Clay’s Weekly Medicaid RoundUp: Week of January 14th, 2019

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

ABOUT THAT WHOLE MEDICAID TRANSFORMATION IN NY THING. YEAH, LET’S STOP DOING THAT- After years of major overhaul efforts to transform its Medicaid program, Cuomo just pressed pause on the key device real driving change. For 8 years, NY has capped Medicaid spending to be within a 10-year rolling average of medical inflation. In this next budget, the Good Guvn’r decided to give Big Med (primarly hospitals) a pass and allow Medicaid spending to exceed the cap (3.1% is the cap; Cuomo is authorizing 3.6%). Why, you ask? As a pre-emptive strike (in his view) to shore up against federal changes coming to Medicaid. What federal changes? Reductions in DSH that were started when ACA passed (in 2010), but Big Med has been able to get delayed year after year.  Lefties, rejoice (and don’t forget to vote for him when he runs for Pres in 2020). Righties, observe yet another tax and spend Dem refusing to reform their ways (cuz, you know, they’re the good guys and your’e evil if you doubt that). Total Medicaid budget now that NY Medicaid is on a cheat-day? $19.6B (which is roughly the GDP of Botswana, and more than the GDP of 118 countries. For freakin’ Medicaid in NY, people).

HOW WAS YOUR EXPERIENCE? MA TO POLL PATIENTS- Medicaid members in The Old Colony State will be asked to rate providers and plans for the first time. Results will be made public in 2020. From what I can tell this is basically a CAHPs-type survey. Results will also likely be used for value-based care payments.

SHAKEUP IN ARKANSAS NEMT- For readers keeping tabs on the Medicaid transportation scene: Southeastrans is picking up more regions as MTM will exit. Handover starts Feb 1.

JUST WHY ARE HOSPITALS IN VIRIGINIA SO EAGER TO BE TAXED? Why do hospitals exist? To help people AND to make money. When asked why they exist, what is the answer? “To help people.” They conveniently leave out that second part. When you put it back in, it makes a little more sense why VA hospitals are eagerly paying a “tax” to help fund the recent explosion (expansion) in Medicaid spending. State reps are getting their first taste of the “surprise” cost over-runs in the expansion they approved last year. This week new adjustments to expansion costs show at least $85M more than what they were told when they voted “yes”. Hospitals, those noble creatures they are, are running full press coverage highlighting how they are so, so happy to pay a tax to help fund expansion. Long time readers remember that Medicaid provider taxes are often a total sham described thusly: we pass the hat to hospitals, who all chip in money. We then beam up the hat to planet CMS, who puts in 6x more money (or 7x or whatever your fmap is), and then sends it back down. The state gets more cash, and so do the hospitals.

PALMETTO STATE JOINS RANKS OF WORK REQUIREMENTS REFORMERS- Looks like another 1115 app will be hitting the halls of 7500 Security Blvd in Balto soon (where planet CMS is). South Carolina is doing town halls on a work requirement proposal as of this week.

IMPLEMENTING BALLOTED (IS THAT A WORD?) EXPANSION PROVING TO BE HARDER THAN CHECKING A BOX ON VOTER CARD- Utah lawmakers are trying to figure out how to pay for the expansion approved by voters in November. There are 2 issues in play: 1) how to keep the limited expansion already in place going while applying for CMS to approve full / “standard” expansion we’ve all come to know and love; and 2) how to come up with numbers during the current budget cycle that at least try to pretend there’s a way the state can pay for it. A sales tax increase is projected to come up about $45M short in the next few years.

HOSPITALS AFRAID SETTING LIMITS ON MEDICAID SPENDING COULD HURT THEIR REVENUES- See earlier entry above about why hospitals exist. As CMS suggests states may find approvals for block grant waiver apps if they only ask, hospitals are going nuts in the press. Sky is falling, cutting spending will kill everyone- you know the dril by now. There are increasingly insightful quotes coming from Verma on this. Here’s a good lil’ nugget: “We also believe that only when states are held accountable to a defined budget can the federal government finally end our practice of micromanaging every administrative process.“ Hear, here!

IN A RELATED NOTE, GA WANTS MORE FREEDOM FROM FEDERALI MICROMANAGING FOR ITS CITIZENS’ HEALTHCARE NEEDS- The Good Guvn’r Kemp (who recently barely beat romance novelist Stacy Abrams) announced a $1M project to explore a waiver with CMS that would give the state more flexibility with its use of federal Medicaid dollars. No other details than that. You get to fill in the blanks (most fill them in with block grants based on early analysis). In a somewhat related news item, GA teachers will be getting a $3k raise this year.

PASSPORT STRUGGLING WITH NEW NORMAL IN KY- For those of you watching this MCO market, Passport has been unscuccessful in getting the state to budge on recent cap rate cuts that hit Passport particularly hard. Short version – state changed up regions and rates in a way that Passport got hammered. And Passport’s whole business is Medicaid. More to come.

CANARY IN COAL MINE IN AR? We all like to think we are special and unique. Medicaid programs are no different (see what I did there?). Arkansas cooked up yet another version of the “here’s how we’ll transition legacy behavioral health providers to a capitated rate” idea a few years back. (It’s an acronym that spells PASSE; did no one look that up in French?) Like most of these inititaives, year 1 starts out all nice and you get basically extra cash to play along and maybe do a little more case management than before. In year 2 you are expected to manage medical services, pay claims, etc (depending on the state). Well, ForeverCare sees the writing on the wall (or is chickening out if you listen to state officials) and is dropping out. They say they will come back in if the Phase II implementation date is moved to July 1. It has already slid from Jan 1 to March 1.


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 –


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- not so fast fraud junkies. No where near enough space this week. You can get your fix in the FWA Curator archives though.

Want all the highlighted news items from this week? Check it out here-Medicaid News Curator Volume 5

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 (buy or chop some firewood) 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: Baba alimtuma Mwana kuokoa ulimwengu.