Clay’s Weekly Medicaid RoundUp: Week of March 28th, 2016


OK NOT OK – A 25% provider rate cut is on the table to address budget holes. Hospitals are wailing, with individual facilities beginning to report impact. (Hit to Duncan Regional – $2M). The cut comes right on the tails of a proposal (blocked this week) to remove 111,000 from the rolls via a waiver excluding non-pregnant, able-bodied adults under 65.

NM PASSES THE HAT TO PAY THE PIPER- NM is looking at the increasing expansion costs over the next few years (it ain’t free forever, people), and is starting to socialize the idea of getting counties to chip in more revenues to cover the bill.

OH ASKS BENNIES TO SPLIT THE TAB- Or at least pay for the appetizers. Kasich is pushing forward a plan to require Medicaid members to pay into an HSA to help cover the costs of their own medical care. Bennies would lose their card if they don’t pay 2% of their income (or $99- which is roughly what 1 carton of Marlboro Reds – what I used to smoke back when I did – now costs in Toledo, OH. Or 3 weeks of a daily Starbucks for those of us who grew up into fancy hipsters. Or 1 prescription for those of us with insurance we pay for under the “new normal” prices for everyone not on Medicaid).

ARE YOU WANTING TO CONTINUE YOUR MEDICAID HOSPITAL FEDERAL FUNDING, BUT DON’T WANT TO EXPAND? NOW YOU CAN (HERE’S HOW)- A little birdy brought a CMS letter to MS Mcd to my attention this week. In the letter (dated Mar 22), CMS tells MS Mcd that their plan to incorporate $533M of hospital UPL payments into its MCO rates as a pass through violates 42 CFR 438.60. But – since MS went ahead and did it, it would be hard to undo so CMS will look the other way for now. I uploaded the letter to the site here ( for those who want to spend a little more time with it and tell me all about how I’m wrong to think this is questionable.

TN MCD DIRECTOR STEPPING DOWN- Darin Gordon has “sat in the chair” since 2006, and is now leaving TennCare. Gordon is widely respected on both sides of the political aisle, remaining in his spot for 10 years and through gubernatorial transitions. Congrats on a great tenure at TennCare, Darin! If you’re reading, I would love to interview you for the book I am working on about Medicaid directors. Working title – “A Day in the Life: The Medicaid Director’s Job Really is Rocket Science.”

ACA TURNS 6- Hard to believe that shining example of bipartisan politics, that grand-ole bill that passed with broad support from both parties elected to represent roughly 50% each of the American people, that policy that passed definitely not by procedural tricks and legislative bullying and good ole’ ram-it-through-no-matter-what-they-think elbow grease – [insert sound of vinyl record scratching to a halt here]. ACA turned 6 this month and a new round of analysis of impact is out. Punchline – for all its bluster about reducing the uninsured with exchanges and reforming commercial insurance, ACA is one big, fat Medicaid expansion. Which is great for us who live and breathe Medicaid. Not so great for the 50% of Americans (those evil Republicans) who are becoming more aware that Medicaid is another tax. Medicaid rolls have grown 25% since 2013 (when exchanges opened, and ACA really began in full force); Commercial coverage has dropped by 9M using CBO numbers (check the twitter feed for links to these #s).

FARRIS’S FANTASTIC FRAUD FOLLIES– I put lots of goodies in the twitter feed for all your fraudies that need your fix this week.

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 (its almost time to plant!) and keep running the race (you know who you are).


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