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GOP Caucus Opposes Medicaid Expansion — With Caveats, by Becca Aaronson

GOP Caucus Opposes Medicaid Expansion — With Caveats, by Becca Aaronson | Medicaid Reform for Patients and Doctors | Scoop.it
House Republicans on Monday agreed not to expand Medicaid as called for under the federal Affordable Care Act — but left the door open to doing it if the Obama administration grants Texas enough flexibility.
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"in its current form" is the key phrase
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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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What Diabetes Costs You, Even If You Don't Have The Disease

What Diabetes Costs You, Even If You Don't Have The Disease | Medicaid Reform for Patients and Doctors | Scoop.it
Diabetes costs the United States $322 billion a year, or $1,000 for each American. That's 48 percent more than it was just five years ago.
Texas Medical Association's insight:

TMA recognizes there is no single solution to preventing or addressing the negative impacts of obesity. Physicians, communities, parents, schools, and workplaces must pursue multiple, scientifically proven approaches. Each must identify potential barriers to implementing local approaches for dealing with this growing crisis. Our legislative leaders can also play an important role by creating and promoting good health care policy that improves the health of Texans. 

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AMA Calls for Coverage Expansion, SGR Repeal

AMA Calls for Coverage Expansion, SGR Repeal | Medicaid Reform for Patients and Doctors | Scoop.it
Undeterred by the results of the midterm elections, the American Medical Association is urging states that have rejected Medicaid expansion programs &
Texas Medical Association's insight:

TMA Says:

 

Texas physicians want to ensure all Texans have access to coverage and, more important, have access to physicians and other health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance 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. (See adjacent chart.) 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; and

• Continue to improve due process of law for physicians and other providers in Texas as it relates to the Office of Inspector General. 

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Majority of Voters Want State Autonomy for Medicaid Programs

Majority of Voters Want State Autonomy for Medicaid Programs | Medicaid Reform for Patients and Doctors | Scoop.it
Voters wouldn’t mind seeing states have more control over their Medicaid programs without federal meddling, according to the results of a new Morning Consult poll. Polling data show that when voters are told about how states and the federal government generally share the costs of Medicaid programs, 63 percent of respondents say states should be …
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The Fate of Medicaid Coverage for 2M People Could Hinge on the Outcomes of the Midterm Election

Texas Medical Association's insight:

Texas physicians want to ensure all Texans have access to coverage and, more important, have access to physicians and other health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance 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. (See adjacent chart.) 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; and

• Continue to improve due process of law for physicians and other providers in Texas as it relates to the Office of Inspector General. 

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The ACA Primary Care Increase: State Plans for SFY 2015

The ACA Primary Care Increase: State Plans for SFY 2015 | Medicaid Reform for Patients and Doctors | Scoop.it
This perspective provides additional information on state plans related to the Affordable Care Act's (ACA) primary care rate increase after the 100% federal financing ends December 31, 2014. The data in this report were collected as part of KCMU’s Annual Medicaid Budget Survey, conducted by Health Management Associates with the support of the National Association of Medicaid Directors,
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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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Perry-Appointed Board Backs Health Coverage Expansion

Perry-Appointed Board Backs Health Coverage Expansion | Medicaid Reform for Patients and Doctors | Scoop.it
A board of medical professionals appointed by Gov. Rick Perry said Wednesday that the state should provide health coverage to low-income Texans under the Affordable Care Act — a move the Republican-led Legislature has opposed.
Texas Medical Association's insight:

TMA says:

 

Texas physicians want to ensure all Texans have access to coverage and, more important, have access to physicians and other health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance 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. (See adjacent chart.) 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; and

• Continue to improve due process of law for physicians and other providers in Texas as it relates to the Office of Inspector General. 

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More States (Not TX or FL) Expected To Expand Medicaid in 2015

More States (Not TX or FL)  Expected To Expand Medicaid in 2015 | Medicaid Reform for Patients and Doctors | Scoop.it

Texas and Florida, with their large uninsured populations, are not expected to offer coverage to many low-income patients. KHN’s Phil Galewitz and Mary Agnes Carey discuss:

 
Texas Medical Association's insight:

TMA says:

 

Texas physicians want to ensure all Texans have access to coverage and, more important, have access to physicians and other health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance 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. (See adjacent chart.) 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; and

• Continue to improve due process of law for physicians and other providers in Texas as it relates to the Office of Inspector General. 

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Feds Have New Leverage in Medicaid Showdown

Feds Have New Leverage in Medicaid Showdown | Medicaid Reform for Patients and Doctors | Scoop.it
Next session, lawmakers will have 29 billion reasons to reconsider Medicaid expansion. That's how many federal dollars the Obama administration could hold hostage in exchange for some solution for 1 million uninsured Texans.
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Who Would Have Health Insurance if Medicaid Expansion Weren't Optional

Who Would Have Health Insurance if Medicaid Expansion Weren't Optional | Medicaid Reform for Patients and Doctors | Scoop.it
A new data set suggests that more than three million people would have gained health insurance across 24 states if the Supreme Court had ruled differently.
Texas Medical Association's insight:

TMA says:

 

Texas physicians want to ensure all Texans have access to coverage and, more important, have access to physicians and other health care providers. According to the Institute of Medicine, even when uninsured patients have access to safety net services, the lack of health insurance 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. (See adjacent chart.) 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; and

• Continue to improve due process of law for physicians and other providers in Texas as it relates to the Office of Inspector General. 

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Coming Medicaid plan rules will set new access standards

CMS officials say they're on track for a January 2015 release of sweeping new Medicaid managed-care regulations intended to ensure that beneficiaries get timely access to care and better integration of services.
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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
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 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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