Clay’s Weekly Medicaid RoundUp: Week of August 1st, 2016

Soundtrack for today’s RoundUp pessimist readers-

Or you can click the one for optimist readers –

THE HEART OF IT ALL STATE WANTS BENNIES TO PUT SOME CASH IN THEIR PIGGY BANK- Ohio wants bennies to put the lesser of 2% of their income or $8.25 / month (or the cost of about 1.5 packs of cigarettes, which would get a chain-smoker through about 4PM one day) into a health savings account (which would be mostly funded by the state). Ohio number crunchers say the plan would save about $1B over 5 years compared to current spending. Whoa! A Medicaid “savings” number that means less actual dollars spent? Not some crazy “but we would have spent more if aliens landed and all enrolled in our program, so this plan “saves” money” savings estimate? The real kicker – bennies who can’t cough up the $8.25/month would be disenrolled. I give this 1 snowball out of 5’s chance (in Hell) of CMS not laughing this out of town.


KEYSTONE STATE CONTRACTS KINKED-UP OVER PROTESTS- All those new MCO contract awards we’ve all been watching the last 18 months in PA? Yeah, not gonna happen anytime soon. The latest round of implementations was supposed to start Jan 1, but a judge sided with Aetna this week on a move to delay until April. Aetna protested part of the state’s proposal review methodology. Now bidders have until August 22nd to submit proposals under the restarted RFP process.


EMPIRE STATE OF THE SOUTH TELLS PROCUREMENT PROTESTORS TO STUFF IT- GA officials let the losers have their say (Americhoice, Humana and Amerihealth Caritas), but in the end said “no thanks, you still lose.” The new GA CMO (That’s an MCO everywhere else except GA) contracts were supposed to start this month, but now are delayed until at least August 2017. Losing MCOs can still take it to the courts if they want to (the current protests were handled by the state Dpt of Administrative Services).


AUDITOR TURNS OVER ROCKS IN OLD NORTH STATE, FINDS (INFERS) UP TO $17M IN NO-NO PAYMENTS FOR DME- For audit geeks nationwide, NC has been a hit parade of sorts the past few years. And the hits keep on coming. Beth Wood (the state auditor) took a national estimate of DME fraud rates and applied them to NC Medicaid claims to come up with the potential NC loss. Then she reviewed NC DMA payment review policies and said they weren’t up to snuff. A PCG post-payment review contract was also cited as an example of poor vendor management (per Wood, NC DMA staff did not do any verification of the PCG results).


NOT THAT ANYONE’S WATCHING, BUT BLUE-GRASS STATE EVIL PLAN TO ROLL-BACK EXPANSION MISSED FIRST DEADLINE- The Good Guvn’r Bevin’s office missed an internal deadline related to submitting its infamous 1115 waiver to CMS this week. Reason cited? Way more comments than expected.


CONGRATS DUE TO ADVANCEMED- They just want a $77M contract from CMS to provide fraud consulting. Congratulations!


WELLCARE BOOSTS M&A TEAM- Tuesday’s earnings call was encouraging for those of us excited to see the WC comeback into the Medicaid space continue. CEO Ken Burdick focused on criteria for targets in both the Care’ and Caid’ spaces (and largely avoided speculation around the WC role in the event of a breakdown in the Anthem/Cigna deal).


FARRIS’S FANTASTIC FRAUD FOLLIES– Just not enough space this week. Plenty in the twitter feed, I promise. Head on over there and get your fix. My favorite this week is probably either the St.Joes story or the Tenet one.


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 (I got lemongrass plants on clearance for $1 this week!) and keep running the race (you know who you are).


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