Category Archives: Health & Human Services

Thousands mistakenly enrolled in California’s Medicaid expansion

you don't say

Shocker, not.

From CNN Money: California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog.

In a Feb. 21 report, the HHS’ inspector general estimated that California spent $738.2 million on 366,078 expansion beneficiaries who were ineligible. It spent an additional $416.5 million for 79,055 expansion enrollees who were “potentially” ineligible, auditors found.

Auditors said nearly 90% of the $1.15 billion in questionable payments involved federal money, while the rest came from the state’s Medicaid program, known as Medi-Cal. They examined a six-month period from Oct. 1, 2014, to March 31, 2015, when Medicaid payments of $6.2 billion were made related to 1.9 million newly eligible enrollees.

There were limitations to the California review, however. The audit extrapolated from a sample of 150 beneficiaries. The authors reported a 90% confidence level in their results — whereas 95% would be more common. That meant that the number of those ineligible could have been as low as 260,000 or as high as 630,000.

“If HHS has a strong reason to believe that California is systematically making enrollment errors, it would be helpful to show that in a more robust analysis,” said Ben Ippolito, a health care economist at the American Enterprise Institute, a conservative think tank. “The federal government should ensure that states are being good stewards of federal money.”

Nonetheless, the audit highlighted weaknesses in California’s Medicaid program, the largest in the nation with 13.4 million enrollees and an annual budget topping $100 billion, counting federal and state money. Medicaid covers one in three Californians.

The inspector general found deficiencies in the state’s computer system for verifying eligibility and discovered errors by caseworkers. The Medicaid payments cited in the report covered people in the state’s fee-for-service system, managed-care plans, drug treatment programs and those receiving mental health services.

California’s Department of Health Care Services, which runs Medi-Cal, said in a statement that it agreed with nearly all of the auditors’ recommendations and that the agency “has taken steps to address all of the findings.”

In a written response to the inspector general, California officials said several computer upgrades were made after the audit period and before publication of the report that should improve the accuracy of eligibility decisions.

Among the 150 expansion enrollees analyzed in detail, 75%, or 112, were deemed eligible for the Medicaid program in California. Auditors discovered a variety of problems with the other 38 enrollees.

During the audit period, 12 enrollees in the sample group had incomes above 138% of the federal poverty line, making them ineligible financially for public assistance, according to the report.

In other instances, beneficiaries were already enrolled in Medicare, the federal health insurance for people 65 and older or who have severe disabilities, and did not qualify for Medi-Cal. Onewoman indicated she didn’t want Medi-Cal but was enrolled anyway.

In 2014, the state struggled to clear a massive backlog of Medi-Cal applications, which reached about 900,000 at one point. Many people complained about being mistakenly rejected for coverage, or their applications were lost in the state or county computer systems.

California was one of 31 states to expand Medicaid under the 2010 Affordable Care Act. The health law established a higher federal reimbursement for these newly eligible patients, primarily low-income adults without children. After expansion started in 2014, the HHS inspector general’s office began reviewing whether states were determining eligibility correctly and spending taxpayer dollars appropriately.

Read the rest of the story here.

DCG

Trump letter enables states to require Medicaid recipients to work

Medicaid is a 1960s-era Lyndon Johnson anti-poverty Great Society government program that provides free health insurance (as well as benefits not normally covered by Medicare, like nursing home care and personal care services) to low-income adults, their children, and people with disabilities, totaling 74 million recipients in 2017. Jointly funded by the state and federal governments, Medicaid is managed by the states, with each state currently having broad leeway to determine eligibility. Although states are not required to participate in the program, all have since 1982. Medicaid recipients must be U.S. citizens or legal permanent residents.

The Affordable Care Act, i.e., Obamacare, significantly expanded both federal funding and eligibility for Medicaid, to include all U.S. citizens and legal residents with income up to 133% of the poverty line.

The U.S. Department of Health and Human Services (HHS) determines the poverty thresholds, updated each year by the Census Bureau. For the 2017 poverty thresholds, go here. As an example, the poverty threshold for a family of four is $24,600. That means a family of four with an annual income of $32,718 (133% of $24,600) or lower is eligible for Medicaid.

Like Medicare and Social Security, the federal government’s spending on Medicaid has burgeoned since the 1990s. If nothing is done, Medicaid spending will balloon to $1½ trillion in 2022.

↓Click image to enlarge↓

The Trump administration has signaled from the outset that it wanted to set a more conservative tone for Medicaid. On the day in March when she was sworn in as administrator of the Centers for Medicare and Medicaid Services (CMMS), Seema Verma dispatched a letter to governors encouraging “innovations that build on the human dignity that comes with training, employment and independence.”

Currently, 10 states intend to impose work requirements on able-bodied adults who are receiving Medicaid, but they need federal permission to do so. The 10 states are Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. Three other states are contemplating the work requirement — Alabama, Idaho, and South Dakota. (Washington Post)

Today, the Trump Administration issued a letter to state Medicaid directors which, for the first time in Medicaid’s half-century history, enables states to cut off Medicaid benefits to Americans unless they have a job, are in school, are a caregiver or participate in approved forms of community service — an idea that the Obama administration had consistently rejected.

To those who, predictably, will accuse President Trump of hard-heartedness, the letter specifies that:

“States must comply with federal civil rights laws, ensure that individuals with disabilities are not denied Medicaid for inability to meet these requirements, and have mechanisms in place to ensure that reasonable modifications are provided to people who need them.

States must also create exemptions for individuals determined by the state to be medically frail and should also exempt from the requirements any individuals with acute medical conditions validated by a medical professional that would prevent them from complying with the requirements . . . . As many Medicaid beneficiaries live in areas of high unemployment, or are engaged as caregivers for young children or elderly family members, states should consider a variety of activities to meet the requirements for work and community engagement . . . . States will be required to describe strategies to assist beneficiaries in meeting work and community engagement requirements and to link individuals to additional resources for job training or other employment services, child care assistance, transportation, or other work supports to help beneficiaries prepare for work or increase their earnings.”

CMMS could approve the first Medicaid work requirement waiver — probably for Kentucky — as soon as tomorrow!

Please keep President Trump in your prayers.

~Eowyn

Big rate hikes for health insurance will slam Washingtonians

O laughs

Obamacare going as planned…

This is not happening just in Washington. I have health insurance with BCBS OK and pay $550/month – up from $380/month last year. I have no co-pays (I pay the full contracted price when I walk through the doctor’s door) and a $6,800 annual deductible. BCBS informed me that my wonderful plan is being eliminated and I will soon receive my options for next year. I can hardly wait to see how much I get slammed.

From MyNorthwest.com: Open enrollment for health insurance in 2018 starts on Nov. 1 and thousands of people in Washington state will see big increases in their premiums.

The state’s insurance commissioner will officially release rates next week, and his office is warning that hundreds of thousands of people who do not get their insurance through an employer, will see a rate hike in the double digits.

Some 330,000 Washingtonians don’t get health insurance through an employer.

“I’m one of the folks who has to go out and get insurance on my own,” said Edward Weatherly, who is currently working a temp job. His monthly premiums?  “It costs me about $430 a month,” Weatherly said.

And the state’s insurance commissioner, Mike Kreidler, says rates for 2018 will go up – by a lot. “We’re looking at rate increases that are going to be in the 20s (percentage). We haven’t seen that, except going back before the Affordable Care Act,” Kreidler said.

The ones hardest hit will be the middle class – people who don’t qualify for a subsidy.

“It’s that person who doesn’t receive any help that I’m worried about. That’s going (to) say, ‘I’m going to hit the wall and I can’t afford this any longer,’” Kriedler said.

Weatherly is one of those individuals. He says it’s already difficult to make ends meet. “In addition to the rent, it’s pretty tough every month,” Weatherly said. “And there have been a couple of times I’ve thought about letting the insurance go.”

It gets worse – the insurance commissioner says people who are not subsidized with the most popular “Silver Plan” could see even more dramatic rate hikes. “On top of the mid-20 percent rate increase, they could see a 9 to 27 percent (increase) on top of that,” Kreidler said.

He says one reason for the steep increases is the uncertainty coming out of Washington, D.C. “I don’t care if they call it ‘Trumpcare’ whatever it is. But you’ve got to do something to make sure you’re taking care of the people. Access to affordable quality health insurance,” he said.

Weatherly says he’s hoping for a change.

I’m hoping we just get to a point where it becomes a right. So many things that we argue about, at both the national and the state level, that to me in the overall scheme of things don’t mean anything. It’s not life and death. Whereas health insurance, to me, is life and death,” Weatherly said.

The state insurance commissioner plans to release official rate hikes Thursday. Where you live could also impact how much your rates will go up, and the rates will be broken down by region, insurer and plan.

DCG

Washington state’s health-exchange rates to jump 24 percent

Shocker, not.

From Seattle Times: Washingtonians buying insurance through the state’s health-insurance exchange will see the largest premium increases next year since the exchange was created in 2013.

The Washington Health Benefit Exchange board this week approved rate increases averaging 24 percent. The rates, first approved by the state’s Office of the Insurance Commissioner, will impact about 180,000 customers.

“We at the exchange understand that, yes, this is going to create a challenging environment that is going to be difficult” for customers, said Michael Marchand, chief marketing officer and spokesman for the Washington Health Benefit Exchange, which was created after the Affordable Care Act (ACA) passed in 2010.

Customers of the exchange will also have fewer insurance providers to choose from in 2018. In King and Pierce counties the number drops from seven to four, Snohomish County goes from six to three and Kitsap County from four to three.

Rate increases averaged 11 percent last year, 4 percent in 2016 and 1 percent in 2015.

Read the rest of the story here.

DCG

Planned Parenthood Will Close 4 Iowa Clinics Due To New State Restrictions

mammograms

Don’t’ believe the fearmongering of this article from Refinery29. There are still PLENTY of health care clinics in Iowa. My quick search found the following:

The Iowa Association of Rural Health Clinics has a list of over 140 rural health clinics in Iowa. And of course, there are the countless other municipal health care clinics as well as private health care facilities.

Plenty of facilities for Iowa residents to receive “vital health services” that only Planned Parenthood can provide.

From Yahoo (Refinery29): Following in Texas’ disastrous footsteps, four Planned Parenthood clinics will close in Iowa because of the state government’s actions to partially defund the health organization. Iowa Gov. Terry Branstad signed a health and human services budget that discontinued the state’s federal Medicaid family planning waiver and replaced it with a state program that excludes any clinic that offers abortions.

Planned Parenthood of the Heartland announced on Thursday that it will close one third of its 12 health centers in Iowa this summer, leaving an estimated 14,600 patients in Quad Cities, Burlington, Keokuk, and Sioux City without their current healthcare provider.

Iowa’s $1.77 billion health and human services budget keeps roughly the same amount of funds for family planning as the previous year, but places new restrictions on which facilities can receive money to cover low-income patients’ health care. Because the Hyde Amendment already prevents federal funds from paying for abortion, the budget change is the latest attempt by Republican politicians to shut down abortion providers.

Defunding Planned Parenthood and forcing clinics to shutter keeps low-income women from accessing vital health services such as contraception and cancer screenings, as the organization says abortions make up roughly 3% all services it performs.

Back in 2011, Texas took similarly drastic measures, cutting its family planning budget by more than $70 million and directing it away from clinics that provided abortion. Across the state, 25% of all family planning clinics closed, and about 30,000 fewer women had access to a health clinic two years later.

Clinic closures in the Lone Star State also forced women to drive four times farther to have an abortion. A Texas Policy Evaluation Project (TxPEP) study found that Texas women whose closest clinic stayed open drove an average of 22 miles, while women whose closest clinic closed drove an average of 85 miles for health services. The women furthest from an open clinic had to drive more than 250 miles.

Iowa’s new regulations forced clinics to close right away, which foreshadows what will happen if the healthcare bill passed in the U.S. House of Representatives earlier in May becomes law. The GOP’s American Health Care Act proposes cutting off Medicaid reimbursements Planned Parenthood currently receives for treating low-income patients for one year unless its clinics stop performing abortions.

“We have seen what happens in states like Texas, and now in Iowa, when politicians attack access to care at Planned Parenthood — it’s devastating, and sometimes deadly, for the women who are left with nowhere to turn for care,” Dr. Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America, said in a statement to Refinery29. “I am concerned about the health and well-being of the people in Iowa who now can no longer turn to their trusted health care provider.”

Texas has already proven that when a state cuts off Planned Parenthood’s Medicaid funds, it forces clinics to close and keeps women from getting the health services they need. Now, Iowa has followed suit and essential care for women is at stake in one more state.

DCG

Aetna drops last 2 state markets under Affordable Care Act

Obama_laughing

Obamacare going as planned. Let’s hope we can get rid of this monstrosity.

From Yahoo: While Republicans rewrite the Affordable Care Act in Washington, the future of the current law has grown hazier with the nation’s third-largest health insurer completely divorcing itself from state-based insurance markets.

Aetna said late Wednesday that it won’t sell individual coverage next year in its two remaining states — Nebraska and Delaware — after projecting a $200 million loss this year. It had already dropped Iowa and Virginia for next year. The insurer once sold the coverage in 15 states, but slashed that to four after losing about $450 million in 2016.

The government-backed marketplaces are a pillar of the Obama-era federal law because they allow millions of people to buy health insurance with help from income-based tax credits. But insurers like Humana, and now Aetna, have been fleeing that market, and the remaining coverage options are growing thin. Other companies like the Blue Cross-Blue Shield insurer Anthem say they are wary of returning without a guarantee that the government will provide cost-sharing subsidies that reduce expenses like co-payments. Those are separate from the tax credits that help pay premiums.

The White House has assured lawmakers it will continue paying the subsidies, but it has offered no long-term guarantee.

About 12 million people bought coverage for this year on the exchanges, and every market had at least one insurer offering coverage. But a growing number were down to one.

Companies are in the middle of figuring out their prices and coverage plans for next year, and insurance experts expect some holes to develop in those marketplaces.

“All it takes is one insurance company to exit, and that can create panic for other insurers and they pull out too,” said Cynthia Cox, a health insurance expert for the nonprofit Kaiser Family Foundation, which studies health care. “Insurers don’t want to be the last one holding the bag.”

The federal law prevents insurers from rejecting patients based on their health, so if competitors pull out, the last insurer may be left covering all the high-cost patients in that market.

Metropolitan or highly populated areas are still expected to draw several insurers. But rural areas may not be attractive to insurers looking to cut losses. They generally have a smaller, older population.

Ultimately, insurers with the most common brand in health insurance, Blue Cross-Blue Shield, will decide the fate of the marketplaces. Many of those plans specialize in individual insurance and have a long-standing presence in their markets. They also are the only remaining option on exchanges in nearly a third of the nation’s more than 3,100 counties.

DCG

Candlelight vigils and funerals are being planned to highlight those who, activists say, will die under Trumpcare

hyperbole

From Vocativ: Activists are planning several protests around the country — at elected representatives’ offices and places of worship — to mourn for those they say will die if the Affordable Care Act is repealed.

Protesters are holding candlelight vigils, symbolic funerals, and die-in demonstrations to protest President Trump and the Republican Party’s efforts to repeal and replace Obamacare with a new bill, called the American Health Care Act or AHCA. The first vote by the House of Representatives on the measure is scheduled for Thursday.

One of the more grim protests being planned will be held in Des Moines, Iowa, in front of Republican Congressman David Young’s office. Organizers say the event is “a vigil to mourn the deaths of the Iowans and Americans that will die if Trumpcare is passed. Almost 200 Iowans are projected to die each year, 2000 total over the next decade. We need to make sure David Young knows what he would be voting for.”

Organizing For Action, the political advocacy group that grew out of President Obama’s first presidential campaign, is planning a funeral procession in New York’s Staten Island with an effigy of Trump as the grim reaper. The protest, planned for Thursday, will march to Representative Dan Donovan’s office.

Indivisible, an organization made up of former Congressional staffers, is also organizing a series of candlelight vigils for the estimated 24,000 people who will die yearly if the GOP plan is passed as it currently stands. One demonstration, to be held at a San Diego church, will “pray for mercy for the sick and suffering in San Diego and across America.”

In Cincinnati, nearly 100 people have said they will attend a “die-in” protest on Wednesday. Each participant is instructed to lie down on the ground while holding a sign stating their hypothetical cause of death. Among the suggestions are “I died from a bacterial infection because I couldn’t afford to go to the doctor” and “My cervical cancer wasn’t discovered in time because I couldn’t go to Planned Parenthood.”

The American Health Care Act is scheduled for a floor vote in the House of Representatives on March 23. President Trump and his administration have reportedly held a series of phone calls and meeting intended to pressure Republicans opposed to the bill to fall in line.  Several Republican lawmakers have come out against the bill, which they say fails to live up to promises of a full Obamacare repeal.

According to the non-partisan Congressional Budget Office, some 24 million Americans are estimated to lose health insurance over the next decade if the plan goes through.

DCG