Clay’s Weekly Medicaid RoundUp: Week of May 14th 2018

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-


HEADED TO BALMORE. DO DROP BY AND SAY HELLO- I will be at MMCC 2018 starting Monday. Chairing a panel Tues morning. Would love for any and all readers at the event to say hi.


Y’ALL SIMMER DOWN NOW- NM recently awarded new MCO contracts. So the protests were filed by the losers. And HHS rejected the protests via the administrative process yesterday, so now the losers can take it to court. Yay! Even longer time to make changes needed for the program… Member impacts include uncertainty over whether they will have to switch providers Jan 2019. You have to understand the losers’ position though. It’s a lot of cash. Example – Molina had $1.3B in premium revenue in NM Medicaid last year. Assuming a 2% profit yields $26M a year lost if the protests don’t work out. So as long as the litigation costs less than $75M or so (3 years of premium profit in the market), why not roll the dice and sue? And that doesn’t even take into account impacts on market capitalization on news of losing key contracts, etc. Want to track the impact of lawsuit on stock price? Follow ticker symbol MOH on the NYSE.


SOUTH CAROLINA EXPANSION LOBBY PRIMES THE PUMP- The Urban Institute (are they still around?) just released a study showing the amazingly 1-sided impacts of a potential Medicaid expansion in SC. 194k would get “coverage” (please define “coverage” class, and then compare and contrast it to “access,” then triangulate it with “intersectionality” – oh bother, I lost myself) if the state moved forward with expansion. Per the study, the state would “only need to chip in $111M per year.” Because you know its magic federal money, that comes from the sky every time you wish upon a star. It makes no difference who you are. Anything your heart desires will come to you (and other states will pay for it!).


ALASKA SLOWING HOSPITAL PAYMENTS- Since the legislature did its job and passed a budget (you know, how the US Constitution and all state ones work?), there is $20M less than requested (do not make the mistake of confusing requested with “needed”) going to Medicaid between now and June 30. That’s about 45 days, people. So when you realize how people are freaking out (that they have to follow what the legislature says when it comes to appropriations) its clear Medicaid is living check to check. Normally the state cuts the checks weekly, but starting this week they will float larger providers a bit longer. Some reps point out that all this is driven by higher than projected costs of Medicaid expansion (remember when the Good Guvnr Bill Walker did it all by his lonesome back in 2015?), but those reps are quickly silenced and reminded on the non-politic nature of such comments. Even more daring reps point out that services for the most vulnerable are being impacted because of expansion overloads. Those reps are so offensive that they are immediately sent to Siberia. You can see it from the Governor’s back yard, you know.


PATIENTS SUE ILLINOIS OVER MEDICAID DELAYS- Illinois just can’t get it together. Seems like the state thinks after it sent us the best-President-ever they don’t have to do anything else at all. Resting on their laurels. Latest chapter in the dumpster-fire story (tragi-comedy? Especially considering sub-plot arcs over the years like Blagojevich) of the Prairie State is a lawsuit from patients suing over long-delayed eligibility applications. Seems the state is out of compliance with federal rules on determining temporary eligibility for new applicants. They are supposed to process apps within 45 days. The biggest pain points are in nursing homes. Per the write-ups I’ve seen, there has not been a single applicant approved under temporary eligibility since the summer of 2016.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph – not so fast. I was too wordy up top this week. Plus gotta keep you coming back for more.

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 (time to get the yard in shape for your Memorial Day party) and keep running the race (you know who you are).


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