Clay’s Weekly Medicaid RoundUp: Week of October 31st, 2016

Soundtrack for today’s RoundUp pessimist readers-

Or you can click the one for optimist readers –


Millions in Academic funding Goes Away- I must admit even I haven’t seen this happen in Medicaid. VT has taken $4M from academic medical centers and given it to family doctors. The redistribution was required in a bill passed last session, and appears to be aimed at maintaining the higher primary care payment rates ACA made possible for 2 years back in 2012-2014.

(Illinois) Medicaid Again Gets Allocation increase- Whatever you think of The Good Guvnr’ Brandstad’s managed care strategy, you have to give him props for stick-to-it-ness. When the press just won’t stop criticizing your decision to move to managed care, and attack you for 2 years with every story they can? Add $33M more to the MCO budget this year and tell those journalists to shove it. Brandstad claims the additional spending is possible because managed care has been even more efficient than predicted, and he is still on track to deliver the $110M in annual savings he promised.

(Virginia) Medicaid Annual costs Go up Again- New numbers out from a VA budget groups shows FY 2017 going up $281M. That’s a 7% increase in Medicaid spending over last year. This upward adjustment comes roughly one year after the most recent update to the VA spending forecast, which also showed staggering increases (and a $1.5B budget gap). Can anyone guess what the go-to solution being touted by The Good Guvn’r McAuliffe is?

Managing Affordable (care act’s perception) Goes Awry- It’s just gotten so very hard to pretend like ACA is successful at doing anything besides reducing the uninsured rate. And somehow, John Q. Public has caught on that even that is not so impressive for a policy that forces people to get insurance via penalties. For easy reference, I have placed a few links to the most relevant stories to come out in the last week or so here, here, and here. To me, the funny thing is that ACA really just decreased access for all the people that already had insurance (via higher deductibles that have a clear cooling effect on seeking care). Looks like all the king’s horses (pundits) and all the king’s men (whackjob healthcare economists) couldn’t put poor ACA back together again. I would write more in depth analyses, but it is considered impolite/impolitik/crimethink in our little healthcare world to do so.

 Managed (care) Assessment Gets Adjusted- States that rely heavily on taxing MCOs to deal with budget boo-boos are struggling under the new federal rules that require they broaden (tax more types of managed care entities besides MCOs) or eliminate the revenue stream – good LORD I lost the verb in here somewhere. Wait, nevermind- its just a few words after “boo-boos.” Anyway, they are struggling. Ohio is a good example, with one county standing to lose $20M in annual funding. Kasich is promising a fix but not a lot of details yet. Some predict he could mimic what PA’s Good Guvn’r Wolf did last year, implementing a $13 pmpm “assessment” on all MCOs. So basically, use a different word for tax to keep the money flowing.

LOTS OF OTHER THINGS THAT JUST WOULDN’T FIT – I missed deadline for last week’s RoundUp, so the twitter feed is especially full this week. News from this week and last on there, including lots of fraud stories.


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 (go vote on Tuesday! The founding fathers bravely rejected the oppressive, corrupt rule of the elites of their day, and you can too) and keep running the race (you know who you are).


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