Clay’s Weekly Medicaid RoundUp: Week of November 28th, 2016

Soundtrack for today’s RoundUp pessimist readers-

Or you can click the one for optimist readers –


MAKE MEDICAID GREAT AGAIN- I have had clients and readers ask my thoughts on what President-elect Donald Trump’s shocking (gasp!) victory means for Medicaid. I have intentionally waited a few weeks for the dust to begin to settle.  You can read my thoughts here-

Since most of the Medicaid news in the past few weeks has been speculation over what the Trumpening means for Medicaid, I have reserved this week’s RoundUp for news summaries of other items.

BUT FIRST, A CORRECTION – An earlier RoundUp incorrectly listed the Good Guvn’r Brandstad as the Governor of Illinois. I have written it correctly at least a dozen times (he gives me lots of material), but the one time I get it wrong, I hear from Richard, Rob, Marni, Claudia and others who wrote in to Correct the Record. I love it when people write in, and I love it even more when they provide corrections. It means they are paying attention. Thank you, and everyone – keep me honest!


SPEAKING OF IOWA- MCOs playing in the Iowa statewide rollout continue to post loss numbers (in the press). Losses in the latest stories range from 18-25% for UHC, AmeriHealth Caritas and Amerigroup in the Hawkeye State. The Good Guvn’r Brandstad tossed another $33M in the MCO pot in October to help cover unexpected costs (especially Rx). Its not all dollars and sense, though- 25,000 members now are getting care coordination services, 230,000 have been engaged with health risk assessments and other outreach efforts and more than 2,000 have been taken off the waiting list for a DD program. Aren’t these smashing successes? Where are the advocates showering confetti and throwing a parade for the MCOs? Seems a bit one-sided to me. Sometimes the naysayers remind me of cavemen- “MCO bad. Me get angry. Me repeat tired arguments against MCOs and me ignore abysmal outcomes in fee for service.”


ARKANSAS STRUGGLING TO KEEP UP- About 28,000 Medicaid applications are in purgatory in the Natural State. DHS officials are still saying they can get them all done by year end (that’s now less than 3 weeks when you adjust for the impact of the Christmas break).


MEDICA MCO WALKS AWAY FROM MINNESOTA- About 300,000 bennies in the Gopher State will need to cut up their old Medica card (“Medica” is the MCO name, which is confusing, and looks like I dropped an “id” or an “re”). Medica says it will end up losing around $150M on 2016 Minnesota Medicaid business. Of course the party line is: ”The evil MCO is making too much money and got greedy.” Assuming they are not lying, can you blame any business for wanting to not lose money?

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. Deborah Brown of Warwick, RI will serve four years and pay $230k for billing for DME (incontinence supplies) not medically necessary. Gregory Dodds, a counselor in Camdem, AR was ordered to pay $250k for defrauding Medicaid. His counseling practice operated from inside the building for Camden’s “Connection International Ministries Church.” His excuse? Mr. Dodds needed to pay off student loans. Bernie – where are you? Riyad Altalla and his wife Muna Alnoubani pled guilty to using their home health company to steal more than $1M from Ohio Medicaid. The lovely couple from Ohio wins this week’s award.


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 (build a fire! And while you are at it, read London’s “To Build a Fire”) and keep running the race (you know who you are).


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