Monday Morning Medicaid Must Reads: May 20, 2019

Helping you consider differing viewpoints. Before it’s illegal.
other MMRS –

In this issue…

Article 1:     Medicaid Demonstrations: Approvals of Major Changes Need Increased Transparency, GAO, 5/17/2019

Clay’s summary:    Now that Medicaid waiver requests are asking for something besides “more,” we may see an interest in actually doing the 1115 “demonstration” reviews.
Key Excerpts from the Article:
 About a third of Medicaid spending is for demonstrations, which allow states to test new approaches to delivering services. States and the federal government are supposed to be transparent about the demonstrations that are proposed and give the public a chance to weigh in. Is that happening?
The short answer is sometimes. Transparency has improved, but there are still significant gaps. For example, the federal government doesn’t always require states to share the projected effects of proposals, even when they could significantly affect beneficiary eligibility.
Read full article in packet or at links provided

Article 2:     The inconvenient truths of Louisiana’s Medicaid expansion, The Advertiser, Chris Jacobs, May 17, 2019

Clay’s summary:     All that “free” federal money? Federal funding still comes from taxpayers like you and me. And expansion may just be killing people on waiting lists.
Key Excerpts from the Article:
Second, the truly vulnerable continue to get overlooked due to Medicaid expansion. Secretary Gee claimed that her “top priority is to ensure every dollar spent [on Medicaid] goes towards providing health care to people who need it most.” But Louisiana still has tens of thousands of individuals with disabilities on waiting lists for home and community-based services—who are not getting the care they need, because Louisiana has focused on expanding Medicaid to the able-bodied.
Since Louisiana expanded Medicaid in July 2016, at least 5,534 Louisiana residents with disabilities have died—yes, died—while on waiting lists for Medicaid to care for their personal needs. Louisiana should have placed the needs of these vulnerable patients ahead of expanding coverage to able-bodied adults—tens of thousands of whom already had private health insurance and dropped that insurance to enroll in Medicaid expansion.
Read full article in packet or at links provided

Article 3:     Why Medicaid carriers are wary of joining the ACA marketplace, BenefitsPro, Scott Woolridge, May 13, 2019

Clay’s summary:     Making money on the exchanges is hard. Just stick with the safe bet of Medicaid capitation revenues, and invest in carving out hard stuff.
Key Excerpts from the Article:
 The analysis by the Robert Wood Johnson Foundation (RWJ) notes that in areas where Medicaid insurers compete with other carriers in the ACA individual market, premiums for that market tend to be lower overall. Of the 31 states that had Medicaid buy-in programs for at least some state residents, 18 states reported premiums that were priced lower than the national average.
“This suggests that convincing more Medicaid insurers to sell marketplace plans could lower marketplace premiums,” the report said. “Participating in marketplaces can benefit consumers as well as insurers: several large Medicaid insurers are turning a profit on marketplace plans. Yet many other Medicaid insurers have chosen not to sell marketplace plans.”
Read full article in packet or at links provided