Clay’s Weekly Medicaid RoundUp: Week of May 7th 2018

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-


QUICK ANNOUNCEMENT – Our webinar provider had a “major outage” yesterday and we did not get to do the full MESC 2018 preview webinar. Look for details re a rescheduled show in the newsletter.

BEEHIVE STATE TILTS AT WINDMILLS – Please write in if you get the reference (no googling!- but you can go to your local library and check the 863s under Cer)… Officials in Utah continued the farce of a post-obama expansion this week by trotting out a series of public hearings to discuss adding 90,000 adults to the rolls. Do people really think CMS will approve this? Or maybe I missed something and Utah is willing to pay 50% of the costs (vs the sweet, sweet 90-100% deal offered in years past?). Think they will agree when CMS comes back with work requirements and other “evil” conditions of paying for it?


IT’S GETTIN’ HOT IN HERE; I’M GONNA CUT SOME BUH-JETS – Apologies to Nelly fans worldwide. Louisiana may be doing it for reals, though. Letters were sent to 37k bennies that they may get booted from Caid based on recent changes to Medicaid budgets. The proposed budget would remove 4 programs (not sure which ones, please write in if you know more). Bennies will also get contacted about getting services on other programs they may still be eligible for.

NO DICE, KANSAS! CMS rejected the KS waiver request to establish a 3-year limit on Medicaid benefits for non-disabled adults. This doesn’t bode well for AZ, UT, ME and WI who have asked for a similar budget relief measure. Since this rejection is in keeping with the dominant paradigm of The Healthcare Left, many are confused. At time of running this article, CNN was trying to figure out how to tie this to Stormy Daniels. Or the Russians. #Resist!

ILLINOIS GETS A LOT OF CASH TO HELP FIGHT THE OPIOID CRISIS- CMS approved a $2B transaction to IL this week, as part of an 1115 waiver application to address challenges in meeting the needs of behavioral health patients. Per analysis used to make the case for the funding, bennies with behavioral health needs drive more than half of all Medicaid spending. July 1 will see new efforts funded around short-term drug addiction treatment centers, moms and babies showing drug withdrawal symptoms, employment assistance and other programs. IL had asked for some of the cash to go to things related to social determinants of health (like rent payments), but CMS shot that down.

TRIBES CONCERNED OVER NEW MEDICAID RULES APPLYING TO THEM- Seems some policy statements / positions in April from CMS / Trump classify tribes as a race. The next step in the Administration’s argument is that exempting tribes from work requirements would show preference for one racial group over another and thus be discriminatory. Different tribes are assessing the impact on them, with Cherokee Nation putting about $46M impact due to a proposed work requirement in OK.

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. Beverly Coker of Windsor, CT was sentenced for her part in a $214k fraud that involved unlicensed providers. (She got probation while her co-conspirators got much harder sentences. May be because she is 70 years old). New Era Rehabilitation Center in Bridgeport, CT will pay back $1.37M for double-billing for methodone treatment. There are some services-not-delivered details in that one, too (check the twitter feed for more). Mrs. Coker – You win this week’s award because you are the oldest convict ever to appear in the Roundup! Congratulations!

 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 (Meet a new neighbor this weekend) and keep running the race (you know who you are).

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