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Menges Group 5 Slides Series for December 2017

The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do. 

This edition addresses some aspects of how quality data are reported and are used in performance-based payment structures.

December 2017 — getting out of the stairwell in quality measurement and improvement

Menges Group 5 Slides Series for October and November 2017

The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do. 

Attached are our two most recent 5 Slide Series reports, both of which are focused on the Medicaid managed care industry.

The October 2017 edition summarizes an analysis of Medicaid MCO financial performance of Medicaid MCOs in each state, showing the degree to which the health plans are collectively experiencing gains or losses.  During 2015 and 2016, about two-thirds of states with MCO capitation programs landed in what we would consider an optimal place – with the health plans collectively earning a positive margin on their Medicaid business but with that margin not exceeding 5%.

The November 2017 edition looks state-by-state at the degree to which its 2016 Medicaid expenditures were capitated.  Nationally, capitation payments represented 48.9% of FFY2016 Medicaid expenditures.  This figure was 27% as of 2010.  It is highly likely that we have now crossed a threshold where the majority of Medicaid expenditures occur via capitation payments.  This is an encouraging trend given all that the Medicaid MCOs do to systematically facilitate access to care, measure and improve quality, and steer care towards cost-effective settings and treatments.  Our one caution is that for the Medicaid MCO model to achieve taxpayer savings, unit prices need to be held closely in line with Medicaid fee-for-service prices.  When providers with strong negotiating leverage secure payments from MCOs well above Medicaid fee-for-service rates, the Medicaid managed care program in that state is probably adding to taxpayer costs rather than yielding savings.

 

November 2017 Use of Capitation in Medicaid by State 2016

 

October 2017 Distribution of States by Medicaid MCO Operating Margin

Clay’s Weekly Medicaid RoundUp: Week of January 15th 2018

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2DveZ0w  (what an amazing song, nay – album!)

 

For optimist readers- http://bit.ly/2DvfoQA

 

LET’S TALK SHOP AT MEDICAID INNOVATIONS 2018 – I will be in Florida again (7th year for me, I think) for the Medicaid Innovations Conference. If you are going, let’s plan on meeting up. Jan 31-Feb 2, 2018. Check it out here- http://bit.ly/2mbKtl1

  

WORKIN’ FOR THE WEEKEND- The big buzz this week was KY getting its Medicaid work requirements waiver approved by CMS. This will have big implications for the dozen or so other states waiting on approval for their own waivers. This is an important change for the Medicaid program, so let’s spend this week’s roundup considering perspectives on it.

 

FIRST THE FACTS, MAM – KY is the first state to get approval for a slew of “conservative” features to modify its Medicaid program. Features include a work requirement (that doesn’t apply to pregnant women, children, the elderly, the physically disabled or the developmentally disabled), bennies will pay premiums up to 4% of their income, and bennies can be locked-out of coverage if they don’t prove their eligibility as required / scheduled. For the work requirements (also called “community engagement”), bennies that must meet these have to put in 80 hours a month starting in July (giving them 6 months to find a part-time job if they want to keep their Medicaid benefits). Overall about 350,000 bennies have to meet this requirement, and about 175,000 of them already meet it. One last thing on the “work” requirement – under new CMS guidelines on the next-gen waivers, if a benny has an addiction, getting treatment can count towards your hours.

 

Now let’s look at some point / counter-point for each camp.

 

TALKING POINTS FROM THE “SKY IS FALLING/ REPUBLICANS ARE EVIL CREW”-

  • It is in violation of the federal statute because it does not meet the objectives of the program, and lawsuits will stop it

Counterpoints: Litigation (with or without a belief in its merit even by the plaintiff) is a proven method of resistance. One can just as easily argue that it makes the program more efficient and thus frees up more money to better meet the objectives of the program.

  • It overcomplicates eligibility / will be too hard to enforce / creates more costs to enforce than it saves

Counterpoints:  Maybe. It could be very simple if states work with the right vendors. This is a whole new area for technology solution providers, and they could build off of existing systems like the unemployment data sets.

  • It is mean / cruel

Counterpoints: Not really. States have made sure to target who this applies to so that those that cannot be expected to work are not under the requirement. But I am sure this attack will be repeated over and over anyway. Emotional (regardless of veracity) appeals work.

  • People will die because of these changes

Counterpoints: Unproveable, but high value to throw out the bombastic claim (with no cost of making it)

  • Sick people cannot hold down a job

Counterpoints: If they are that sick, then do they meet the disability requirements?

  • Few will be under these requirements because most on Medicaid can’t work –

Counterpoints: What about the 50% of those under new requirements in KY that already are working? Or the study in JAMA showing about half of Medicaid bennies in Michigan working? This is just “making it official” for half of those impacted, and putting the other half on notice.

  • This is unproven

Counterpoints: So are all new ideas at first (especially in Medicaid). And most 1115 demo waivers remain demos forever and never really get evaluated anyway (see recent OIG criticism on this). If we slapped buzzwords like “population health” or “big data” on it, would you like it then? Or maybe a job could be one of those “social determinants of health”?

  • This will hurt hospitals / providers because there will be less “coverage”

Counterpoints: Maybe. Or maybe DSH never really went away, and maybe uncompensated care costs are an unproven black box useful for strong-arm budget tactics.

POINTS FROM THE “THIS IS WHAT INNOVATION LOOKS LIKE EVEN IF YOU DISAGREE WITH IT CREW”-

  • We are tired of Medicaid destroying our budgets and this is a fair way to deal with this

Counterpoints: For the most part I agree. The tricky part is this is healthcare, and you have to think through how to deal with catastrophic coverage. And the idea that healthcare is a human right has gained a lot of ground in recent years.

  • People who can work should (if they want public benefits)

Counterpoints: See above

  • This will help people rise out of poverty / brings them dignity in work

Counterpoints: I also agree. I personally know several people who were homeless / near homeless and a job and the commitment to it changed their life. But- Making this work will require an overall strategy in your state tied to jobs / your local economy. You can’t just get this waiver approved and expect various issues to magically be resolved.

  • This will allow for more money to be spent on the disabled / most vulnerable

Counterpoints: Makes total sense. Now if we could also deal with all the cash lost to fraud. I have some ideas on that. Call me.

  • People who don’t make the effort to work probably won’t make the effort to improve their own health

Counterpoints: Big Duh, here. Big question is where line is drawn investing limited dollars on those who won’t get engaged (at the cost of not spending it on those who will). Or just pretend there is unlimited dollars for Medicaid and all is fine and we can go back to the fairy tale of the way Medicaid was funded before Evil Trump came along.

  • Its about time the federal-state nature of Medicaid wasn’t a one-way street. States should have more control of their programs and not just have to do whatever the feds force them to do (with ridiculous, coercive funding incentives that create no real choice for states).

Counterpoints: I think you can guess by now I agree with this one. Here, Hear!

WHAT’S NEXT – There’s a cue forming for these types of waivers. Last I looked it was 10 states — Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin.  Combine the KY approval with CMS guidance recently released, and we will watch most of these get approved before summer. And more will follow.

CMS head Veerma is not playing around. She continues describe opponents of these ideas as holding onto “the soft bigotry of low expectations.” Whether the general blogosphere / MSM will ignore that volley, or attack it directly (many do), I am not sure. But she is claiming moral high ground from a conservative vantage point. And to do that in Medicaid is perhaps unprecedented. Or at least its been so long since we’ve seen it maybe we don’t recognize it. It may just be that fiscal hawks have had enough of being bullied by the doves, and have found their voice in a lady named Seema.

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (at least to put salt on your steps) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Tėvas pasiuntė Sūnų išgelbėti pasaulį.

Clay’s Weekly Medicaid RoundUp: Week of January 1st 2018

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2CGMpZP

 

For optimist readers- http://bit.ly/2CCXlI7

 

It’s a new year. And now that the tax bill is now law, I am starting to see normal Medicaid news again (i.e. this plan did that, or this state did this- instead of THE SKY IS FALLING IF TERRIBLE BILL XYZ FROM THE EVIL GOP IS PASSED!!!!). In other news, I was in Walmart the other day perusing the after-Christmas clearance aisles, and I saw these funny-shaped pink hats marked down to $1.99. Seems whatever market those were for disappeared in the new year. (One can hope).

 

I digress.

MAINERS PASS EXPANSION, GOVERNOR INSISTS SOMEBODY MUST PAY FOR IT– It’s not “free” when your neighbor pays for it, is it? “You have to pay for the law,” LePage said. “It’s going to cost money. And I intend to implement it, and the Legislature is required to fund it. If they do not fund it, it will not be implemented.”

 

INITIAL REPORTS OF ENROLLMENT DOWN IN SOME STATES – Now you can choose to believe its because of a new culture of fear or whatever CNN pumps into your brain these days, or you could maybe apply some more precise logic around what Medicaid is (healthcare assistance for the poor) and consider maybe the economy is finally picking up. How does your paycheck look today, by the way? Alabama and Arkansas (down 117k members, but really down only 58k when you realize 59k were just moved to subsidized exchange coverage) both are reporting enrollment decreases this week. Arkansas says the declines came from better enrollment verification (making sure those on the program were supposed to be) and higher employment (Medicaid as a trampoline not a hammock, as a certain Govn’r of Indiana used to say).

BCBS OF WESTERN NY HOPS INTO GENESSEE / NIAGRA MARKET- The Blue had left in 2013 under pressures of high Medicaid utilization, but now has approval to return. Blue is rolling out the return via an Amerigroup partnership plan.

KANSAS MOVES FORWARD WITH WORK REQUIREMENTS WAIVER DESPITE HOSPITAL OBJECTIONS– Hospitals in the state want an exception for rural members who have less job options.

RX MISCLASSIFCATION REBATE LOSSES GO BEYOND MYLAN- Looks like it was more than Epipens that got miscategorized and caused Medicaid to spend $1B more than it had to. Latest analysis shows about 900 drugs were getting rung up at too-low rebate levels between 2012 and 2015. But… only 2 drugs accounted for 90% of the total estimated losses. From what I can tell some of the misclassification error ties to FDA processes, and CMS may be somewhat hamstrung in what it can do to address this.  If you know more, please write in.

MARIO AND ANDY (WOULD HAVE BEEN SO GREAT IF HIS NAME WAS LUIGI INSTEAD, OR MAYBE IF MARIO’S NAME WAS OPIE. OR BETTER YET, BARNEY) TEAM UP TO MAKE LOTS OF CASH IN MEDICAID- Yes, yes I know. Both Dr. Mario Molina and Andy Slavitt have tons of fans here on LinkedIn for their many good works. Good works are profitable (sometimes) and have allowed Mario and Luigi enough cash to invest in Cityblock Health. Cityblock Health just received another $21M from investors (not all of it from Andy and Opie). Cityblock’s current value prop is providing “personalized care,” preventive visits and access to other social programs. Expect that value prop to evolve as the idea moves onto Series B funding, etc (the Private Equity world is a fluid one).

ACLU SUES R.I. MEDICAID AGAIN- The state has a program that pays Medicare premiums for duallies, but that system is SNAFU-ed fairly regularly. No determination has been made yet if it has reached a state of FUBAR. The ACLU has filed a Whiskey Tango Foxtrot lawsuit, saying that its nice that the state fixes the issues on a case by case basis, but it really needs to fix the computer system once and for all. Duallies keep getting notices of non-payment of premiums from SSA, and that computer system (the federali one for SSA) is deducting premium payments from their social security check instead of letting R.I. Medicaid pay for it. As the Beastie Boys opined in the Halcyon days of the late 1990s- Never trust a Hal 9000.

DE TO COVER 12 OBESITY VISITS A YEAR- Starting this month, if you are on Delaware Medicaid with a BMI of 25 or higher you can see a clinician to help with your obesity. The state is one of the founding members of national program called My Healthy Weight.

BLUELIGHT SPECIAL– Remember Kmart? Seems the retailer overbilled various state Medicaid programs decades ago for drugs (I guess I never knew they had pharmacies). States joined up in a Qui Tam suit and each got some payouts. The ones I saw this morning include HI ($84k) and IL ($1M).

LET’S TALK SHOP AT MEDICAID INNOVATIONS 2018 – I will be in Florida again (7th year for me, I think) for the Medicaid Innovations Conference. If you are going, let’s plan on meeting up. Jan 31-Feb 2, 2018. Check it out here- http://bit.ly/2mbKtl1

 That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (holy cow its cold) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Tēvs sūtīja Dēlu, lai glābtu pasauli.

A list of 3 things: A blue truck. A gold watch. A yellow rake. (A requiem)

This will be my Year in Review post for 2017. It is also a requiem. (If you have never heard Faure’s Requiem performed live, you really should, by the way).

A requiem for my Father.

He died yesterday afternoon.

This post will be raw and rambling. I have shepherded it a bit, like a drunken sheep being nudged by a more drunk shepherd through rocky crags and valleys. But for the most part I wanted you to see this as it is. If Faulkner perfected stream of consciousness, I have refined (butchered?) stream of consciousness and compounded with ADHD.

Last year’s Year in Review mixed reflections on my personal life and thoughts on Medicaid industry happenings. This one is pretty much just thoughts on personal life. So if you are here for the Medicaid insights only, probably a good one to skip.

 

Last chance to stop reading. Tears ahead. Bridge may ice in winter.

 

Long time readers will know I gave up long ago trying to disentangle the “personal” from the “professional.” We are people: whole, integrated people comprised of a million different parts and hats and roles and desires and heartbreaks and dreams. Fearfully and wonderfully made. We choose which parts of ourselves to show in certain situations, such as work or LinkedIn. But to choose the same parts to show and the same parts to hide every single instance depending on the setting is strange. That is called acting. And I am not an actor. At least I hope not.  Let us not be actors. Let us sometimes show each other our humanity.

If you read my end of year message last year, you know it was also a sort of requiem for our dear dog Keegan.  If you are a glutton for punishment and just want to cry, here’s a link to that one – https://www.linkedin.com/pulse/saying-goodbye-2016-year-review-clay-farris/

 

But onto the Goodbye to 2017.

 

People’s lives sometimes are often symbolized and summarized by objects they used. Or gave. Or held onto. Or coveted and gave all their precious life to possess. Don’t be one of those people to whom the latter sentence applies.

This list of three things are what summarize my thoughts on my Daddy this morning. There was of course so much more to him (there’s so much to any person), but I like threes. And you need to stop reading at some point eventually, so we will stick with three.

A blue truck

As far as I know this was the only car (vehicle) Daddy ever bought new. It was a 1986 Ford F-150, dark blue and gorgeous to this day as it sits in my yard. Sure, now its rusty and has a window that won’t roll down. But that model is still a popular one 31 years later- I had someone just the other day stop at the driveway and ask if they could buy it. Dozens of people have asked that over the years I have driven it. I assume they are people – like myself – who sold a car they loved (mine was a 1964 ½ Ford Mustang) and regretted it and forever chase it on the wisp of a hope to catch that feeling of having it again. Of driving it again. And having all the feelings they had when they had it the first time.

My wife complains about The Truck sitting in the yard. But she is not from here and she does not know that having an old truck sitting in the yard in Alabama is an important status symbol. To not have one is to be of apparent low-class and not be aware of the rules of your culture. When in Rome.

And besides, I know the truth. When whatever beater of a car I had would break down, Daddy would let me borrow the truck for months at a time. Girls in college used to think it was cool.

But the thing about The Truck is not The Truck itself. Its what it was used for. And the memories I have being in it.

Like the time when I was 10 or 11 and Daddy, my grandfather (PawPaw) and me were all 3 riding in it on our way to a primitive island off South Carolina to go fishing.  As we drove 50 miles an hour on some country highway, a lawn mower threw a rock through that little triangular smoker’s window right in front of the main window. Little pieces of glass shattered and it made a terrifying noise. But we were all ok. It became a vivid memory that a small child held onto as he became a man.

Or family vacations we took in it, with the three kids riding and sleeping in the bed of the truck in a campertop. 2 things – that seems so insane in today’s age. When was the last time you saw someone riding in the back of moving truck? Yes, I know its unsafe. But it is glorious. When was the last time you rode in the back of a moving pickup? Don’t you want to? You cannot deny it is fun. And #2- I am glad he got rid of the camper years ago. I have always thought they were nerdy.

One time the truck was converted into a diamond engagement ring. I had known my wife for all of four or five months before I couldn’t take it anymore and I had to get a ring on her finger. Problem was I had a yellow sports car. And between the payment on it, insurance (I used to get lots of tickets), costs to park it in downtown Hotlanta and the 93 octane it just had to have – there was no ring money left over. So – yet again – I sold a car I loved. But this time it was because of a woman I loved and I still have the woman so I don’t miss the s2000 as much as I miss the Mustang.

When I sold it, I started driving The Truck. But since my wife (fiancé at the time) didn’t know the backstory then, all she saw was this guy who used to have a fast, sexy yellow car now was pulling up in a very old truck.  But that all turned out ok (see comment above about how The Truck wins girls over).

The Truck cost $6,000 brand new in 1986. There is no way it hasn’t saved $30,000 in moving fees alone. All the times I used that truck to move me, or my roommates or friends. The times he did the same. Over and over and over.

I love the dent it has in the door from Mrs. Jackie, Daddy’s neighbor 4 doors down who loved him so much and is so sad at his dying. I love how hard it is to drive (except for me, and that’s the truth. My little brother David never could drive it without grinding the gears), and that I will have it to teach my children how to drive a stick. I love that he gave it to my son Caleb (when he was 4) to fix up when he is older (he’s 7 now, so it will be sitting in the yard a while, honey).

I love how its got at least 300,000 miles on it, but we are not sure because the odometer wasn’t working for a few years in the early 2000s.

I love the Old Blue Truck.

A gold watch

Daddy was a preacher. And part of being a preacher (usually) is not having much money. This is important in a paragraph or two, so hang on to it.

I am an overeducated fool. I have two – count em’, too!- masters degrees that are basically unrelated to each other. And I took out student loans for both of them that took me ten years to pay off. (So maybe there are other ways to be broke besides preaching. But this is not the sentence you need that other sentence for. Just hang on to it a bit longer).

When I walked for my masters in history, I flew back to Birmingham from Baltimore where I was finishing my masters in public health. And Daddy gave me a gold watch with the UAB insignia on it. I will never forget how proud of me he was. And I will never forget what he said when he gave me the watch – “I wish I could give you more, but I don’t have a lot right now.”

(That was the sentence).

That was in 2002. For a few years I did not wear the watch. It just did not fit whatever silly fashion style I was trying to pull off back then I guess.

But when he started to get sick a few years back, I pulled it out. I wore it whenever I could. And when I would go to see him I made sure I was wearing it.

And as much as I generally hate possessions, it has become precious to me. I often think of Bruce Willis’ storyline in Pulp Fiction when I think about this watch. If you haven’t seen the movie, Bruce Willis is a boxer who has gotten mixed up with the mob. He throws a fight and is rushing to get out of town when he remembers he left his watch. You learn that it was his father’s watch. I understand now why Bruce Willis risked his life to go back and get it.

I love my Gold Watch. Though Daddy thought it was a pauper’s gift when he gave it, it became priceless to me.

A yellow rake

We moved back to Birmingham 5 years ago to be near my parents for when they started to need help. And having gone through the last 2 years of Daddy’s depression, then brain cancer, I am so grateful and praise God for doing whatever He did to put that burden to return home on me / in me.

When we moved back we bought an old 1970s brick ranch with 2 acres. For me the main feature was a large garden that had been used by neighbors (it still is) and the previous homeowner.

One of my first memories is of a garden Daddy made at the first church he preached at. Like all things Daddy did (and that I do), he way overdid it. The garden was ridiculously large. And he loved it and tended it with a passion.

Another of my first memories is running away. I was about 7 and was upset for whatever reason a 7-year-old gets upset, and I packed my suitcase full of books and went and ran away. To the end of one of the rows of corn.

But back in the present (or 3 years ago, the recent present if there is such a thing), we bought this house and started a garden. My ulterior motive was to lure Daddy up to our house (we live on a mountain a few miles from them. Or from Momma, now. I guess). You see, once a preacher, always a preacher. And even though he hadn’t had a church for decades, he still spent all his free time doing something to help somebody. Like lots of somebodies. And usually the undesirables, who are never conveniently located. So Daddy was gone a lot. To nursing homes or mental institutions or prisons or bridges under the interstate. But he was also around a lot. The trick to increasing the ratio in your favor of more time with him was to involve fishing or Auburn football.

Or maybe a garden.

I had dim memories of him loving that huge garden way back when and thought if I made a garden he would come.

And he did.

He planted 2 rows of beans two years in a row. And when I say planted, what I mean is he spent 3 solid days crafting a hundred or more perfect little hills of dirt to plant them in. And another 2 days constructing a support system out of bamboo and garden wire for them to climb.

After he planted, he would again disappear off somewhere. Like out of town somewhere to see an old friend. But he would call. To check on the beans. “How are my beans doing? Have they sprouted yet? Have any started to climb? You know, there’s that one down at the end of the first row, I think it will be ready to climb in a few days if we get that rain.”

Once beans sprout you start to see weeds sprouting, too.

And that’s where the Yellow Rake comes in.

Daddy meticulously hand-weeded two 80 foot rows of beans. On his belly. Multiple times a summer. It took him days and days each time. And when he was done, he used this little yellow rake he picked up somewhere to sweep up the brush. That rake is now in my shed and I will use it come spring in the garden again. I will use it until it cannot be used any longer.

I got a Yellow Rake out of the deal- but I also got more time with my Daddy.

At the end

I don’t know if you have had a front row seat to death yet, but this was my first experience. And I feel the need to talk about that experience just a bit and maybe even provide others a little bit of what to expect if you haven’t gone through this yet.

Daddy was in in-home hospice for about two months. He got a diagnosis of stage IV melanoma with metastasis to the brain and it was all pretty quick from there. A few weeks ago, the decline really started and on Wednesday we were pretty clearly locked into the final path.

Tuesday morning, we realized we would run out of morphine soon. All day was spent frantically trying to work through health system paperwork and health system failures – until finally at around 9pm that night I found myself in the Walgreen’s drive through with my sister picking up new supply.

The hospice nurse came that night and checked vitals. She thought it was soon, but not tonight (its such a hard thing for them to be asked “when” by the way. They know it’s the only real question families have, but they feel so unequipped to answer this. So please ask, but understand how hard it is for them. Give them grace. And hug them, too). So I went home to be with my wife and kids. It has been hard on them because I have been gone a lot these past few weeks.

I went back down to Momma and Daddy’s house the next morning (yesterday) and there was no real change. I stayed a while and went back home to busy myself with a fireplace-painting project. Anything to distract from the waiting. To distract from When.

And then – just when I had painted white over the very first little strip of grout in that dark 1970s brick fireplace – my phone rang from across the room.

It was my sister. Using all the strength she could muster to hold composure to deliver that terrible message of two words, she said – “Dad’s dead.” And then her voice just fell apart and she could only cry and I said I was on my way.

 

It has all been a blur since then.

 

Within half an hour of me getting there, a team of people began arriving. First a sweet social worker named Sharita. Then the nurse Cynthia who cared for Daddy these last few weeks. Then a chaplain from hospice. Then the preacher from the church (you can never have too many preachers at a time like this. Counting Daddy that made 3 preachers in one house). Then police.

The house fills up quickly and it reminded me of how a labor and delivery room filled up quickly with the birth of my second child. When complications are expected, the delivery room can fill up with extra nurses and doctors within seconds. And I thought it was strange and ironic and symmetrical that, at the time of death, Daddy’s house filled up with people there to help him just like the hospital room filled up when Caleb (who is named after him in an interesting way, I will tell you that story at a conference sometime later) was born.

And just as all this activity happens in order to close out hospice processes and to make the death legal and to help the family in that initial shock, the family has its own tasks to begin. You have to start calling people to let them know.

I grabbed Daddy’s phone and just started going through his contacts. I made ten calls before I got through the “A”s. You see when you live a life like his, you end up knowing a lot of people. And those people loved him dearly because he loved them. And you have to tell them that he’s dead. But – and perhaps more importantly – you have to tell them that they mattered to him and that’s why you are calling them.

So many calls to be made.

About 20 percent of the entries were under nicknames (Daddy loved to give people nicknames), so that made it harder. “Have you called James?” “I don’t know, is he “Elmo”? Or “Skinny”?

 

And if you want to stop reading this right now and go through your contacts and tell those people they matter to you I won’t mind. Not one bit.

 

And then the hospice team and other non-family members start to leave one by one. And the house is quiet for a moment.

But almost immediately the stories of joy and old memories start to roll off the tongue. Laughter sets in quickly while the body lies in the next room. As statements of his current joy hanging out with his sweet Jesus are made, a clear sense of relief for the ending of the suffering is palpable in the air. Its startling (but wonderful) the resilience of the human heart. The grace that God gives us in moments like these.

 

The Widow has the funeral home staff laughing while they sit on the couch filling out the paperwork. “A traditional funeral (with or without a wake)?”

 

That’s when I realize the human heart can hold extreme sadness and bounding joy at the same exact moment. When your brain holds 2 conflicting thoughts its called cognitive dissonance. When the heart does it, it more resembles love or comfort or peace (or something I can’t name really, but it’s a good thing). Joy and sadness mixed together make you human. The mixture sustains you.

 

But then the people from the funeral home let us know there is one more thing to be done. Because there is one person who hasn’t left yet who must leave.

They take the body.

And there is a new void. One you didn’t fully appreciate just moments ago when you were laughing. A hole. A sense of weight pulling at you.

Just before you have a chance to fall into despair, your phone starts ringing again. People who you left voicemails an hour ago are now returning your call. And some are crying. Some try to comfort you. But all are telling you how your Daddy impacted their life.

 

A brief bio of Bill Farris

I realize that my Father’s life was one of extremes and passion. Eerily similar to mine.

He went into the Navy to pay for school on the G.I. bill. Became an auditor, then an accountant, then a preacher, then worked at a hardware store, then a tire shop then became an accountant again. But at no point (except for the 3 times he was completely way-laid with depression for 9-12 months every 10 years or so) did he ever stop tirelessly loving people and telling them about Jesus. He told them with words but mostly he told them by fixing their cars, or bringing them groceries, or visiting them weekly in a mental institution, or cutting their grass, or moving them cross-country or being the only person standing up for someone wrongfully accused and then housing that person in his own home when that person was finally let out of jail. And a million other ways. If you ever met him (and you may have – he talked to every single stranger he ever met, and he drove all over the Southeast to see one of his kids or his beloved Auburn Tigers), then within five minutes 3 things happened: 1) he knew your life story, 2) you knew his, and 3) you had heard the name of Jesus.

He lived a life of passion and extremes. But in a good way.

Then he developed melanoma in lymph nodes in his scalp in 2016. He became depressed again. Had multiple other health issues. In early October this year he had melanoma tumors removed from his brain. He started hospice in November. And he died yesterday at the age of 68.

I always called him Daddy, no matter how old I got. Up to the end. Like a child. Never dad, or father. Daddy.

 

Closing Up

 

That was a lot to read, I know. Thank you for reading it.

Let’s close out with a few quick thoughts.

The death of one’s father is a turning point in everyone’s life. Both a hardening and a softening of the heart. A quickening of the plot. I do not know what 2018 holds, but I hope and pray it holds change and renewal. I pray that for you and for me.

If you pray for me, pray for me to find a path that involves evangelism. I have resumed playing music recently. If you suddenly don’t see Mostly Medicaid you may be able to find me singing old hymns in people’s homes, nursing homes, prisons or under a bridge somewhere. Let us hope. One can dream.

Write to me @ clay@mostlymedicaid.com. If you want to share, I want to listen.

If you would like, send donations in memorial to Bill Farris through the Gideons .

 

Thank you for reading this. You didn’t have to. And I really appreciate all of you who read week to week and let me know it.

 

I am reminded of one of Daddy’s favorite songs (he sang a lot):

This is my story

This is my song

Praising my Savior- All the day long.

 

I can’t end it better than that.

 

 

Clay Farris

December 29, 2017

Birmingham, Alabama

Onward and Upward!

Menges Group 5 Slides Series for July, August and September 2017

The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do. 

The July 2017 edition tabulates Medicare’s per capita costs in each state and U.S. territory, showing the level of cost variation that exists between jurisdictions.  These figures are from 2015 and represent costs in the fee-for-service setting for Part A and Part B services.  The August edition tabulates information from the Medicaid MCO financial statements we collect and compile, showing the overall profitability among plans whose revenue is primarily (and often entirely) obtained through serving Medicaid populations.  The September edition provides suggestions for making Medicaid managed care optimally effective.

August 2017 Medicaid MCO Financial Performance 2011-2016

July 2017 Medicare Per Capita Costs by State 2015

September 2017 Optimizing Medicaid Managed Care — Input from Musicians

Weekly Medicaid RoundUp: Week of December 4th, 2017

Soundtrack for today’s RoundUp pessimist readers-

Soundtrack for optimist readers

 

LET’S TALK SHOP AT MEDICAID INNOVATIONS 2018 – I will be in Florida again (7th year for me, I think) for the Medicaid Innovations Conference. If you are going, let’s plan on meeting up. Jan 31-Feb 2, 2018. Check it out here- http://bit.ly/2mbKtl1

 

IN HONOR OF THE TAX BILL MAKING ITS WAY INTO LAW- Whether you believe the “its evil and terrible – the only thing more terrible are the last 5 Republican bills we promised were the most terrible ever” – nonsense about the developing tax plan, it’s a topic of discussion. Maybe not as big a topic as Stuart Smalley this week, but still- taxes are on most people’s mind (at least the 50% of us that pay taxes) this time of year anyway.  So, in honor of taxes (long live King George!): Let’s also look on the spending side. More specifically, the fraudulent spending side.

 

TO TEE IT UP- The latest GAO report on fraud in Medicare and Medicaid is out this week. You know, the one they put out every year that all of us in the space ignore because it ain’t our money (or whatever reason we use to justify not caring about 10% of the funds meant for these vulnerable members we claim to care so much about just vanishing. Most of my good friends opt for the “but fraud happens in other payer verticals, too” garbage.) This year’s report – out this week – shows $95B lost to improper payments in Medicare and Medicaid. Cue hair-splitting discussion re: fraud vs waste vs improper vs Oh, look a squirrel! GAO is giving CMS credit this year for new investments to fight fraud, notably red-flagging certain provider types, creating a Center for Program Integrity and requiring anti-fraud training. But that’s where the compliment sandwich ends (spoiler- its more of an open faced-sandwich this time). According to GAO, CMS has missed basics like conducting a fraud risk assessment for Care and Caid. And in GAO’s view, this is a big omission. The size and complexity of the 2 programs make this an “Of course there is a huge fraud risk here” issue. Check out the article on this in the twitter feed to make sure and see Kirk Nahra’s comments on anti-fraud data analytics being oversold in the last 20 years. Sobering.

 

 

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Antoine E. Skaff of Charleston, WV stole $735k from Medicaid for dental services over 7,836 acts of fraud between 2011 and 2016. Salomon Melgen of West Palm Beach, FL is in court over $100M he stole from MediCARE using bogus eye visits and tests. Investigators nabbed him using data showing Melgen seeing 100 patients a day and performing procedures in seconds that should take 10 minutes. Kristina Mirbayeva of Brooklyn lead a huge fraud operation (34 defendants, spanning 14 companies and 100 bank accounts) that sent recruiters into soup kitchens and job centers to get Care and Caid members enticed with $40 kickbacks to go to one of their clinics and get a ton of tests done. In 2 short years this netted the bad guys about $146M. Joseph Korzelius of Tryon, NC was sentenced this week for using his counseling business to pilfer $436k from Medicaid. Mr. Tryon used his side job of elementary school guidance counselor to steal students’ Medicaid numbers and submit false bills. Maxim home health in Massachusetts settled with Medicaid this week over stealing $14M by billing for unnecessary services for elderly members (95,000 claims for services not covered). A new report out from the Louisiana DOH shows $717k in payments for dead members between 2013 and 2017. That’s better than the $1.85M paid for dead folks in 2012/2013. Cynthia Stiger and Jacques Roy of Dallas (along with 5 other defendants) just finished up their trial. These 2 stole $374M from MediCare using their bogus home health company. They made up fake plans of care and then the good doc (Roy) would sign off on them so they could bill. Hard to do a tally this week since there’s some big MediCare ones in there. But the clear winner is Kristina. She showed leadership by inspiring a huge team of defendants to navigate a complex web of deceit! But hey- evil Republicans reduce spending. Tax cuts for the 1% Eat the rich.. #Resist!!

 

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (pour some salt on your steps) and keep running the race (you know who you are).

 

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: phrabida daisong phra bud pheu banthuk olk.

Conference Swag Ratings: MHPA 2017

As many of you know, I spend a LOT of my time at various industry conferences to speak, to see old friends, meet new ones and to stay abreast of what is going on. Part of Conference Life is swag.

It is important to know what vendors bring good swag, so you can plan room in your luggage. Below are my swag ratings for MHPA 2017. Only vendors with at least 3 out of 5 stars are shown, so as not to embarrass those that only brought pens or bought candy at the gift shop last minute to put in a bowl. (You know who you are).

Links are to company pages on LinkedIn. Helps you find actual humans you may know in these companies.

4 or More Stars Out of 5

Vendors in this category demonstrate mastery of the Art of Swag. Themes in this elite circle include brand-relevance, investment in the swag (cash spent), uniqueness, utility in the home setting, whether kiddos would like it and overall presentation.  If you are a 3 out of 5 swag-rated vendor, you should pay close attention to these vendors when planning your next event. (Assuming you are running low on whatever you bought 10,000 of last year).

 

National Vision Administrators (NVA)

LinkedIn company page

What’s great about the swag offering: Its well branded across multiple items.

What can be improved: Replace that water bottle that looks like a 1987 camcorder with a 1987 camcorder. Memories of Father’s Days gone by will abound.

Cipher Health

LinkedIn company page

What’s great about the swag offering: A lot actually. There is an understated thoughtfullness to these items. The pen with fuzzy hear and a stethoscope has details not usually seen in the world of plastic pens. The bandaids are pretty unique. When Friso first explained them to me at dinner the night before I was skeptical. But he knew they would be a hit. He knew.

Not pictured: Rubik’s cube. Still trying to solve it 1 month later.

What can be improved: I think a mini-first aid class could be built around the band-aids. Perhaps offer CPEs for clinicians who stop by the booth?

Cotiviti Healthcare

LinkedIn company page

What’s great about the swag offering: This is just an awesome toy (this colorful pop up thing). If I was picking an overall winner, this would be it.

What can be improved: Don’t change a thing you sly devils. My kids will be Cotiviti customers in 20 years, and they won’t know it was because they saw your logo over and over again when they were youngsters playing with this thing.

 

Relias Learning

LinkedIn company page

What’s great about the swag offering:  This is a great lion. Its a quality stuffed animal – actually has a little personality to it if you stare into the eyes a minute. The oversized nose / mouth give it a cuteness that would not be there if it was more exact to an actual lion. (Think of those cards with cats or dogs on them with really big eyes). This is not just a boring piece of cloth like so many conference stuffed animals. Take these home to your kiddos and they will love it.

What can be improved:  Maybe add a book to connect with the learning theme?

 

Liberty Dental Plan

LinkedIn company page

What’s great about the swag offering: The relevance-to-product score is off the charts. Taking one of these replicates the in-office experience of going to the dentist exactly.

What can be improved: Let me pick stickers from a small basket if I didn’t cry during the cleaning. I prefer Doc McStuffins stickers. Or Batman.

Human Arc

LinkedIn company page

What’s great about the swag offering: So very practical. I get one of these (chip clips) every single time.

What can be improved: Not much, really. Maybe offer more colors? But that might not be brand-compliant. Ignore what I say. Just keep bringing these to show, please.

Healthcrowd

LinkedIn company page

What’s great about the swag offering: Everything. Kids love these pigs. I have grabbed at least a dozen in the last 2 years alone. And the team does solid giveaways, too (see pics below).

What can be improved: Add another farm animal.

 

Mediware

LinkedIn company page

What’s great about the swag offering: I am a sucker for tools, especially ones with surprises. You think this thing is a highlighter at first. But then you see the level on it and you are intrigued. So you open it up and its also a screwdriver. WITH A FLASHLIGHT. Mind blown.

What can be improved: Add maybe a jumpdrive or phone charger function.

3 to 4 Stars Out of 5

 

3M

LinkedIn company page

What’s great about the swag offering: These are nice notebooks. Really nice. My wife still lives in the dark ages and uses paper and loves notebooks. So I got like 5 of these for her to take home. Christmas shopping – done.

What can be improved: Add something non-notebooky. Something electronic maybe?

Edifecs

LinkedIn company page

What’s great about the swag offering: I am not sure- but I do love them. The shape of these things reminds me of a cartoon character. They soothe me somehow. I think they hold your phone?

What can be improved: Put faces or googly eyes on them.

 

CareStar

LinkedIn company page

What’s great about the swag offering: Very brand-relevant. Logo is the star shape. Also foam, so doubles as kid toy. Kid: “Daddy, what did you bring me from your business trip?” Me: “This red star!” Kid: “This is the best day of my life!!!!!” Four hours later I am picking up ripped up pieces of these things in every room. But it was a great 4 hours for the kids.

What can be improved: Maybe a little more detail on the printing? I would like to maybe see the edges of the star outlined in a contrasting color.

Sentinel Rx

LinkedIn company page

What’s great about the swag offering: This is a table full of candy. At a healthcare conference. Bold. (Keep in mind this event was actually on Halloween – so this is a very thoughtful / relevant showing).

What can be improved: Set up next to the Liberty Dental guys / gals.

 

TMG Health

LinkedIn company page

What’s great about the swag offering: It actually had a reputation all its own. Before I even got to this booth, people were telling me to check it out. I think it is a nail file.

What can be improved: Add a label to tell me how to use this thing.

 

i2i Population Health

LinkedIn company page

What’s great about the swag offering: Yo-Yos!!!!!!

What can be improved: Yo-yo lessons. I can’t even walk the dog.

 

Express Scripts

LinkedIn company page

What’s great about the swag offering: These cups are legendary. I am not joking. People collect the whole set. And this year they added some. Unless I am mistaken the Icecream one and the “Medicaid State of Mind” one are new.

What can be improved: Put Starbucks gift cards in each cup to incentivize people to take them. I have found that people don’t want to take breakables back home in luggage.

 

Veyo

 

LinkedIn Company page

What’s great about the swag offering: It’s just cool. It even has sunglasses. And the overall color pallette is charcoal grey (on the swag anyway).

What can be improved: Tell me what the heck the twisty thing is.

 

Cribs for Kids

What’s great about the swag offering: It’s actually not swag. They are not giving this stuff away. The product is all this cool stuff that goes in a box to go to Medicaid mommas. Babies!

What can be improved: More wipes. Always more wipes.

Cozeva

LinkedIn company page

What’s great about the swag offering: They spent cash on you, the attendee. Phone charger banks!!

What can be improved: Add a garden item to the swag. The green and the plant-like icon in the logo make it a no-brainer.

Weekly Medicaid RoundUp: Week of November 20th, 2017

Clay’s Weekly Medicaid RoundUp: Week of November 20th, 2017

Soundtrack for today’s RoundUp pessimist readers-  No room for pessimists this week. Be thankful you pessimists!

 

For optimist readers- https://www.youtube.com/watch?v=uYJ-MXwbQlY

 

 TOP 10 THINGS I AM THANKFUL FOR ON THANKSGIVING 2017- 1) A God that loves me; 2) A family that loves me; 3) Being born in the most awesomest country in the world, warts and all; 4) Clients that have vision to improve a critical but deeply flawed Medicaid program; 5) Gardening; 6) Music; 7) One more Thanksgiving with my Dad before he is no longer with us due to brain cancer; 8) Asking “what’s public health?” decades ago while finishing up a history degree and never looking back; 9) Friendships that I have had for more years than I have not; 10) Making new friends at conferences each year. Speaking of…

 

LET’S TALK SHOP AT MEDICAID INNOVATIONS 2018 – I will be in Florida again (7th year for me, I think) for the Medicaid Innovations Conference. If you are going, let’s plan on meeting up. Jan 31-Feb 2, 2018. Check it out here- http://bit.ly/2mbKtl1

 

THIS ONE IS A SHORT ONE THIS WEEK DEAR, DEAR READERS- It’s 4:30 AM the day after Thanksgiving and apparently that means to go buy stuff at Kohl’s. So my wife is out doing that – and soon I will have the sound of little feet turning to a stampede in my house as the cousin-children all wake up with excitement to see each other. And I will not be able to pontificate on all things Medicaid my normal duration (measured in cups of coffee; normal time – 2 cups to write it, 1 to proof it). Here are the quick hits of what happened in our world this Thanksgiving week:

 

MA PROPOSES NOVEL RX IDEA: DON’T SPEND MEDICAID DOLLARS ON SNAKE OIL, FEND FOR YOUR OWN DISCOUNTS- Most Medicaid drug coverage policy is summarized as “if the FDA approves it, we pay top dollar for it.” So if Hadacol were still around, states would be begging to buy it. (The things I have seen in state RX data would make your stomach turn – don’t get me started on $10k nail fungus drugs). So- Massachusetts, driven by a lack of options to deal with the crushing weight of specialty drugs costs, is going rogue. Or asking permission to go rogue if you want to get technical. They are submitting a waiver request to be able to non-cover drugs with limited effectiveness AND to negotiate their own darn discounts, thank-you-very-much fancy national MDRP program. In a time of stalemate on Rx costs and ideas to deal with them, we wish you luck Massachusetts.

 

IOWA CAID GROANS IN FRUSTRATION- One of the results of an MCO skipping town (see previous reporting on Amerihealth’s departure, and by skipping town I do not mean to imply they did it lightly. Read up on it before passing judgment) is that there is less member choice in terms of plans come enrollment time. Which is starting to bubble up in the local news with stories of members who are being turned away by non-network providers, and then being told by the state they can’t switch plans. Adding to the pressure of Amerihealth’s departure is the fact that Amerigroup is no longer taking new members. Finally- the Federalis are not yet rubberstamping Iowa’s request to roll the state back to Fee For Service and do away with managed care altogether.

 

GOOD GUVN’R BEL EDWARDS SAYS ALL ANIMALS ARE EQUAL, BUT SOME ANIMALS ARE MORE EQUAL THAN OTHERS (WHEN IT COMES TO GOVERNING USING CHECKS AND BALANCES THAT IS)- The Good Guvn’r says he “had no choice” but to ignore the also-duly-elected-by-the-people Louisiana legislature when the reps wanted to be a part of the MCO contract renewals decision last month. Bel Edwards (like many Governors) has realized there actually is a heck of a lot he can do without approval of the legislature, and recently rammed through “emergency contracts” to keep MCOs going past the current termination date (November). Why did it ever get to this point in the first place? What type of contracting process allows this outcome? Anyone in The Pelican State that knows more on LA procurement practices, please write in and let me know.

 

WELCOME TO THE SHOW MR RANDOL- Joining the rare but growing ranks of the 2-timers, former Kansas Medicaid Director Michael Randol will now sit in the chair of Iowa Medicaid. Congratulations Michael!

  

TELEMEDICINE CATCHES THE EYE OF OIG- OIG has scheduled a review of the appropriateness of Medicaid payments for telemedicine for 2019. The Federalis expect Medicaid telemedicine spending to grow significantly in the next few years, and OIG wants to check in on how compliant recent spending has been with the regs before the ramp up happens.

 

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (work off that 4th serving of dressing) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Атам дүйнөнү куткаруу үчүн Уулун жиберди.

 

Weekly Medicaid RoundUp: Week of November 6th, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2md4Wpt (for what ails ya!)

For optimist readers-  http://bit.ly/2mbQpKW  Do not forget Veteran’s Day!

LET’S TALK SHOP AT MEDICAID INNOVATIONS 2018 – I will be in Florida again (7th year for me, I think) for the Medicaid Innovations Conference. If you are going, let’s plan on meeting up. Jan 31-Feb 2, 2018. Check it out here- http://bit.ly/2mbKtl1

PINE TREE STATE VOTES YES ON EXPANSION – Mainers voted yes on Question 2 on Thursday, making the preference of 59% of voters known. In an interesting move, the state elections officials set up a PayPal kiosk at polling places to collect the money needed to pay for the voters’ decision. While 59% voted yes on expansion, only $13.73 was collected on voting day. Seems voters want someone else to pay for it (they did their part by voting). If you are out of state and would like to contribute to the state share for the expansion, you may be able to make a donation via the Maine State Treasurer’s Office – http://www.maine.gov/treasurer/  I have also agreed to be a donations bundler for the state expansion lobby, so if you send me your personal bank account information to clay@mostlymedicaid.com I will be happy to make you’re your personal commitment to the cause is made known. #Resist!

CONSTITUTION STATE RETHINKS ITS EXPANSION MODEL- New Hampshire is looking to continue covering the expanded population now the waiver is up for renewal. But it wants to move expansion bennies from the exchanges (a premium subsidy program) to be covered under one of the actual Medicaid MCOs. Also wants to add work requirements for non disabled adults with no children. 

HAWKEYE STATE DEM CANDIDATES POOH POOH MCOS- All four of the brilliant Iowa Guvn’r candidates on the left side are promising to rollback managed care and return the state to its Halcyon days of fee for service, in all its unmanaged, abysmal quality and cost management glory. Idiots.

OLD DOMINION STATE GUBBNERS RACE RESULTS RESTARTS EXPANSION HOPES- Dems picked up 5 house seats in recent Virginia elections. Which will help to soften resistance to expansion in the legislature (its been shot down for several years). The Guvnr-Elect Northam also campaigned on expanding Medicaid.

WHAT THE LADY SAID – Flexibility. Work requirements. Faster approval for waivers and SPAs. The sleeper issue in Mrs. Verma’s speech to NAMD this week? State dashboards using new CMS data systems. Can you imagine the fallout if states were showing up on a regular report of poor quality metrics? Right now there might be a report of a few states on a few measures using data that lags 4 years. State dashboards would be the best thing to happen to Medicaid. Ever.

TREASURE STATE TO SPEND MORE TREASURE- A Montana legislative committee has put the kibosh on (did you know that word was originally kye-bosk, with the earliest citation in Dickens?) a proposed 2.9% provider rate cut. The state DHS officials are understandably frustrated because they feel avoiding the cut now will just make them have to make deeper cuts later. And, oh yeah – the same freaking legislature holding up the cuts ordered them to cut costs.

NEW HHS PICK MAY COME FROM PHARMA- Rumors have it that Alex Azar of Lilly USA fame may replace Price. As long as Azar can follow aviation policies, of course. (Ba-doom-boop-boom).

PRAIRIE STATE OBTAINS BOND TO PAY MEDICAID BACKLOGGED BILLS- MCO shareholders across the nation rejoiced on the news that Illinois sold $9B in bonds to help pay off debts to Medicaid providers. So we have finally done it – made Medicaid like the subprime mortgage fiasco by factoring the debt to outside investors. Holy cow. You can now basically buy stock in how poorly a Medicaid program is run via bond issues from states in fiscal default.

WELCOME TO THE SHOW MR BAKER, THE GENTLEMAN FROM THE PALMETTO STATE- Joshua Baker of SC Medicaid got promoted to the Director Chair this week. Glad to have you Mr. Baker!

 

GOOD GUVNR BROWN DECIDES TO GET THAT CASH BACK FROM MCOS AFTER ALL (THE BEAVER STATE)- A few weeks of bad press and the milk has soured. The gloves are off. Although early reports suggested Oregon would not attempt to recoup capitation payments made in error to MCOs, this week Dem Guvn’r Brown directed the agency to do just that. (After her GOP opponent in the 2018 race called her out on it). The errors are on the state enrollment side- people who should not have been enrolled, or duals for whom which Medicare should have paid first.  Current total of snafu is $74M. We covered this in last week’s news show by the way if you want to check out the recording- http://bit.ly/2yinw1i

SUNFLOWER STATE ASKS FOR $90M TO REDUCE WAIVER WAITING LIST- Kansas thinks it can open up a bunch of new waiver slots for HCBS waivers if the legislature will approve it.

SOONER STATE PULLS TRIGGER ON $34M IN PROVIDER CUTS- Oklahoma legislators said no-dice (short by 5 votes) on the new taxes (at least I think that’s how to translate “revenue-raising measures”) needed to fill the Medicaid budget hole this week. A total of $35M in cuts went into effect this week, with providers getting between 4 and 9% reductions.

BUCKEYE STATE OWES FEDERALIS TRUCKLOAD OF CASH. CMS ASKS FOR IT ALL IN SINGLES-  We have seen this issue in other states. Basically ACA handed out lots of rewards cash for increasing Medicaid enrollment, but it was only supposed to go for non-kids and non-ABD members (people who generally get pretty decent coverage; Mr. Obama was looking to add new types of people to the rolls, not those already eligible). Anywho- federal OIG says OH got $30M too much for improper classification of new enrollment, and they want CMS to get the money back.

 

BBBBUT MEDICAID IS UNDERFUNDED! GOLD RUSH IN THE GOLDEN STATE- A new report over at Kaiser Health News shows California MCOs making ridiculous (in the eyes of the beholder) amounts of profit on Medicaid operations. Would we ever see a story that shows the CA Medicaid budget “deficit” side by side with MCO “obscene” profits? Doubt it. That would not be helpful to the #Resistance.

 

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph… Sorry friends, not this week. I have already been too verbose. Lots of fraud goodies for you in the twitter feed. Don’t worry, we lost millions again this week as well. Same as last week. And the week before…

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (send out your Christmas party invitations) and keep running the race (you know who you are).

 

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Bavê Kur şand ku cîhanê rizgar bike.

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