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Clay’s Weekly Medicaid RoundUp: Week of July 15th, 2019

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2Y8ReSk

For optimist readers- http://bit.ly/2Y93BOl

AND SO IT BEGINS (MCO ENROLLMENT IN NC)- Open enrollment for the first ever Medicaid managed care plans in the Tarheel State began this week. 540,000 members in 27 counties can pick their insurance cards until September (if they don’t pick, one will be picked for them). There could be a monkey wrench though- the MCO rollout costs about $200M in start-up money. And that money is tied up in fights over the current state budget. The Good Guvn’r Cooper is trying to use this fight to force expansion on the state and vetoed the latest Republican compromise bill. Stay tuned.

IOWA RATES FINALLY FINALIZED 2 WEEKS INTO FISCAL YEAR– Which is better than last year which went 2 months past the contract start dates. MCO rates got bumped another 8.6%- but that’s all going right back out to providers (facilities, mostly) and Big Pharma (hep c coverage). There is also new funding included for more MCO “oversight.”

FL COUNTIES RAISING ALARM OVER TRUE COSTS OF MEDICAID EXPANSION DREAMS– See, all that “free” Medicaid money comes from somewhere, even at the state level. And in many states, a ton of that state money comes from counties, who must fund it with property taxes. So, one neighbor’s millage is another’s Medicaid. Whether the funding neighbor likes it or not (or even knows it). Well in FL (where they Expansion Lobby incessantly tells everyone they must expand, just like in every other non-expansion state), some small counties are trying to build awareness. It doesn’t hurt that Florida has a law that requires actual economists (which are different from NYT columnists promoting junk science, by the way) to assess the financial impact to Florida’s “fiscally restrained” counties.

MANY STATES TALK ABOUT CONTROLLING OUT OF CONTROL MEDICAID SPENDING DEATH SPIRAL; ALASKA IS ACTUALLY DOING IT- AK Governor Dunleavy is not playing the normal game of “appear hard on Medicaid spending but eventually cave” and just do what the Medicaid lifers (and industry lobbyists) tell you to do. The Good Guvn’r just vetoed $58M in state monies for Medicaid (including jettisoning the adult preventive dental benefit). The immediate, across-the-board provider rate cuts triggered a lawsuit from the Alaska Hospital and Nursing Home Association (the groups who get the lion’s share of the Medicaid biscuit). Yeah, I just replaced pie with biscuit- and you love it. Hold on tight, Guvn’r.

ID SUBMITTED A 1332 WAIVER TO ALLOW MEDICAID EXPANSION MEMBERS TO NOT ACTUALLY HAVE TO BE ON MEDICAID- Idaho is expanding Jan 1, 2020. Right now there are about 18,000 Idahoans on the exchange who will have to drop their commercial policies because they would qualify for Medicaid. The state has asked CMS for permission to instead subsidize their exchange premiums instead of moving them onto Medicaid. Analysts currently expect CMS approval, since it is similar to a request approved for Utah earlier this year.

 

I SEE WHAT YOU DID THERE (EMPIRE STATE SHENANIGANS MEANT TO COVER UP FAILURE TO CONTROL MEDICAID OVERSPENDING)- This one is delicious. The good Guvn’r Cuomo quietly slid $1.7B in Medicaid spending by delaying a payment 3 days. Why does that matter? Because it was at the very end of a fiscal year, and it allowed the state to look like it was compliant with state law that keeps Medicaid spending increases capped at 3%. If the transaction were made when it was supposed to (and more reflective of actual costs and spending, which is of course more in keeping with both the letter and spirit of the law), then the state’s fiscal failure would be obvious. Its looking like the state is on track to overspend again this fiscal year. Don’t worry, they will just slide the payment again next year!

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker- no fraud follies this week, friends. Just not enough time in the day or space in the column. Let’s all just pretend its not happening this week (makes me feel better, anyway).

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 (pressure wash your driveway, its miraculous!) and keep running the race (you know who you are).

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