Monday Morning Medicaid Must Reads: July 9th, 2018

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


Article 1:  

N.J. bill would cap Medicaid ER visits at $140 for non-emergencies, Nicole Leonard, Press of Atlantic City, July 3, 2018

Clay’s summary: Great idea. Now spend 1,000 years arguing about all the exceptions to the rule. Forrest for the trees and all that.

Key Passage from the Article


If a Medicaid patient comes into an emergency room with what turns out to be a minor or nonemergency case, New Jersey hospitals will see a standard $140 reimbursement payment for that health care if a new bill becomes law.

Legislators who crafted the bill, which now awaits Gov. Phil Murphy’s signature, said the goal is to save the state and taxpayers money by capping payments to hospitals for these “low-acuity” cases, but some provider organizations and hospital experts fear it will do more harm than good.

“Our biggest concern is that hospitals will be penalized for treating patients who have nowhere else to go,” said Neil Eicher, vice president of government relations and policy at the New Jersey Hospital Association.

The bill, which passed the Assembly and Senate on June 21 with support and opposition within both political parties, applies specifically to Medicaid patients in the fee-for-service program.

About 1.8 million residents get coverage through Medicaid, according to state reports, and patients in the fee-for-service managed-care program account for about 5 percent of that population.

The state Office of Legislative Services estimated their collective outpatient health care services amounted to nearly $206 million in fiscal year 2017, but the amount that is related to emergency department visits is unknown.



Read it here 

Article 2:   

Finally, Some Answers on the Effects of Medicaid Expansion, Aaron Carrol, New York Times, July 2, 2018

Clay’s summary: If the goal was an insurance card in every pocket, we did awesome. According to lots of researchers.

Key Passage from the Article

 Since the start of Medicaid expansion, 77 studies, most of them quasi-experimental in design, have been published. They include 440 distinct analyses. More than 60 percent of them found a significant effect of the Medicaid expansion that was consistent with the goals of the Affordable Care Act.

Only 4 percent reported findings that showed the Medicaid expansion had a negative effect, and 35 percent reported no significant findings. Negative effects could include more uninsurance and increased wait times, but none showed decreased quality. It should be noted, moreover, that the few studies with negative outcomes were more likely to employ methodologies that were less likely to be able to show that Medicaid was causing these outcomes.

The majority of analyses looked at access to care, and they showed that after the Medicaid expansion, insurance coverage improved and the use of health services increased. It’s harder to study quality than access, but 40 analyses in 16 studies did so. About half of these reported improvements in quality measures like diabetes monitoring or preventive care screenings.

Read it here




Article 3:   

Kentucky cuts dental, vision coverage for nearly 500,000 Medicaid recipients, Tami Luhby, CNN, July 3, 2018

Clay’s summary: I’ve been telling you guys he’s not bluffing.

Key Passage from the Article

 Kentucky Republican Gov. Matt Bevin has suspended dental and vision benefits for nearly 500,000 Medicaid recipients after a federal judge blocked his plan to overhaul the safety net program.

Bevin’s administration was set to launch a massive reorganization of Medicaid benefits on July 1. The changes, which were approved by the Trump administration in January, included requiring certain beneficiaries to work and to pay premiums. The reorganization also would have changed dental and vision coverage for many low-income adults.
The effort was halted — at least temporarily — on Friday after US District Judge James Boasberg voided the federal approval and kicked the matter back to the Department of Health and Human Services for further review. Calling the agency’s approval “arbitrary and capricious,” Boasberg said HHS Secretary Alex Azar had neglected to analyze whether Kentucky’s plan would cause recipients to lose their health insurance coverage.
Bevin administration officials quickly warned that the state would have “no choice but to make significant benefit reductions” to offset the increasing cost of Medicaid expansion. On Sunday, they announced that dental and vision coverage would end for about 460,000 recipients until the overhaul moves forward.

Read it here