Clay’s Weekly Medicaid RoundUp: Week of February 11th, 2019

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

NEW ONLINE TRAINING COURSE IS OUTWant to understand the opioid crisis? Our newest online course will help. Check it out here-

IDAHO DECIDES TO MEASURE IMPACT OF EXPANSION- Medicaid expansion is getting its very own budget item so it can be tracked precisely. I know about 30 states who wished they would have thought of this.

ALASKA BACKLOG OF APPLICATIONS GOING DOWN BUT STILL A PROBLEM- The Frontier State is struggling to scale its Medicaid program after expansion nearly doubled its rolls.

 MEDICAID ROLLS DECREASING IN SOME STATES; LEFTIES FORGET THE “BUT MEDICAID IS COUNTERCYCLICAL TO THE ECONOMY” LINE- To admit the economy is improving would admit The Duly Elected President of the United States of America (DEPOTUS) just might be helping rescue us from the disastrous economy he inherited. Such an admission is impossible for most in our Medicaid world. Other theories: re-enrollment apps are too many pages long (TN has 47 pages to fill out to get back on the rolls) or bennies re-applying have to wait on the phone lines too long (MO). Overall, Medicaid enrollment declined about 1.5% nationally last year. Which really isn’t that much when you realize it basically doubled in an 8-year period under ACA. So, class- Medicaid grew 100% in 8 years, then it took a 1.5% step back in the last year. (At this rate it would be 2120 before we got back to pre-ACA bennie levels). Let’s all FREAK OUT!!!! ORANGE MAN BAD! I’ll leave you with this quote from a TN Medicaid official – ““Tennessee is experiencing a state economy that continues to increase at what appears to be near-historic rates.”

 MICHIGAN WORK REQUIREMENTS BATTLE RAGES ON- The Good Guvn’r (the new one- Whitmer) is looking to undo the work requirements plans already approved by CMS. She has a new report with bigger numbers on how many will lose coverage if they don’t comply with the requirements. Pro tip for those wanting to undo work requirements already approved by elected (that word is put there to remind you that about 50% of voters disagree with you) officials: looks like you just need to know the right consulting firm to get the numbers you need to justify the reversal.


VOLUNTEER STATE STEPS FORWARD FOR BLOCK GRANTS- TN state reps filed 2 bills this week (1 in the house, 1 in the senate) to require the Medicaid agency to request a waiver from CMS to convert to a block grant program. 1st shots fired. For history buffs wanting to chase a rabbit trail right this moment instead of doing whatever you are supposed to be doing at work, read the wiki page about an American hero involved in the first shots fired during the American Revolution- Crispus Attucks. For all you whippersnappers drinking the green kool-aid, the American Revolution was how this unique, wonderful country got started and began the beautiful, unique, one-of-a-kind story that is America. Thank you, Crispus, for your role in making this place awesome.


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. Manuel Barit of WV plead guilty to stealing $200k. His crime? Submitting claims for treating bennies when he was actually out of the country. The scam went on for six years. Ryan Sheridan of Austintown Township (Ohio) was charged with stealing $31M with bogus substance abuse treatment claims (DBA “Braking Point Recovery Center”). He and his buds operated recovery centers all over town. Lillian Richardson and Bridgett Burrel of Minnesota got convicted this week of stealing $7.7M in Medicaid bucks using five (count em’, five!) home care agencies they set up under the names of different family members. They submitted lots of bogus claims for helping disabled Medicaid members with daily tasks. Fun Fact- Richardson was convicted on a different Medicaid fraud in 2012 but pinky-swore to not do it again. Guess pinky swears are not what they used to be in 4th grade.  Mr. Sheridan – you win. $31M is a decent chunk of change, even for Medicaid fraud.

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 (or stay inside and order seeds – its that time again) and keep running the race (you know who you are).

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Trystero: Rama dikirim Putra ka ngahemat dunya.