Monday Morning Medicaid Must Reads:September 3rd, 2018

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


Article 1:  

California Eyes Medicaid Reimbursement for Telehealth Counseling, Eric Wicklund, mHealth Intelligence, August 28, 2018

Clay’s summary: The opioid crisis is driver broader acceptance of telehealth. CA is the 2nd state in as many months to approve more telehealth reimbursement to deal with the crisis.

Key Passage from the Article

With passage of the bill, which was unanimously approved by state legislators, California joins a growing list of states who are enabling reimbursement for connected care services that address substance abuse addiction disorders. Telehealth and telemedicine experts say a telemental health platform can improve access to care for underserved communities, giving more people with substance abuse issues the ability to access virtual treatment. They also have the support of the Centers for Medicare & Medicaid Services. Earlier this year, CMS sent a letter to state Medicaid directors urging them to consider telehealth and mHealth in new programs addressing the nation’s opioid abuse crisis. Medi-Cal currently offers telehealth as part of the Drug Medi-Cal Organized Delivery System, but that coverage doesn’t extend across the entire state. This bill would enable providers across California to quality for reimbursement. “The opioid epidemic has ravaged communities and ruined the lives of too many families,” the bill’s sponsor, State Assemblyman Rudy Salas, D-Bakersfield, said in a press release. “For those seeking treatment, we need to ensure that they can access help when they need it most. Telehealth is an innovative way to remove barriers for people seeking help in rural areas so that they can get treatment from specialists and get on the road to recovery.”


Read it here 

Article 2:   

Don’t Blame Older Adults For Big Increases In Medicaid Spending, Howard Gleckman, Forbes, August 23, 2018

Clay’s summary: Looks like I will have to get some new charts that aren’t as simplified as the old KFF ones we’ve all been cribbing in our slides for the last 20 years..

Key Passage from the Article

Is the growing need for long-term supports and services (LTSS) by older adults driving big increases in Medicaid spending? Not according to a new study by Don Redfoot and my Urban Institute colleague Melissa Favreault. Indeed, they found that while Medicaid enrollment and expenditures for older adults grew in recent decades, it had far less effect on the program than increases in other Medicaid populations, especially younger people with disabilities. Older adults accounted for only about 13% of Medicaid spending increases from 1975 to 2011. Their paper, published in the Gerontological Society of America’s Public Policy and Aging Report, found that over that period the number of Medicaid beneficiaries tripled from about 22 million to 68 million and program spending increased four-fold from $90 billion to $365 billion (in 2011 dollars)…


Read it here




Article 3:   

 Humana Bold Goal Targets Members’ Social Determinants of Health, Thomas Beaton, Health Payer Intelligence, March 27, 2018

Correcting an injustice: HHS moves to stop unions from skimming from Medicaid, Chantal Lovell  & Vincent Vernuccio, Washington Examiner,  August 07, 2018

Clay’s summary: We need more studies of actual SDOH projects like this. The time for research on SDOH from an academic perspective is over (sorry researchers).  Go do stuff.

Key Passage from the Article

The Bold Goal 2018 Progress Report reveals that implementing community-level changes has led to positive health outcomes for elderly beneficiaries with diabetes, heart disease, respiratory conditions, mental health issues, and other chronic diseases. Humana looked for patterns of key social determinants within senior citizen populations such as food insecurity, housing instability, limited English proficiency, social isolation, and inadequate emotional support. The payer found these social determinants had a strong correlation with poor beneficiary health. Older beneficiaries that had limited access to healthy food options were 50 percent more likely to develop diabetes, 14 percent more likely to experience higher blood pressure, and had a 60 percent higher chance of having a heart attack.Social isolation was cited as a significant social determinant of health for elderly beneficiaries. Humana Medicare members living in social isolation had a 26 percent higher likelihood of dying prematurely than members who lived with friends or family. These socially isolated members also had double the risk of Alzheimer’s disease. “As the nation’s senior population grows, they’ll play a larger and more vital role in all of our communities,” said Bruce D. Broussard, Humana’s President and CEO…


Read it here