Clay’s Weekly Medicaid RoundUp: Week of July 23rd 2018

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

MEDICAID ROLLS KEEP DROPPING IN FL- Current estimates show about 500k less bennies on the roll for this SFY compared to last. One theory- once the state started using Equifax to link income data to Medicaid eligibility, a huge amount of bennies who made too much money were dropped.

WORK REQUIREMENTS IN MS? NOT IF ADVOCATES HAVE ANYTHING TO SAY ABOUT IT– The Tupelo protest machine is starting up. Agency officials submitted a plan for adding a Medicaid work requirement, but groups like the Mississippi Health Advocacy Program and Community Catalyst have begun official opposition in recent weeks.

TREASURE STATE SURPLUS MEANS MORE TREASURE BACK TO PROVIDERS- After some initial confusion over whether the agency was following court orders to reinstate nursing home payment rates, The Good Guvn’r Herbert announced full rates for the huge facility-provider lobby (er- I mean nursing homes) were back on. How, you ask? MT apparently has a revenue surplus. The extra cash will be used to undo a 2.99% rate cut to nursing homes and for mental health case management funding. About $45M is getting pumped back into the Medicaid budget.

 THE GRANITE STATE WANTS TO UP PROVIDER PAYMENTS, TOO- Seems the migration of about 50,000 Medicaid members from a private commercial program (exchange-subsidy program maybe)? to Medicaid managed care will cause substance abuse providers to see about a 50% drop in their per diem. Lawmakers met this week find another $7.5M to avoid the drop in provider revenues. New Hampshire currently has a $22M surplus- making the SA providers whole would take about a third of it.

NEVADA SET TO REDUCE ALLOWED NUMBER OF COUNSELING SESSIONS- Medicaid members can currently get 26 visits per year. If a new policy designed to combat fraud by mental health providers goes into effect, the total allowed visit will drop to 3 per year – before the provider has to submit more paperwork to authorize additional visits.

STRONG GROWTH REPORT FOR ANTHEM- Highlights include: 23% YOY revenue growth, with operating revenues now at nearly $23B. A drop of about 880k lives was attributed to shedding exchange plans. Class, remember: you make money on Medicaid (you pretend to assume risk); you lose money on exchanges (you have actual risk). Reports also show an expected increased emphasis for Anthem on Medicare opportunities.

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. Waveny Bleckman of D.C. pled guilty this week to stealing $9.8M in Medicaid bucks using his DME company. Georgia Phillips of Brownsville, TX was ordered to pay $500k back to Medicaid after stealing taxpayer dollars (Medicaid funds) using her speech pathology clinic. Slow week for Medicaid fraud (I’m sure that these 2 cases were all the fraud that happened, so no worries taxpayers!). Waveny, you win hands down!

DON’T FORGET TO BOOK YOUR OCTOBER TRIP FOR MHPA- I will be there again this year. Should have discount code for MM readers soon. Check out agenda here –


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 unusually cool weather) and keep running the race (you know who you are).

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