Monday Morning Medicaid Must Reads: June 5, 2017

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


Article 1: FACT CHECK: Does The Trump Budget Gut Medicaid? Daily Caller, David Sivak, 5/30/2017

Clay’s summary: Maybe the sky is not falling.

Key Passage from the Article

What many refer to as “cuts to Medicaid” are actually cuts to the growth of Medicaid, not the current size of the program. The Trump administration allocates more for Medicaid every year of the budget. Director of the Office of Management and Budget Mick Mulvaney calls the misconception “a classic example of how Washington speaks differently than the world back home.”

Critics counter that despite increased spending in the budget, the size of Medicaid shrinks over time as a percentage of GDP, a measure of the size of the economy, dropping from two percent today to 1.7 percent in 2027.

While this is true, when looking at the size of Medicaid as a percentage of the total budget, it remains, on average, about the same size – 9.6 percent of the total budget – compared to 2016 funding levels. For this reason, it’s misleading to characterize the savings as cuts to Medicaid.

Read it here 

Article 2: Medicaid efficiency is needed now, more than ever The Hill, Bill Lucia 5/31/2017

Clay’s summary: New TPL legislation could help prevent improper payments when there is coverage besides Medicaid. Also, cool to see Bill Lucia publishing.

Key Passage from the Article


Unfortunately, some liable third parties have found loopholes in laws and regulations that shift costs to Medicaid. HR 938 aims to close these loopholes and ensure that the right party is paying the right claims. Among the key provisions in the Medicaid Third Party Liability Act that will result in Medicaid savings and efficiency are:

Prevents liable parties from denying claims due to a lack of prior authorization, thereby shifting these costs to Medicaid.
Gives Medicaid Managed Care Organizations (MCOs) the same rights as state Medicaid agencies to be the payer of last resort. This is important as nearly 70 percent of Medicaid recipients are currently enrolled in Medicaid managed care plans.
Replicates prompt payment standards routinely enforced in the commercial sector, but for Medicaid reclamation claims. These are claims for the recovery of payments made by Medicaid that are actually the responsibility of another healthcare program or liable insurer.


Read it here


Article 3: CMS chief: Medicaid needs reform, House healthcare bill ‘outdated’, McKnights, Emily Mongan, June 1, 2017

Clay’s summary: CMS Chief Verma is strategic in her view of the current funding fights. And she knows that CBO numbers are historically garbage.

Key Passage from the Article

Verma also dismissed the Congressional Budget Office’s cost estimate for the House’s healthcare proposal, noting “CBO numbers have historically been problematic” and that her focus has turned to the Senate’s version of the legislation. The CBO report estimated the bill could cut Medicaid funding by $834 billion over ten years, and leave 23 million people without health coverage by 2026.
“I’ve been working with a lot of the senators. We want to make sure that the president’s core principles are incorporated into the final version,” Verma said. “I think what’s more important is what the Senate comes up with. Really, the House version is something that’s outdated at this point.”

Read it here


Article 4: Medicaid’s Cracked Halo, Forbes, Sally Pipes, May 30, 2017

Clay’s summary: Forbes continues to write articles about Medicaid that no liberal wants to read. Or acknowledge that there is some truth to.

Key Passage from the Article

A recent issue brief from the Kaiser Family Foundation, meanwhile, concludes, “Medicaid is cost-effective.”

But the data tell a different story. Medicaid is a budget-busting program rife with waste, fraud, and abuse that doesn’t even expand access to quality care or improve health outcomes.

For starters, Medicaid’s costs are spinning out of control. In 2015, total Medicaid spending shot up almost 10 percent. Overall national health spending, by contrast, climbed only 5.8 percent. Last year, the Congressional Budget Office had to raise its projections for the 10-year cost of Medicaid by $146 billion, as per-enrollee costs came in far higher than expected.

Medicaid now accounts for 19 percent of states’ general fund spending. It’s their second-biggest budget line item, after education.

States across the country are facing budget crises this year, largely because of ballooning Medicaid costs.

Read it here


Article 5: AIS Survey Data Show Significant Growth in Medicaid Managed Care, AIS Health, Lauren Kelly, April 27, 2017


Clay’s summary: Medicaid managed care enrollment is up and its not just because of expansion.

Key Passage from the Article

Medicaid expansion is one explanation for increases in a few states, but many Medicaid expansion programs have been in force for several years, so it is not a factor in year-over-year growth for all expansion states. Numbers are up in several non-expansion states, including those without managed care, and slight decreases are seen in both expansion and non-expansion states.

Read it here