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Medicaid Expansion Presents Policy Challenges - NJ Spotlight

Medicaid Expansion Presents Policy Challenges - NJ Spotlight | Medicaid Reform for Patients and Doctors | Scoop.it
Experts point to outreach and provider incentives as key factors in reaching enrollment goals (NJMedicaid, still a lot of work ahead: http://t.co/t1xdRJE6pZ)...
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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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Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey | Medicaid Reform for Patients and Doctors | Scoop.it
This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies as of January 2016 provides a snapshot of state Medicaid and CHIP policies in place two years into the post-ACA era.
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CMS Approves California Medicaid Waiver. How Does It Differ From Texas’ Expiring 1115?

CMS Approves California Medicaid Waiver. How Does It Differ From Texas’ Expiring 1115? | Medicaid Reform for Patients and Doctors | Scoop.it
California is the latest state to receive federal approval for the renewal of a waiver meant to pay for reforming the Medicaid program by instituting new care delivery strategies and platforms.
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Iowa’s radical privatization of Medicaid is already struggling

Iowa’s radical privatization of Medicaid is already struggling | Medicaid Reform for Patients and Doctors | Scoop.it
The rollout of Republican Gov. Terry Branstad’s plan has gone even worse than HealthCare.gov.
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Montana is 30th state to accept ObamaCare Medicaid expansion

Montana is 30th state to accept ObamaCare Medicaid expansion | Medicaid Reform for Patients and Doctors | Scoop.it
Federal officials approved changes to the program to put on a conservative twist. 
Texas Medical Association's insight:

TMA's position: 

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; andContinue 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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California and Federal Government Locked In Debate Over Billions In Medicaid Funding

California and Federal Government Locked In Debate Over Billions In Medicaid Funding | Medicaid Reform for Patients and Doctors | Scoop.it
Delays in reaching an agreement on $7.25 billion in Medicaid funding for reforms in California has public hospitals and other providers worried.
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Medicaid Spending Soars — Mostly In Expansion States

Medicaid Spending Soars — Mostly In Expansion States | Medicaid Reform for Patients and Doctors | Scoop.it
New report finds the annual increase in Medicaid spending is the largest in at least two decades, spurred by the federal health law expansion.
Texas Medical Association's insight:

"Most of the growth in Medicaid enrollment has been from people who became eligible under the health law and therefore totally paid for by the federal government. States that expanded the program saw their share of costs increase by 3.4 percent compared to nearly 7 percent in states that did not expand. Much of the growth in the non-expansion states was from increased enrollment among previously eligible parents and children."

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Proposed Medicaid Expansion in Montana

Proposed Medicaid Expansion in Montana | Medicaid Reform for Patients and Doctors | Scoop.it
This fact sheet describes Montana’s Section 1115 and briefly describes Montana’s Section 1915(b) waivers, together called the Health and Economic Livelihood Partnership (HELP) Program, that expand the state’s Medicaid program under the ACA.
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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State indifference on health care baffling

State indifference on health care baffling | Medicaid Reform for Patients and Doctors | Scoop.it
Together, these two reports help flesh out a nasty portrait of Texas health policy. [...] the state’s failure to set up its own ACA exchange and to expand Medicaid as an option under the act have contributed to the state, despite the drop in the rate of those without insurance, still having both the largest percentage and number of uninsured in the nation. Texas doesn’t care. Because subsidies are involved, it decries the ACA as socialized medicine, though the coverage is offered by private i
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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Law Could Bring Remote Doctor Visits to Schools, by Alana Rocha, Justin Dehn and Edgar Walters

Law Could Bring Remote Doctor Visits to Schools, by Alana Rocha, Justin Dehn and Edgar Walters | Medicaid Reform for Patients and Doctors | Scoop.it
A new law will allow physicians to get paid for seeing children over a sophisticated form of video chat, as long as the patient is at school and enrolled in the state’s Medicaid program for the poor and disabled.
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Medicaid: Key Issues Facing the Program

Medicaid: Key Issues Facing the Program | Medicaid Reform for Patients and Doctors | Scoop.it
Texas Medical Association's insight:

GAO report on access, oversight, program integrity, and federal financing issues. With accompanying podcast. Worth the listen

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Texas Politicians And Businesses Feud Over Medicaid Expansion

Texas Politicians And Businesses Feud Over Medicaid Expansion | Medicaid Reform for Patients and Doctors | Scoop.it
Texas has turned down federal funds to expand Medicaid under the Affordable Care Act. Hospitals and some business owners want the money, but it's a tough sell in Republican-dominated state politics.
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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Skyrocketing Medicaid signups stir ACA fights

Skyrocketing Medicaid signups stir ACA fights | Medicaid Reform for Patients and Doctors | Scoop.it
Medicaid enrollment under Obamacare is skyrocketing past expectations, giving some GOP governors who oppose the program’s expansion under the health law an “I told you so” moment. More than 12 million people have signed up for Medicaid under the Affordable Care Act since January 2014, and in some states that embraced that piece of...
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President Proposes New Incentive for States to Expand Medicaid

President Proposes New Incentive for States to Expand Medicaid | Medicaid Reform for Patients and Doctors | Scoop.it

President Obama is proposing an extra incentive to states that have not yet expanded their Medicaid programs. Specifically, his Fiscal Year 2017 Budget will include a legislative proposal to provide any state that takes up the Medicaid option the same three years of full Federal support and gradual phase down that those states that expanded in 2014 received, no matter when the state takes up the option.

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Edwards sets July 1 date for planned Louisiana Medicaid expansion

Edwards sets July 1 date for planned Louisiana Medicaid expansion | Medicaid Reform for Patients and Doctors | Scoop.it
Louisiana Gov.-elect John Bel Edwards has set an ambitious timeline for a Medicaid expansion, saying he wants to have government-funded health insurance cards in thousands more people's hands by July 1.
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The ACA and Medicaid Expansion Waivers

The ACA and Medicaid Expansion Waivers | Medicaid Reform for Patients and Doctors | Scoop.it
This brief focuses on Section 1115 Medicaid demonstration waivers related to implementation of the ACA Medicaid expansion (eligible for ACA enhanced matching funds) or other coverage (not eligible for ACA enhanced matching funds).

 

To date, six states are currently implementing or planning to implement the Medicaid expansion through an approved Section 1115 Waiver (Arkansas, Iowa, Michigan, Indiana, New Hampshire, and Montana). New Hampshire and Montana will be effective in January 2016. Pennsylvania received waiver approval, but transitioned to a state plan amendment in mid-2015, so Pennsylvania is not included in the discussion of current and pending waivers.


In addition, two states currently have waiver proposals pending with CMS: Arizona and Michigan. Arizona implemented the expansion, but is now seeking changes based on state law. Michigan has a pending waiver amendment seeking changes required by state law to continue its expansion after April 2016.

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California And Federal Officials Reach Deal On Medicaid Reforms

California And Federal Officials Reach Deal On Medicaid Reforms | Medicaid Reform for Patients and Doctors | Scoop.it
A "conceptual agreement" worth $6.2 billion comes as a relief to California public hospitals, just as an earlier Medicaid agreement was set to expire.
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The North Carolina Experiment: How One State Is Trying To Reshape Medicaid

The North Carolina Experiment: How One State Is Trying To Reshape Medicaid | Medicaid Reform for Patients and Doctors | Scoop.it
With legislation that passed last month, North Carolina is trying to build a hybrid managed care, accountable care model – with doctors, hospitals and insurance companies all sharing some risk. Advocates worry it could eclipse gains made by Medicaid in the state in the past.
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How to make Medicaid expansion work for physicians

How to make Medicaid expansion work for physicians | Medicaid Reform for Patients and Doctors | Scoop.it
For primary care physician Doug Curran, MD, seeing Medicaid patients comes at a price—literally.

The Athens, Texas-based doctor’s only new Medicaid patients are children who leave the
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; andContinue 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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Why Expanding Medicaid Doesn't Always Make People Healthier

Why Expanding Medicaid Doesn't Always Make People Healthier | Medicaid Reform for Patients and Doctors | Scoop.it
New research shows that having affordable health insurance can improve people's health -- but only if a state’s health-care system actually works.
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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North Carolina providers, insurers may compete for managed Medicaid

North Carolina providers, insurers may compete for managed Medicaid | Medicaid Reform for Patients and Doctors | Scoop.it
A political and philosophical brawl among providers, insurers and policymakers in the Tar Heel State is reaching a possible resolution as North Carolina's Legislature attempts to coalesce around a bill that would overhaul the state's Medicaid...
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Arkansas governor proposes changes to Medicaid expansion

Arkansas governor proposes changes to Medicaid expansion | Medicaid Reform for Patients and Doctors | Scoop.it
Arkansas Gov. Asa Hutchinson supports keeping the state's first-in-the-nation hybrid Medicaid expansion, he said Wednesday, but only if the federal government provides the state with more flexibility to impose limits on the program.
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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Not Expanding Medicaid Can Cost Local Taxpayers

Not Expanding Medicaid Can Cost Local Taxpayers | Medicaid Reform for Patients and Doctors | Scoop.it
In some states that have declined to expand Medicaid under the Affordable Care Act, the cost of caring for people who would have qualified for Medicaid is being borne by local taxpayers.
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Feds unveil long-awaited overhaul of Medicaid managed care

Feds unveil long-awaited overhaul of Medicaid managed care | Medicaid Reform for Patients and Doctors | Scoop.it
The 700-page "uber rule" contains the biggest changes to Medicaid in a decade.
Texas Medical Association's insight:

TMA's Medicaid Managed Care recommendations:

 

✓ Establish a centralized credentialing portal so physicians can apply to participate in all the Medicaid HMOs participating in the service area simultaneously.

✓ Integrate Medicaid/Medicaid HMO application and credentialing processes for physicians applying to the program for the first time.

✓ Improve coordination of benefits between Medicaid and Medicaid HMOs to prevent recoupment of money from physicians after services were provided in good faith.

✓ Require Medicaid HMOs to communicate clearly to physicians and patients the process for obtaining services when an in-network physician/provider cannot be found.

✓ Require the HMOs to establish a dedicated contact person for a physician to call to request assistance in arranging services not available in network.

✓ Establish a Texas Health and Human Services Commission (HHSC) ombudsman to oversee Medicaid HMO network adequacy, respond to patient and physician complaints, and enact physician recruitment initiatives.

✓ Establish a division within HHSC dedicated to recruiting new physicians to participate in Medicaid, and/or allow the HMOs to recruit physicians who are not enrolled in Medicaid but whose specialty is needed in the network.

✓ Monitor HMO network adequacy more stringently. Apply stiffer penalties for plans that fail to maintain adequate networks.

✓ Require the state to publish in-network and out-of-network utilization trends and data about patient/physician complaints.

✓ Protect 2013 legislation that improves due process for physicians who are confronted with a Medicaid fraud or overpayment accusation.

✓ Ensure physicians and providers have a meaningful opportunity to appeal allegations of Medicaid fraud and/or abuse to an independent third party.

✓ Eliminate redundant efforts and expenditure of state funds, employee time, and other resources involved in investigating alleged violations of Medicaid regulations.

✓ Ensure Texas laws and regulations clarify the coordination of responsibilities, authority, and interaction among enforcement agencies regarding the Medicaid program.

✓ Eliminate data collection programs, such as the Texas Health Care Information Council, that don’t provide patients with useful information to make informed health care decisions.

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