Clay’s Weekly Medicaid RoundUp: Week of April 25th, 2016

BRITISH PETROLEUM TO FUND AL MEDICAID- Lawmakers struggling to scrounge up funds to fill the Mcd budget gap have come up with a way to leverage money the state is owed from the BP oil spill. It’s a little tricky for me to understand but it involves a bond issue that then gets paid off with BP money and I think somehow a new (or quicker) $85M pops out to plug Mcd. Not sure yet on the reaction from coastal residents who may see the move as snatching the funding tied to the devastation of their environment six years ago.

EMPIRE STATE TO COVER HEP C DRUGS- This follows a recent lawsuit requiring commercial plans in NY to cover drugs like Sovaldi and Harvoni. There are 25,000 new Hep-C cases in NY each year. At some point, each of those could become eligible for the drug, creating a new $2B annual spending item for Hep-C rx alone.

LA MEDICAID EXPANSION IS ROLLING OUT NOW- The state is beginning to migrate members from existing programs that already meet the Mcd expansion population requirements. Members of Take Charge Plus and New Orleans Community Health Connection were asked to update addresses this week so that they can receive their brand new Mcd cards.

AZ HOSPITALS RECEIVED MORE THAN $1/2B RETURN ON THEIR MCD “TAX”- The Medicaid Magic Money machine strikes again. St Joe’s had the biggest ROI on the “tax”, receiving more than $24M than it put in. The money trees in D.C. did look a little sickly last week, but they were watered and rebounded quickly.

MOUNTAIN STATE WILL GLADLY PAY YOU ON FRIDAY FOR A HAMBURGER TODAY- It’s never a good sign when the Mcd agency sends you a letter saying it may be a while before you get paid because state revenues are down. Yet that’s what WV did to 24,000 Mcd providers this week. At least they gave you a heads up, I guess?

MCO WINS IN THE KEYSTONE STATE- Centene and UPMC won bids in SE PA this week under a new effort to negotiate pay for outcomes MCO contracts (up to 30% of payments tied to outcomes). Congrats to our friends and colleagues in Centene and UPMC!

AH, THE MEGA RULE- As most of you by now know, the final Medicaid Managed Care Rule was released Monday. There’s simply too much to cover but 2 quick things- the already voluminous 653-page rule more than doubled itself to 1,425 pages (maybe they fed it after midnight, or got it wet?). And #2- everyone I know says it seems like CMS just ignored most of the comments. Not sure on that last one, but hope to do a show on it soon and have some good discussion on it.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Darin Cox of NY got $80k in Mcd payments for his taxi service carting bennies to appointments. Thing is, he didn’t have a taxi license. Robert Rouzaud of Cleveland, OH got charged this week for false Mcd claims for tooth fillings. Mr. Rouzad got paid $343k for fillings for teeth that had previously been pulled, or for patients with dentures. And in one of our rare (rarely detected, anyway) cases of member fraud – Jennifer Garret of Chandler, AZ got indicted this week. Mrs. Garret received more than $70k in Mcd (and other) state benefits, all while her and her husband made loads of cash on their car restoration business. Enough to buy a Nissan 350-Z and Mercedes SUV while toting a Medicaid card in her pocket. Mr. Rouzad, you win! Mr. Cox – perhaps you should consider an Uber career? Mrs. Garret – perhaps Mr. Cox could borrow your Mercedes if he gets out before you do?

That’s it for this week. As always, please send me a note with your thoughts to or give me a buzz at 919.727.9231. Get outside (remember to water those seedlings!) and keep running the race (you know who you are).


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