Clay’s Weekly Medicaid RoundUp: Week of January 2nd, 2017

Soundtrack for today’s RoundUp pessimist readers-

Or you can click the one for optimist readers –

BONUS Optimist Song:


SOMEBODY TELL THE GOOD GUVN’R HE’S WEARING LAST YEAR’S FASHIONS: Perhaps the protracted battle with the outgoing Guvn’r has left NC Good Guvn’r Roy Cooper a little confused. He is talking about expanding Mcd in the Tarheel State, seemingly unaware that expansion is yesterday’s news. He promised to submit a state plan amendment by this Friday to expand under ACA rules, which have to be approved by CMS. This is either a PR stunt only, or the new Guvn’r is more clueless than the average bear.


NOW THERE’S AN IDEA: AK ASKS TO KEEP ACA CASH FLOWING BUT WANTS MORE CONTROL ON LIMITING ELIGIBILITY THAN ALLOWED BY MASTERS IN THE DISRICT (CAN I USE 2 COLONS IN A HEADLINE?): The Good Guvn’r Hutchinson has been in talks with the new cabinet members about letting AR tighten eligibility requirements for its expansion bennies. He may end up getting what he’s been begging CMS for for years after all. Amazing the difference a new king (er, President) makes.


AND SO IT BEGINS- One half of the country seems to be moving into the next phase of grief. The denial phase was like watching a train wreck- fascinating (Stein’s stratagem and the attempts at electoral mutiny), terrifying (Fake News pots calling kettles black) and pitiable (b-b-but the Russians did it!) all at the same time. We are now witnessing the negotiation and acceptance phases best I can tell. I now see Op Eds discussing how block grants may not be that bad (as long as its tied to healthcare inflation) and detailed analysis of the expected GOP battle plans to repeal the sacred cow of ACA (as opposed to the previous stance of “but they can’t do that).


KS ELIGIBILITY APPS: STILL LATE- 2 years and counting for the backlog. State officials did get it down to 1,400 or so in September (from a high of 15,000), but its climbing again. The latest number is 2,247 apps at least 45 days old.


MCO TIDBITS: Item 1) WellCare completed its acquisition of Care1st of AZ this week, adding 115,000 lives to the ledger. Item 2) Iowa newspapers are now reporting they have obtained secret documents showing MCOs calling the Iowa program “drastically underfunded” and a “catastrophic experience.” Sensing that these documents reveal a disconnect between what is being said publicly and privately, Mr. Pin Ochio has stepped in with new evidence that Oceania hacked the Iowa Medicaid agency. He insists we ignore the contents of the documents and focus on the manner of their discovery.


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. There’s actually just one this week: Abe Freund, operator of Acacia Mental Health Clinic, LLC in Milwaulkee has been charged by the feds with stealing as much as $7M from Medicaid. Acacia was billing $474 for drug tests that should have been paid at $20. At the end of the feeding frenzy, 99% of all Wisconsin substance abuse counseling payments were going to Acacia. Acacia payments surged from $300k to $3M over a few years. Lesson learned (?)- when you see 99% of your SA payments going to one provider that’s grown tenfold in a few years, maybe you should have something in place to stop paying that provider number before it gets to that point?


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 (enjoy the snow! One Yankees nuisance is a Southerners magical experience) and keep running the race (you know who you are).


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