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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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McAuliffe explores whether he can expand Medicaid coverage without legislature’s okay - The Washington Post

McAuliffe explores whether he can expand Medicaid coverage without legislature’s okay - The Washington Post | Medicaid Reform for Patients and Doctors | Scoop.it
The governor and his advisers explore whether they can bypass the legislature to achieve a policy priority.
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Illinois Medicaid moves to managed care

Illinois Medicaid moves to managed care | Medicaid Reform for Patients and Doctors | Scoop.it
Sherry Loveless can see the promise of managed care right through her bedroom door.
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Is Arkansas' "Private Option" A Block Grant? Insurance Expert Bob Laszewski Thinks So, But He Is Wrong

Is Arkansas' "Private Option" A Block Grant? Insurance Expert Bob Laszewski Thinks So, But He Is Wrong | Medicaid Reform for Patients and Doctors | Scoop.it
During the past few months, insurance industry insider Bob Laszewski has chronicled many of the failures of ObamaCare’s launch. He has raised some very important questions and concerns from the insurance industry about future policy and premium bumps that lay ahead under the ACA. Unfortunately, his recent attack on Republican governors and state lawmakers who have rejected ObamaCare’s misguided Medicaid expansion completely misses the mark. He contends that Arkansas’ “Private Option” is really just a block grant for Medicaid. But the truth lies in the fine print, and while there is no question the Private Option puts state taxpayers at risk, it also creates a new entitlement and ceded most of the control for the program to the federal government. It’s like putting the fox in charge of the hen house.
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State Medicaid ACOs Up but Struggles Mount

State Medicaid ACOs Up but Struggles Mount | Medicaid Reform for Patients and Doctors | Scoop.it
Colorado was one of the first states to launch an accountable care-like model in Medicaid. Other states are following suit, but Colorado has its own issues it's trying to smooth out.
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Texas Medicaid holds off on proposed limits for Gilead hepatitis drug

[Reuters] By Caroline Humer - Texas is reconsidering whether to impose strict limits on Gilead Sciences' $84,000 hepatitis C treatment for patients on the state's Medicaid health plan for the poor, at the urging of outside advisers, a state...
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Why Utah is the state to watch on Medicaid expansion

Why Utah is the state to watch on Medicaid expansion | Medicaid Reform for Patients and Doctors | Scoop.it
Gov. Gary Herbert is close to winning key concessions from the Obama administration.
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Medicaid Expansion Using the Private Option Could Mean Fewer Benefits

Medicaid Expansion Using the Private Option Could Mean Fewer Benefits | Medicaid Reform for Patients and Doctors | Scoop.it
At issue are “wraparound” benefits, such as free rides to doctors, designed to give low-income people the same kind of care and health outcomes as other people.
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Medicaid expansion proposals hit a wall in Florida Legislature

Medicaid expansion proposals hit a wall in Florida Legislature | Medicaid Reform for Patients and Doctors | Scoop.it
Hospitals, business alliances and grassroots groups continue to support Medicaid expansion. But lawmakers don’t want to have the debate.
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$34 million saved in effort to cut needless ER visits in Washington state

$34 million saved in effort  to cut needless ER visits in Washington state | Medicaid Reform for Patients and Doctors | Scoop.it
After fierce disagreement, the state Medicaid program and a coalition of doctors and hospitals devised a plan that last year helped cut nearly $34 million from expensive unnecessary emergency-room visits.
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Budding Liberal Protest Movements Begin to Take Root in South

Budding Liberal Protest Movements Begin to Take Root in South | Medicaid Reform for Patients and Doctors | Scoop.it
More than a dozen members of Moral Monday Georgia, a liberal activist group that has held weekly protests at the Capitol since January, were arrested.
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NCQA previews new medical home standards

NCQA previews new medical home standards | Medicaid Reform for Patients and Doctors | Scoop.it
The National Committee for Quality Assurance, under increasing pressure to demonstrate the value of its recognition programs, previewed new patient-centered medical home standards intended to put more emphasis on team-based care, integrating behavioral health and sustaining practice transformation.
Texas Medical Association's insight:

TMA says: Promote the patient-centered medical home for every Texan


Consider that the costliest 1 percent of patients in the United States account for more than 20 percent of what the nation spends on health care. They are older patients with cancer, diabetes, heart disease, and other serious chronic conditions. Many have multiple health problems, and their relatives might not be helping with their care. Most have private insurance and are white and female.

 

As public and private payers look for ways to lower costs, improve patient outcomes, and ease burdens to access, they are turning to models of care that both increase economic efficiencies and enhance patient care. One of these is the patient-centered medical home (PCMH) model. A PCMH is a primary care physician or physician-led team who ensures that patient care is accessible, coordinated, comprehensive, patient-centered, and culturally relevant. The physician or team directly provide, coordinate, or arrange health care or social support services as indicated by the patient’s individual medical needs and the best available medical evidence. The model uses a team-based approach with the patient’s primary care physician leading the overall coordination of care. Trained teams and well-constructed electronic health records (EHRs) are key to a successful PCMH.

 

TMA supports the use of the PCMH model in Medicare, Texas Medicaid, and commercial insurance plans. Public and private payers have, increasingly, been looking to this model as a way to reduce fragmented care, lower costs, avoid repetitive and costly procedures, and improve patient outcomes. Given the budget constraints that Texas faces and a growing population with unique health care needs, the PCMH offers the potential for Medicaid cost savings as well as improved patient outcomes and physician and provider satisfaction. 

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Pressure On Governors To Expand Medicaid Under ObamaCare

Pressure On Governors To Expand Medicaid Under ObamaCare | Medicaid Reform for Patients and Doctors | Scoop.it
As millions of newly eligble Americans sign up for Medicaid health insurance for the poor under the Affordable Care Act, pressure builds on states and their Republican governors that have balked at going along with the health law's expansion of the program. Under the law, states have a choice about whether [...]
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Medicaid plans divide Utah GOP

Medicaid plans divide Utah GOP | Medicaid Reform for Patients and Doctors | Scoop.it
After months of anticipation, Gov. Gary Herbert released a proposal Thursday to use federal money to help 111,000 low-income Utahns buy private health coverage, saying the state has a “moral obligation” to its citizens. “I believe we can accomplish the goal of taking care of the neediest among us in a fiscally responsible way,” Herbert said in announcing his “Healthy Utah Plan”. It is not, Herbert said, an expansion of ...
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Medicaid Battles Become Political Quagmires

While Pennsylvania Gov. Tom Corbett, a Republican, awaits a federal decision on his request to link a work requirement to Medicaid expansion benefits, Democratic governors and GOP lawmakers in Missouri, Montana and Virginia have battled each other to stalemates on the expansion.
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Health Coverage and Care in the South in 2014 and Beyond

Health Coverage and Care in the South in 2014 and Beyond | Medicaid Reform for Patients and Doctors | Scoop.it
This issue brief provides an overview of health coverage and care in the South today, with a focus on demographics, the impact of the ACA coverage expansions, and ongoing efforts to improve the delivery system and safety net in the South.
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States that did not expand Medicaid may see higher premiums

States that did not expand Medicaid may see higher premiums | Medicaid Reform for Patients and Doctors | Scoop.it
Some industry experts are warning that states that chose not to expand Medicaid coverage under Obamacare could see higher insurance premiums next year as hospitals continue to shift the costs of uncompensated care to private insurers.
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State to use $8 billion in Medicaid savings to help struggling Brooklyn hospitals

State to use $8 billion in Medicaid savings to help struggling Brooklyn hospitals | Medicaid Reform for Patients and Doctors | Scoop.it
ALBANY — New York and the feds have finalized a deal allowing the state to use $8 billion in projected Medicaid savings to help revive struggling Brooklyn hospitals, Gov. Cuomo announced Monday.
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In Miss., Medicaid patients struggle to find doctors

In Miss., Medicaid patients struggle to find doctors | Medicaid Reform for Patients and Doctors | Scoop.it
JACKSON, Miss. -- In the land of the poorest poor, less than half of Mississippi's primary care physicians are willing to see new Medicaid patients.
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NH Medicaid expansion signed into law

CONCORD – New Hampshire joined 25 other states Thursday in expanding Medicaid eligibility when Gov. Maggie Hassan signed Senate Bill 413 into law.
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Study: States refusing Medicaid expansion would benefit the most

Study: States refusing Medicaid expansion would benefit the most | Medicaid Reform for Patients and Doctors | Scoop.it
More than 15 million uninsured, underinsured people live in poverty line in those states.
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Medicaid deadlock firmly in place as Va. lawmakers return

Medicaid deadlock firmly in place as Va. lawmakers return | Medicaid Reform for Patients and Doctors | Scoop.it
McAuliffe’s 2-week campaign has done little to dent GOP opposition to expanding health program in Virginia.
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April 1 is a go for Michigan's Medicaid expansion

April 1 is a go for Michigan's Medicaid expansion | Medicaid Reform for Patients and Doctors | Scoop.it
Snyder, who fought to persuade fellow Republicans in the Legislature to agree to the Medicaid expansion under the contentious federal health care law, said he expects 320,000 residents to sign up in the first 12 months. Early April had long been the target date for starting the "Healthy Michigan" program, but Snyder wanted to be cautious after the federal government's botched rollout of healthcare.gov, the insurance market for the middle class in 36 states including Michigan. The expansion establishes individual health savings accounts for adult recipients and requires them to pay up to 5 percent of their annual income toward the government health insurance program that Michigan runs through managed-care plans. Monthly premiums and copays can be reduced if participants engage in healthy behaviors â€" starting with completing a yearly health-risk assessment to identify smokers, substance abusers and those who are overweight or not up to date on vaccinations.
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N.H. may be first of Medicaid expansion holdouts to sign on

N.H. may be first of Medicaid expansion holdouts to sign on | Medicaid Reform for Patients and Doctors | Scoop.it
Healthcare providers in Nebraska, New Hampshire and Maine are anxiously monitoring hearings in their states as lawmakers debate whether Medicaid will be expanded, while providers in Utah and Virginia will continue lobbying in advance of likely special sessions to settle the issue.
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