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KY/Providers- Eligible Kentucky hospitals can get up to $1.1B more in Medicaid payments in 2022

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[ MM Curator Summary]: KY Medicaid financing maneuvers will now send an additional $2B to hospitals.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Kentucky hospitals that meet federal quality measures can receive up to $1.1 billion in increased Medicaid payments in 2022, Gov. Andy Beshear announced Dec. 29.

The funding is available through a federally approved, state-directed payment model, according to a news release from the governor’s office.

This is the second announcement in 2021 of additional funding after Mr. Beshear announced in January that Kentucky hospitals would receive an additional $800 million to $1 billion.

More than one-third of the state’s population is enrolled in Medicaid, according to the release.

“Health care is a basic human right, and our people deserve the best care possible,” Mr. Beshear said. “This year, our state has faced so much tragedy and heartbreak from the pandemic, tornadoes and other natural disasters, and we are thankful to our hospitals for continuing to provide quality health care to our Kentucky families in need.”


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Medicaid DSH cuts nixed from Build Back Better Act


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[ MM Curator Summary]: Dems were unable to punish hospitals in non-expansion states with DSH cuts.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


After receiving pushback from hospitals, the Senate scrapped plans to cut Medicaid disproportionate share hospital payments in 12 states from its version of President Joe Biden’s $1.7 trillion social spending package.

Under the House-passed Build Back Better Act, the 12 states that haven’t expanded their Medicaid programs faced a 12.5 percent reduction in Medicaid DSH allotments. The AHA said the cuts could be as much as $4.7 billion over 10 years. Under the House version, if a state chooses to discontinue its Medicaid expansion, its DSH allotments would be reduced as well.  

In early November, eight healthcare organizations argued that reductions in DSH allotments would be an “additional hardship for hospitals” in states that didn’t expand Medicaid and would “make it difficult for hospitals in those states to continue to serve their patients and their communities.”

Although the DSH cuts were scrapped, the Senate version keeps a provision to limit federal payments in states that didn’t expand Medicaid for a separate uncompensated care pool.


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Latest Medicaid Data Show A Deeply Broken Program

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[ MM Curator Summary]: Almost 22% of Medicaid payments are made in error according to the latest report from CMS.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



“Medicaid spending has grown by even more staggering proportions, from about $900 million in 1966, … [+] to $5.1 billion by 1970, to $456 billion by 2013,” writes Sally Pipes.


A bank that misplaced over one-fifth of its deposits would be shut down almost immediately. So would a hospital that bungled one in five operations, or a private health insurer that mishandled one-fifth of its claims.

But apparently, the bar is a lot lower for government programs. The Biden administration recently admitted that “improper payments” made up 21.69% of total Medicaid spending in fiscal year 2021, which ended September 30.

That error rate, which the administration buried in the tenth paragraph of a press release about the supposedly great work they’re doing on fraud prevention, underscores how deeply broken the program is.

Congress created Medicaid in 1965 to cover indigent Americans, including the blind, the disabled, the impoverished elderly, and mothers of dependent children. Enrollment skyrocketed almost immediately—from about 4 million in 1966, about 2% of the U.S. population at the time, to 14 million by 1970, or 7% of the population.

Eight years ago, one in five Americans was covered by the program. This year, about one in four Americans—nearly 83 million people were beneficiaries of Medicaid and a related program for children called CHIP.

Spending has grown by even more staggering proportions, from about $900 million in 1966, to $5.1 billion by 1970, to $456 billion by 2013.

The growth of the program surged starting in 2014. That year, the federal government began funding an expansion of the program to anyone making less than 138% of the federal poverty level under the terms of Obamacare. Thirty-eight states and the District of Columbia took the new federal dollars.

Spending predictably ballooned, exceeding $683 billion in fiscal 2020, a 50% increase since the expansion started and a nearly 13,300% increase since 1970.

Despite that staggering tab, Medicaid does a poor job advancing enrollees’ health, in part because many doctors refuse to see the program’s beneficiaries because of its low reimbursement rates. A limited 2008 expansion of Medicaid in Oregon that enrolled beneficiaries through a lottery—creating a perfect natural experiment to compare the newly insured population to their uninsured peers—resulted in no statistically significant boost in physical health outcomes.

In other words, neither enrollees nor taxpayers are getting much value out of the program. One analysis found that more than half of Medicaid recipients would prefer $2,800 in cash benefits rather than $7,000 in Medicaid spending on their behalf.

The program does appear to excel at making payments it’s not supposed to. In its press release, the Biden administration said 88% of improper payments “were due to insufficient documentation.” A separate fact sheet claimed that “most improper payments are not attributable to fraud.”

Evidently, the administration wants Americans to rejoice in the fact that, of the well over $100 billion in improper payments, only one-tenth or so was actually fraudulent.

And fear not, the administration adds: “HHS continues to develop a multi-faceted approach to corrective actions.” They’re offering robust guidance to providers. They’re having more meetings at the Medicaid Integrity Institute. They’re hosting webinars about “best practices.”

In other words, the solution to this wasteful government program is—you guessed it—more government.

Taxpayers deserve better than a series of bureaucracies that exists solely to track the waste of other bureaucracies. Here’s an idea—let’s stop throwing good money after bad. After market discipline disappears, fiscal integrity tends to deteriorate, too.


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$1.8B in additional Medicaid funds headed to several Florida hospitals

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[ MM Curator Summary]: Nearly $2B in “directed payments” will start flowing to Florida hospitals soon.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Hospitals across the state will begin receiving their share of $1.8 billion in additional Medicaid funds under a new supplemental financing initiative called the Hospital Directed Payment Program.

The $1.8 billion in payments will be made through the state’s Medicaid managed care system. Managed care plans can begin distributing the funds under a budget amendment Agency for Health Care Administration officials sent to legislative leadership Nov. 19. Those amendments take effect 14 days after submission so long as there are no objections.

The Hospital Directed Payment Program is a supplemental payment program that is meant to bridge the difference between Medicaid reimbursement rates and the actual costs of providing the care. It is funded through local dollars that are used to draw down federal Medicaid dollars.

Florida used more than $622 million in local funds to draw down $1.24 billion in matching federal Medicaid funds for state fiscal year 2021-2022, or Year 1 for the program.

The program is administered regionally and provides supplemental payments to three different types of hospitals: cancer, public, and private.


In order to qualify, all regional hospitals in the class must agree to participate in the program and be subject to an assessment.

In order for private hospitals to participate, they must agree to work with a local government partner to create what is known as a “local provider participation fund.”

According to the budget amendment, all public hospitals in the state participated in the DPP program Year 1. None of the cancer hospitals participated in the program in Year 1. And private hospitals in Medicaid Regions 5,6 and 10 were not able to participate the first year because they weren’t able to find a governmental partner.

The budget amendment notes that “in all other regions the private hospitals were at least able to find one governmental partner who will fund the region’s state share.”

No facility will receive more than Jackson Memorial Hospital in Miami, the state’s largest provider of Medicaid services. It will collect more than $208 million in so-called DPP funds, a budget spreadsheet shows.


Jackson netted an increase of more than $138 million in supplemental DPP funds, after accounting for the funds the hospital contributed to help finance the program.

While the Year 1 DPP funds have been approved and are being sent to hospitals there are concerns about the financial security of the supplemental Medicaid program going forward after the federal Centers for Medicare & Medicaid Services recently rejected three direct payment programs in Texas.

Senate Health and Human Services Appropriations Committee Chair Sen. Aaron Bean said previously he thought CMS was being punitive to Republican states.

“Do I think it’s punishing red states? Yes, I do. Do I think they have singled out certain states? Yes, I do,” Bean said.

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Four Texas Democrats Call for Restoration of Medicaid Section 1115 Waiver Funding

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[ MM Curator Summary]: After 4 months of uncertainty created by CMS retroactively denying the TX DRSIP waiver, now even dems are showing signs of worry.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Four Texas Democratic members of Congress have appealed to the federal government to restore health care funding that has been frozen over the last few months.

Those legislators are Reps. Veronica Escobar (D-TX-16), Henry Cuellar (D-TX-28), Marc Veasey (D-TX-33), and Filemon Vela (D-TX-34).

Funding to Texas’ Directed Payment Programs (DPPs), which reimburses health care providers for uncompensated care, was suspended on September 1.

“[T]he approval of new DPPs and the successful renewal of existing waivers are critical to sustaining access to health care services and lowering health inequalities for Medicaid enrolled and uninsured people across the state,” reads Veasey’s letter.

Over $10 billion in annual funding is at risk in DPP funding.

“Texas is now entering its fourth month without funding for Directed Payment Programs which support vital healthcare services for our most vulnerable,” said Texas Essential Healthcare Partnerships President, Don Lee.

Texas is embroiled in a fight with the federal government over its Medicaid Section 1115 Waiver, and the funding that comes with it.

Back in April, the Biden administration’s Department of Health and Human Services (HHS) retroactively denied Texas’s waiver application. Before the regime changed hands, the Trump administration’s HHS and Centers for Medicare & Medicaid Services (CMS) approved Texas’ application for a 10-year renewal.

Texas then sued the federal government and secured a temporary injunction. A final decision has not yet come.

The waiver grants funding for certain categories of uncompensated care and is something certain hospitals rely upon heavily because of the large amounts of patients they serve who cannot pay. It is estimated to be worth about $30 billion for hospitals in Texas.

Overarching this dispute is a broader one featuring the expansion of Medicaid and Texas’ refusal to acquiesce Democrats’ demands to exercise that section of Obamacare. Texas Republicans view the federal government’s reneging as an effort to force the state’s hand into expanding Medicaid.

Expanding Medicaid would increase the number of people eligible for the state-sponsored program that supplies health insurance to poor individuals and families. It would also increase the percentage of health care spending that the federal government takes on.

But the move would only give the option of coverage for 15 percent of Texas’ uninsured population, the largest in the nation, that weren’t already eligible for it — about even with the percentage of Texas’ uninsured that are already eligible but have chosen not to enroll.

Texas is currently negotiating with the federal government to reapprove the waiver and has until September 2022 before the current waiver expires.

Veasey’s letter concluded, “While over a million uninsured Texans may acquire coverage because of Democrats’ unshakable commitment to extending health-care coverage in the state, over 3 million will remain uninsured, making these financing sources even more vital to guaranteeing access to care and needed resources.”


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Judge stops federal COVID-19 vaccine mandate in Medicare, Medicaid facilities in 10 states

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[ MM Curator Summary]: A lower court in eastern Missouri has ruled that CMS does not have the authority to make vaccination a condition required for provider payments.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.




(The Center Square) —  U.S. District Judge Matthew T. Schelp on Monday ordered a preliminary injunction against the Biden Administration, stopping mandated COVID-19 vaccinations for health care workers in Centers for Medicare and Medicaid Services (CMS) facilities.

“Because it is evident CMS significantly understates the burden that its mandate would impose on the ability of healthcare facilities to provide proper care, and thus, save lives, the public has an interest in maintaining the ‘status quo’ while the merits of the case are determined,” Judge Schelp wrote in a 32-page memorandum and order in the U.S. District Court in the Eastern District of Missouri.

Missouri Republican Attorney General Eric Schmitt led a 10-state coalition filing the lawsuit on Nov. 5 to stop the CMS vaccine mandate. On the courthouse steps in St. Louis, Mr. Schmitt, a candidate for the seat of retiring Republican U.S. Senator Roy Blunt, stated many will benefit from the ruling.

“This is a significant ruling and the first of its kind in the country,” Mr. Schmitt told reporters. “What the court said today was CMS and the Biden administration has no statutory authority to do this, none whatsoever.”

Starting in late October, Mr. Schmitt led coalitions of states in filing three lawsuits against federal vaccine mandates – for federal contractors and federally contracted employees, for the Occupational Safety and Health Administration’s mandate on private employers with 100 or more employees, and CMS.

The Fifth U.S. Circuit Court of Appeals in New Orleans blocked the private-sector OSHA mandate earlier this month.

Mr. Schmitt said Monday’s ruling will help all Missourians and all served in CMS facilities.

“Our office may have led the charge on this, but it is the health care workers in Missouri and across the country, it’s the rural hospitals here and elsewhere facing certain collapse due to this mandate, and it’s the patients of those hospitals who are the real winners today,” Mr. Schmitt said.

Judge Schelp stated five times in the ruling that it’s likely Mr. Schmitt and the coalition will ultimately succeed if the ruling is appealed. The ruling only applies to the 10 states in the lawsuit – Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota, and Wyoming.

“I would expect this to be appealed and I would expect this to go all of the way to the Supreme Court,” Mr. Schmitt said. “But the fact is we won.”

The ruling stated CMS lacked clear authorization from Congress to mandate the COVID-19 vaccine. Currently, CMS doesn’t require any vaccinations for health care workers.

“CMS failed to adequately explain its contradiction to its long-standing practice of encouraging rather than forcing – by governmental mandate – vaccination,” Judge Schelp wrote. “For years, CMS has promulgated regulations setting the conditions for Medicare and Medicaid participation; never has it required any vaccine for covered facilities’ employees – despite concerns over other illnesses and their corresponding low vaccination rates.”

Judge Schelp also stated CMS violated its own regulations by not accepting comments on policies.

“Moreover, the failure to take and respond to comments feeds into the very vaccine hesitancy CMS acknowledges is so daunting,” Judge Schelp wrote.

Judge Schelp highlighted the vaccine mandate’s negative impact on staffing at rural hospitals.

“As an example, for a general hospital located in North Platte, Nebraska, implementation of the mandate would result in the loss of the only remaining anesthesiologist,” Schelp wrote. “Understandably, without an anesthesiologist, there could be no surgeries – at all. Thus, such a loss irreparably causes a cascading effect on the entire facility and a wide range of patients. Other examples show the mandate’s far-reaching implications not just on the administration of health care itself, but the functioning of the facilities in general.”

Mr. Schmitt said the virus will always be present and the federal government needs to understand citizens and their rights.

“The truth is COVID is with us and there is always going to be a variant,” Mr. Schmitt said. “But I think the people have had enough of the government locking people down. They have had enough of government instituting mask mandates and vaccine mandates. Every time there’s an overreach, we’re going to push back.”

Bureaucrats who have never driven the back roads of Missouri or visited its rural hospitals have no idea of the effects of the vaccine mandate, Mr. Schmitt said.

“Here in flyover country, we’ve had enough and we’re going to fight back every single time they try to take our freedoms away,” Mr. Schmitt said.

Joe Mueller covers Missouri for The Center Square.


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With big federal boost, Virginia shows Medicaid surplus this year, helping offset future costs

[ MM Curator Summary] Virginia predicts a Medicaid funding surplus next year, followed by a big jump to create nearly $1B more in Medicaid spending in the state within 2 years.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Governor Northam talks about the state’s budget reserves

Virginia is showing a surplus of almost $654 million in its Medicaid program, boosted by federal spending that will help offset future cost increases in the next state budget for the $18 billion program for poor, elderly or disabled Virginians.

Medicaid costs will go up by a net $821 million in the two-year budget for July 1, 2022, to June 30, 2024, which Gov. Ralph Northam will introduce on Dec. 16, but state officials also foresee a $124 million windfall if the federal government raises its share of the program expenses by almost 1% next year as tentatively proposed.

Program costs are projected to grow 1% in the first year and 5% in the second, administration officials said Wednesday.

“The numbers have come in lower than they have historically,” Secretary of Finance Joe Flores said in a briefing with leadership of the Department of Medical Assistance Services, the state Medicaid agency.

At the same time, Virginia will begin sorting out the effects of the COVID-19 pandemic, which added 392,000 people to the Medicaid rolls, some temporarily, as well as refugees from the Taliban takeover of Afghanistan who have settled in the state and qualify for health care assistance. Medicaid now serves more than 1.9 million Virginians in a state of 8.6 million.

The federal government has boosted emergency support of the program during the pandemic, extending a temporary 6.2% increase in its share of funding through March 31. The enhanced aid will reduce Virginia’s share by almost $146 million in the fiscal year that began July 1 and save the state more than $1 billion since the public health emergency began in March 2020.


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Louisiana Lawmakers Try to Tighten Medicaid Cost Estimates


[ MM Curator Summary] Louisiana is trying to figure out a way to more accurately predict Medicaid spending.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


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BATON ROUGE (AP) — Louisiana lawmakers are trying a new approach to determine how much the state will spend on Medicaid services each year, as the program has ballooned to more than one-third of the state’s budget and added hundreds of thousands of people during the pandemic.

A Medicaid forecasting panel created by lawmakers last year held its first meeting Wednesday, to create a new process for estimating spending needs for a program that provides health care to 1.9 million people — about 41% of Louisiana’s population.

The Louisiana Department of Health currently does its own economic modeling and then seeks funding from state lawmakers to match the forecast, which often overestimates how much money will be needed to cover services. The Medicaid Estimating Conference will involve lawmakers, the Health Department, the governor’s chief budget adviser and an outside health care economist, along with financial advisers to the Legislature.

“This program is too big not to have adequate data,” said Sen. Sharon Hewitt, the Slidell Republican whose bill created the conference.

Louisiana’s Medicaid program is estimated to spend $16 billion in the current budget year on health care services, the large majority of it federally funded and much of it through managed care companies. Hewitt said the state’s putting up $1.8 billion of the cost from its general fund.

But estimating — and restraining — the program’s price tag can be difficult.

Many costs associated with Medicaid are out of the state’s control. To get federal Medicaid funding, states are required to provide certain services through the program, and they aren’t allowed to force people off the rolls if they took boosted Medicaid funds offered because of the coronavirus pandemic as Louisiana did.

Louisiana added more than 300,000 people to its Medicaid rolls since March 2020 when the coronavirus outbreak began.

Daniel Cocran, the state’s Medicaid deputy director, said about 70% of that growth was in the Medicaid expansion program. Democratic Gov. John Bel Edwards authorized the expansion when he took office in 2016, to cover working-age adults who don’t get health insurance through their employers. Nearly 700,000 people are currently enrolled in Medicaid through that expansion.

Many of those enrollees wouldn’t continue to qualify for Medicaid coverage because they now make too much money or stopped meeting other eligibility criteria. But Louisiana can’t kick them off the rolls because of the strings tied to the enhanced federal pandemic Medicaid financing.

Those people can be removed from Medicaid only when the federal public health emergency is lifted, Cocran said. It’s unclear when that will happen, and then federal regulations describe a lengthy process to bump someone from the program even after that, he said.

President Joe Biden’s social safety net expansion legislation pending in Congress also has further restrictions for removing people from Medicaid that would come into play if the measure passes, health officials said.

All of that will be considered as part of the new forecasting process, Hewitt said. She hopes to have the conference’s first forecast complete in December or January. The panel’s projections will be nonbinding but are expected to have a heavy influence on budgeting. The nonpartisan Legislative Fiscal Office hired a health care economist as part of the effort.

Sen. Gerald Boudreaux, a Lafayette Democrat on the conference, said he thinks the new approach can help lawmakers determine the true costs of the Medicaid program, but he also cautioned that he doesn’t want it to be used to try to limit access to health care services.

“It is very important to a lot of people, more people than some of us realize,” Boudreaux said.


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Assembly Health Committee taking testimony on Medicaid effectiveness, sustainability

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NY is reviewing the effectiveness of cost savings measures put in place 10 years ago.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



ALBANY, NY (WRGB) — Assembly Health Committee Chair Richard N. Gottfried will take testimony Monday morning to examine the Medicaid program’s efficacy and sustainability.

In 2011, the Medicaid Redesign Team (MRT) was established to reduce costs to the state Medicaid program. The resulting changes shifted almost all the remaining benefits and beneficiaries not already in managed care into managed care plans.

MORE: Will booster shots change the definition of ‘full vaccinated’?

The Medicaid Global Spending Cap, also created in 2011, controls the overall Medicaid spending in the state budget. The Fiscal Year 2021 Budget reconstituted the MRT forming the MRT II to once again find solutions to contain spending growth.

Since the implementation of the initial MRT actions and budget actions in subsequent years, including the MRT II, advocates have cited numerous ways these changes are affecting the Medicaid program’s ability to provide an adequate safety net.


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Maryland Department of Health announces new Medicaid rate increases

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MD will spend the ARPA money it got for HCBS on rate increases for 3 provider types.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



Baltimore, MD – Today, the Maryland Department of Health (MDH) announced Medicaid rate increases for home and community-based services (HCBS) providers. Increased Medicaid rates will enable HCBS providers to strengthen service delivery.

“These rate increases will prove instrumental in further serving our Medicaid recipient population,” said MDH Secretary Dennis R. Schrader. “The new rates are the result of working closely with Medicaid providers and stakeholders, and they will help Marylanders who need assistance the most.”

The American Rescue Plan Act (ARPA), which became law on March 11, supports Medicaid HCBS providers during the COVID-19 pandemic by providing a 10 percent enhanced federal medical assistance percentage (eFMAP). The law requires states to use these funds to enhance, expand or strengthen HCBS.

During the most recent legislative session, the Maryland General Assembly passed HB 588, the state’s FY2022 budget bill, which directs Medicaid to spend at least 75 percent of federal ARPA reinvestment dollars for a one-time-only provider rate increase. As such, Maryland is implementing the following rate increases:

  • A 5.5 percent rate increase for most HCBS developmental disability providers
  • A 5.4 percent rate increase for most HCBS behavioral health and Applied Behavior Analysis (ABA) providers
  • A 5.2 percent rate increase for community-based long-term services and support providers

The provider rate increases target providers and services that are eligible for the enhanced federal match. Additionally, the provider increases vary slightly based on the amount of reinvestment monies generated within the long-term care, behavioral health, and developmental-disabilities programs. 

For more detailed information, including the methodology used to determine the estimated fiscal impact and rate increases, please see MDH’s initial HCBS Spending Plan, submitted to The Centers for Medicare and Medicaid Services.

Impacted Medicaid providers have received alerts and public notices detailing the services to which rate increases apply, the services that are excluded, and other related information. Providers may submit questions via the form at




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