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Medicaid expansion is possible

Medicaid expansion is possible | Medicaid Reform for Patients and Doctors | Scoop.it
[...] he was Rick Perry. Senate Finance Chairman Tommy Williams, R-The Woodlands, has laid out potential elements to a “Texas solution” that include co-pays and deductibles, managed-care expansion, and more incentives for patients to use “routine...
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Medicaid Reform for Patients and Doctors
Find a way to provide health care to low-income Texans with realistic payment, less stifling bureaucracy, and no fraud-and-abuse witch hunts
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Utah governor: Deal is done with Obama administration on Medicaid alternative

Utah governor: Deal is done with Obama administration on Medicaid alternative | Medicaid Reform for Patients and Doctors | Scoop.it
Gov. Gary Herbert announced Thursday that after months of negotiations, he has reached a final agreement with the Obama administration on his novel alternative to expanding Medicaid. “They are giving us more flexibility than has ...
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Feds Withholding $75M Over Questions About Hospital Funding

Feds Withholding $75M Over Questions About Hospital Funding | Medicaid Reform for Patients and Doctors | Scoop.it
A federal agency is reviewing arrangements between private Texas hospitals and local government entities to ensure they did not violate a rule that allowed the state to draw down federal dollars to cover health care for the uninsured.
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Texas and Florida Expand Medicaid – For Kids

Those states were among 21 – including some big Democratic-led states, such as California -- that were required to widen Medicaid eligibility for children between the ages of 6 and 18 by 2014.  That little-known provision of the health law is a key reason hundreds of thousands of kids gained coverage in the state-federal health insurance program for the poor, according to a Kaiser Health News survey of a dozen states. 

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How Can States Fix Their Medicaid Programs?

How Can States Fix Their Medicaid Programs? | Medicaid Reform for Patients and Doctors | Scoop.it
All states will inevitably have to find ways to reform how they pay for Medicaid services. Right now, that way is looking like accountable care organizations.
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Study finds rise in ER visits after Medicaid expansion

Study finds rise in ER visits after Medicaid expansion | Medicaid Reform for Patients and Doctors | Scoop.it
Texas Medical Association's insight:

 Many people newly insured by Medicaid under the federal health care law are seeking treatment in hospital emergency rooms, one of the most expensive medical settings, a study released Monday concludes.

The analysis by the Colorado Hospital Association provides a real-time glimpse at how the nation's newest social program is working.

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GAO: HHS's Approval Process for Arkansas's Medicaid Expansion Waiver Raises Cost Concerns

GAO: HHS's Approval Process for Arkansas's Medicaid Expansion Waiver Raises Cost Concerns | Medicaid Reform for Patients and Doctors | Scoop.it
Texas Medical Association's insight:

In approving the demonstration, HHS did not ensure that the demonstration would be budget- neutral—that is, that the federal government would spend no more under the state’s demonstration than it would have spent without the demonstration. Specifically, HHS approved a spending limit for the demonstration that was based, in part, on hypothetical costs—significantly higher payment amounts the state assumed it would have to make to providers if it expanded coverage under the traditional Medicaid program—without requesting any data from the state to support the state’s assumptions. GAO estimated that, by including these costs, the 3-year, nearly $4.0 billion spending limit that HHS approved for the state’s demonstration was approximately $778 million more than what the spending limit would have been if it was based on the state’s actual payment rates for services under the traditional Medicaid program. Furthermore, HHS gave Arkansas the flexibility to adjust the spending limit if actual costs under the demonstration proved higher than expected, and HHS officials told us that the Department granted the same flexibility to 11 other states implementing demonstrations that affect services for newly eligible beneficiaries. Finally, HHS, in effect, waived its cost-effectiveness requirement that providing premium assistance to purchase individual coverage prove comparable to the cost of providing direct coverage under the state’s Medicaid plan, further increasing the risk that the demonstration would not be budget-neutral.

 
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Medicaid Expansion Is a Windfall for Hospitals

Medicaid Expansion Is a Windfall for Hospitals | Medicaid Reform for Patients and Doctors | Scoop.it
For-profit hospital chains report fewer visits from uninsured patients and greater revenue from Medicaid, according to a PwC analysis
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Texas tops in paying for other states' Medicaid expansion

Texas tops in paying for other states' Medicaid expansion | Medicaid Reform for Patients and Doctors | Scoop.it

TeIf the 23 states that have rejected expanding Medicaid under the 2010 health care law continue to do so for the next eight years, they’ll pay $152 billion to extend the program in other states _ while receiving nothing in return.

Texas Medical Association's insight:

States that decline to expand Medicaid give up billions in aid

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Avoiding Medicaid expansion, lawmakers seek a ‘Texas way’

Avoiding Medicaid expansion, lawmakers seek a ‘Texas way’ | Medicaid Reform for Patients and Doctors | Scoop.it
Texas lawmakers are exploring ways the state could provide more access to health care for 1.9 million uninsured poor people without acquiescing to guidelines set under the Affordable Care Act, sometimes referred to as Obamacare.
Texas Medical Association's insight:

Texas physicians want to ensure all Texans have access to coverage and, more importantly, access to physicians and health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance results often results in delayed diagnoses and treatment of chronic diseases or injuries, needless suffering and even death. That’s why TMA supports allowing state leaders to work with the Centers for Medicare & Medicaid Services (CMS) to develop a comprehensive solution that fits Texas’ unique health care needs. Several states have taken this step with some success, including Indiana, Arkansas, Iowa, Michigan, and Pennsylvania. TMA believes the Texas Legislature too can create an ingenious solution that works for the state and helps Texans in the coverage gap get affordable and timely care.

 

Any Texas-style solution expanding access must:

Draw down all available federal dollars to expand access to health care for poor Texans;Give Texas the flexibility to change the plan as our needs and circumstances change;Clear away Medicaid’s financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;Relieve local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors;Provide Medicaid payments directly to physicians at least equal to those of Medicare payments; andContinue to uphold and improve due process of law for physicians in Texas as it relates to the Office of Inspector General.
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Texas Medical Association's curator insight, August 15, 8:39 AM

Texas physicians want to ensure all Texans have access to coverage and, more importantly, access to physicians and health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance results often results in delayed diagnoses and treatment of chronic diseases or injuries, needless suffering and even death. That’s why TMA supports allowing state leaders to work with the Centers for Medicare & Medicaid Services (CMS) to develop a comprehensive solution that fits Texas’ unique health care needs. Several states have taken this step with some success, including Indiana, Arkansas, Iowa, Michigan, and Pennsylvania . TMA believes the Texas Legislature too can create an ingenious solution that works for the state and helps Texans in the coverage gap get affordable and timely care.

 

Any Texas-style solution expanding access must:

Draw down all available federal dollars to expand access to health care for poor Texans;Give Texas the flexibility to change the plan as our needs and circumstances change;Clear away Medicaid’s financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;Relieve local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors;Provide Medicaid payments directly to physicians at least equal to those of Medicare payments; andContinue to uphold and improve due process of law for physicians in Texas as it relates to the Office of Inspector General.
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What Is the Result of States Not Expanding Medicaid?

What Is the Result of States Not Expanding Medicaid? | Medicaid Reform for Patients and Doctors | Scoop.it
This brief looks at the economic impact on states that did not expand Medicaid.
Texas Medical Association's insight:
Key Findings

States that have not expanded Medicaid will miss out on $423.6 billion in federal funding between 2013 and 2022.

The decision of state leaders not to expand Medicaid also means their local hospitals will collectively forgo $167.8 billion in Medicaid reimbursement payments over the same timeframe.

Based on analyses of state budgets, for every $1 a state spends expanding Medicaid, $13.41 in federal funding flows into the state.

In total, hospitals in states not expanding stand to forgo $167.8 billion in reimbursement funding from 2013 to 2022

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Only 10% of Medicaid ER use is unnecessary, MACPAC says

Only 10% of Medicaid ER use is unnecessary, MACPAC says | Medicaid Reform for Patients and Doctors | Scoop.it
Last year, healthcare reform supporters reeled after the media gave widespread attention to a study of a 2008 Medicaid expansion in Oregon showing it had increased emergency room use by low-income adults. This week, the Medicaid and CHIP Payment and Access Commission released its official pushback document.
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Two Americas on Health Care, and Danger of Further Division

Two Americas on Health Care, and Danger of Further Division | Medicaid Reform for Patients and Doctors | Scoop.it
The Affordable Care Act was designed to make health care more affordable and more uniform, but court rulings could deepen the disparities among states.
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Everything is Bigger in Texas...Including Medicaid

Everything is Bigger in Texas...Including Medicaid | Medicaid Reform for Patients and Doctors | Scoop.it
Medicaid enrollment has climbed by 80,000 in Texas despite the state opting out of Medicaid expansion. - Todd Campbell - Health Care
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Pa. Medicaid managed-care expansion plans struggle to sign providers

Pa. Medicaid managed-care expansion plans struggle to sign providers | Medicaid Reform for Patients and Doctors | Scoop.it
Medicaid managed-care plans providing coverage under Pennsylvania's Medicaid expansion are struggling to find enough hospitals and physicians for their networks.
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Indiana’s Gov. Pence Presses Obama on Medicaid Plans

Indiana’s Gov. Pence Presses Obama on Medicaid Plans | Medicaid Reform for Patients and Doctors | Scoop.it
Indiana Gov. Pence put the future of the Medicaid program front and center when President Obama landed in Evansville, Ind., on Friday.
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For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says

For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says | Medicaid Reform for Patients and Doctors | Scoop.it
A federal report says state standards for access to health care are rarely enforced and that Medicaid patients may wait for months or travel long distances to see a doctor.
Texas Medical Association's insight:

TMA says:

 

Ensure competitive Medicaid and CHIP payments for physicians

Physicians want to take care of Texans who rely on Medicaid coverage for their care. Unfortunately because of the red tape and bureaucratic hassles coupled with low payment rates, many physicians struggle to continue to see their Medicaid patients.

 

Medicaid is a state- and federally funded health care program that provides low-income patients access to essential health care services. For every dollar Texas invests in Medicaid, the federal government contributes another $1.40. Without Medicaid, millions more Texans would be uninsured: As of June 2014, Medicaid covered nearly 3.8 million Texans. To qualify, patients must have a low income, but being poor doesn’t always mean a patient will qualify for the program. For example, low-income childless adults are not eligible in Texas even if their income meets the state’s Medicaid income requirements. Most Medicaid recipients in Texas are children, pregnant women, or disabled.

 

Texas allocated $56 billion in all funds to Texas Medicaid for budget years 2014-15; the state’s share was $22.1 billion, and the federal government paid $33.9 billion. While most enrollees (75 percent) are pregnant women and children, they account for only about 40 percent of the program’s costs. Seniors and patients with disabilities make up the other 25 percent of the patient population but account for 60 percent of the costs. In 2013, the Texas Legislature enacted numerous reforms to reduce total Medicaid expenditures by $961 million, including authorizing further expansion of Medicaid HMOs, improving birth outcomes, and restructuring the medical transportation program.

 

The Children’s Health Insurance Program (CHIP) provides health insurance to low-income children who do not qualify for Medicaid. Like Medicaid, the costs are shared between the state and federal government: In 2014, the federal government paid 70 percent of Texas’ CHIP costs. The Affordable Care Act (ACA) reauthorized CHIP through 2019 and approved funding for the program through September 2015. Pending continued funding, beginning in federal fiscal year 2016, the ACA will increase the CHIP federal matching amount another 23 percent, meaning Texas’ cost-sharing would drop from 30 percent to 7 percent. As of April 2014, some 500,000 low-income children were enrolled. To qualify, a family of four may not earn more than $47,700 (in 2014).

 

For physicians, Medicaid and CHIP are typically the lowest payers. They often do not cover the basic cost of providing the service. On average, Medicaid pays 73 percent of Medicare and about 50 percent of commercial insurance payments. In 2010 and 2011, the state cut already-meager physician payments another 2 percent.

 

Recognizing the inadequacy of Medicaid payments and the need to pay better to expand access to care, the ACA gave primary care physicians a temporary reprieve from low Medicaid rates. The act increased Medicaid payments to Medicare parity for primary care services provided by eligible physicians from Jan. 1, 2014, to Dec. 31, 2015. The federal government provided 100 percent of the funding to pay for the higher rates. CHIP services were excluded from the rate increase as were subspecialists.

 

Without action by Congress — or the Texas Legislature — the higher payments will soon expire. As federal action appears unlikely, Texas lawmakers should invest the necessary resources to improve appropriate and timely access to medical services for Medicaid patients not only by maintaining higher payments for primary care physicians, but also by ensuring competitive physician payment rates for subspecialists and the CHIP program.

 

If lawmakers cut physicians’ payments further or fail to invest in a robust physician network, millions of Medicaid recipients will have an enrollment card but fewer physicians caring for them, driving patients to use more costly emergency departments. 

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States' Customized Efforts To Expand Medicaid Could Complicate Reform

Some conservative states have won concessions from the administration in exchange for moving forward on expansion, and other states are carefully weighing those choices.
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Virginia governor unveils more modest Medicaid expansion plan

(Reuters) - Democratic Governor Terry McAuliffe proposed a plan on Monday to provide medical insurance for 25,000 uninsured Virginians, a move that falls short of his vow to expand coverage to 400,000
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Medicaid Expansion Creates Stark Contrasts Among Hospitals

Hospitals in states that have rejected expansion have seen flat or sagging admissions and little if any reduction in the numbers of uninsured and non-paying patients, while states with Medicaid expansion have seen the opposite, a PwC study finds.

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Maine Rolls Back Health Coverage Even As Many States Expand It - Kaiser Health News

Maine Rolls Back Health Coverage Even As Many States Expand It - Kaiser Health News | Medicaid Reform for Patients and Doctors | Scoop.it
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Tenn., Utah Exploring Medicaid Expansion Options - Kaiser Health News

Tenn. Gov. Bill Haslam says the state may soon send a proposal to Washington, while Utah Gov. Gary Herbert says he is "cautiously optimistic" that he can come to terms on expansion with the Obama administration.
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Arkansas Private Option's Latest Boondoggle: "Health Independence Accounts" Increase Dependence and Increase Costs

Arkansas Private Option's Latest Boondoggle: "Health Independence Accounts" Increase Dependence and Increase Costs | Medicaid Reform for Patients and Doctors | Scoop.it
Private Option cheerleaders in Arkansas have long promised that their ObamaCare Medicaid expansion plan would give patients “skin in the game” and “encourage personal responsibility.” A closer look at the newly introduced Health Independence Accounts highlight that they do the exact opposite, while also increasing dependence and costs. The HIAs are nothing like HSAs.
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TMA-Backed Law Prompts Medicaid Red-Tape Relief

TMA-Backed Law Prompts Medicaid Red-Tape Relief | Medicaid Reform for Patients and Doctors | Scoop.it
Texas Medical Association's insight:

Apparently, the state got the message loud and clear: Physicians and patients are overly frustrated with the myriad administrative roadblocks that came along with the expansion of Medicaid managed care in Texas. Thanks to the Texas Medical Association's advocacy during the 2013 legislative session and the successful passage of Senate Bill 1150, relief from red tape may finally be in sight.

 

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A Hospital Reboots Medicaid To Give Better Care For Less Money

A Hospital Reboots Medicaid To Give Better Care For Less Money | Medicaid Reform for Patients and Doctors | Scoop.it
In Cleveland, a public hospital may be succeeding at the seemingly impossible: saving money while making patients healthier. It's doing so by giving patients personalized attention.
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Arkansas Weighs Plan To Make Some Medicaid Enrollees Fund Savings Accounts

Arkansas Weighs Plan To Make Some Medicaid Enrollees Fund Savings Accounts | Medicaid Reform for Patients and Doctors | Scoop.it
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