Clay’s Weekly Medicaid RoundUp: Week of July 8th, 2019

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

CA MAKING IT EASIER TO TEXT- While it pains me to realize that 1991 is now 28 years ago (1991 is when the law blocking spam texts was passed; its also when this album came out and changed all of music), it does seem like maybe our SMS policy needs a touch up. See, when healthcare companies can’t use the communication method that 50% of Americans say is their primary day to day method, we have a problem. Why can’t an MCO text Clay the Medicaid bennie? Because laws. And stuff. The California health agency is working to remedy that by laying out some basic ground rules to make it easier for MCOs. Summary of the rules: submit a form to the state to text to members, make it free, give them an opt-out option and let us know your game plan re: privacy protections (hint- don’t let Amazon or Facebook access the info so they can market them new products via their discounted Medicaid/EBT Prime accounts).

GARDEN STATE WELCOMES NEW DIRECTOR TO THE HELM- Jennifer Jacobs will be the next New Jersey Medicaid Director by late July. Jennifer- We’re glad you’re here!

INDIANA WORK REQUIREMENT BEGAN LAST MONDAY- By Tuesday morning, there were 17 lawsuits filed, 4 HuffPo articles explaining how Evil this is, 2 protests in the streets and 4 new Democratic Presidential Candidates. Ok that last one was unrelated to the work requirements program beginning. Members subject to the requirements (as in all the of the states trying to roll out this feature, almost all members are exempt) will have to work 20 hours a month in year 1 (which boils down to 5 hours a week, or 1 hour a day, M-F).  So 240 hours of total work to obtain a benefit valued around $6,000 comes out to being paid $25/hour if you have to work for your health insurance.

OREGON MCO AWARDS ARE OUT- CCO 2.0 (Coordinated Care Organizations, for those that missed the first memo 5 years ago about how this was the next great idea that was going to save Medicaid from a financial death-spiral) is now live after the MCO awards were announced this week. All incumbents won except for 1 (Primary Health), with 4 newbies given 1-year contracts as a type of probation.  Congrats to our friends and clients in the winning orgs. Here’s to five more years!

EMPIRE STATE TAKING LTC RESIDENTS BACK OUT OF MANAGED CARE- Under new NY policy, skilled nursing facility residents will be back in fee for service if they are in a facility more than 90 days (assuming the carve-out is approved with the CMS waiver in play). The thinking behind the change is that there’s not a lot of cost management achievable for long term institutional residents (NY thinks they will save $158M savings in the first fiscal year)- so why pay an MCO basically an additional administrative fee. I personally am skeptical that there is no room for efficiencies in nursing facility management, but we shall see.

NEED A JOB IN ILLINOIS? There are 300 new job openings to help deal with the pile of Medicaid applications that are backlogged (more than 100,000 currently, which are older than 45 days – which is non-compliant with federal rules).

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award. Not a lot to cover this week, but let’s at least scratch the itch… Vasso Godiali of Bay City, MI got popped for his role in a $60M healthcare fraud (not sure how much was Care vs Caid). Seems he had a penchant (been a while since I used that word) for bogus stent claims. What started out as a Medicaid fraud case got bumped up to include Medicare when the state folks realized they were just the tip of the iceberg. Qaiser Gondal of Watervliet, NY plead out in Albany this week. He was part of the dozen or so thugs using Ti Taxi to steal multiple Medicaid millions. And finally, Nikkitta Chesney of Bridgeport, CT joined her partner in crime (Toshirea Jackson) at the sentencing hearing for their Medicaid fraud. Their crime? They stole Medicaid bennie IDs (about 150 of them) and then used them to steal $3.9M using fake claims for psychotherapy services. The lovely ladies Nikkitta and Toshirea are our winners this week, albeit on a technicality (since we don’t know the Care/Caid loot mix for Mr. Godiali). Congrats, fraudsters! You get a Mostly Medicaid Fraud All-Stars T-Shirt. It comes in orange and also in orange.

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 (if you bag the grass when you cut it, it does really help with weeds after a few years. Every think about how many seeds are in the soil in your yard? Scientific notation is surely required) and keep running the race (you know who you are).

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Trystero: Chuir an t-Athair am Mac gus an saoghal a shàbhaladh