Tag Archives: Medicaid Expansion

Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

Modern Healthcare reported yesterday that the State of Arkansas dropped almost 4,000 of its citizens from the Medicaid expansion because of failure to comply with work requirements the state enacted months ago.

The following summary and link is provided:

Nearly 4,000 Arkansans lost their Medicaid expansion coverage in October because they didn’t comply with the state’s new work requirement. Another 8,462 low-income adults lost benefits in the previous two months.

Source: Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

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Midterm Mashup

Well, the 2018 Midterm elections are over, and the analysis is beginning as to what this all means.

For those who wanted to send a message to the Russian puppet in Washington, the election meant that the House of Representatives will be controlled for the next two years starting in January by the Democrats.

For the Republicans, it means a greater control of the Senate, with at least one race, the one in my current state of Florida undecided and headed for a recount, as per state law.

However, there were many defeats for the party of Obama, Bill Clinton, Jimmy Carter, LBJ. JFK, Truman and FDR. Andrew Gillum lost to a nobody for governor of Florida who is connected to the Orangutan by an umbilical cord. Beto O’Rourke made a valiant, if futile effort against the worse person to hold a Senate seat, Lyin’ Ted Cruz. And a few Democratic senators lost seats in Indiana, Missouri and North Dakota.

But as far as health care is concerned, the change in the leadership of the House of Representatives means that the ACA is safe for another two years. and Medicare and Medicaid will not be cut, as the Senate Majority Leader has indicated he wanted to do.

Medicaid, in particular, came out of the Midterms a little better than expected before the election, as the following posts from Healthcare Dive, Joe Paduda, and Health Affairs reported this morning.

First up, Healthcare Dive, who reported that Red states say ‘yes’ to Medicaid . Idaho, Utah, and Nebraska said yes to expansion; Montana said no.

Joe Paduda echoed that in his post, “And the big winner of the 2018 Midterms is…Medicaid“. However, Joe stated that results in Montana were not final; yet, they had decided to expand Medicaid two years ago, but the vote was temporary, and yesterday’s vote was to make it permanent.

And lastly, Health Affairs reported in “What the 2018 Midterm Elections Means for Health Care” that besides blocking repeal of the ACA, Democrats may tackle drug prices, preexisting conditions protections, Opioids, Medicare for All, Surprise bills (unexpected charges from a hospital visit). regulatory oversight, extenders such as MACRA, Medicaid Disproportionate Share Hospital (DSH) payments, and Medicaid expansion, especially since gubernatorial wins in Maine, Kansas, and Wisconsin will make expansion more likely in those states.

Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas

Last month, you may recall, I posted an article about Medicaid work requirements in Arkansas from an article in Health Affairs.

Today, Health Affairs posted a follow-up article that reported that thousands are being shed from the Medicaid rolls in Arkansas.

According to the article, the Arkansas Department of Human Services officials announced on Sept. 12 that 4,353 people who were enrolled in the state’s Medicaid expansion program had been locked out of coverage for failing to comply with the work requirement for three months.

The agency has said those people will have until October 5 to apply for a good cause exemption if they were unable to access an online reporting portal because of network server issues that affected it and other agencies.

Source: Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas

Rural Hospitals to Fail If Medicaid Expansion Ends

In April of 2015, I wrote the following post, Hospital Closures Due to Failure to Expand Medicaid.

This morning, Health Affairs posted a brief, Ending Medicaid Expansion Would Cause Rural Hospitals to Go Under.

As the current regime in Washington, and its allies in Congress slowly dismantle the ACA, rolling back Medicaid expansion will lead to rural hospitals closing, and rural patients being forced to travel long distances to get to a hospital, or to forgo medical at all.

What impact this will have on the entire health care sector is too early to tell, and what this may mean for workers’ comp, is also speculative, but it can’t be good if hospitals in the heartland go out of business.

Some way to make America great again. On the backs of, and on the health of, rural Americans who voted for this clown.

ACA Repeal Opens Up Medical Travel: A Second Look

Note: Here is Laura’s second article on repeal of the ACA and its’ impact on medical travel. She breaks the article down by areas of the healthcare industry that will be affected by repeal and that might benefit from medical travel.

Repeal of Affordable Care Act Impacts International Medical Travel
by Laura Carabello

wphealthcarenews.com- The repeal of the Affordable Care Act (ACA) has been met with considerable market uncertainty. As the transition gets underway, many Americans will be scrambling to access affordable, quality care.

Fortunately, the international medical travel industry -“Travel for Treatment” – may finally gain the attention it deserves from the American public and U.S. employers. Experts predict that the number of Americans traveling abroad for medical care or episodes of treatment is expected to increase 25 percent annually over the next decade.

Medical travelers are likely to come from every market sector: the growing ranks of uninsured individuals, self-insured employers facing higher healthcare expenditures, disenfranchised Medicaid beneficiaries, as well as Medicare enrollees with high out-of-pocket expenditures and the loss of coverage for preventive care.

Individual Consumers
Once “minimum essential healthcare coverage” is no longer mandated, the burden of payment will transfer onto healthcare providers and systems that will be forced to continue cost shifting onto the backs of paying customers.

Fewer insurance companies will be willing to underwrite coverage in the exchanges. In fact, many will leave the individual marketplaces altogether because of the potential loss of federal subsidies for both beneficiaries and insurance companies themselves.

Burdened by hefty cost-shifting, more Americans will be forced to pay out of their own pockets for surgeries or treatments in the U.S. Those who can afford a plane ticket will find it increasingly attractive to travel outside the country for quality, affordable options, such as joint replacement, cardio-thoracic surgery, oncology, bariatrics, and a host of other medical procedures, including treatment for Hepatitis C.

Low-Income (Medicaid) and Seniors (Medicare)
For Medicaid beneficiaries who remained optimistic that their home state would offer expanded coverage, their prospects look dim. The unraveling of the ACA will leave millions of the poorest and sickest Americans without insurance. Many states may either abandon Medicaid expansion or be forced to significantly redesign their programs to ensure that individuals below 400 percent of the federal poverty level can receive affordable healthcare coverage and services.

While these low-income families may not have cash reserves to fund expensive care in the U.S., they might be able to gather the resources to access needed surgeries overseas – and pay less than half of the US rates. Those who have emigrated from Latin American countries, in particular, will take advantage of opportunities to travel to their homelands to gain access to care that is substantially less expensive, and in a familiar setting.

The 57 million senior citizens and disabled Americans enrolled in Medicare could also benefit from accessing international medical travel. Under a full repeal of the ACA, seniors face higher deductibles and co-payments for their Part A, which covers hospital stays, and higher premiums and deductibles for Part B, which pays for doctor visits and other services. Medicare enrollees may also lose some of their free preventative benefits, such as screenings for breast and colorectal cancer, heart disease and diabetes. The opportunity to access quality care at lower costs – plus prescription drugs that are sold at far lower price points outside the US – present attractive options.

Employers
Healthcare will continue to be driven through employers, and cost pressures will push high-deductible plans, risk-based contracting and consumerism. In the United States today, even a negotiated, discounted rate for a total knee replacement at a local hospital may well exceed $45,000, $60,000, or more. The bottom line for self-insured employers – the coverage model that now dominates the marketplace: even after factoring in the cost of travel and accommodations for the patient and the companion, as well as waiving deductibles and co-pays as incentives to program adoption, the savings on surgical procedures such as joint replacement are significant.

Employers will also be more likely to send workers to emerging COEs outside the country in light of the many partnerships that are underway between US providers and foreign hospitals. These collaborative programs are bringing American ingenuity, sophisticated technology and advanced levels of care to institutions throughout the world.

Quality and safety standards at many institutions are now equal to or exceed US benchmarks. Many foreign hospitals are accredited by Joint Commission International, an extension of the US-based Joint Commission. Select hospitals outside the country adhere to US clinical protocols.

In fact, one organization that serves self-insured employers – North American Specialty Hospital in Cancun – even offers U.S. surgeons with US malpractice insurance who perform pre- and post-operative care in the US and then travel to Cancun for surgery. This ensures continuous engagement and continuity of care.

Hospitals
The ACA has contributed to hospitals experiencing higher volumes of insured patients, but those volumes would drop with the law’s repeal. It could also cause fewer people to keep prescription coverage, which would be modestly negative for the pharmaceutical industry.

Experts believe the majority of primary care physicians are open to changes in the law but overwhelmingly oppose full repeal, according to a survey published in The New England Journal of Medicine.

Insurance coverage for the 20 million people who obtained insurance from the exchanges sparked growth in patient numbers for hospitals, which offset lower payments. Without this, hospitals can expect deepening economic problems. This could lead to higher prices, and greater impetus among individuals to seek medical care outside of the U.S.

Key Destinations for International Medical Travel
With the growing ranks of uninsured, medical travel options are likely to emerge as a critical solution to healthcare cost woes. Hospitals and providers in nearby locations such as Latin America – known as the LAC Region – are likely to become destinations of choice: less expensive travel expenses, reduced language barriers, and cultural familiarity. Individuals and employers will require guidance in terms of choosing the right providers and determining costs to overcome the challenges that lie ahead.

To view the original article, click here.

Low-Income Uninsured Declines Due to ACA Expansion: Kentucky

Richard’s Note: This is my 250th post, although not all of them were written by me, and some of them are just infograms; nevertheless, this is an important milestone. It shows that with dogged determination, in the face of heavy odds and criticism, one can persevere and be insightful at the same time. My only wish is that more people would read this blog, and that it would be taken more seriously. One does not need a title to be taken seriously. Just ask Donald Trump.

As reported today in Health Affairs, Kentucky, which was one of two Southern states to expand Medicaid in 2013, saw a sharp decline in the percentage of uninsured from 35 percent at the end of 2013 to 11 percent in late 2014.

This decline was part of a study that was completed before the new Kentucky governor, Matt Bevins, a Tea Party lackey, announced that he would discontinue the expansion.

The study used data from the Behavioral Risk Factor Surveillance System, an annual survey conducted by the Centers for Disease Control and Prevention. Residents of Missouri, Tennessee, and Virginia, three neighboring states not expanding Medicaid eligibility, served as study controls.

Some of the other study findings revealed declines in the number of people with unmet medical needs and lacking a regular source of health care.

But now that the new governor has discontinued the expansion, it is quite probable that rates of uninsurance will once again climb, as those who gained insurance under the ACA, will more than likely have it taken away from them.

What this means for the health care system in Kentucky, and in the other states that expanded Medicaid, should their states elect more Matt Bevins, is that people who one did not have insurance, will find themselves back in the same position before the ACA.

As I wrote back in May of last year, in my article, “Failure to Expand Medicaid Could Lead to Cost-Shift to Work Comp“, states such as Florida (my state), Texas (naturally), Virginia (legislature said no, governor wants it), Wisconsin (Scott (I hate unions) Walker, and others, are likely to see such cost-shifting.

Adding Kentucky to that mix will only make matters worse. Why the health care industry in general, and the workers’ comp industry in particular, does not explore ALL possible options to providing health care to low-income and injured workers, is beyond me.

But to leave out one particular option because some judge won’t order it (do doctors order executions?), or because some people think that medical care outside the three mile limit of the US is sub-standard, or because they like the status quo and are fooling themselves into believing that some new program or scheme will fix the problem?

And to tell your industry that those “ideas” are new trends without even trying that one particular option, cannot be called “outfront ideas”. It is just more of the same.

Readers of this blog know what that option is…it is part of the reason this blog exists, and why it will continue to exist. We must open our health care options to every conceivable possibility, no matter how far fetched or “out there” it is. It is a law of economics if you can find a product or service at lower cost, and at equal or better quality somewhere else, you will buy it. That seems to work for everything else, but health care.

 

 

 

Workers’ Comp Goes Federal: An Update

The other day, I wrote a post that said that state Medicaid programs will be able to recover all of the proceeds from a settlement that were expended on behalf of a beneficiary.

My reporting of MaryRose Reaston’s article garnered some very positive comments from some of my readers.

Yet, today, my fellow blogger Joe Paduda countered MaryRose’s article, and stated that “No, ACA has not ‘overstepped its bounds‘”.

According to Joe, the efforts by the states are just that, state-based, and they are allowed and enabled by federal legislation…separate and distinct from the ACA.

Joe cites an article written by Michael Stack, Principal of Amaxx LLC that summarizes Medicaid recovery in workers’ comp cases.

As Joe reports, Michael noted that the legislation that allows Medicaid to pursue settlements was part of the Medicare Secondary Payer Act, a part of the 2013 budget bill.

Normally, when I write about some issue someone else wrote about, I never have to provide my readers with an update that challenges the original author. Generally, my updates are just that, updates that add to the discussion. This is not the case here.

So just to be fair to everyone, I decided to correct the situation by writing a follow-up. I trust my readers will understand that I did not mean to mislead or take only one side.