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

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

MEDICAID PROGRAMS TO START COVERING CIGARETTES AS BENEFIT- Might as well, we’re still paying for all the results of Medicaid bennies smoking. New numbers out show we could save $2.6B if just 1% of Medicaid smokers quit.  On average states would save $25M (which is enough to put a dent in some of the state costs of expansion). To me this one is like fraud – do some fixin’ on it before you pass the hat for more, more, more, evermore tax dollars.


MCO MAKES GIANT LEAP FORWARD TO IMPROVE PBM PRICING ISSUES-  CareSource made big news when it dropped its PBM and decided to partner up with Express Scripts under a new contract. Even bigger was the news they decided to give the state of Ohio an unredacted copy of the contract, including all pricing info. You can’t get more transparent than that. Unless of course you’re some knucklehead journalist who somehow thinks not only state officials but all of the public should also have a copy of the contract. No good deed.

ROBERT MUELLER TO INVESTIGATE IOWA MCOS- He does have some time on his hands these days. Advocates in Iowa have been clamoring for years to get a special investigation into what they say is rampant service denial by MCOs. While the news stories are short on facts and long on mantras, you do have to wonder when you see things like the recent United exit.

KANSAS DECIDING WHETHER TO USE SURPLUS TO SPEND MORE ON MEDICAID HEALTHY ADULTS OR GIVE IT BACK TO THE PEOPLE PAYING FOR MEDICAID COSTS- Kansas tax revenues will be slightly less than 1% more than projected (must be this terrible economy), so lawmakers are doing their duty and figuring out what to do with the extra cash. The Good Guvn’r Kelly is softly messaging Tax Relief Bad, More Medicaid Good. Well maybe not so softly- she did veto a tax relief bill a few weeks back. Her numbers to pay for Medicaid expansion are around $34M net, so if she could maybe inspire 1% of Medicaid bennies to stop smoking, she could cover it (see lead article).

MONTANA EXPANSION FIGHT GETS INTERESTING- It has come down to straight up horse trading between saving coal jobs and expanding Medicaid. Maybe they need to review the tape of one our brightest luminaries to get some ideas.

MICHIGAN UNIVERSITY MAY BE TAKING TOO MUCH OF A CUT IN MEDICAID BUCKS FOR PROVIDERS’ LIKING- Best I can decipher of this one, it may be a UPL-type issue. Seems Wayne State University (Detroit) gets beau-coop Medicaid bucks in a draw-down meant to fund Medicaid services through its medical facilities. It then pays providers who perform those services. But turns out it may be keeping millions for itself as a middle-man fee. Which actually is entirely legal based on what I understand of the UPL (upper payment limit) regs. But that doesn’t mean it doesn’t make the docs ticked when they find out they were shorted millions from the overall pot.

WAIT- YOU MEAN WE HAVE TO PAY FOR MEDICAID EXPANSION? NOBODY SAID ANYTHING ABOUT PAYING FOR IT- Idaho lawmakers now have the enviable job of paying for what voters bought back in November. One of the leading ideas on how to pay for expansion is to assess counties a fee based on how many Medicaid eligibles there are in that county. Makes sense, right? Well class, remember, we are not a group focused on logic unless it fits our own agenda. In reality, more of anything (including the Magic Wand of Medicaid Cards) costs more, and there will be winners and losers. In Idaho, 21 counties will pay less and 23 will pay more. And the pot will likely be property tax, which of course disproportionately impacts property owners… Some of them are not exactly happy, and I would wager may not have been in the 61% that voted yes on More Medicaid. But they just need to suck it up, and if we vote it in, we can force you to pay. Democracy and all.




THE MEDICAID BLACK BOOK IS HERE- Want to know what’s on the mind of MCO CEOs? Want to see our in-depth reviews of vendors? Current issue is out. You can check it out here –

COME HANG OUT IN CHICAGO END OF APRIL- I’ll be speaking / chairing the 4th Annual Medicaid Managed Care Leadership Summit, April 29-30th in Chicago. If you are interested in going, send me a note so we can coordinate, and I can also get you a 15% off registration. Check out the event here-

COME HANG OUT IN BALTO IN MAY– I’ll be speaking and generally gallivanting at the Medicaid Managed Care Congress May 20-22nd in Baltimore. Would love to see you there. Check out the event here-




FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award- er, not so fast readers. Not enough space this week. Check out some oldies but goodies in the archives (links below).

Need even more Medicaid fraud stories? – You can get your fix in the FWA Curator archives.

Want to read the articles summarized here, highlighted for your reading pleasure? Check out the News Curator archives.


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 (plant 300 square feet of sunflowers- I did!) and keep running the race (you know who you are).

FULL, FREE newsletter@ . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

Trystero: piyāṇan vahansē lōkayaṭa gaḷavannaṭa putrayā evū sēka