Clay’s Weekly Medicaid RoundUp: Week of May 6th, 2019

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

(Special Mother’s Day song selections)

YOU WILL ACCEPT MEDICAID WHETHER YOU LIKE IT OR NOT- Clark County (NV) passed an ordinance this week that requires any new ERs to take Medicaid (and Medicare). Magically, existing ERs / hospitals don’t have to comply.

HUMANA TO CENTENE: “IF THAT WELLCARE THING DOES’T WORK OUT, TAKE A CHANCE ON ME”- Hedge funds with important stakes in Centene have voiced second thoughts about the recently announced WellCare deal. Smelling opportunity, Humana has batted its doe-eyes at Centene. Centene shares up; WellCare shares down. More to come.


OK WE’RE GONNA START CHECKING INCOME FOR REALS, YALL- Louisiana reps are moving forward with a bill that will – wait for it- connect Medicaid eligibility systems to federal tax data to verify income eligibility. Where are all the kudos from the people telling me interoperable big data is the answer to everything? Can I get an Amen? The space-age tech comes on the heels of highly publicized news of LA having to kick 30k members off the rolls for earning too much money (some of them six figures). #Resist!


GROUNDHOG DAY: NORIDIAN WINS IOWA MMIS CONTRACT, AGAIN- Yet another snub to the whole modular / let’s shake things up and get some fresh blood in the MMIS world movement. Noridian (congrats, btw) won the Iowa MMIS contract again. It has held it since 2004.


FASTER WAIVERS- CMS approved waivers in 16% less time in 2018 compared to 2016. New reports coming out of Madame Verma’s office show that long overdue bureaucratic reforms are working. 78% of waivers are now approved within the first 90-day review period. And the backlog of pending state plan amendments is now down 80%.


LOOKING LIKE LIMITED EXPANSION WILL PAY AT SAME RATE AS FULL ACA EXPANSION, SUCKERS! –  I have sat through nearly a decade of obnoxious taunts from blue states to red states about being fools for not taking the awesome federal gravy train money deal for expansion. Seems like hold outs may have the last laugh- not only will they possibly get the same FMAP (90%) under a more responsible, limited expansion on their own terms – they also got to sit out of the spending orgy that got all those expansion states even more addicted to the federal teat from 2010 to 2016. CMS is saying its open to paying 90% of costs of “conservative” expansion plans like the ones being asked for in GA (that go up to 100% FPL vs 133/8). The Peach State plans to submit its waiver to CMS by the end of the year.


VOLUNTEER STATE MOVES FORWARD WITH BLOCK GRANTS; PEARLS CLUTCHED- State reps passed a bill that gets the governor to submit an 1115 to CMS to convert TennCare into a fixed-payment program (vs the open-ended, spend forever, drive-it-like-you-stole-it normal model). Similar to what Utah did in February. Other sources report that CMS is expecting more states to request a block-grant conversion, and the agency is drafting guidance on how to make the ask.


WE, LIKE, TOTALLY VOTED FOR THE SIMPLE EXPANSION, MAN! GIVE US THE SIMPLE ONE NOT THIS COMPLEX MEDICAID STUFF- You can’t blame voters in Nebraska for thinking the work in expanding Medicaid was done when they filled in their ballot bubble. Everything is oversimplified for the electorate, and healthcare is no exception. Problem is somebody must pay for what they thought they were ordering off the taxpayer menu. In their minds they were getting the Porterhouse for 100,000 of their newest Medicaid card-carrying friends. In reality there’s no budget for Porterhouse, so voters may end up ordering off the kids menu. What do you do when you don’t get what you want in modern America? Sue! And that’s of course where this is going… Resisters have already fired up the outrage machine and are threatening litigation.




THE MEDICAID BLACK BOOK IS HERE- Want to know what’s on the mind of MCO CEOs? Want to see our in-depth reviews of vendors? Current issue is out. You can check it out here –

COME HANG OUT IN BALTO IN MAY– I’ll be speaking and generally gallivanting at the Medicaid Managed Care Congress May 20-22nd in Baltimore. Would love to see you there. Check out the event here-




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 (record scratch sound)- not so fast this week dear readers. I wrote too much above and need to land this plane.

Need even more Medicaid fraud stories? – You can get your fix in the FWA Curator archives.

Want to read the articles summarized here, highlighted for your reading pleasure? Check out the News Curator archives.

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 (thin things that are sprouting to the proper spacing- there’s info on that seed packet if you didn’t throw it away) and keep running the race (you know who you are).

FULL, FREE newsletter@ . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

Trystero: piyāṇan vahansē lōkayaṭa gaḷavannaṭa putrayā evū sēka