Medicaid

For Autistic Adults, Options Scarce

Sep 23, 2014

It’s getting easier for parents of young children with autism to get insurers to cover a pricey treatment called applied behavioral analysis. Once kids turn 21, however, it’s a different ballgame entirely.

Many states have mandates that require insurers to cover this therapy, but they typically have age caps ranging from 17 to 21, says Katie Keith, research director at the Trimpa Group, a consulting firm that works with autism advocacy groups.

CHIP Future Unclear Under Health Law

Sep 18, 2014

The Children’s Health Insurance Program, a joint federal-state program known as CHIP, has helped cut in half the number of uninsured children since being enacted less than two decades ago, but its future is in doubt due to limited funding in the federal health law of 2010.  A year from now, CHIP will run out of money.  Some advocates for the program want the federal government to finance CHIP for another four years, while other experts have suggested two would suffice.  The Senate Finance Committee’s Subcommittee on Health Care will hold a hearing on the issue Tuesday.

Income inequality is taking a toll on state governments.

The widening gap between the wealthiest Americans and everyone else has been matched by a slowdown in state tax revenue, according to a report released Monday by Standard & Poor’s.

Even as income for the affluent has accelerated, it’s barely kept pace with inflation for most other people. That trend can mean a double-whammy for states: The wealthy often manage to shield much of their income from taxes. And they tend to spend less of it than others do, thereby limiting sales tax revenue.

Many people newly insured by Medicaid under the federal health care law are seeking treatment in hospital emergency rooms, one of the most expensive medical settings, a study released Monday concludes.

The analysis by the Colorado Hospital Association provides a real-time glimpse at how the nation’s newest social program is working.

It also found indications that newly insured Medicaid patients admitted to hospitals may be sicker than patients previously covered under the same program, which serves more than 60 million low-income and disabled people.

The nation's respite from troublesome health care inflation is ending, the government said Wednesday in a report that renews a crucial budget challenge for lawmakers, taxpayers, businesses and patients.

Economic recovery, an aging society, and more people insured under the new health care law are driving the long-term trend, according to the report published online by the journal Health Affairs.

States Help Pay ACA Tax On Insurers

Sep 2, 2014
Kaiser Health News

When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers.

But with an $8 billion tax on insurers due Sept. 30 -- the first time the new tax is being collected -- the industry is getting help from an unlikely source: taxpayers.

Amerigroup

Two major health care groups have named new Chief Operating Officers for their Florida operations.

 Liz Miller has been promoted to the position at WellCare of Florida, the Tampa Bay Business Journal reports. She has been the vice president of product operations at the Tampa-based company since 2012. WellCare is Florida’s large Medicaid HMO contractor.

Pediatricians challenging how the state pays for Medicaid services to children could see the nine-year-old case end in October, the Miami Herald reports.

The lawsuit, filed in 2005, claims that the Agency for Health Care Administration, Department of Health and Department of Children and Families violated federal law, and also hampered patient access by making low Medicaid payments to providers, the Herald reports.

Florida looks to lose more federal money set aside for Medicaid than any state that has opted out of expanding the health care program for the poor, says a new report from the Robert Wood Johnson Foundation and the Urban Institute.

 Several Florida safety net hospitals have filed a complaint claiming the Florida Agency for Health Care Administration underpaid them $73.3 million for Medicare patient care over the past 13 years, the Gainesville Sun reports.

The expansion of Medicaid managed care is the reason for the elimination of 85 state jobs at the Florida Department of Health in Polk County, the Lakeland Ledger reports. Among the positions that will be eliminated are registered nurses, advanced registered nurse practitioners, licensed practical nurses and health support workers. According to the Ledger, 28 of the positions are vacant.   

While many didn’t notice Gov. Rick Scott’s line item veto of funding to investigate Medicaid fraud, the chairman of the Criminal & Civil Justice Appropriations Subcommittee certainly did.

Judge Won't Dismiss Medicaid Lawsuit

Jul 9, 2014
law.fiu.edu

A federal judge refused Tuesday to dismiss a lawsuit that alleges Florida provides inadequate care to children in its Medicaid program, despite state claims that privatizing the program will resolve many of the problems.

Florida’s Agency for Health Care Administration will argue in a hearing today that its new Medicaid managed-care system, which takes full effect next month, should end a legal battle over the quality of care for children in Florida’s Medicaid program. As the News Service of Florida reports, the lawsuit brought by the Florida Pediatric Society says low payment rates mean doctors can’t afford to treat children, thus denying the young Medicaid patients access to physicians. A federal judge will hear the case Tuesday in Miami.

Florida hospitals have just one year to repay $267 million for Medicaid charges the federal government says it shouldn’t have covered during the past eight years, the Times/Herald Tallahassee Bureau reports.

State and hospital officials are asking for three years to pay back the overpayments to hospitals through the so-called Low-Income Pool fund, saying one year would leave them in dire straits.

The federal government has joined a whistleblower lawsuit against a company that provides doctors and other health professionals to work in hospitals in Florida and many other states. IPC The Hospitalist Group operates practice groups in Jacksonville, Ocala, Southwest Florida, Tampa, Broward County, Palm Beach County, Miami-Dade County and Orlando.

Florida can do a better job of caring for its elderly and disabled residents and the loved ones who care for them, a new report says.

The state ranked 43rd nationwide in a new AARP scorecard on long-term care released today, which measured criteria from affordability and access to choice of setting and providers. In particular, Florida placed dead last or near the bottom regarding quality of life and quality of care regarding adults with disabilities.

Shands Health Care System will pay $3.25 million to settle part of a whistle-blower lawsuit claiming six Shands hospitals billed and received overpayments from the government’s Medicare, Medicaid and Tricare programs, the Orlando Sentinel reports.

Medicare Won't Pursue Overpayments

Jun 2, 2014

Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a new report from the inspector general of the U.S. Department of Health and Human Services.

But in its reply to the findings, the Centers for Medicare and Medicaid Services (CMS), which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most expensive visits because it isn't cost effective to do so.

WellCare Health Plans

The interim CEO of WellCare Health Plans says he’s trying to move past the company’s troubles and focus on expanding its Medicare, Medicaid and prescription drug business, the Tampa Bay Times reports.

Dave Gallitano, the WellCare board chairman who led the ouster of the Tampa-based firm's most recent CEO last November, has made significant changes the past six months.

Pediatricians are worried the privatization of the state’s Children’s Medical Services program will leave some children without services, the News Service of Florida reports.

Medicaid coverage for these children changes to pre-paid health plans on Aug. 1. Some pediatricians think the transition has been poorly planned and could leave as many as 70,000 children without medical coverage.

In a column in the Tampa Bay Times, John Romano writes that more than a year ago, lawmakers claimed they were going to look for a solution to help low-income Floridians get health coverage after the House  turned down  a Senate bill to accept $51 billion in federal funds -- money made available through an alternative to  Medicaid expansion under the Affordable Care Act.

With 800,000 uninsured Floridians stuck in the “coverage gap” - too much money to qualify for Medicaid, but not enough for subsidies under the Affordable Care Act - the focus is turning on what can be done to help. 

The Florida Legislature turned down the option of accepting $51 billion in federal funds that would have provided them health coverage last year. With only one week left in this year's session, those in the gap - 20 percent of Florida’s uninsured - will most likely be left hanging.

A Marion County woman accused of defrauding Medicaid said in an affidavit she was caught up in living well and "got greedy," the Ocala Star-Banner reports.

CBS Miami

A plan to redistribute federal money among all of Florida’s hospitals will be delayed at least a year, legislators announced at a joint Health and Human Service budget conference committee meeting on Monday.

The so-called “tiering” plan would be a significant blow to the state’s 14 safety-net hospital systems, such as Miami’s Jackson Health System, which had been bracing for a $140 million cut to its budget, and the state’s two free-standing children’s hospitals, which were prepared to lose a combined $17.6 million.

  All session long, Florida's legislative leaders have frustrated advocates for the poor, as well as much of the business community, by declining to talk about the billions of federal dollars for Medicaid expansion that the state is forgoing.

While 7 million Americans enrolled for health insurance before the March 31 Affordable Care Act deadline,  Charlene Dill wasn’t one of them.

The young mother of three collapsed and died from a treatable heart condition on March 21. She fell into  Florida’s health care gap; her income from part-time commission-based jobs was just $9,000, too poor for Affordable Care Act subsidies, the Orlando Weekly magazine reports.

Medicaid.gov

Florida Medicaid received word Friday evening that federal officials have authorized a $2 billion hospital fund for indigent care starting July 1 and an extra $200 million for the state’s medical schools.

Justin Senior, Florida’s Medicaid director, said the Centers for Medicaid and Medicare Services okayed $2.2 billion for the “Low Income Pool (LIP),” which is used to support “safety-net” hospitals and clinics that treat a lot of Medicaid patients. The LIP is a combination of local and state funds that draw down federal match.

Getting rid of the five-year waiting period for children of legal immigrants to get health coverage through KidCare will improve health outcomes and save money, writes Cindy Arenberg Seltzer, president/CEO of the Children's Services Council of Broward County, in a column in the South Florida Sun Sentinel. Seltzer is urging lawmakers to pass measures that would eliminate the waiting period and give KidCare to more than 25,000 children.  

Florida’s Republican lawmakers remain staunchly opposed to expanding Medicaid — a system they’ve repeatedly said is too expensive and doesn’t improve health outcomes. Yet Florida’s Medicaid rolls are expanding under the Affordable Care Act whether Florida likes it or not.

That’s because people trying to sign up for health insurance under President Obama’s new health law are finding out — to their surprise — that they qualify for Medicaid, the federal health insurance program for the poor.

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