Thursday, June 30, 2011
Wednesday, June 29, 2011
Tuesday, June 28, 2011
Monday, June 27, 2011
Sunday, June 26, 2011
Future Medicaid Eligibility Rules Raise Concerns - CQ HealthBeat
Future Medicaid Eligibility Rules Raise Concerns
By Rebecca Adams, CQ HealthBeat Associate
Editor
In 2014, Medicaid is scheduled to expand to cover more people, and all states will have to use a national eligibility standard. Currently the rules vary by state. The health care overhaul (PL 111-148, PL 111-152) says that starting in 2014 a person’s eligibility will be determined based on his or her modified adjusted gross income (MAGI) — a calculation that excludes some Social Security benefits. Applicants will be eligible if they earn 133 percent of the federal poverty level or less. This year, the federal poverty limit for a couple is $14,710.
As a result, Medicare Chief Actuary Richard Foster has said that hypothetically, a married couple could get Medicaid benefits if the pair each got Social Security benefits — say, $25,000 each, which they could leave out of the MAGI calculation — and the rest of their income was less than 133 percent of that year’s poverty limit. Even though the couple’s total income, including benefits, would be tens of thousands of dollars above the limit, they could still get Medicaid because those Social Security benefits wouldn’t count in the eligibility formula.
The Republican Governors Association released a statement Tuesday saying that the possibility “will boost Republican governors’ argument that Obamacare’s rules concerning Medicaid don’t make sense.” The group added that “Republican governors have long been advocating that the Medicaid provisions in Obamacare are in desperate need of reform.”
As word of this possible glitch in the new Medicaid rules spread, there appeared to be concern within the Department of Health and Human Services that some people not meant to get Medicaid benefits could wind up with them under the new law.
Richard Sorian, HHS assistant secretary for public affairs, posted a blog item explaining how the new rules will work. But in ending his item Sorian said: “However, we are concerned that, as a matter of law, some middle-income Americans may be receiving coverage through Medicaid, which is meant to serve only the neediest Americans. We are exploring options to address this issue, so that we can use taxpayer dollars responsibly while ensuring that all Americans have access to affordable, high quality health insurance coverage.”
Undert the health overhaul, the federal government will initially pay the Medicaid costs for newly eligible beneficiaries. The federal share will decline over time so that ultimately, it will pay 90 percent of the costs.
A spokeswoman for the Senate Finance Committee, the panel that wrote the provision, said that lawmakers used modified adjusted gross income as the standard for both Medicaid and the new exchange markets that will open in 2014, so that beneficiaries would face the same standards under both programs.
“Making eligibility for Medicaid and the health insurance exchange consistent will help millions of Americans connect with the affordable health care options they need,” said Finance Committee spokeswoman Erin Shields. “These changes don’t take effect until 2014, so we have time to review all possible cases to ensure Medicaid meets its mission of serving only the neediest Americans.”
Foster had estimated that as many as three million Social Security beneficiaries could be eligible even though their benefits, if counted, would have pushed them over the 133 percent-of-federal-poverty threshold.
However, a Centers for Medicare and Medicaid Services (CMS) spokesman said that when the new Medicaid eligibility guidelines take effect in 2014, there also might be some people who would currently be eligible for Medicaid who could not enroll in the program under the new rules. That’s because the MAGI formula does not allow the same income deductions to be considered that are allowed under states’ current Medicaid eligibility rules. Some people whose income had been lowered through deductions under the current rules and were therefore eligible for Medicaid might no longer qualify under the new formula. All states are required to allow beneficiaries to deduct some work-related expenses and child care costs. Other states might choose to allow more deductions, such as income that a student earned.
“When new health insurance exchanges open in 2014, there will be a simple set of rules that determines eligibility for both Medicaid and tax credits to help Americans afford coverage,” said CMS spokesman Brian T. Cook. “This simplification will stop people from falling into coverage gaps, and may cause some to be newly eligible for Medicaid and others to no longer qualify.”
Foster did not respond to an email seeking comment.
Thursday, June 23, 2011
Wednesday, June 22, 2011
Tuesday, June 21, 2011
Medicaid Mandate Targeted in Debt Talks, but Savings Are Questionable - CQ Healthbeat
Medicaid Mandate Targeted in Debt Talks, but Savings Are
Questionable
By John Reichard, CQ HealthBeat Editor
As talks intensify over reducing the nation’s debt, there is a real chance that negotiators could end up eliminating a 2009 rule requiring states to maintain current levels of Medicaid eligibility.
Republicans don’t much like the rule, called the “maintenance of effort” mandate, which was supposed to expire this month but was extended in the 2010 health care law. And eliminating it would give them a psychological lift in their so-far futile effort to bring down the health care law (PL 111-148, PL 111-152). Democrats and the Obama administration might find scrapping it useful as well — they could say they have started to overhaul costly entitlement programs.
But it’s a mistake to think that eliminating the “MOE” rule would significantly reduce Medicaid spending and enrollment. There are two reasons for this. First, states would only be able to roll back eligibility to a point, meaning savings would be limited. Second, those states most eager to get rid of the rule don’t cover that many people in Medicaid anyway.
The MOE originated in the 2009 stimulus law (PL 111-5), which gave states billions in extra Medicaid funding. In exchange, states had to maintain “eligibility standards, methodologies, and procedures” in place as of July 1, 2008 until June 30, 2011, the day the extra stimulus funding stops. That effectively prevented states from using the new money for non-Medicaid budgetary needs.
The 2010 health overhaul then extended the MOE for adults on Medicaid until 2014 when the state insurance exchanges start and for children through 2019. But the law did not continue the flow of extra money to maintain coverage levels required by the MOE.
“The reason they put it in effect was to say we ought to not slide backward so we have a higher mountain to climb in 2014,” said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. In 2014, the Medicaid eligibility threshold rises to 133 percent of the federal poverty level, extending coverage to an estimated 16 million uninsured Americans.
But even with somewhat improved revenues, states continue to struggle to balance their budgets, especially because the stimulus money is almost gone. Republican governors are pressuring members of Congress to pass a bill (HR 1683) that would eliminate the MOE rule, easing states’ ability to curtail enrollment.
At the same time, officials in
“They’re talking about trillions — with a ‘t’ — in cuts,” said Matt Salo, executive director of the National Association of Medicaid Directors. “And when you’re talking about trillions in cuts, almost everything has to be on the table,” including removing the requirement barring eligibility reductions.
But with trillions to cut, ending MOE provisions would do little to balance the federal budget. The Congressional Budget Office estimates that HR 1683 would reduce deficit spending by just $2.1 billion in 2012-2021.
The Power of the MOE
States want to eliminate the MOE not to slash Medicaid enrollment but to make some pragmatic changes, said Salo, who added that the requirement has also blocked some anti-fraud efforts. “We had situations in a couple of states where they do self-attestation of income — no documentation of income required. Tell us what your income is and we’ll enroll you. You don’t check. That’s a really easy tool to get people in.”
That procedure, Salo said, lacks the oversight needed to verify an applicant’s income. When states tried to toughen it, the Health and Human Services Department objected, saying that would violate the MOE prohibition on enrollment policy changes, he said.
He also said the MOE has gotten in the way of states’ efforts to crack down on people who transfer or hide assets in order to qualify for Medicaid. A 2006 deficit reduction law (PL 109-171) gave states new tools to fight that kind of fraud. But when
Other analysts say that the MOE does not, in fact, inhibit anti-fraud efforts and that Medicaid loses far more money to phony billing by providers and suppliers than it does through undeserving enrollees slipping into the program. And the states that most ardently back MOE removal won’t save much, they add.
“Many states have not expanded beyond core federal minimum eligibility requirements, except for children. If the MOE is repealed, states still could not reduce eligibility below these federal minimums. However, states could tighten enrollment procedures which would make it difficult for individuals to obtain and retain coverage if the MOE is repealed,” said Robin Rudowitz, a Kaiser Family Foundation analyst. CBO estimates that 300,000 Americans would lose coverage if the MOE were repealed, small compared to the 67 million now in Medicaid.
Health care law defenders say if the MOE rule goes, many children would lose coverage. And the planned Medicaid expansion in 2014 would be even more of a stretch. Urban Institute President Robert Reischauer said that if enrollment does contract, “two years from now we’ll be sitting here saying, ‘How can the states make such a huge change in who’s covered under Medicaid?’ I mean the expansion’s going to be even bigger than we thought.”
Medicaid Discussions Heat Up as Funding Pressures Grow
By John Reichard, CQ HealthBeat Editor
From a call by Republican governors to overhaul the program, to forums, speeches and new reports, the Medicaid program attracted an unusual level of attention in
At the start of the week, 29 Republican governors released a set of principles for overhauling Medicaid. Two days later, Sen. Orrin G. Hatch of
In a speech to the Heritage Foundation, Hatch said that the law’s 2014 expansion of the 67-million-enrollee Medicaid program to add 16 million uninsured is a “direct assault” on states’ rights in the Constitution. And Hatch essentially said that he agreed with the view that being on Medicaid is worse than having no coverage at all in terms of the health care recipients get.
Sen. John D. Rockefeller, IV., D-W.Va., let loose with a similarly fiery speech — in defense of the program. “Medicaid does exactly what it was designed to do . . . provide a safety-net for low-income Americans,” he said in a June 13 speech on the Senate floor. “There are lots of worthwhile and positive ways that we can improve the program. But trashing Medicaid for political gain should not be an option,” he said.
The sense of gravity surrounding the future of the program also was apparent at a June 13-15
They emphasized that the debate about Medicaid’s future focuses on dollars and budgets and not on the possibility that big cuts might mean that safety net hospitals could close and that recipients who are severely disabled might not be able to get the care they need on the private market. But attendees also were reminded that the nation faces a grave economic threat associated with its national debt and that the Medicaid entitlement must be addressed.
Dean’s Take
Warnings of the big stakes involved in curbing Medicaid growth were not confined to Republicans. Former Vermont Gov. Howard Dean said at a different forum Thursday sponsored by the
Dean called for a “global budget” for
Urban Institute President Robert Reischauer defended the Medicaid expansion, saying that “more people are in need and have had to turn to the government for this help.” But he said that the consequences of failing to control health spending growth are “tragically large” because higher state Medicaid costs are translating into them not spending enough on education. Reischauer said the
The week’s wide-ranging discussions about Medicaid did not suggest that support is coalescing for specific cost control tactics.
GOP governors spoke favorably about Medicaid block grants in their statement of principles but were otherwise vague in their policy prescriptions other than to emphasize state control of Medicaid. Democrats are unlikely to accept block grants in debt ceiling negotiations with Republicans, however.
Removal of “maintenance-of-effort” standards that require keeping current Medicaid eligibility standards in the health law is a real possibility as part of those talks (See related story, CQ HealthBeat, June 17, 2011). But elimination of the “MOE” is unlikely to trim enrollment levels or spending in a big way.
The Medicaid and CHIP Payment Assessment Commission released a report during the week detailing the role of managed care in Medicaid (See related story, CQ HealthBeat, June 15, 2011).
The report did not point the way to specific cost control strategies but it did note that an increasing number of people, including those with complex health care needs, now belong to private managed care plans that contract with Medicaid.
But there’s no consensus that moving Medicaid recipients into capitated managed care plans is an effective cost control tactic. A Connecticut state official told the National Medicaid Congress that his state is moving away from such private plans because they aren’t really working closely with providers to make health care more efficient (See related story, CQ HealthBeat, June 14, 2011).
And a study by the Commonwealth Fund concluded that payments to capitated plans entail considerable waste (See related story, CQ HealthBeat, June 15, 2011).
Another study documented problems with access to specialty care in Medicaid. Researchers posing as the mothers of sick children covered by Medicaid or the Children’s Health Insurance Program called clinics representing eight medical specialties in
“As we encounter new opportunities for restructuring the
Sunday, June 19, 2011
Thursday, June 16, 2011
President Kathryn K. Cheek, M.D. Welcomes You to the Georgia Chapter of the American Academy of Pediatrics Blog!
Welcome to our Blog!
On behalf of the Georgia Chapter of the American Academy Georgia
We also want to hear from you. First, when you see stories in your community that you think may be of interest to Chapter members, please send them to us and we can post them for others to read. Secondly, you’ll have the opportunity to comment on news stories or exchange opinions with other Chapter members about these events. (Please send these news stories to Jaime Rice Searcy at the Chapter office, at jrice@gaaap.org.)
I hope you will enjoy this new means of staying connected with your Chapter peers and other colleagues. I invite your feedback for future ideas and suggestions. As always, thank you for your support of the Chapter and the important work you do. We are pediatricians……..caring for Georgia
Kathryn K. Cheek, MD
President
Wednesday, June 15, 2011
Tuesday, June 14, 2011
Monday, June 13, 2011
Thursday, June 9, 2011
Wednesday, June 8, 2011
Tuesday, June 7, 2011
Monday, June 6, 2011
What Has the Georgia AAP Done for You Lately?
 |
| Kathryn K. Cheek, MD, FAAP |
From the President.
This is a question asked by many people as they wonder about the value of many organizations they are a part of. At the Georgia Chapter I think we have good answers to that question for you this spring.
The Georgia General Assembly adjourned a few weeks ago and we were there, involved and advocating on your behalf and for the patients we care for daily. Unfortunately, Medicaid rates were cut by 0.5%. We testified to legislative committees that Medicaid reimbursement was on an unsustainable path which would ultimately impact access to care. We were glad the cut was no worse than that in a very tough budget year; but we will still ask the Governor to veto this cut and preserve some stability in the Medicaid program. We were successful in making other things happen that you will be pleased about: Medicaid eligibility will improve thanks to “
Express Lane ” changes in the budget, scope expansions by other providers were held in check, and an idea that would have required fingerprinting of Medicaid patients was also stopped.
Express Lane ” changes in the budget, scope expansions by other providers were held in check, and an idea that would have required fingerprinting of Medicaid patients was also stopped.
Our winter board meeting was well attended and highly informative, with guest speaker Brian Castrucci, head of the state’s Maternal & Children Health branch. MCH programs are vitally important to our patients and we work closely with MCH to help you have these services available in your community for your patients.
In a few months, the Georgia Breastfeeding Coalition will have a new coordinator housed at the Chapter office. Our goal is to make the Chapter a leader in this important area and a resource to you as well. A revitalized coalition will improve the supportive climate for breastfeeding and we think it is something you’ll soon notice in your community.
We had a meeting with new Department of Community Health commissioner David Cook. We were the first of the specialty societies to meet with him. We brought several of our Medicaid concerns to his attention and we were impressed by his receptiveness to listening and to taking a hard look at the current Medicaid structure in our state. He wants to hear from us about our issues and with your help, he will. Please continue to provide us with your concerns/problems so we may work to facilitate solutions. You may do so by completing the Hassle Factor Form on the web site gaaap.org or calling us directly at 404-881-5020.
In January we learned of an unfair practice by one of the Medicaid CMO’s who recouped funds retroactively for a code (96110) which they decided no longer to pay. They stopped this egregious practice after we protested; and efforts to get them to refund what was recouped are ongoing.
We also, after months of discussion, convinced Medicaid to stop requiring NDC’s for vaccines when filing for administration fees. If you are still having any problems with reimbursement related to this issue please let us know.
We continue to meet regularly with the Ga. Coalition of Children’s Hospitals to investigate improved Medicaid service delivery models in the future. We are in the process of developing a ½ day meeting soon to facilitate our efforts to better inform ourselves about other more successful Medicaid programs across the US
As you read this, we will have launched a new Georgia AAP blog, along with Twitter and Facebook accounts to help our members keep in touch with the Chapter and each other more easily. We hope to be able to inform you of state/local events in a more timely fashion using these outlets. These new media channels will be most successful with your input and we looking forward to interfacing with you in a new way.
Bob Wiskind, MD and a Georgia team attended an AAP Disaster Planning meeting in Chicago Melinda Willingham, MD , went to the AAP federal legislative affairs conference in Washington
Near the end of April we met with new Public Health Director, Brenda Fitzgerald, MD, to discuss the many issues in child health which our two organizations share. We’re confident she’ll be a terrific advocate for children and we are looking forward to a great partnership with the new Department of Public Health.
Finally, we have a terrific CME conference planned for you in mid-June at Pediatrics by the Sea. All this above could not be accomplished without the interest and engagement of members like you, our board and committee chairs, along with our excellent staff. YOU make it happen—by your membership and involvement. Thank you. Grab your bathing suit - I hope to see you there!! Remember, we are…pediatricians, caring for Georgia
Kathryn K. Cheek, MD, FAAP
President
Sunday, June 5, 2011
Thursday, June 2, 2011
Just two weeks until...
Pediatrics by the Sea 2011
June 15-18, 2011
The Ritz-Carlton Amelia Island , Fla.
Pediatrics by the Sea is just 3 weeks away so make your registration soon to attend one of the Southeast’s finest pediatric CME meetings. This year we’ll welcome national faculty members Carol Baker, MD, Texas (infectious diseases); Michael Brady, MD, Ohio (infectious diseases) and, Larry Pickering, MD, along with our own outstanding faculty from Georgia
Plus…
¨Outstanding Seminars in Coding, Childhood Obesity, & Immunization. ¨Afternoon Workshops on New Concepts in Behavioral Health & ENT Skill Building
¨ Section on Families and Professionalism Luncheon on Friday on Emerging Therapies for Childhood Cancers.
¨ Friday morning Sunrise Yoga & Saturday morning Fun Run & Walk.
¨ Music at Saturday reception by the God Bless the Child Quartet.
For complete program & lodging information, visit http://e2ma.net/go/7077624024/208570746/223161407/14454/goto:http:/www.gaaap.org. Rooms are still available at nearby hotels, (but the Ritz has limited availability.) For more info: call Jaime Searcy at 404-881-5091; or email: jrice@gaaap.org.
From the Georgia Chapter Staff:
Best Wishes to all our Members & their Staff for a
Happy Memorial Day Weekend & Summer!