Clay’s Weekly Medicaid RoundUp: Week of July 18th, 2016

Soundtrack for today’s RoundUp pessimist readers-

Or you can click the one for optimist readers –


ACA COSTS WAY MORE THAN EXPECTED/ADVERTISED? YOU DON’T SAY? Those meanie right-wingers over at Forbes just keep insisting on holding federal officials accountable to their cost projections for ACA. Per Forbes analysis this week, HHS 2015 ACA per-enrollee projected costs were off by 50%. While HHS said new ACA bennies would cost $4,281 per year, they actually cost $6,366 per year. Cue leftist explanatory gymnastics (but whatever you do, don’t suggest that government officials are either unable or unwilling to estimate the true costs of what they are proposing even as little as 1 year out).


BUT WE WANTED IT TO BE OUR IDEA! In NC, a huge push for Medicaid overhaul has been going on for a few years, and the state recently submitted an 1115 to CMS to bring managed care to the state. Now left wingers are directly pleading with CMS to reject it, arguing that the current Medicaid system in NC is just fine. Read between the lines and you will see that managed care is expected to reduce costs (payments) in NC Medicaid (which have been wildly unpredictable the past several years) and threatens the future of CCNC (a valuable – but also politically powerful – vendor of provider EHR and care coordination services).


ANOTHER EXPANSION TRIAL BALLOON IN TN LEGISLATURE- Volunteer State House Speaker Beth Harwell is getting back on the bicycle to try yet another flavor of expansion. This time she is hoping a focus on vets and mental health will be the push that expansioners need to get a plan passed.


CMS TO UTAH: “TALK AMONGST YOURSELVES” If you’ve been following the planned UT expansion here in the RoundUp, you know it’s a pretty focused approach – chronically homeless, in the justice system or needs MH/SA help. So CMS will be very careful with this one, and this week they asked UT to get some more public comment in their state before CMS reviews (and opens their own public comment period). CMS has specifically noted that the budgetary portion of the proposal was not finished when the UT public comment period ended. My guess is they won’t get any “aha moments” from extended comment, but it will be interesting to see what the “input” from the public is on the costs. “You’re spending too much on this” – said no Medicaid bennie or advocate ever.


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. Ted Suhl of Little Rock, AR got convicted of bribing a Medicaid official this week. Seems Mr. Suhl paid off AR DHS Deputy Director Steven Jones (who plead guilty last year) to make sure Suhl’s mental health companies got $90M in Medicaid moo-lah. Cynthia Harlan of Charlotte, NC was convicted this week for her role in a $10M services-not-provided scheme. Paul Mil of Springfield, NJ is headed to the big house as of Thursday. Mr. Mil nabbed $7M of your tax dollars using a bogus home health Medicaid scheme (unqualified providers, fake claims – surely, and sadly, you can fill in the rest of the sentence by now dear RoundUp reader). Patricia Torrington of Bridgeport, CT was sentenced for $1.6M in bogus Medicaid psychotherapy services.  Mr. Suhl – you win this week’s award by a landslide! Maybe you and Mr. Jones can be cell mates? I’m sure he will remember you as a friend for all those bribes you paid him when he was a state government employee. (Lots of honorable mentions for the follies in the twitter feed this week, folks).


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 maybe stay in- its HOT!) and keep running the race (you know who you are).


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