reported count of unduplicated individuals enrolled in the states Medicaid program at any time during each month in the quarterly reporting period. The enrollment data identifies the total number of Medicaid enrollees and, for states that have expanded Medicaid, provides specific counts for the number of individuals enrolled in the new adult eligibility group, also referred to as the VIII Group. The VIII Group is only applicable for states that have expanded their Medicaid programs by adopting the VIII Group. This data includes state-by-state data for this population as well as a count of individuals whom the state has determined are newly eligible for Medicaid. All 50 states, the District of Columbia and the US territories are represented in these data. Notes: 1. VIII GROUP is also known as the New Adult Group. 2. ...
On January 21, 2016, the Centers for Medicare and Medicaid Services (CMS or the Agency) released an advance-print copy of the long-awaited final rule on the Medicaid Drug Rebate Program (MDRP). The final rule implements various statutory amendments, revises the calculation of Average Manufacturer Price (AMP), makes certain changes to the determination of Best Price and addresses other issues relating to Medicaid price reporting and reimbursement. The final rule also discusses the definition of a covered outpatient drug and other issues with implications for both Medicaid and the 340B Drug Pricing Program.. The final rule takes effect April 1, 2016. The final rule contains a comment period for certain provisions - specifically, comments on the definition and identification of line extension drugs are due 60 days after Federal Register publication, currently scheduled for February 1, 2016. Although the final rule does not adopt a number of proposed provisions that concerned pharmaceutical ...
Downloadable! Recent theoretical work suggests that means and asset-tested social insurance programs can explain the low savings of lower income households in the U.S. We assess the validity of this hypothesis by investigating the effect of Medicaid, the health insurance program for low income women and children, on savings behavior. We do so using data on asset holdings from the Survey of Income and Program Participation, and on consumption from the Consumer Expenditure Survey, matched to information on the eligibility of each household for Medicaid. Exogenous variation in Medicaid eligibility is provided by the dramatic expansion of this program over the 1984-1993 period. We document that Medicaid eligibility has a sizeable and significant negative effect on wealth holdings; we estimate that in 1993 the Medicaid program lowered wealth holdings by 17.7% among the eligible population. We confirm this finding by showing a strong positive association between Medicaid eligibility and consumption
Californias Medicaid agency has posted draft language of a new state plan amendment (SPA) that would make major changes to federally qualified health center (FQHC) and Rural Health Clinic (RHC) reimbursement.
Introduction Approximately 20 million new sexually transmitted infections (STIs) are diagnosed yearly in the United States costing the healthcare system an estimated $16 billion in direct medical expenses. The presence of other STIs increases the risk of HIV transmission. The Centers for Disease Control and Prevention (CDC) has long recommended routine HIV screening for individuals with a diagnosed STI. Unfortunately, HIV screening prevalence among STI diagnosed patients are still sub-optimal in many healthcare settings. Objective To determine the proportion of STI-diagnosed persons in the Medicaid population who are screened for HIV, examine correlates of HIV screening, and to suggest critical intervention points to increase HIV screening in this population. Methods A retrospective database analysis was conducted to examine the prevalence and correlates of HIV screening among participants. Participant eligibility was restricted to Medicaid enrollees in 29 states with a primary STI diagnosis ...
There is excess amenable mortality risk and evidence of healthcare quality deficits for persons with serious mental illness (SMI). We sought to identify sociodemographic and clinical characteristics associated with variations in two 2015 Healthcare Effectiveness Data and Information Set (HEDIS) measures, antipsychotic medication adherence and preventive diabetes screening, among Medicaid enrollees with serious mental illness (SMI). We retrospectively analyzed claims data from September 2014 to December 2015 from enrollees in a Medicaid specialty health plan in Florida. All plan enrollees had SMI; analyses included continuously enrolled adults with antipsychotic medication prescriptions and schizophrenia or bipolar disorder. Associations were identified using mixed effects logistic regression models. Data for 5502 enrollees were analyzed. Substance use disorders, depression, and having both schizophrenia and bipolar disorder diagnoses were associated with both HEDIS measures but the direction of the
Brian P. Lee, M.D., from the University of California in San Francisco, and colleagues examined whether different Medicaid policies affect distribution of LT for ALD. Medicaid policies were surveyed in all states actively performing LT and were linked to national registry data on LT recipients during 2002 to 2017 with ALD as the primary listing diagnosis. A difference-of-differences analysis was performed comparing 2002 to 2011 versus 2012 to 2017 to assess whether restrictive policies correlated with a reduced proportion of LTs paid by Medicaid among patients with ALD. Data were included for 10,836 LT recipients during 2002 to 2017, with 7,091 from 24 states in the restrictive group and 3,745 from 14 states in the unrestrictive group.. The researchers found that among restrictive versus unrestrictive states, the adjusted proportion of LTs paid by Medicaid during 2002 to 2011 was 17.6 percent (95 percent confidence interval [CI], 15.4 to 19.8 percent) versus 18.9 percent (95 percent CI, 15.4 to ...
Congresswoman Chellie Pingree (D-Maine) today joined 34 of her House colleagues in writing to U.S. Department of Health and Human Services (USDHHS) Secretary Alex Azar and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to oppose the Trump administrations plan to covert Medicaid into block grants.. The purpose of block grant waivers is to overhaul the states Medicaid program by capping federal funding. In turn, states would be given a lump sum of federal money, freed from federal oversight or accountability measures; measures which encourage baseline benefits and quality of care to be available to all enrollees. These waivers would give states the ability to limit and remove enrollees or cut certain health care benefits and rates, if they believe they are too costly or unnecessary, Pingree and her colleagues wrote in the in the letter. Tomorrow, CMS Administrator Verma is expected to send letters to state Medicaid directors announcing the Administrations plans to ...
Officials dont know when applications will be ready for Healthy Michigan - the states new Medicaid program for people at or below 133 percent of the federal poverty level. Medicaid enrollment and coverage officially begins April 1, according to legislation approved last year. Eligibility covers a single adult with annual income of $15,000 or less and families of four with annual income below $34,000.
The 2010 Affordable Care Act (ACA) Medicaid expansions aimed to improve access to care and health status among low-income non-elderly adults. Previous work has established a link between Medicaid coverage expansion and reduced mortality (Sommers, Baicker and Epstein, 2012), but the mechanism of this reduction is not clearly understood. Prior to the ACA, one of the largest policy changes in non-elderly adult Medicaid access was a 2005 contraction through which nearly 170,000 enrollees lost Medicaid coverage in Tennessee. We exploit this change in Medicaid coverage to estimate its causal impact on inpatient hospitalizations. We find evidence that the contraction decreased the share of hospitalizations covered by Medicaid by 21 percent and increased the share uninsured by nearly 61 percent, relative to the pre-reform levels and to other states. We also find that 75 percent of the increase in uninsured hospitalizations originated from emergency department visits, a pattern consistent with losing ...
Proposed Medicaid Payment Rates - Proposed Medicaid Payment Rate for the Medical Policy Review of Clinical Laboratory Services (G0433 - Human Immunodeficiency Virus (HIV) Testing) Proposed Medicaid Payment Rates for the Medicaid Biennial Calendar Fee Review Proposed Medicaid Payment Rates for the Medical Policy Review of Family Planning Services (J7301 & J7307) Proposed Medicaid Payment Rates for the Medical Policy Review of Magnetoencephalography Proposed Medicaid Payment Rates for the Quarterly Healthcare Common Procedure Coding System Updates ...
The Florida Medicaid Formulary is an important resource if you receive Medicaid benefits in Florida. Learn how changes to the Formulary impact your Florida Medicaid health insurance.
TY - JOUR. T1 - The Indiana chronic disease management programs impact on medicaid claims. T2 - A longitudinal, Statewide Evaluation. AU - Katz, Barry P.. AU - Holmes, Ann M.. AU - Stump, Timothy E.. AU - Downs, Steven M.. AU - Zillich, Alan J.. AU - Ackermann, Ronald T.. AU - Inui, Thomas S.. PY - 2009/2/1. Y1 - 2009/2/1. N2 - Background: Disease management programs have grown in popularity over the past decade as a strategy to curb escalating healthcare costs for persons with chronic diseases. Objectives: To evaluate the effect of the Indiana Chronic Disease Management Program (ICDMP) on the longitudinal changes in Medicaid claims statewide. Research Design: Phased implementation of a chronic disease management program in 3 regions of the state. Fourteen repeated cohorts of Medicaid members were drawn over a period of 3.5 years and the trends in claims were evaluated using a repeated measures model. Subjects: A total of 44,218 Medicaid members with diabetes and/or congestive heart failure in ...
National Association of Chain Drug Stores senior economist Laura Miller tracked a major shift of prescription drug spending and volume from Medicaid to Medicare in the wake of the Medicare drug benefit program. Miller reported the findings in an article she co-authored in the December/January edition of the journal Health Affairs. The article, Changes In Medicaid Prescription Volume And Use In The Wake Of Medicare Part D Implementation, examines the impact of Medicaid prescription spending and volume, generic dispensing rates and a shift in the mix of drugs used by Medicaid beneficiaries. The article was based on a study conducted by Miller and Brian Bruen, former policy staff member of NACDS who is now at the Washington-based health policy research firm Avalere Health.. According to the study, total payments to pharmacies by Medicaid fell by nearly 50 percent in 2006, from $38.5 billion in 2005 to $20.9 billion in the inaugural year for Part D. The number of Medicaid-paid prescriptions ...
A landmark study of Medicaid outcomes in Oregon published in the New England Journal of Medicine shows the program to be ineffective at improving the health of enrollees.. Researchers found enrollment in Medicaid protected most recipients from financial disaster, though they did report spending more on medical expenses. There were no significant differences in health outcomes between those who remained uninsured and those on Medicaid.. This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain, the studys authors wrote.. Rare Research Opportunity. In 2008, Oregon expanded its Medicaid program with a drawing from a waiting list. Researchers used this rare opportunity to study the effects of the Medicaid program on randomly selected ...
To qualify for Medicaid coverage of long-term care, you must satisfy very complicated financial eligibility rules-rules that often can be traps for the unwary. One of the most significant traps is Medicaids right to recover its expenses from your estate after you die - a practice known as estate recovery.. Under current Medicaid law, states are required to attempt to recoup Medicaid spending for long-term care services. Since about the only asset youre allowed to own and still get Medicaid coverage is your home, this right of estate recovery is the states claim against your home. In other words, if you own a home, Medicaid is really a loan. It will pay for your care, but your house will have to be sold when you die to repay the state for the services it provided.. Now, five elder advocacy groups are calling on Congress to eliminate Medicaid estate recovery after a congressional advisory commission concluded that the practice recoups only a tiny percentage of Medicaid spending while ...
Illinois, like other states, is considering expanding its Medicaid program as envisioned under Obamacare. Doing so takes money that America doesnt have to provide bad health insurance to young, healthy people who dont need it, for the benefit of the people with the best lobbyists.. The Medicaid expansion has now passed both chambers of the Illinois General Assembly, but the House made several amendments that the Senate must now approve. There is still a chance that wisdom could prevail over the false appearance of helping people. Medicaid itself is an expensive program that doesnt appear to help its recipients. According to Avik Roy of the Manhattan Institute, if Medicaid were a drug, zero doctors would prescribe it.. Medicaid patients tend to use Emergency Room services for everything they can, because ER visits are covered without co-pay under the program. Obamacare was sold as a way to get people out of the ER and into more efficient clinics, but with Medicaid expansion the effect will ...
Howell, a Republican who represents Attala, Carroll, LeFlore, Grenada and Montgomery counties, said when he first began serving in the legislature in the early 90s, the Medicaid budget was just under $300 million.. We most certainly, because of this increase, are going to be facing a much bigger deficit than weve been.. Some state Democrats have pushed to see the Medicaid rolls expanded because of an increase in federal funds promised by the Affordable Care Act to cover it. The states hospitals would also see a financial benefit from increased federal Medicaid dollars, which, according to Howell, come in now at about $5.5 billion.. However, the fight has been on for two years, and will likely go to a third because Gov. Bryant and other state lawmakers believe that the portion of federal Medicaid money offered by the Affordable Care Act expansion would dissolve, leaving the state holding the bag, and unable to afford the increased number of people on Medicaid.. When the legislature gavels in ...
Passage of the Patient Protection and Affordable Care Act (ACA)‡ in 20104 profoundly changed the Medicaid program through its expansion of Medicaid eligibility to all legal residents younger than 65 years with individual or family incomes at or below 138% of the FPL.§ Hence, the ACA not only added a large population of adults (ages 19 through 64) who became newly eligible for Medicaid, but in many states, the expansion also increased the number of eligible children (through age 18) by mandating a higher minimum income eligibility.‖ The ACA directed the federal government to fund Medicaid expansion in full through 2016 and then at lower but still significant levels thereafter (tapering to 90% funding by 2020). The landmark Supreme Court decision upheld the constitutionality of the ACA with respect to the contested individual mandate for every American to obtain health insurance by a 5 to 4 margin.5 However, the Court also struck down as unconstitutional an enforcement provision of the ACA ...
DC In much of the country, growth in Medicaid enrollment under health reform will greatly outpace growth in the number of primary care physicians willing to treat new Medicaid patients, according to a national study released today by the Center for Studying Health System Change (HSC).. And, temporary increases in Medicaid reimbursement meant to entice more primary care physicians into accepting Medicaid patients are unlikely to make much of a difference in the states facing the biggest enrollment jumps, according to the study funded by the Robert Wood Johnson Foundation (RWJF). Under federal health reform, Medicaid eligibility will expand to cover as many as 16 million more poor and low-income adults by 2019. Nationally, 42 percent of primary care physicians in 2008 were accepting all or most new Medicaid patients, compared with 61 percent of PCPs accepting all or most new Medicare patients and 84 percent accepting all or most privately insured patients. Given the unwillingness of many PCPs to ...
STATE OF OKLAHOMA OKLAHOMA HEALTH CARE AUTHORITY STATE MEDICAID HIT PLAN (SMHP) VERSION 2.0 CMS Letter - 9/3/2010 Enclosure A October 13, 2010 This page intentionally left blank. State of Oklahoma Oklahoma Health Care Authority State Medicaid HIT Plan (SMHP) CMS Letter 9/3/2010 Enclosure A October 13, 2010 Page 1 1 SMHP REVISION This State Medicaid Health Information Technology (HIT) Plan (SMHP) Revision addresses the questions raised in the Centers for Medicare & Medicaid Services (CMS) letter dated September 3, 2010, and addenda. The CMS questions are noted below with relevant SMHP sections and revised text provided. All revisions are provided in the order of the question received from CMS and highlighted in bold italics to facilitate review. Future changes to this SMHP will be published in SMHP section order. Global changes to the SMHP included: 1. SoonerCare Electronic Health Record (EHR) Incentive Program is changed to Oklahoma EHR Provider Incentive Payment Program throughout the SMHP. ...
STATE OF OKLAHOMA OKLAHOMA HEALTH CARE AUTHORITY STATE MEDICAID HIT PLAN (SMHP) VERSION 2.0 CMS Letter - 9/3/2010 Enclosure A October 13, 2010 This page intentionally left blank. State of Oklahoma Oklahoma Health Care Authority State Medicaid HIT Plan (SMHP) CMS Letter 9/3/2010 Enclosure A October 13, 2010 Page 1 1 SMHP REVISION This State Medicaid Health Information Technology (HIT) Plan (SMHP) Revision addresses the questions raised in the Centers for Medicare & Medicaid Services (CMS) letter dated September 3, 2010, and addenda. The CMS questions are noted below with relevant SMHP sections and revised text provided. All revisions are provided in the order of the question received from CMS and highlighted in bold italics to facilitate review. Future changes to this SMHP will be published in SMHP section order. Global changes to the SMHP included: 1. SoonerCare Electronic Health Record (EHR) Incentive Program is changed to Oklahoma EHR Provider Incentive Payment Program throughout the SMHP. ...
STATE OF OKLAHOMA OKLAHOMA HEALTH CARE AUTHORITY STATE MEDICAID HIT PLAN (SMHP) VERSION 2.0 CMS Letter - 9/3/2010 Enclosure A October 13, 2010 This page intentionally left blank. State of Oklahoma Oklahoma Health Care Authority State Medicaid HIT Plan (SMHP) CMS Letter 9/3/2010 Enclosure A October 13, 2010 Page 1 1 SMHP REVISION This State Medicaid Health Information Technology (HIT) Plan (SMHP) Revision addresses the questions raised in the Centers for Medicare & Medicaid Services (CMS) letter dated September 3, 2010, and addenda. The CMS questions are noted below with relevant SMHP sections and revised text provided. All revisions are provided in the order of the question received from CMS and highlighted in bold italics to facilitate review. Future changes to this SMHP will be published in SMHP section order. Global changes to the SMHP included: 1. SoonerCare Electronic Health Record (EHR) Incentive Program is changed to Oklahoma EHR Provider Incentive Payment Program throughout the SMHP. ...
They may not use the same terminology! This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group. This page provides basic information about being certified as a Medicare and/or Medicaid home health provider and includes links to applicable laws, regulations, and compliance information. ALERT: Medicare criteria for payment for home care are stricter than Medicaidâ s. Medicare only covers care from one Medicare-approved home health agency at a time. A Home Health Agency may be a public, nonprofit or proprietary agency or a subdivision of such an agency or organization. Note that there are many private home care agencies that are NOT Medicaid providers and that may NOT bill Medicaid retroactively. Medicare certified and state licensed HHAs will need to meet all regulations listed below. A recent letter from CMS to the Missouri Medicaid program verifies that Medicaid has no skilled need requirement as a condition for paying for home health aide ...
Pursuant to a congressional request, GAO obtained insurance company and state agency estimates of the potential effects on Medigap premiums and Medicaid expenditures of a repeal of the Medicare Catastrophic Coverage Act.GAO found that: (1) insurance companies estimated that the repeal would cause an average 15.4-percent monthly premium increase, totaling $250 million in Medigap subscriber costs for 1990; (2) the repeal would increase Medicaid expenditures by an estimated $1 billion, including about $444 million in state funds and about $587 million in federal funds; and (3) state Medicaid personnel attributed the estimated increases to increased deductible and coinsurance payments, skilled nursing facility costs, and numbers of elderly people eligible for Medicaid.
303-866-3144. DENVER, CO - Today, the Colorado Health Foundation released a report Assessing the Economic and Budgetary Impact of Medicaid Expansion in Colorado: FY 2015-16 through FY 2034-35. The report is an update to an analysis first performed in 2013, prior to the expansion of Medicaid. Below is a statement from Health Care Policy and Financing Executive Director Susan E. Birch MBA, BSN, RN. Birch oversees the Department that administers Medicaid and Child Health Plan Plus (CHP+) programs.. This updated analysis is great news for Colorado and for the states economy. The new analysis shows the positive impact of expanding Medicaid. The new information is better than initial projections forecasted - more health care jobs have been created, state economic activity increased and average household earnings are higher than anticipated. Healthy Coloradans can be more productive citizens. We are heartened by the many lifesaving and life changing stories of newly covered members. The expansion has ...
BERKELEY -- University of California health care economists have created the first detailed picture of the impact of cigarette smoking on Medicaid costs in all 50 states.. Published today, the analysis provides a solid foundation for financial claims by states against the tobacco industry.. It also demonstrates that a proposed settlement being negotiated, whereby the tobacco industry would pay out $368.5 billion to 40 states over 25 years, is not high enough to cover any medical claims other than Medicaid.. Smoking-related Medicaid costs amount to $12.9 billion per year, or $322 billion in 25 years without inflation, the economists discovered. This does not include the financial impact of cigarette smoking on Medicare or private insurance companies, they said.. The tobacco industry has caused immeasurable harm to the public health, said Leonard Miller, professor of social welfare at the University of California, Berkeley. These figures strengthen the idea that economic sanctions are ...
According to reports in the New Jersey Star-Ledger and the Washington Post, New Jersey Gov. Chris Christie was expected to announce his support on Tuesday afternoon, Feb. 26, for the expansion of the states Medicaid program under the terms of the Affordable Care Act (ACA). Gov. Christie would be the eighth Republican governor to do so in recent months, following a similar announcement on Feb. 21 by Gov. Rick Scott of Florida.. Taken together, these eight states will extend Obamacares coverage expansion to 3.2 million Americans, according to this analysis from the Urban Institute, the Washington Posts Sarah Kliff wrote. They will take in a cumulative $90 billion in federal funds to do so. The quick succession of governors to come out in favor of this part of the Affordable Care Act suggests that, when it comes to the Medicaid expansion, the lure of federal dollars may trump anti-Obama politics, Kliff added. When you look at the deal that the states are getting, its pretty easy to see ...
High-stakes health-care debate hits Nevadas Medicaid program, By Ben Botkin, August 5, 2017, Las Vegas Review-Journal: Marta Jensen, Nevadas point person on Medicaid, watched on C-SPAN recently as the U.S. Senate debated health care reform. She had four different bills pulled up on her computer. The stakes were high for Nevada. Each of the bills would have repealed at least parts of the Affordable Care Act and affected Medicaid, the federal-state program that provides poor and disabled Americans with medical coverage. More than one-fifth of the states residents now receive their health insurance through Medicaid…. ...
Medicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI) assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries. The household component of the nationally representative Medical Expenditure Panel Survey (MEPS) 1996-2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB) regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency
H.Con.Res. 25, House Budget Resolution (Ryan) public program issues, deficit reduction proposals16. Specific Lobbying Issues (continued): S.Con.Res. 8, Senate Budget Resolution (Murray) public program issues, deficit reduction proposals H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. ...
In South Carolina, the burden of dental decay disproportionately affects disadvantaged children enrolled in Medicaid (Dye et al., 2012; Martin et al., 2012; Ayers et al., 2013). To address this oral health disparity, South Carolinas Medicaid Program initiated payment to physicians for the delivery of fluoride varnish (FV), an evidence-based preventive dental service at the well-child visit, to children up to thirty-six months of age. Fluoride varnish has been found to reduce dental decay by thirty-seven percent when applied two to four times a year (Weyant et al., 2013; Marinho et al., 2013). Two retrospective cohort studies were undertaken to assess the effectiveness of FV policy, using deidentified billing records for 52,841 children insured by SC Medicaid. The first study found that during SFY2008-2013, the FV rates per child-year delivered by physicians and dentists were 1 percent and 23 percent respectively. A policy intended to increase the provision of FV through pediatric primary care was not
EXECUTIVE SUMMARY:. This final report points out that Medicaid providers received reimbursements for oxygen related items of durable medical equipment (DME) and supplies at rates that were higher than the Medicare allowable amount. The higher reimbursements occurred because the State agency did not reflect Medicare reductions in the Medicaid reimbursement limits set for these items. Based on our review of payments for Medicaid DME and supply claims with dates of service during our audit period of January 1, 1998 through December 31, 1999, we found that savings of approximately $2 million (Federal share $1 million) could have been realized if the Medicaid rates had been limited to amounts allowable under the Medicare program. We have recommended that the State limit the maximum allowable price for DME and supplies to an amount equal to or less than the Medicare allowable amount for the same items.. ...
No or low cost Medicaid and dual eligible health coverage for Nebraska from UnitedHealthcare Community Plan. Helping people is at the heart of all we do.
TALLAHASSEE - A panel of Florida lawmakers today is taking up a privatized alternative to Medicaid expansion that could result in as many as one million low-income Floridians qualifying for
GAO reviewed Medicaid abuse in six states and provider abuse in four states to: (1) determine whether the states were effective in identifying Medicaid abuse; and (2) assess the extent of states actions to apply sanctions against Medicaid abusers.GAO found that: (1) the Department of Health and Human Services (HHS) has not taken effective action to strengthen management controls over states postpayment utilization review programs; (2) some states do not effectively use their computerized management information systems to identify potential Medicaid abuse; (3) some states review only a small portion of the potentially abusive recipients they identify; (4) most states have applied few sanctions against abusive Medicaid recipients; and (5) the Health Care Financing Administration (HCFA) has adequate resources to provide technical assistance to states with problems in using their information systems.
Although many families with low incomes are eligible for various health insurance programs, more than three of five eligible children are not enrolled in Medicaid or the State Childrens Health Insurance Program (SCHIP). Churning in enrollment is also common: over half of low-income family members who repeatedly experience periods without coverage leave Medicaid and then re-enroll later. Focusing on eight states, this project will examine factors that affect program enrollment and coverage stability, including a new federal rule requiring people to document their citizenship when applying for or renewing Medicaid coverage. In Phase 1, state officials and others convened to discuss the implications of the new citizenship documentation requirements and how these effects might be measured. In Phase 2, the researchers will analyze administrative data to determine the impact of the new Medicaid rule and other factors. Findings will inform debate over extending public coverage to a greater number of ...
While congressional Republicans may have given up on their latest attempt to repeal the Affordable Care Act, Kentucky is moving ahead with other ways to pare back Medicaid, the 50-year-old program that provides health insurance for poor and low-income Americans.. Last year, Kentucky Governor Matt Bevin submitted a waiver request to the federal Centers for Medicare and Medicaid Services (CMS) to make changes to Kentuckys Medicaid program. The proposal, called Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) seeks to encourage employment and assist individuals as they move from dependence on public assistance to independence. If approved, the Kentucky plan would mark the first time that people eligible for Medicaid would be subject to work requirements. It would also change Kentuckys Medicaid program from a traditional assistance program to a consumer-driven model, which includes establishing specific enrollment periods, enforcing premium payments, and removing retroactive ...
ALBUQUERQUE, NM - The proposed cuts to Medicaid in the Trump administrations budget for fiscal year 2019 would prevent hundreds of thousands of New Mexicans from accessing healthcare. The budget, if approved by Congress, would cut Medicaid by $1.4 trillion dollars between 2019-2028; eliminate critical funding for Medicaid expansion, which provides over 250,000 New Mexicans with healthcare coverage; and end subsidies that help individuals and families when buying insurance through the marketplace.. The drastic cuts to Medicaid would make healthcare unaffordable for millions of Americans and hundreds of thousands of New Mexicans, said Abuko D. Estrada, attorney for the New Mexico Center on Law and Poverty. After handing out tax cuts to the richest households, the administration now wants to cut Medicaid by over a trillion dollars in the next decade. This would devastate New Mexicos budget or force our state to ration healthcare to children, the elderly, people with disabilities, pregnant ...
If the New Hampshire legislature has its way, Dartmouth-Hitchcock will soon be paying more to the state than it takes in to care for patients covered by Medicaid, the government-run health insurance program for the poor and disabled. The move came after several years of cuts to the states already-meager Medicaid reimbursement rates.. Care: We used to say, If [legislators] keep cutting us, theyll be paying us nothing to care for Medicaid patients, says Frank McDougall, DHs vice president of government affairs. Well, they went right by nothing. In the spring of 2011, the legislature changed a policy set in 1991; the move delivered a $43-million hit to DH alone. But some of the states hospitals are fighting back. In July, DH and nine other New Hampshire hospitals filed a lawsuit against the state in federal court. Our case, says McDougall, is that the [states] present budget abuses the Medicaid statutes with regard to access for patients.. Action: In FY10, DH cared for about 43,000 ...
According to some estimates, expanding Medicaid eligibility in New Jersey could add 225,000 or more residents to the states healthcare rolls. While the increased coverage will clearly benefit low-income children, individuals, and families, it also raises a number of challenges for a broad spectrum of healthcare providers and experts, including doctors, hospitals, and policymakers.. These critical concerns were the jumping off point for the NJ Spotlight Roundtable: The Impact of Medicaid Expansion on New Jerseys Healthcare System. They include:. ...
Medicaid Expansion Offers Coverage for Behavioral Health Care for Vulnerable Populations. The Medicaid expansion is increasing coverage for behavioral health services for low-income adults and children. The expansion has led to populations shifting from the Childrens Health Insurance Program (CHIP) to Medicaid in some states. This shift gives more children access to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which provide developmental and behavioral screening to children in Medicaid (CMS, 2015a). Starting in 2015, the ACA also extended Medicaid eligibility for children and young adults who aged out of the foster care system (and previously had Medicaid) until the age of 26. This provision was especially critical given that young adults are less often insured, and at the same time youth in foster care report both health conditions that limit their daily activities and receiving behavioral health counseling at higher rates than their peers (Lehmann et al., 2012). ...
Jensen-Otsu, E.; Ward, E.K.; Mitchell, B.; Schoen, J.A.; Rothchild, K.; Mitchell, N.S.; Austin, G.L., 2015: The effect of Medicaid status on weight loss, hospital length of stay, and 30-day readmission after laparoscopic Roux-en-Y gastric bypass surgery
Study after study shows that Medicaid expansion saves lives, plain and simple. Georgians need reliable, quality health coverage to stay well, but so many in our state continue to go uncovered because of Brian Kemp and Georgia Republicans stubborn refusal to expand Medicaid, said Rebecca Galanti, spokesperson for the Democratic Party of Georgia. Georgians deserve leaders doing everything they can to increase access to care and improve health outcomes in our state - not politicians like Brian Kemp, who is ignoring the overwhelming majority of health experts and refusing to expand a program proven to prevent deaths and improve health. The science is clear: Kemp and Republicans failure to expand Medicaid is not only disgraceful - its inhumane ...
STATE OF OKLAHOMA OKLAHOMA HEALTH CARE AUTHORITY STATE MEDICAID HIT PLAN (SMHP) VERSION 1.0 July 26, 2010 State of Oklahoma Oklahoma Health Care Authority State Medicaid HIT Plan (SMHP) July 26, 2010 Page i Prepared by OHCA with assistance from: 6263 North Scottsdale Road, Suite 200 Scottsdale, AZ 85250 (480) 423-8184 www.foxsys.com State of Oklahoma Oklahoma Health Care Authority State Medicaid HIT Plan (SMHP) July 26, 2010 Page ii TABLE OF CONTENTS 1 EXECUTIVE OVERVIEW...................................................................................................1 1.1 Background .....................................................................................................................2 1.1.1 Current HIT Landscape in Oklahoma............................................................................3 1.1.2 Vision of HIT Future....................................................................................................11 1.1.3 Provider Incentive Program Implementation ...
What happens if I need long-term care in a nursing home and I cant afford to pay for it? I hear this question frequently from clients who are concerned about long-term care because the cost of nursing home care is so high. In Massachusetts, nursing home care costs anywhere from $11,000 to $17,000 per month ($132,000 to $204,000 per year) and continues to increase regularly. The short answer is Medicaid (MassHealth), a joint federal/state government benefits program, will cover your long-term care nursing home expenses so long as you meet the medical and financial eligibility criteria for the program. Here are 5 important numbers to keep in mind with respect to eligibility for long-term care Medicaid benefits in Massachusetts.. You Must Be 65 Years of Age or Older. The first hurdle to apply for and receive Medicaid long-term care benefits is that you must be 65 years of age or older.. You May Not Have More Than $2,000 of Countable Assets. Medicaid has strict limitations with regard to the value ...
Engaging external partners is an important part of Indianas effort to make actionable government data publicly available. Thats why, to mark the public launch of the first Medicaid datasets, MPH was proud to support the 2017 Indiana Medicaid Data Challenge hosted by the Regenstrief Institute. The first-of-its-kind competition drew more than 150 talented clinicians, data scientists, and healthcare subject matter experts to explore the newly-released data, network with industry leaders, and compete for cash prizes. The following submissions were recognized for being the most innovative and having the greatest potential impact on Indianas Medicaid system. Thank you to all the teams that participated!. Weve published these submissions to start conversations and spark ideas. We do not make any representation or warranty as to the accuracy or validity of a particular submission. Please reach out to the individual submitter organization with questions.. ...
Many exchange insurers offer Medicaid plans and exchange plans to ensure continuity of coverage and care for people whose incomes change. For some providers, churn is a focal point in their Obamacare outreach strategy. After Michigan opened enrollment for its expanded Medicaid in April, Detroit Medical Center let consumers know about it. We made sure to let people know that if their situation changed, whether it be a loss of work or a divorce or whatever the bad thing was, they were still eligible for insurance, said Conrad Mallett, the hospitals chief administrative officer.. When patients churn from Medicaid to exchange plans, however, that can create payment problems for providers. Exchange plans often have high deductibles and cost-sharing. Medicaid patients are used to having very limited cost- sharing, so they dont necessarily understand their financial responsibilities under a private plans deductible or coinsurance, said Craig Hauben, chief sales and marketing officer at NSLIJ ...
How To Apply. Apply in-person. You can visit the Community Service Office (CSO) to apply in person for the Washington Medicaid program. You will be provided with the application form which you can then fill out and send back along with the required documents.. Apply Via Phone. You can also contact the Medicaid office in your community by calling at 1-800-562-3022. A Medicaid representative will provide you with relevant information about the program and the application procedure.. The applicant can also visit the Washington official Marketplace to see if they meet the eligibility criteria for the Medicaid. The Marketplace was established to provide the healthcare benefits to citizens of America who are otherwise not able to do so. You can also find information related to the Affordable Healthcare Act on the website.. Apply Online. Also, visit the Washington State Healthcare Authority website at Washington Medicaid to find more about the program policies and to get a better understanding of the ...
TY - JOUR. T1 - Costs to medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland. AU - Moore, Richard D.. AU - Chaisson, Richard E.. PY - 1997/3/1. Y1 - 1997/3/1. N2 - Human immunodeficiency virus (HIV) infection is increasingly an urban disease in the United States, and Medicaid is the principal payer of the health care costs of patients with HIV. We wished to determine the costs to Medicaid of patients in Maryland infected with HIV as immunosuppression progresses, and to determine how costs varied by demographic characteristics of the patient. We analyzed combined economic and clinical data in patients from the Johns Hopkins HIV Service, the provider of primary and specialty care for a majority of HIV-infected patients in the Baltimore metropolitan region. All patients were enrolled in Medicaid and received care longitudinally in Maryland from July 1992 to June 1995. Monthly Medicaid payments were calculated for all inpatient and outpatient services by ...
In 2015, the American Lung Association received a competitive award from the Centers for Disease Control and Preventions (CDC) National Center for Environmental Health to track asthma guidelines-based care in state Medicaid programs for the 23 CDC-funded National Asthma Control Program states. As part of this project, a group of key stakeholder organizations was convened to discuss key components of guidelines-based asthma care coverage for state Medicaid programs. This document defines benchmarks for asthma guidelines-based care for seven different criteria, which, if covered, together encompass key elements of the NAEPP EPR-3 guidelines, Community Guide and other relevant guidelines. Throughout the document, common barriers to care are cited as an impediment to guidelines-based care.. To conduct this review, ALA conducted its own primary research (publicly available) to determine state Medicaid program coverage for comprehensive asthma guidelines-based care. This research includes reviewing ...
This report is the first in a series of monthly reports on State Medicaid and Childrens Health Insurance Program (CHIP) data, and represents State Medicaid and CHIP agency eligibility activity for the calendar month of October 2013, which coincides with the first month of the initial open enrollment period for the Health Insurance Marketplace.. Read the full CMS report here…. The School Medicaid Link: California Recognizing that schools are a key access point to uninsured children and newly eligible family members, groups like The Childrens Partnership in California have created campaigns to distribute information and tools tailored to schools on providing outreach and enrollment assistance to children and families. The health exchange marketplace in California, Covered California, has also tapped schools by highlighting their role as essential in the Enrollment Assistance Program which seeks to enroll as many of the 5.3 million eligible and uninsured population in California. The Medi-Cal ...
Medicaid consultants from the Naples, FL region will help individuals apply for Medicaid in the state of Florida. Medicaid eligiblity requirements for Florida vary from other states. Our staff will help protect your assets from the Medicaid spend down and reduce your nursing home costs before entering into a retirement home in Naples, Florida. Call us for all your Medicaid planning needs.