Clay’s Weekly Medicaid RoundUp: Week of December 24th, 2018

Soundtrack for today’s RoundUp pessimist readers-


For optimist readers-

READY FOR MEDICAID INNOVATIONS 2019- I will be there again this year (my 9th time), chairing one of the very best Medicaid events you can go to. Also, its sunny Florida in February (I’m looking at you, Michigan). If you decide to go, let me know and we can meet up. Check it out here –

PELICAN STATE TO START USING IRS DATABASE TO CONFIRM MEDICAID ELIGIBILITY- After a few weeks of taking a beating in the news over blowing $80M on non-eligibles, Louisiana is rolling out several news stories about an enhanced system. To be fair, it looks like the enhancements were planned for some time (so I guess they have known their system is crappy for a while but still kept overpaying millions?). The new system will start using tax data for bennies in May of 2019 (one month after we all file our taxes).

AND ON THAT NOTE, A BRIEF MATH DETOUR- I’ve been working on a little math exercise where I try to figure out how much of my own personal taxes help pay for Medicaid. Its not easy (mostly because of the imaginary way we handle group expenses in our country under “budgets” and “debt”). But I am getting closer to a workable framework. Here’s my current, early, certainly wrong (but I invite you to provide alternative estimates) evaluation based on income groups. If you make $65k/year, then about $1,800 of what you pay in taxes goes to Medicaid spending (about 1/3rd the cost for one average bennie; about $185 from your taxes is lost to Medicaid fraud). If you make $120k/year, then about $3,400 of what you pay in taxes goes to Medicaid spending (about 2/3rds the cost for one average bennie; about $350 from your taxes is lost to Medicaid fraud). And so on… Once I am done, I will publish the broader analysis and will invite comments, corrections, etc…

BUCKEYE STATE JUST CAN’T GET RX RIGHT- The report of CVS spread-pricing shenanigans in Ohio will be conveniently delayed until after legislators consider a budget in 2 months. Note to CVS Grand Pooh-Bah: whatever you are paying your lobbyists in Ohio, they deserve a raise. In a related (?) note, reporters in the state are trying to get answers about why the state still has not implemented a unified drug list that was rolled out by Kasich as a key initiative 2 years ago (and in October of this year was still projected to go-live Jan 1, 2019). Medicaid officials announced this week that the effort would be “delayed indefinitely.” You know who opposed that initiative? PBMs. Why, you ask? Because they could no longer keep their rebate deals secret and states would know how much rebates they would have gotten vs what was passed on to them. Am I being too hard on you this week, PBMs? Open invite to come on the show and explain yourself anytime you like.

ALOHA STATE INCHES FORWARD MEDICAID PAYMENTS FOR HOUSING- Hawaii is leading the way towards getting Medicaid dollars approved for housing. An existing waiver that pays for house (or apartment) hunting help is being expanded. While the dollars can’t pay for rent, they can be used to help with all the effort to find a place. There are 8 other states with a request for similar funding for supportive housing from CMS.


SHOW ME STATE CONSIDERS THOSE EVIL WORK REQUIREMENTS- By now you can fill in the rest from here, right? Won’t be effective, just an evil ploy to kick people off rolls, Orange Man Bad.


SNEAKY STATE REPS IN THE GRANITE STATE TRYING TO UNDO CMS DEAL- This is pretty interesting. A week or so ago, CMS approved a New Hampshire request for work requirements (aka, “how the process works”). Without getting into the weeds (are there weeds in NH? In my mind its this idyllic place, with nothing out of place), duly elected reps in NH negotiated a deal in which the state’s expansion program can continue IF there are work requirements in place. So that got passed, then CMS approved what was agreed to by both parties. Now, Dems (Rosenwald and McWilliams) are introducing bills to make work requirements illegal in NH. When you’re opponents keep changing the rules, its hard to keep up. Will be fascinating to see how this one plays out. Some of the CMS comments were fairly clear on the tradeoff between expansion and work requirements as the heart of the bargain.


WAIT- YOU MEAN WE HAVE TO PAY FOR THIS EXPANSION THING BY PASSING A STATE BUDGET? Idaho activists were able to get expansion voted in back in November (seems ages ago, doesn’t it?). But now it seems the next steps are out of their hands. From what I understand in Idaho, each year this group of people called “legislators” get together in this place called the “Capital” and they manage something called an “appropriations process.” They have to make these things called “decisions.” And sometimes they have to choose between different priorities. And – here is the shocking part- some Idahoan reps think the function of Idaho state government is broader than Medicaid. Something about education, roads, state pensions – I mean does it matter?. Somebody connect these doofuses to Alexandria – she clearly has it all figured out.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award… Actually, in the spirit of Christmas, let’s just pretend there’s not bad guys stealing 10-20% of all the funds meant for the most vulnerable this week. We’ll pull our heads out of the sand again next week/year.


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 (burn all those amazon boxes) 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 .

Want the Curator News Pack for this week’s Roundup? Medicaid News Curator Volume 4


Trystero: Fadern skickade Sonen för att rädda världen.