VOLUME 2 - ISSUE 29
SEPTEMBER 1, 2011



Welcome to the Medicaid Update eNewsletter
This issue sponsored by NAPH's "This Week in Washington" Podcast



Republican Governors Call for Medicaid Overhaul
A new report from the Republican Governor's Association argues for a total overhaul of the Medicaid program and offers 31 proposals for change, including allowing States to control eligibility and benefits within a fixed global budget while being accountable for specific quality and outcome metrics. (Bloomberg News, August 30)

To Cut Medicaid Costs, GOP Governors Target Illegal Immigrants
And this Wall Street Journal piece highlights proposal #5 in the Republican Governors' report, which demands that the Federal government assume total responsibility for the health care costs of illegal immigrants. (The Wall Street Journal, August 30)

Profiles of Super Committee Members
Families USA has prepared a profile of each member of the debt reduction Super Committee and where they stand on Medicare, Medicaid, and the ACA. (Families USA, August 31)

Ruling: AHCCCS Copays Break Law
A three-judge panel of the 9th U.S. Circuit Court of Appeals has overruled HHS Secretary Sebelius and declared that Arizona's plan to impose co-payments of from $4 to $30 for childless adults and others on Medicaid who meet spend-down limits is a violation of federal law. The ruling affects some 200,000 Arizonans, including many homeless and others with chronic conditions and mental illness. (AZcentral.com, August 25)

Consortium for Citizens with Disabilities Ask CMS to Reject California Medicaid Cuts
In an August 25 letter to CMS Administrator Don Berwick, a coalition of 33 national advocacy groups representing persons with disabilities has asked that California's proposed 10% cut in Medi-Cal provider payments be rejected by CMS. (CCD, August 25)

Insurers See Growing Risks as Well as Revenues in Medicaid Managed Care
A Kaiser Health News piece looks at risk and reward in Medicaid managed care, with a particular focus on the 425,000 new Texans who will be so covered in the Rio Grande Valley next March as a result of legislative action this year driven by budget pressures. (Kaiser Health News, August 29)

Colorado Scaling Back Medicaid after Drastically Underestimating Numbers, Cost
Colorado's expanded Medicaid program for childless adults has proven far more costly than anticipated, prompting the State to reduce eligibility and cap enrollment. (DenverPost.com, August 31)


Illinois Medicaid's Managed Care Effort Stumbles
Illinois is finding that key hospitals and physician groups are refusing to accept new Medicaid patients because of low reimbursement and concerns about the practices of managed care plans, to whom Medicaid has been devolved, causing severe access problems for beneficiaries. (The Chicago Tribune, August 26)

Hospitals Slow to Sign up for Medicaid Managed Care
And in Virginia, where three new managed care plans will assume responsibility for Medicaid members as of October 1, only 15 of the State's 109 hospitals have signed up with one of the three new plans so far, citing confusion and lack of clear communication. (The Richmond Register, August 23)

State Medicaid Program to Request More Money from Governor
A short-term fix for the Georgia State budget, wherein lawmakers borrowed money from Medicaid to cover other expenditures such as State employee retiree and health care costs, has now come home to roost with a request for $570 million to cover a shortfall in Medicaid for 2012-2013. (AJC.com, August 25)

Michigan to Review Blue Cross Blue Shield Purchase Plan
The Michigan attorney general has announced that he will be reviewing the purchase of Medicaid managed care plan AmeriHealth by Blue Cross Blue Shield of Michigan, together with Independence Blue Cross in Pennsylvania, to make sure the transaction is "in the best interest of Blue Cross rate payers and Michigan taxpayers." (Detroit Free Press, August 19)

Hospitals Seek More ER Patients even as Medicaid Tries to Lessen Demand
Efforts by State Medicaid agencies to reduce inappropriate use of emergency rooms for basic primary care are being thwarted by hospitals that are aggressively marketing their ERs (convenience, low wait times, even online appointments) as revenue sources and presumably as gateways to admissions. (The Washington Post, August 22)

Ark. Gov. Zeroes in on 9 Areas for Medicaid Reform
As part of a plan to move Medicaid from fee-for-service to managed care, Arkansas Governor Mike Beebe has written to HHS indicating he wants to experiment with episode of care payments in nine areas to achieve savings. The nine are pregnancy and neonatal care, long term care, prevention, Type 2 diabetes, upper respiratory infections, cardiovascular disease, developmental disabilities, attention deficit hyperactivity disorder,and back pain. (Bloomberg Businessweek, August 22)

Glitches Leave Ohio Medicaid Providers Unpaid
Ohio's transition from a largely paper-based claims payment system for Medicaid to a new computerized system encountered some glitches in its first runs, leaving a small but very frustrated group of self-employed providers unpaid. (Chron.com, August 23)

South Carolina Dares Feds to Deny Medicaid Coverage to Male Breast Cancer Patient
The State of South Carolina Medicaid program is going ahead and approving treatment for a man diagnosed with breast cancer even though current Federal rules say only women can be covered. (FoxNews.com, August 19)



Federal and State Share of Medicaid Spending, FY2009


Click chart above and to see report.

Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from Centers for Medicare and Medicaid Services HCFA-64 reports, 2011.


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Medicaid Block Grants: a Tool to Give States More Control over Spending and Benefit Design

Grace-Marie Turner
President, Galen Institute, Washington, DC