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2019 Year in Review

And now its that time.

We review another 12 months of the Medicaid industry together. And I also attempt to share what has been going on in my life for the past year.

If you have missed the last 3 of these, here is a link. (Hint- each icon in the section breaks represents one of the years in reviews. Not sure if that’s how you pluralize that. Sort of like how toothbrushes works).

So glad you are here this year, all my reader friends.

Let’s review all the work / industry stuff first.

Work Requirements 2019 Edition

Let’s do this in memes.

Yes- you read that right. We are going to review Medicaid 2019 in memes.

Work requirements carried over as an issue from 2018 and the update for most of 2019 was “lawsuits are pending.” I think for me it mostly got tiring hearing lefties monolithically argue against work requirements using one of the 3 following canards:

  1. Most Medicaid bennies are already working, so this is pointless -This argument was supported by a few “studies” (limited surveys) trotted out by the usual ideological suspect publications in 2019- but we don’t really know that this claim is true unless its actually reported, do we? At its heart, the opposition is really resistance to anything that slows down the death march towards universal healthcare paid for by taxpayers. No matter what Kaiser, et al tells you – there are still plenty of people who are not Nazis that oppose universal healthcare funded by taxpayers for a lot of different reasons.
  2. Tracking compliance will cost a lot– sure. But since when do we care about the costs of doing anything in Medicaid? Especially technology investments? And how much is saved for every member removed who should not be on Medicaid if earning your health insurance for the able-bodied is a legitimate requirement for coverage?
  3. Orange man bad– This is just something in the air, I guess.

So here’s my answer to all this nonsense in the form of a meme:

See the thing is – the thing no DoubleSpeaking expansion advocate (work requirements and expansion are inextricably linked) will let you notice – is that healthy, able-bodied Medicaid members who got added under expansion bring lots more (90-100%) federali money than the traditional aged, blind and disabled (you only get regular ole’ federali cash for those folks, usually between 50%-75%). Its not the altruistic pretty picture expansion zombies would have you believe. Its cash, cash, cash. Screw the disabled so that healthy adults can get a Medicaid card. Screw that, I say.

And of course, there are a few intellectual contortionists who came up with junk analysis to say expansion doesn’t hurt traditional Medicaid members. Don’t believe them. If you are a state budgeteer and you can get 100% federal money for one population, or have to come up with millions more in state funds to increase services for another population- what are you going to do? And please, please, please don’t trot out the “free federal money” argument to pretend you can have sufficient money for both ABD and expansion, too. If I hear that nonsense one more time I just might throw up in my mouth.

I have decided that waiting lists are the absolutely most clear condemnation of Medicaid expansion possible. Get the tens of thousands of truly vulnerable off the waiting lists in states across the nation – then I will listen to you boo-hoo about work requirements. Until then – I have to work for my own healthcare coverage, and I think anyone who can work should have to, too.

Show me the money

2019 was the year Medicaid spending didn’t go up. All these innovations around value-based payment have finally started to pay off. Just kidding! (or psych! as we used to say in middle school in 1989).

We saw another round of budget crises in nearly every state this year. And it was the same script in 2019 as it was in 2018 as it was in 2017… In order to keep services the same, and not have the sky fall and kill all the children (of course), every statehouse heard the plea for more, more, more. Some states- like Alaska- actually tried to tighten the belt. Guess what happened there? You guessed it, a judge ruled that Governors actually don’t have any power and allowed the provider lawsuits needed to “restore cuts.”

So here’s the conclusion I have come to. Price is the issue. Not cost. Price as set by providers. As differentiated by what it costs to make a product (or provide a service) versus what the merchant charges for it (price).[1] If we don’t address healthcare price- which absolutely has been on a cocaine-fueled, skyrocketing joyride for nearly all of recent history- no amount of policy smoke and mirrors (“innovation”) will ever put a dent in it.

And the scariest thing to me about price is that I don’t think there is a single example of anything (i.e. student loans, housing) that is subsidized by the government ever NOT having nightmarish price trends. Its almost as if the merchants say – “Hey look, the government has to buy it, and we get to set the price, so why not set it higher and higher and higher?”

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One more meme just for giggles



And now for the personal / life stuff. Thanks for letting me wrant (I just made that word up- its when you rant in written form) about the Medicaid industry stuff.

NOTE [1] Don’t believe providers who tell you they are losing money on Medicaid. Once we have actually data on costs, or until we have at least more price transparency, the black box of provider “costs” is simply a tool to allow the merchants to charge uninformed buyers whatever they want. And make the buyers feel guilty for pay “so little.”

Overarching analogy (the glue)

Let’s set up the overarching analogy first. The thing that will make this globby read stick together.

____________ is what you play and when you play it.  

You can fill in the blanks, but any musicians out there with a lick of theory will know that Music goes in that blank nicely.

I heard it from Earl, my very first guitar instructor when I was 19 years old.

“Really, Clay – music is just what you play and when you play it. The notes are the what, and when you play them is as important as what you play.”

I think this applies to just about all of the human experience. Let’s run with it.

Reviewing the non-work part of life

This year’s disclaimer: For some reason – I think its because I write these things in December, which is a reflective time, and reflection is almost always somber, or at least not chipper- my Year In Reviews (we are up to 4 or 5 now, I think) tend towards bittersweet. I am not sure why you people keep reading them, but you do (based on all the wonderful notes I get each year), so I will keep writing them. And honestly I probably would write them whether or not anyone read them.

But thank you for reading. Please write in (clay@mostlymedicaid.com) with any reactions you have.

This year is bittersweet, too. But not as much of a tear-jerker as last year.

And it includes football, and old people, and hymns, and dogs and graveyards. What’s not to love about that?

Pros of 2019

  • No one died this year. Well no one that I know. I am sure many readers lost some people dear to them.
  • No pet died this year, although we did lose one. Funny thing about border collies. They are bred to herd and they herd by nipping. And they don’t distinguish between 6-year olds and sheep. Up until December 27th, the verdict was still out if Shepherd remained a Farris, but we ended up driving him to a farm an hour and a half from home and setting him off on his next chapter. He was a great dog, but the time was just not right. Its what you play and when you play it.
  • I leveled up on my love for my wife. At first I wanted to say that it is natural that this happens when the one you love has a progressive auto-immune disorder. But if I am honest, I have simply been able to see more of her beauty that was always there. Although my eyeglasses prescription gets worse each year, some things not seen with the eyes are better seen with age.
  • I played 48 nursing home gigs. The first Monday and Friday of every month. More on that later.

Cons of 2019

Taxes are still a thing. If only I could select what they went to (like a sushi menu), I would gladly pay more. As it is now, I resent them and look for all legal ways to minimize them. I guess if the only real con I can think of for a whole year is that I have to pay taxes in the very best country that ever existed on the face of this planet, 2019 really wasn’t bad at all. 

Life in the old folks home

One of the very best decisions I made in recent years was to go into nursing homes and sing old hymns to the residents. Correction- with the residents.

My first few gigs were in 2017. I loved them so much I scheduled standing gigs in 2018 and this year I played 48 gigs. The value of those moments with elderly believers worshipping God is incalculable. I have cried so many tears of joy singing with them. At least once a month my voice cracks up as I sing Great Is Thy Faithfullness. Or Victory in Jesus. Precious Lord is the real crowd pleaser, and for me it is tied with Because He Lives and Precious Memories. Who am I kidding? I love all of these songs, nearly equally well.

Go into a nursing home the first Monday of every month and you make friends. They start to look for you. And you for them.

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Mr. Brown (not his real name) taught me a whole new verse to Amazing Grace. One that is not in my 1975 Baptist Hymnal.[2] But first let me tell you about how I met Mr. Brown.

I and the older 2 kids (they LOVE seeing children. And I finally learned when I bring the kids to just put them in front of the mic. The residents do not care what I sound like at that point) had just finished playing. There were maybe 20 residents there (which is a huge gig for us). We were packing up the gear, and Mr. Brown asked if he could have the mic.

At first I hesitated. This hadn’t happened before.

What was he going to say?

He didn’t say anything, but instead starting singing.

Let me back up a minute and describe Mr. Brown so you have a picture of him. Not that his appearance matters, but just you can visualize him. And maybe so I can, too. Years later when I read this again, like I obsessively re-read things I wrote years and years later.

Mr. Brown is in his early 80s. He is about 5 10 (I’m just guessing- Ive only every seen him sitting down). About 300 pounds. Wears sweatshirts and jeans and a ball cap. His smile – though missing a few teeth- is on my top 10 smiles of all the ones I’ve seen in my life. Mr. Brown is also black- but from a time where calling him “African-American” would be as weird to him as it is to me.

After I got to know Mr. Brown over the course of a few months, he was sitting out on the front porch while we were loading in. Loading in from out of my 1996 Blazer (I have a thing for old run down cars and keeping them running. There’s an analogy for me in there somewhere. Maybe underneath the catalytic converter). That Blazer was a gift to me from my father in law when we were just starting our family. And at that point it was 10 years old. But it was huge blessing.

I can not see myself getting rid of it. Ever.

But Mr. Brown remarked that it was a nice car. And I agreed, but also thought to myself that most people would not think so. I can almost guarantee you that the majority of people reading this consider a Lexus a nice car. Or a brand new Pilot. Or maybe – maybe- a new Camry. But not a 22 year old blazer with 150,000 miles on it.

But I kept my thoughts to myself. And I’m glad I did, because it gave Mr. Brown space to continue.

“I never had no car. That’s a nice car.”

In that moment I knew my appreciation of the blessing of this old car was insufficient. That I had any car at all was such a blessing. Mr. Brown had lived 80 years and never had a car.

Back to that secret verse of Amazing Grace you may not know about.

Once I hand him the mic, Mr. Brown started singing two words over and over, to the melody of Amazing Grace:

Praise God

Praise God

Praise God

Praise God

I had never heard this done.

It was so powerful. And the other residents all sang along. He was their leader and I knew in that moment he played an important role in that community of aging, dying believers. Day in and day out he was there. Encouraging them with his toothy smile and loving words. I was just there for an hour every 30 days.

From that moment on I looked to include Mr. Brown however I could.

But I didn’t get many more chances. He was there maybe 3 more times. I asked the activities director if he was ok for a few months. She would always say he was just tired.

Now I haven’t seen him in nearly a year, and I fear he is gone (dead). I think the activities director wanted to spare me the sadness because she could see how fond I was of him.

But that’s the gig in these gigs – you are playing (and bonding with) to an audience not long for this world. I often wonder how people who work in nursing homes are not crying every day. Maybe they are.

There are so many people I want to tell you about from these gigs. But let me share just a few more.

There is a lady in the memory care unit of one of the places we go. If you have never been to a memory care unit, the important thing to understand if that these residents are an elopement risk. Many of them wear anklets that are paired to alarms near doors so staff know they may be attempting a break out. There is a wide range of memory issues seen in these units, but in general the very mildest cases are what you would consider “severe” from a lay person’s perspective.

What I noticed early on with this population is you need a different set list. You need older songs. Instead of hymns from say 1940-1960, you need ones from the late 1800s (those songs are what their parents taught them as young children). They know hymns from both time periods, but the older ones resonate with them much more deeply (think Blessed Assurance vs His Name is Wonderful). But the really beautiful thing is that these residents may not know their children’s name (of course that is sad, but wait for the concluding clause)- but they remember all the words to How Great Thou Art. And they light up when they sing it with gusto.

I am very impressed with this particular facility. Not all of them are as compassionate as you would hope. Or maybe the word is not compassionate, but rather thoughtful. This facility does things like buy a jukebox with pop songs from the 1950s in it. And they put cribs in one of the common areas, complete with baby dolls in them. You may think that’s strange. I did at first, too. But then I saw how soothing it is to some residents. And I was thankful that the staff are working to meet the residents where they are in their journey.

I have heard nursing homes referred to as “Heaven’s Waiting Room.” I think there’s a lot of truth to that. When I first tell people (people not in nursing homes) the songs I sing, they are somewhat shocked. Because all the old hymns pretty much talk about death. And about looking forward to it as the only way to reunite with our Savior. That last part is key.

But what I noticed is that the residents don’t mind. Not only do they not mind- they are encouraged by it. Sometimes not just encouraged, but emboldened.

And so am I.

Which is one of the reasons I love “When We All Get to Heaven” so much. I tell them it’s a marching song. And they love that.

But back to this lady in the memory unit.

Most times she is completely silent and sits there and cries while listening to us sing. Sometimes she mouths a few words of the song. Lately she has actually spoken a few sentences and smiled.

Normally her daughter (I assume its her daughter) is there when we play. I think she comes to visit on her lunch break. And I am so grateful that someone has a child that still comes to visit. Almost none of the residents have that. But that daughter comes to see her mother regularly – Praise God.

When the daughter is there, she stands behind her mother (who is sitting on a couch) and leans in to place her cheek on her mother’s cheek. And they just share the time together like that. For an hour. Sometime the mom cries. The daughter only ever smiles. She has never said anything to me.

That woman did something right when she raised that daughter.

At that same facility is another lady who without fail asks my oldest son if he has a girlfriend. Like at least 20 times. From the time we are setting up the mic to when we break down. This is how Caleb remembers this place.

“Is this the one where the lady asks me if I have a girlfriend?”

“Yes, son.”

At first I think it may have bothered him a bit, but now he understands. And he is nothing but sweet and answers her question every time.

“Do you have a girlfriend? How old are you?

“No, mam. I am 9.”

“You sure are handsome. You’re gonna have lots of girlfriends.”

“Thank you, mam.”

Repeat that about 20 times.

She asks Nora if she has a boyfriend. The exchange plays out similarly, but when Nora tells her no, the lady adds: “Well, you are smart, then.”

NOTE [2] I have the Broadman Hymnal as well somewhere in this old house. Its red and smells like wood, carpeted pews and maybe holy water. But of course there’s no holy water in a Baptist Church so maybe my smell-brain is confusing memories…

A few quick others.

One lady, wearing a bright read sweater and hair all done up (it humbles me to tears that they think my songs are worthy of dressing up for) called out once-

“I have a testimony!”

Having learned to not hesitate after the Mr. Brown incident, I told her by all means to go ahead. And she gave a few minutes of her testimony[3] and it is one of the treasures I carry with me in my heart.

My last example is the lady who always thanks me for reading Scripture during the set. I think we assume there are people going in and ministering to these people all the time, but that may not be the case. She seems like she has been starved of hearing Scripture spoken each month. And so grateful for me simply reading from the Psalms.

I don’t know that playing these songs ever would have occurred to me when I was younger. But I learned them all before I turned 12.

It’s what you play and when you play it. Now is the right time to play these songs for these people. The nursing homes may be Heaven’s Waiting Room, but those folks need music, too. And if I can be a part of singing them into heaven, then I am blessed beyond measure.

[3] For those of you who didn’t grow up in a protestant church, this is when people share either their personal salvation story or something God has done for them in their lives.

Life in the Graveyard


If you are not familiar with the national wreath laying program for our veterans laid to rest in national cemeteries, it’s a wonderful event where families and friends of our lost heroes gather to lay a wreath on their graves. It happens every year in early December. You can find out more at https://www.wreathsacrossamerica.org/. I highly recommend you participate at least once.

We went this year (and have each year so far since Daddy died and was buried at the national cemetery in Alabama). We are always amazed at how many new headstones there are each time we visit.

What struck me most this year was that the living have basically made the graveyard (cemetery, I guess, since not attached to a church- but there is a chapel, I think) a part of their life. By that I mean they place everyday items that mean something to them (and I assume to the deceased) at the tombstone. We were accustomed to the coins left on headstones (learn what that is all about here). But there are also very specific rules about what can be used as decoration, and I think we saw lots of violations that day. My guess is the groundskeepers look the other way around Christmas to help the grieving make it through another December without their daddy, or momma. Or daughter, or son. Or best friend.

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Looking at what the grieving choose to leave is eye-opening. In a good way. It shows you that not only does life go on after the burial, but it includes the one buried. Some objects are very specific to that family (like a sea shell or a snow globe). Some are sports teams- we found 2 Alabama Crimson Tide items, and are in the process of making sure we get some Auburn ones in there soon.

To me this shows that there is life in the graveyard. It shows me that the people buried there played the right things and played them at the right time. They left an impression- a good one. They are missed but in no way forgotten.

You should participate in a wreath laying sometime. Here’s that link again – https://www.wreathsacrossamerica.org.


Life in an Empty Stadium

We took the kids and Momma to see the Christmas lights at Callaway Gardens this year. This is another thing I recommend you do at least once- its actually on various lists of top 10 lights events in the world.

On the way back home from Callaway, we stopped in Auburn (see last year’s Year in Review for a similar pilgrimage). We checked out the new Arena first (the basketball facility). And it was cool.

In it I found this quote on the wall:

That quote says it pretty well, I think.

As we were leaving the Arena, my oldest asked to go over to the football stadium. As we also did in last year’s escapade, we snuck in.

Once inside, it all took care of itself.

We were in the right place at the right time. What you play, when you play it.

We made our way, like salmon back to where we were spawned, to the field. Anyone who was ever a teenager knows its cool to get into places when you’re not supposed to. None of that high school mischief compares to standing on that grass at Jordan-Hare Stadium. And stand on the grass we did.

And we took pictures. And remembered the amazing game where we beat nasty Alabama just a few short weeks before. It was an astonishing game and if you watched it and didn’t like it, then you don’t like football and I can’t help you.

We got into an open construction entrance near section 44. We made our way down about 25 steps or to that little gray gate in the corner of the endzone. It wasn’t locked. We were supposed to be there.

The kids and I took pictures. Walked over spots we knew those Auburn Tigers had run over with amazing skill just recently. To beat Alabama. (Praise God)

And quietly Nonna walked 100 yards to the other side of the stadium to the other endzone.

Where she and my dad had sat together in the same seats for decades. Where their season tickets had been. (We lost my dad 2 years ago).

And she just sat and looked out over an empty stadium. Staring across a lifetime. Back from when she lived there as a young wife with my Dad in the early 1970s. When he went to school, coming off a stint in the Navy to pay for his degree. Back when she and he attended games in this same stadium but in the student section, instead. I am sure much crossed her mind as she sat there and stared on this beautiful December day in 2019 some 40 odd years later than all that long, lost time. But this time she was alone, without her Bill. And he without his Preppie.  

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Jordan Hare stadium has seats for about 86,000 people. If its sold out at halftime the will let in another 20,000 or so to stand in the ramps that lead to the upper deck. You then have a gathering of people – all there because they love Auburn and know it is the very best a college or town either of those things can be- that is bigger than most cities in the world.[4]

But that day there were only 7 of us in that stadium. And as momma sat on the cold, metal stadium seats, to her there were only 2. I cannot fathom the feelings of both emptiness and fullness of heart she must have been feeling.

Yet there was life in the stadium that day.

As kids we had season tickets about 2,000 feet in the air in the upper deck. My kiddos saw these upper seats towering above us and were amazed. ‘Can we go up there, Daddy?”

Trying to say yes more these days, I said “As long as we can find a working elevator.”

And we did. Pretty quickly. We were meant to be here this day.

God was opening stadium gates and turning on elevators.

Once we got to the upper deck, I walked the kids about 70 steps or so to the very top.

“We are as high as the birds,” Nora said in awe as a group of pigeons flew level with us about 4 sections over.

After a few minutes up there, we descended back down to the bottom of the upper deck to head home.

We got back to Momma (Nonna) and Stacy (Momma). “Its time to head on,” I said. They had been talking about who knows what while I and the kids journeyed to the upper deck and back down.

And a few minutes later, two police officers walked up to us from behind that little tunnel area where you walk into the stadium from the corridor where the concessions and bathrooms are.

I smiled at the officers and turned back around to look at the stadium again, committed to acting like we were supposed to be there.

“The stadium is closed.” The officers words came from behind me, and I turned around and smiled.

“Yes, sir. It’s time to head on kids.”

“Are you guys from around here?”

“No, sir. Well, my mom’s husband – my dad- went here. And so did my sister.”

“There’s just some construction going on in the stadium today, but no one is supposed to be here.”

“Thank you, officer. We will head out now. Please remind me where the elevator is.”

We made our way down the elevator and back down to the ground floor. The officers were walking about 100 feet behind us to make sure we left.

And we did.

On the way out my oldest daughter asked me if I had ever been arrested.

No, Nora.”

“Well have you had a lot of interactions with the police? You seem to know what you were doing speaking with them.”

“Those are stories for another time, honey.”

Life is what you play, when you play it.

Thank you officers, for letting us play that day.

NOTE [4] To give a little more perspective – those 2 numbers together around about 100,000 people, round figures. Shakespeare’s London had about 200,000 people in it. So imagine about half of all Londoners going to see Hamlet, screaming their lungs out, grown men crying tears, women jumping for joy- for about 3 hours straight. And that’s an Auburn football game. Except you can understand all the words, because it ain’t the Queen’s English.


Challenge to readers

I want to leave you with encouragement.

I want to remind you one last time- Life is what you play, when you play it.

I want to wish you this:

When you enter old age, may you have visitors every day. May the graveyards of your kinfolk be filled with mushy trinkets and singing. May your empty stadiums overflow with Precious Memories. And may whatever demons you tilt at turn out to just be windmills after all.

Here’s your assignment- Find something to do consistently (and monthly) that brings joy to strangers and do it 12 times next year. It will change you. Vets are a great target market for this. So are the elderly.

2020 is your year.

Go play something awesome. Play it loud. Make your voice crack. Break a sweat.

Report back December 31st, 2020.

The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full. John 10:10 (NIV)


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Menges Group 5 Slides Series for July & November 2019

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 two new editions of the 5 Slide Series, filling in gaps from 2019.  The July 2019 edition conveys information on the health care companies in the Fortune 500, focusing primarily
on 2018 profit margins.  The November 2019 edition tracks Medicaid and Medicare enrollment growth across the past several decades, with the two programs together now covering 38% of the US population.

Fortune 500 Health Companies July 2019 Volume 74

Nov 2019 5 Slide Series Insurance Coverage Through the Decades

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Monday Morning Medicaid Must Reads: October 21st, 2019

Helping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K

In this issue…

Article 1:        Medicaid Spending Rises Even As Enrollment Declines, WIBC.com

Clay’s summary:      I feel for the legislators who keep getting the goal posts moved on them. “Look over here – here’s our new shiny thing that will control costs!” 3 years later: “Well here’s why costs were not controlled those last few years. Can we interest you in a new shiny thing as you consider this year’s budget bill?”
Key Excerpts from the Article:
 Last fiscal year’s Medicaid enrollment was Indiana’s lowest in three years, yet spending was up $800 million.  
Read full article in packet or at links provided

Article 2:        Why Medicaid Enrollment And Fraud Has Exploded Under Obamacare, The Federalist

Clay’s summary:      Those expansion states that keep trying to shame your state into taking the plunge? Their expansion enrollment was 2x what their wisest predictors told them it would be.
Key Excerpts from the Article:
By the end of 2016, enrollment in 24 states that expanded Medicaid enrollment to able-bodied adults exceeded the states’ original projections by an average of 110 percent.
New studies and data suggest two related reasons why: Ineligible individuals getting on (or staying on) the Medicaid rolls, and people dropping private coverage to enroll in Medicaid expansion.
Read full article in packet or at links provided


Article 3:        Childless, able-bodied adults are driving cost and enrollment under Medicaid expansion, Adam Crepeau, The Maine Wire

Clay’s summary:      The young adults without children predicted least likely to enroll in expansion in the study used to sell expansion to Mainers? Yep, they ended up being the ones who enrolled at 5x the rate predicted. Its almost like Bernie clued them into the place to get all that free healthcare he’s been talking about.
Key Excerpts from the Article:
Since Governor Mills signed the executive order when she took office in January, more than 37,000 individuals have enrolled under expansion. According to the Maine Department of Health and Human Services (DHHS), adults without children represent 81 percent of those who have enrolled thus far. Of those individuals, 10,500 of them, or nearly one-third of all enrollees, are between the ages of 19 and 29.
These trends are much different than what was projected in a study conducted this year by the Muskie School of Public Service. Their research indicated that adults between the ages of 19 and 24 were least likely to enroll under expansion. This age group represented just 6.6 percent of eligible low-income, childless adults whereas individuals between the ages of 55 and 64 were expected to make up approximately 45 percent of the expansion population.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: October 14th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K

In this issue…

Article 1:        AAFP Objects to Planned End of Medicaid Access Rule, AAFP

Clay’s summary:      The rule is intended to show whether docs get paid enough to “encourage” them to provide Medicaid services, but it takes a good bit of effort to report on that info. And docs don’t like the idea of removing anything intended to make sure they get paid.
Key Excerpts from the Article:
In the rule,(www.govinfo.gov) published in the July 15 Federal Register, CMS noted its intention to ease some of the administrative burden that states currently face in trying to document whether Medicaid payments in fee-for-service systems are high enough to encourage physicians and other health care professionals to provide services to Medicaid beneficiaries.
The proposed rule outlines CMS’ contention that by compelling states to collect specific information, the agency “excessively constrains state freedom to administer the program in the manner that is best for the state and the Medicaid beneficiaries in the state.”
The AAFP noted its shared commitment to reducing administrative burden for states and clinicians, but argued that the proposed rule, as written, would likely negatively affect Americans in rural areas, as well as some of the country’s most vulnerable patient populations that depend on Medicaid for health care services.
Read full article in packet or at links provided

Article 2:        Walmart’s First Healthcare Services ‘Super Center’ Opens, Bruce Japsen, Forbes

Clay’s summary:      Amazon is creating empty shelves / space in those huge Walmart buildings. So far Bezos hasn’t figure out how to do 2 day shipping on a doctor’s visit, so Walmart is opening clinics. CVS, too…
Key Excerpts from the Article:
 The retailers see 10,000 baby boomers aging into Medicare coverage each day and are also looking to fill emptying space in their brick and mortar stores in the face of changing consumer shopping habits driven by online retail giant Amazon, which is also exploring new ways to get into the healthcare business but has yet to offer face-to-face personalized healthcare services for customers…
This year, CVS has said its new health hub concept store will reach four U.S. metropolitan areas and 50 locations by the end of this year as part of a major expansion. CVS said the HealthHub rollout will grow to 1,500 locations by the end of 2021, or about 500 HealthHubs a year, CVS chief executive officer Larry Merlo told analysts on the company’s second quarter earnings call.
Read full article in packet or at links provided


Article 3:        Medicaid expansion increased ED use, study shows, Modern Healthcare

Clay’s summary:      A Medicaid card provides immunity to medical debt, so ED visits went up. You don’t say?
Key Excerpts from the Article:
Patients under Medicaid don’t have to fear debt collection, removing one big barrier that could deter someone from a hospital visit. Those visits may be perceived as more convenient than a regular doctor’s office visit even if they’re more expensive to Medicaid, since the patient doesn’t have to find a physician who accepts his or her plan…”This pattern of estimates is intuitive,” they wrote. “Medicaid expansion effectively lowers the price of an ED visit for the patient, and so we would expect for an increase in visits for those that are discretionary.”In general, people who qualified for Medicaid under the expansion went to doctors or hospitals at higher rates than the people who didn’t qualify. The authors said that suggests basing the expansion on income rather than specific categories of need “successfully targeted” the people most in need of medical care.
That suggestion held in non-expansion states as well. The people in those states who bought plans on the individual market exchanges with the aid of income-based subsidies were also those who most needed medical care.
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Monday Morning Medicaid Must Reads: October 7th, 2019

2019 10 07 MMMRHelping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K

In this issue…
Article 1:

New Bombshell Report Reveals Obamacare’s Epic Medicaid Waste, Sally Pipes, Forbes

Clay’s summary:      It’s almost as if when you pass a gigantic, economy transforming bill without reading it, forcing everyone to go along or else they’re evil- and there happen to be some train wrecks, negatives we find out years later. But I have no doubt the Medicaid Left will only ever sing its praises as if it is a complete and total success until the end of time.
Key Excerpts from the Article:
...according to a new study published by the National Bureau of Economic Research, it’s the insurer of record for a significant number of middle-class Americans. The cost to taxpayers? Hundreds of millions of dollars.
The culprit for this epic amount of government waste shouldn’t be a surprise—Obamacare…By the end of 2016, some 11.5 million able-bodied adults had enrolled in Medicaid because of the expansion, more than double the original enrollment projections. This brings the total number on Medicaid to 65.6 million.The cost of the expansion has been higher than expected, too—76% more per person.
Read full article in packet or at links provided

Article 2:        Are the Right People on Medicaid? – Flathead Beacon, Bob Keenan, Tom Burnett

Clay’s summary:      Most people don’t mind taking money from them (“taxes”) to help their needy neighbor. They do mind when it turns out bennies are not actually eligible. Even in Montana.
Key Excerpts from the Article:
... 25% of Medicaid expansion enrollees were likely ineligible in both California and New York. A state audit in Louisiana found 82% of expansion enrollees were ineligible at some point during the year they were enrolled. 25% of Medicaid expansion enrollees were likely ineligible in both California and New York. A state audit in Louisiana found 82% of expansion enrollees were ineligible at some point during the year they were enrolled.
Read full article in packet or at links provided


Article 3:        Analysis: Medicaid deals offer election headache for Edwards, AP, Melinda Deslatte

Clay’s summary:      Sometimes Medicaid helps you get elected (like when you ran on expansion Mr. Edwards). Sometimes it might get you un-elected (like when you are blamed for the current procurement fiasco with MCOs). Good luck with that.
Key Excerpts from the Article:
…The contracts pay for private companies to oversee care for about 90% of Louisiana’s Medicaid enrollees, an estimated 1.5 million people — mostly adults covered by Medicaid expansion, pregnant women and children. The contracts are among the largest in state government, accounting for roughly one-quarter of the state’s annual operating budget…Losing bidders for the next round of multibillion-dollar contracts to manage health services for Medicaid patients are accusing the Edwards administration of bias and conflicts of interest. Republican and Democratic lawmakers are worrying publicly about whether health care access will be disrupted for half a million Medicaid enrollees, many of whom are in Edwards’ expansion program.
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Menges Group 5 Slides Series for June & August 2019

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 June 2019 Edition was produced by Manisha Gupta and Mohammed Hamdan.  It focuses on the level of marketing spending in the MCO industry, comparing the Medicaid, Medicare, and commercial sectors.  On average, we found that Medicaid MCOs
used 0.19% of their revenues on marketing, advertising, and commissions.  These percentages were much higher among Medicare-dominant MCOs (2.26%) and commercial MCOs (3.43%).

The August 2019 edition was produced by Grace Williams and summarizes our analyses of NCQA’s most recent quality ratings for commercial/private MCOs.  Kaiser Permanente led the multi-state MCOs with a stellar 4.28 average rating, scoring
over half a point higher than the 2nd place MCO and scoring more than ¾  of a point higher than the national average.

MCO Marketing Spending Across Product Types–June 2019

August 2019 Private NCQA Ratings

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Menges Group 5 Slides Series for April & May 2019

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 April edition describes a Pop-Up Clinic founded and led by one of our employees, Nehath Sheriff.  As many of you strive to “bring health care to the people” this type of construct could be a low-cost, high-value option to consider.

The May edition outlines a pilot program we encourage Medicare policymakers to adopt.  It involves testing Medicaid’s key design features in the Medicare arena, which if successful could evolve into a fundamental transformation of Medicare as has occurred with Medicaid (whose transformation also began with pilot testing of this approach).

5 Slide Series — April 2019, Pop Up Clinic

5 Slide Series May 2019, Piloting a New Medicare Coordinated Care Approach

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Q2 2019 Issue of The Medicaid Black Book Released!

Medicaid Managed Care Insights and Vendors Reviews in Latest Issue of The Medicaid Black Book

Click Here to Subscribe

NOTE: A new reduced rate is available to nonprofits. Email clay@mostlymedicaid.com to find out more

Read the little Black Book that everyone in the Medicaid industry is talking about.

The Medicaid Black Book is the premier market intelligence subscription product for the Medicaid Managed Care industry. Each quarterly issue includes:

  • Exclusive interviews with Medicaid Health Plan CEOs and Investment leaders
  • Highly focused content that matters to Medicaid managed care leaders, including
    • Surveys of what is top of mind for health plan CEOs
    • Analysis of key regulatory changes
    • Analysis of Medicaid health plan financial performance
    • Analysis of mergers and acquisitions activity
  • In depth review and rating of 10 vendor firms that are currently trying to partner with Medicaid health plans

Interviews in this issue include Erhardt Preitauer (President and CEO, CareSource) and Binoy Bhansali (Vice President, Sandbox Industries).

Vendors reviewed include….

  1. 360 Health Systems
  2. Axciom
  3. American Specialty Health
  4. Automated Health Systems
  5. CA Technologies
  6. Collective Medical Technologies
  7. GreatCall
  8. Independent Living Systems
  9. OutcomesMTM
  10. PrescribeWellness

Distribution of results

  • 2.5 or less out of 5 stars – 2 vendors
  • 3 or 3.5 stars 5 stars – 2 vendors
  • 4 or 4.5 stars out of 5 stars – 4 vendors
  • 5 out of 5 stars- 2 vendors

Click Here to Subscribe

NOTE: A new reduced rate is available to nonprofits. Email clay@mostlymedicaid.com to find out more

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Monday Morning Medicaid Must Reads: July 15th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K

In this issue…

Article 1:       California Becomes First In Nation To Expand Medicaid To Undocumented Young Adults

Clay’s summary:     Before all you federal “taxpayers” get upset- I am pretty sure anything the are offering to these folks is paid for by state only funds.. So its not exactly Medicaid. But it makes a great headline, amiright?
Key Excerpts from the Article:
 Some lawmakers argued California should be spending health care dollars on its own citizens, rather than people who are not living in the state legally.
“We are going to be a magnet that is going to further attract people to a state of California that’s willing to write a blank check to anyone that wants to come here,” said Republican Senator Jeff Stone at a recent legislative hearing.
President Donald Trump also criticized California for offering health insurance to undocumented people.
“They don’t treat their people as well as they treat illegal immigrants,” the Republican president told reporters in the White House on Monday. “It’s very unfair to our citizens and we’re going to stop it, but we may need an election to stop it.”
Read full article in packet or at links provided

Article 2:       Block Granting Medicaid is Still a Terrible Idea

Clay’s summary:      Sort of related, sort of serious question: Is a salary sort of a micro-block grant? Like at the individual level?
Key Excerpts from the Article:
While the promise of increased flexibility can sound enticing, the reality is that so-called flexibility pits funding choices against one another and ultimately leads to cuts. Medicaid already has the flexibility it needs to respond to economic downturns or public health crises, and capping funding for the program makes these responses more difficult.
Block grants have not worked in the Temporary Assistance for Needy Families (TANF) program. What we know from 20 years of experience with TANF is that funding has not increased with inflation or in response to poverty and need. Moreover, states have used TANF funds to support alternative programs and have significantly decreased the aid going directly to families.
Read full article in packet or at links provided

Article 3:       The inconvenient truths of Louisiana’s Medicaid expansion

 
Clay’s summary:     All that “free” Federal funding still comes from taxpayers like you and me.
Key Excerpts from the Article:
In the wake of a wave of stories about the tens of thousands of ineligible individuals who received Medicaid benefits, supporters keep trying to defend Louisiana’s expansion of Medicaid to the able-bodied. But their defenses ignore several inconvenient truths.
 
First, money doesn’t grow on trees. Health Secretary Rebekah Gee recently claimed that Louisiana’s “Medicaid expansion comes at no additional cost to taxpayers.” Because she believes the federal government will pay all the cost of Medicaid expansion, she thinks Louisiana taxpayers are “off the hook” for the program’s spending. But anyone who had to mail a check to the Internal Revenue Service on April 15 would disagree. By definition, any new government spending imposes a cost to taxpayers, because Louisiana residents pay taxes to Washington just like everyone else.
 
And Louisiana has seen a ton of new government spending due to Medicaid expansion. In 2015, the Legislative Fiscal Office projected spending on expansion to total $1.2 billion-$1.4 billion per year. In the last fiscal year, Louisiana spent nearly $3.1 billion on expansion—or more than double the Fiscal Office’s original estimates.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: July 8th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
other MMRS – http://bit.ly/2T7CP7K

In this issue…

Article 1:       Wayne State generated $112.8 million a year in enhanced Medicaid funding over six years

Clay’s summary:     You can make a lot of money in the Medicaid financing shell game. A lot. Cue outrage from Medicaid lifers who swear IGTs, CPEs, etc are not a scam.
Key Excerpts from the Article:
PEPPAP was designed for Michigan in 2004 as a federal-state Medicaid matching program to give payment add-ons to doctors that would increase their reimbursements to Medicare-equivalent levels. Many states have variations of the program, but all are designed to encourage providers to increase access to care for poor people on Medicaid.
But in order to receive the funds, Wayne State is required under the program to send to the state Department of Health and Human Services matching funds that averaged $32.2 million per year. On a quarterly basis, MDHHS calculates the state-federal match and sends the university a check.
Besides Wayne State, which is considered a “public entity” under the Medicaid state plan amendment rules, there are six others receiving PEPPAP funds in Michigan. They are Michigan State University, Central Michigan University, Oakland University, University of Michigan, Western Michigan University and Hurley Medical Center, the only publicly owned hospital in Michigan, in Flint.
Read full article in packet or at links provided

Article 2:       Letters: Time to ask tough questions about Louisiana Medicaid, The Advocate (Baton Rouge)

Clay’s summary:    Ruh-roh. Someone’s noticing things. Things that make Medicaid expansion look bad. Look- a squirrel!
Key Excerpts from the Article:
From the beginning, Louisiana’s conservative legislators have simply asked that Medicaid expansion serve those most in need. Since then, scathing report after report has revealed that this was not the intention of this administration. The Pelican Institute recently revealed in a report that thousands of individuals per month are dropping their private insurance plans to join the taxpayer-funded program. What’s worse, there are more than 1,000 individuals enrolled in Medicaid who earn annual salaries of $100,000 or more. Medicaid expansion’s original intention was to help those who needed it most, but those are the ones greatest impacted as we expand eligibility while providers shrink.
Read full article in packet or at links provided

Article 3:      Tennesseans Losing Medicaid; State Hasn’t Bounced Back from Software Failure

Clay’s summary:     Advocates concerned over declines in Medicaid rolls point to a software issue that happened in 2013.
Key Excerpts from the Article:
Tennessee is one of three states in the country with the sharpest drop in Medicaid enrollment between 2017 and 2018.
According to a report by the consumer health care group Families USA, the number of Tennesseans enrolled in Medicaid fell by nearly 10%, and more than 100,000 people lost coverage.
Eliot Fishman, senior director of health policy at Families USA, says that since 2013 the state has been struggling to bounce back from a massive software failure linked to TennCare, the state’s Medicaid program.
Read full article in packet or at links provided