Monday Morning Medicaid Must Reads: July 2nd, 2018

Helping you consider differing viewpoints. Before it’s illegal. 


Article 1:  

CMS to increase oversight of Medicaid enrollment, managed-care plans, Virgil Dickson, Modern Healthcare, June 26, 2018

Clay’s summary: Care’ and Caid’ blew $89B on improper payments in the last reporting year. I refuse to get my hopes up that anyone actually cares at this point.

Key Passage from the Article


The agency announced Tuesday that it is boosting audits to confirm that Medicaid beneficiaries are correctly identified as expansion or pre-expansion enrollees. States receive higher federal match rates of around 90% for expansion enrollees, while the match rate can be as low as 50% for pre-expansion enrollees.

“This imbalance in the federal matching rate creates financial risks for taxpayers by incentivizing states to shift cost to the federal government,” CMS Administrator Seema Verma told reporters Tuesday. “This requires us to make sure that states are making accurate eligibility determinations.”

The CMS also said it will audit states found by HHS’ Office of Inspector General to be at high risk for enrolling ineligible people in Medicaid. California, Kentucky and New York have been cited by the OIG for doing this in the past.


Read it here 

Article 2:   

Rx: Zucchini, brown rice, turkey soup. Medicaid plan offers food as medicine

Clay’s summary: I know I feel better when I eat healthier. Some Philly MCOs are doing SDOH via good food. Cool.

Key Passage from the Article

 Since 2015, Health Partners has joined a small group of insurers around the country to offer some members specially designed meals to improve their health. The company paid the full cost for 560,000 meals to be delivered to more than 2,100 of its members with various conditions such as diabetes, heart disease and kidney failure.

The Metropolitan Area Neighborhood Nutrition Alliance (MANNA), a Philadelphia-based nonprofit organization that provides medically appropriate food for people with serious illnesses, prepares and delivers the meals.

The service covers three meals a day and typically lasts six weeks, although members can renew for two additional six-week cycles. It also provides nutritional counseling. MANNA provides the meals to everyone in the household to help family members support patients who need to change bad diets. Health Partners, which serves Philadelphia and nearby counties, said its investment is paying off.

With the kick-start that comes from receiving these free meals and continued counseling to shop better and prepare healthy meals, the members are better able to control their diabetes, use the hospital less and reduce their medical costs, according to the health plan.

Read it here




Article 3:   

CMS should intensify Medicaid eligibility checks at certain facilities, government asserts, Elizabeth Newman, McKnight’s Long Term Care News, June 28, 2018

Clay’s summary:  Related to the first one, but with info and link-outs on ramping up Medicaid provider background checks.

Key Passage from the Article

The Centers for Medicare & Medicaid Services should prioritize fingerprint-based criminal background checks and conduct site visits to high-risk providers to mitigate Medicaid fraud, a government watchdog official said Wednesday.

CMS has agreed with the HHS Office of Inspector General recommendations but has extended the deadline for implementing the background checks, Brian P. Ritchie, Assistant Inspector General for Audit Services, testified Wednesday before the Senate Committee on Homeland Security and Governmental Affairs. CMS announced a series of Medicaid fraud initiatives Tuesday in advance of Ritchie’s testimony.

Read it here