Clay’s Weekly Medicaid RoundUp: Week of September 10th 2018

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

4,353 ABLE-BODIED, WORKING AGE ARKANSANS DECIDE FREE HEALTCHARE IS NOT WORTH WORKING (OR VOLUNTEERING) 20 HOURS A WEEK- That’s how many AR Medicaid bennies got kicked off last week for failing to meet work requirements. Assuming pmpm of around $200 (typical for healthy, middle-aged Medicaid bennies), the state just saved $10,447,200 by giving the members a voice in whether the coverage was worth it to them. The flip side is 83-90% (depends on whether you count the denom of those subject in month 1 vs current) of AR bennies met the requirement or were grandfathered in. There are also 1,000 bennies who did not have a job before who chose to go out and get one to keep the coverage. Resistors- Commence name-calling, pearl-clutching, et cet era.

EXPANSION STILL NO DICE IN BAMA- The Good Guvn’r Kay Ivey re-iterated this week that Alabama will not be pursuing expansion any time soon. She seems stuck on this whole “you have to pay for it” silliness. Maybe she hasn’t heard the magical incantations about its free federal money? Or the wise counsel to ignore other tales of woe from expansion states that got shackled to crippling Medicaid debt? Quick, someone call Mrs. Ivey and tell her she simply must take the “free” money.

HEAD OVER 1 STATE EAST, THOUGH- And Stacey Abrams (Dem gubernatorial hopeful in Georgia) is promising Medicaid expansion “is the only answer to Georgia’s challenges.” I must say her background is interesting.. a career in finance and tax law. If anyone can figure out how to get more Medicaid moula, surely it would be a tax attorney. But wait a minute, there’s more- according to an op-ed she wrote for Forbes in the spring, she owes $50,000 in taxes and has outstanding credit card and student loan debt of $170,000. I must say- Mrs. Abrams is uniquely qualified to set Medicaid policy. All she has to do is take her current personal finance skills and scale it up to the level of a state agency. Onward and Upward!

OK, I KEEP READING ABOUT ABRAMS, AND IT JUST GETS BETTER- She is also a romance novelist. I kid you not. Titles include “Hidden Sins,” Secrets and Lies,” The Art of Desire,” and “Deception.” Here is a link to her Harper Collins author page if you don’t believe me. I am unable to resist the temptation to personify Medicaid (as the male interest, a public health Fabio, if you will) in one of her novels. “I looked across the meadow, and the Budget Deficit was staring at me. A look of voracious desire burned a hole into my bones. As he ran to meet me, all I could do was smile and think “Medicaid expansion.” The wind blew through his hair, and we embraced. Mr. Budget Deficit and I were a match made to be. Some might even say, a Federal Match.” FMAP- get it? Ba-dum-bum-bum. Please, please, please Georgia voters- elect this gem. She will give all us writers 4 years of complete silliness to write about.

WE WERE JUST KIDDING ABOUT MORE PRIOR AUTH RULES- Says the NV Medicaid agency. NV Medicaid spending doubled when in expanded, and regulators are desperately looking for any tools to help control costs. They wanted to put more prior auth around certain mental health services to slow down utilization – but providers were loud enough that the state decided not to. Also I think maybe there was a go fund me that raised $10M that said they would NOT call agency officials mean names if they reversed the decision. Or am I getting that confused with some other state?

THINGS IMPROVING IN CT NEMT- We reported previously on the challenged Veyo contract in CT. Looks like there have been significant turnaround efforts (re-training call center reps, improved provider outreach) and the call center wait times are down from 5.5 mins to 2.8. I’m loving the terms and conditions on this contract though- Veyo got $52M in year one of a three-year contract. Lots of terrible press in past few months about service quality, so they have been fined. Total fines Feb. to Sep- $13,500. You can’t make this stuff up.

REMEMBERING 9/11- That’s still ok to do, right? This week we hit the 17th anniversary of this evil attack on U.S. soil. I remember exactly where I was when it happened (living on a friend’s couch) and most of that day very clearly. Have a 9/11 story? Would love to hear it sometime. Send a note. Give a call. Too young to remember it? Here’s a recording of CNN coverage as it happened.

 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. Haydn Thomas and Catinia Farrington of Raleigh, NC plead guilty to stealing $4M Medicaid bucks using their mental health counseling business to submit false claims. Francis Steen and Alicia Sanders of Savannah, NY got caught in “Operation Find the Dough” (that’s the real name local investigators gave their op, and I love them for it). This dynamic duo provides for us one of our rare member fraud cases (rare in that they got caught and were above our $50k minimum for Roundup appearance, technically). It’s a pretty cool list of thieveries for these two- $23,957 in SNAP benefits, $676 in Low Income Home Energy Assistance Program (LiHeap- bonus points!), and $44,594 in Medicaid benefits. Centers Plan for Health Living in Staten Island agreed to pay $2M to double dog promise it did not steal Medicaid bucks by enrolling non-eligible members and then sending Medicaid the bill. Haydn and Catinia – You win! Taxpayers, you lose – about $6.1M based on the ones we showcased today. Work harder!

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 (get a surprise puppy and forever be a hero in the minds of your children) and keep running the race (you know who you are).

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