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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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Medicaid Enrollment & Spending Growth: FY 2021 & 2022

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The latest survey of Medicaid directors suggests that 2022 enrollment growth will slow from 10% in 2021 to 4.5% in 2022.


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.


Key Takeaways

In March 2020, the COVID-19 pandemic generated both a public health crisis and an economic crisis, with major implications for Medicaid – a countercyclical program – and its beneficiaries. During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling. While state revenues have substantially rebounded after dropping precipitously at the onset of the pandemic, the public health crisis has continued as a new surge of COVID-19 infections, hospitalizations, and deaths, fueled by the Delta variant, began to take hold in the U.S. in late July and August 2021. To support Medicaid and provide broad state fiscal relief, the Families First Coronavirus Response Act (FFCRA), enacted in March 2020, authorized a 6.2 percentage point increase in the federal Medicaid matching rate (“FMAP”) (retroactive to January 1, 2020) if states meet certain “maintenance of eligibility” (MOE) requirements. Since then, the MOE requirements and temporary FMAP increase have been the primary drivers of Medicaid enrollment and spending trends. The fiscal relief and the MOE requirements are tied to the duration of the public health emergency (PHE).

This brief analyzes Medicaid enrollment and spending trends for state fiscal year (FY) 2021 and FY 2022 (which for most states began on July 1)1 based on data provided by state Medicaid directors as part of the 21st annual survey of Medicaid directors in states and the District of Columbia. Forty-seven states2 responded to the survey by mid-September 2021, although response rates for specific questions varied. In their survey responses, most states anticipated that the fiscal relief and MOE would end in December 2021 and that had major implications for enrollment and spending projections. The PHE was recently extended to mid-January 2022, which would affect these projections and possibly delay anticipated effects of slowing enrollment and spending currently assumed in state budgets for FY 2022. The methodology used to calculate enrollment and spending growth and additional information about Medicaid financing can be found at the end of the brief. Key survey findings include the following:

  • Enrollment growth: After increasing sharply in FY 2021 (10.3%) due to the MOE requirements and the pandemic’s economic effects, responding states expect Medicaid enrollment growth to slow to 4.5% in FY 2022, based largely on the assumption that the PHE and the related FFCRA MOE requirements will end in FY 2022 (most states assume mid-way through FY 2022).
  • Total spending growth: FY 2022 state budgets for responding states assume total Medicaid spending growth will slow to 7.3% compared to 11.4% in FY 2021. States identified enrollment growth as the primary driver of FY 2021 expenditure growth and assume slower enrollment growth will result in lower total spending growth in FY 2022.
  • State spending growth: While states reported that the state (nonfederal) share of Medicaid spending grew by 4.0% in FY 2021, they projected sharper FY 2022 growth of 14.0% based on the assumption that the PHE and related enhanced FMAP would expire in mid–FY 2022, shifting the state and federal spending shares even though total Medicaid spending growth is expected to slow.

As in 2020, the 2021 survey was fielded during a time of great uncertainty. State fiscal conditions had improved, but the rate of recovery varied across the states and employment indicators had not yet reached pre-pandemic levels. After COVID-19 infection rates dropped to encouragingly low levels in the late spring of 2021, a summer surge driven by the Delta variant was generating more uncertainty around the PHE end date, to which the MOE requirements and enhanced FMAP are tied. In their survey responses, most states projected slowing Medicaid enrollment growth and total spending growth along with increases in the share of state Medicaid spending in FY 2022 due to the assumption that MOE requirements and the enhanced FMAP would end in December 2021, half-way through the fiscal year for most states. However, the PHE was recently extended to mid-January 2022 and may be extended further if cases and deaths from the Delta variant remain high or increase heading into the winter. Extensions of the PHE would likely delay state projections/trends for spending and enrollment growth depicted in this report (for FY 2022). How states respond to the eventual end of the PHE and the unwinding of their MOE will have significant implications for enrollment and spending.


Following declines from 2017 through 2019, total Medicaid and CHIP enrollment nationwide began to grow following the onset of the COVID-19 pandemic. Between February 2020 and April 2021, enrollment grew to 82.3 million, an increase of 11.1 million or 15.5%. In 2020, Medicaid (together with CHIP) provided coverage to nearly one in five Americans. This enrollment growth reflects both changes in the economy, as people enrolled following income and job losses, as well as the FFCRA MOE provisions that require states to ensure continuous coverage for current Medicaid enrollees to access a temporary increase in the FMAP rate. Total Medicaid spending was over $662 billion in FY 2020 with 67.4% paid by the federal government and 32.6% financed by states. Medicaid accounts for one in six dollars spent in the health care system and more than half of spending on long-term services and supports.3

States experienced a dramatic and rapid reversal of their fiscal conditions when the pandemic hit in March 2020. Before the pandemic, unemployment was low, states expected revenues to grow for the 10th consecutive year, and state general fund spending was on track to grow by 5.8%. In this context, governors developed FY 2021 budget proposals that reflected continued revenue and spending growth. The pandemic began during the second half of FY 2020 and quickly reversed state fiscal conditions. Early estimates projected state budget shortfalls of up to $555 billion for fiscal years 2020 through 2022, and states experienced their first general fund revenue decline in FY 2020 since the Great Recession, though some declines in revenue can be attributed to states delaying their 2020 income tax collections from April to July (the start of FY 2021 for most states). Faced with continued uncertainty regarding the course of the pandemic, ongoing revenue collections, and additional federal fiscal relief, states adopted conservative FY 2021 budgets. Unlike the federal government, states must meet balanced budget requirements. To address budget shortfalls heading into FY 2021, states used strategies such as layoffs or furloughs for state workers, hiring freezes or salary reductions, across the board spending cuts, or one-time use of rainy day funds.

State economic conditions have since improved mitigating the need for widespread spending cuts last year. National economic indicators have moderated in recent months. For example, September 2021 saw a national unemployment rate of 4.8% across all states including DC, below the peak of 14.8% in April 2020 but still above the February 2020 rate of 3.5% right before the pandemic. State revenue collections have rebounded
due, in part, to federal aid provided to states, improved state sales tax collections on online purchases, and smaller personal income tax revenue declines due to the disproportionate impact of the pandemic on low-income workers. While state general funds are estimated to have grown by 3% in FY 2021, general fund spending in FY 2021 remained 2% below spending projections made before the pandemic. In FY 2022, however, general fund spending is expected to grow by 5%. In contrast to budgets adopted for FY 2021, proposed FY 2022 state budgets did not include general fund spending decreases, and most states enacted FY 2022 budgets with increased state spending and revenue.

Viewed nationally, state fiscal conditions have improved, but pandemic-related economic impacts vary by state. The severity of the pandemic-induced economic downturn and speed of recovery varies by state depending on state characteristics such as tax structure, industry reliance, social distancing policies and behaviors, and virus transmission. Economic indicators are improving across states, with indicators for some states returning to pre-pandemic levels while others remain distressed. For example, in September 2021, Nebraska saw an unemployment rate of 2.0%, which is below their pre-pandemic rate of 3.0% in February 2020, while Nevada’s unemployment rate was 7.5%, well above their pre-pandemic unemployment rate of 3.7%. While state revenues overall appear to have surpassed pre-pandemic levels, there is variation across states. Also, this data pre-dates the recent Delta variant fueled COVID-19 surge and is volatile due to most states delaying their income tax filing deadlines for 2020 and 2021.

While the FFCRA FMAP increase currently continues to support Medicaid programs and provide broad fiscal relief to states, states are preparing for the FMAP increase to end in FY 2022. In the past, federal fiscal relief provided through Medicaid FMAP increases during significant economic downturns has helped to both support Medicaid and provide efficient, effective, and timely fiscal relief to states. FFCRA uses this model as well by providing a temporary 6.2 percentage point increase in the Medicaid FMAP from January 1, 2020 through the end of the quarter in which the PHE ends. The current PHE declaration expires in mid-January 2022, meaning the enhanced FMAP will remain in place until the end of March 2022 unless the PHE is extended further. This FMAP increase does not apply to the Affordable Care Act (ACA) expansion group, for which the federal government already pays 90% of costs. To be eligible for the funds, states must meet certain MOE requirements that include not implementing more restrictive Medicaid eligibility standards or higher premiums and providing continuous eligibility for enrollees through the end of the PHE. Though the recent rise in COVID-19 cases and deaths due to the Delta variant cast uncertainty on the duration of the PHE, states are beginning to prepare for the end of MOE requirements, and new guidance from CMS gives states 12 months to address Medicaid eligibility renewals and redeterminations following the end of the PHE.

Key Findings

Trends in Enrollment Growth FY 2021 and FY 2022

Medicaid enrollment growth peaked in FY 2021 and is expected to slow in FY 2022 (Figure 1). Medicaid enrollment growth peaked in FY 2015 due to ACA implementation and tapered thereafter. Enrollment actually declined in FY 2018 and FY 2019 and was relatively flat in FY 2020. Enrollment rose sharply, however, in FY 2021 (10.3%), and is projected to continue to grow, though more slowly, in FY 2022 (4.5%). Many states noted uncertainty in their projections due to the unknown duration of the PHE and related MOE requirements. Following the end of the MOE requirements, redeterminations will resume, and eligibility will end for beneficiaries who are determined to no longer meet eligibility standards. For budget projections, a majority of states were assuming the MOE would end as of December 31, 2021. This assumption was contributing to slowing enrollment growth in FY 2022; however, states also identified challenges to resuming normal eligibility operations such as the need for system changes, staffing shortages, and the volume of new applications and redeterminations.

States largely attributed enrollment increases to the FFCRA’s MOE requirements. All responding states reported that the MOE requirements were a significant upward pressure on FY 2021 enrollment. Over two-thirds of responding states reported that the MOE was likely to be a significant upward driver of FY 2022 enrollment, though some assumed that this upward pressure would end mid-year. In the absence of the MOE, individuals may lose Medicaid coverage because they have a change in circumstance (such as an increase in income), because they fail to complete renewal processes or paperwork even when they remain eligible, or because they age out of a time- or age-limited eligibility category (e.g., pregnant women or former foster care youth). In FY 2021, only about a quarter of states noted that the economy was a significant upward pressure on enrollment. Conversely, signs of economic improvement at the time of the survey likely contributed to some states citing economic conditions as a downward pressure on enrollment in FY 2022. Among Medicaid expansion states that responded to the survey, expansion adults were the most frequently mentioned eligibility group with notably higher rates of enrollment growth relative to other groups.  States also reported that groups more sensitive to changes in economic conditions (e.g., children, parents, and other expansion adults) grew faster than the elderly and people with disabilities.

Trends in Spending Growth FY 2021 and FY 2022

FY 2022 state budgets for responding states assume total Medicaid spending growth will slow to 7.3% compared to a peak of 11.4% in FY 2021 (Figure 2). High rates of enrollment growth, tied first to the Great Recession and later to ACA implementation, were the primary drivers of total Medicaid spending growth over the last decade. Following ACA implementation but prior to the pandemic, declining or slowing enrollment growth resulted in more moderate spending growth. In prior surveys, states noted that spending growth in FY 2020 (prior to the major effects of the pandemic) was tied to increasing costs for prescription drugs (particularly for specialty drugs), rate increases (most often for managed care organizations, hospitals, and nursing facilities), overall medical inflation, pressures from an aging state population, and a higher acuity case-mix.

FY 2021 spending growth increased sharply, primarily due to enrollment growth. Some states noted upward pressures from increased COVID-19 related expenditures, but half of states reported pandemic-related utilization decreases for non-COVID care as a downward pressure on overall spending. A majority of states reported acute care utilization on a per member basis decreased in FY 2021, but most of these states expect a full rebound in acute care services utilization in FY 2022 (most states were responding to the survey before a new surge in cases from the Delta variant were emerging). Most states indicated nursing facility utilization decreased in FY 2021; however, a majority of states noted the decreased utilization was partially or fully offset by utilization in home and community-based services (HCBS). Among states seeing decreases in nursing facility utilization, only a small number expect nursing facility utilization to fully rebound in FY 2022. Changes in payment rates and utilization patterns for acute and long-term care services may have contributed to states reporting that per enrollee spending for the elderly and people with disabilities was growing faster relative to other groups in FY 2021.

For FY 2022, a majority of states expect enrollment growth trends to be a primary factor driving total spending growth.  While a majority of states cited enrollment as an upward pressure, over a third of states expect enrollment to become a downward pressure in FY 2022, assuming that the MOE requirements end midway through FY 2022 and states would resume redeterminations resulting in slower enrollment growth. Beyond enrollment, states reported additional upward pressure coming from provider rate or cost changes and increased utilization driven by a return to pre-pandemic utilization levels or by pent up demand resulting from pandemic-related delays in care.

Assumptions about the duration of the PHE and the expiration of the enhanced FMAP affected state Medicaid spending growth assumptions (Figure 2). The state share of Medicaid spending typically grows at a similar rate as total Medicaid spending growth unless there is a change in the FMAP rate. During the Great Recession, state spending for Medicaid declined in FY 2009 and FY 2010 due to fiscal relief from a temporary FMAP increase provided in the American Recovery and Reinvestment Act (ARRA). State spending increased sharply when that fiscal relief ended.

This pattern has repeated during the pandemic-induced economic downturn, with state Medicaid spending declining in FY 2020, increasing but at a slower rate than total spending in FY 2021, and then projected to increase sharply to surpass total Medicaid spending in FY 2022 due to assumptions about the expiration of the fiscal relief. More than three-quarters of responding states assumed the enhanced FMAP rate would end December 31, 2021, half-way through the state fiscal year, with only two states assuming a later date. The spike in state spending growth reflects these assumptions. However, the recent PHE extension to mid-January 2022 extends the enhanced FMAP through at least March 2022, which will mitigate the state spending increase observed here. Of course, a further extension of the PHE due to the Delta variant or other factors could mean that the enhanced FMAP would be in place through June 2022 (the end of the state fiscal year for most states), meaning the spike in state spending would not occur until the following fiscal year.

Nearly all responding states report using the federal fiscal relief to support costs related to increased Medicaid enrollment. About two-thirds of responding states also report using the fiscal relief to help address Medicaid or general budget shortfalls and mitigate provider rate and/or benefit cuts. Fewer states anticipate Medicaid budget shortfalls in FY 2022 (prior to the Delta variant surge) compared to last year’s survey, reflecting improving state revenues that allow states to fund their share of Medicaid spending increases. However, many states noted the importance of federal fiscal relief to avoiding a shortfall and uncertainty of a shortfall due to the unknown duration of the enhanced FMAP.

Conclusion and Looking Ahead

State economic conditions have improved, though the recovery varies across states and employment indicators have not yet reached pre-pandemic levels. Almost all states have adopted budgets for state fiscal year 2022 (which started July 1 in most states), and revenue and spending projections incorporated improvements in revenue reflecting increased economic activity due to COVID-19 vaccination efforts and eased restrictions, assumptions about the duration of the PHE, and federal stimulus funds that were part of the American Rescue Plan. A summer surge in COVID-19 cases, hospitalizations, and deaths driven by the Delta variant, however, has generated greater uncertainty regarding future state fiscal conditions.

The end date of the PHE remains uncertain and will have significant implications for Medicaid enrollment and spending. The recent COVID-19 surge casts further uncertainty around the duration of the PHE and the MOE requirements and enhanced FMAP that are tied to the PHE. The MOE requirements and enhanced FMAP have already been extended further than most states anticipated in their budget projections and may be extended even further if the current COVID-19 surge continues or worsens. If the PHE is extended beyond January, Medicaid enrollment growth will likely continue in FY 2022, but the expected increase in state Medicaid spending will be delayed while the enhanced federal fiscal relief remains in place. Regardless of when the PHE ends, most states will start to prepare for the eventual unwinding of their MOE policies and procedures, as resuming Medicaid eligibility renewals will be a large administrative task for states. Guidance from CMS gives states 12 months to complete renewals and redeterminations following the end of the PHE. Additional guidance and oversight from the federal government could help mitigate differences in how states approach the end of the MOE. With the unwinding, states are likely to face pressures to contain growth in state spending tied to enrollment, particularly after the enhanced FMAP ends, even as they work to overcome challenges with systems and staffing to ensure that eligible individuals remain covered by Medicaid or transition to other sources of coverage.


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Florida Medicaid, DOH, present FY 2022 budget requests

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FL Medicaid is asking to spend more on multiple program areas, including a planned upgrade to its MMIS.



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.






Nicole Pasia | Oct 14, 2021 | Florida

Three agencies — the Agency for Health Care Administration (AHCA), the Florida Department of Health, and the Department of Children and Families — presented their legislative budget requests (LBR) for fiscal year (FY) 2022 to the House Health Care Appropriations Subcommittee for consideration on Monday. 

Recurring requests among the agencies included health care workforce support to address high turnover rates, replacing outdated IT systems, and health quality assurance (MQA) measures. 


See a list of notable items from each agency below: 

Agency for Health Care Administration

Total legislative budget request (federal and state): $36.5 billion

  • Medicaid rate adjustments: $277.47 million in general revenue

Florida has seen 1.1 million more enrollments in Medicaid during the COVID-19 pandemic, leading to the state’s largest Medicaid population (4.9 million) in history. Rate increases to fit these new parameters were determined at the August 2021 Social Services Estimating Conference (SSEC). 

  • Florida KidCare adjustments: $53.9 million in general revenue


  • Institutional and Prescribed Drug Providers: $1.16 billion

This reflects cost adjustments for prescribed drug provider operations, such as over-the-counter prescriptions and drugs administered in outpatient settings.

  • Statewide Medicaid Managed Care Procurement Activities: $2.3 million in general revenue

This will support legal and actuary expenses to respond to protests of contract awards as during procurement negotiations. AHCA is required to reprocure contract awards every six years.

  • Medicaid Hospital Direct Provider Payment (DPP) Program: $154,000/2 FTE in general revenue

AHCA will create two positions to oversee this new program, which is expected to bring $1.8 billion in direct payments to hospitals and other providers in its first year. CMS approved this program earlier this year.

  • Florida Medicaid Management Information System: $117.8 million in general revenue

AHCA is set to replace its 20-year-old Florida Medicaid Management Information System.

  • Transfer of PACE from DOEA to AHCA: $37.7 million in general revenue/2 FTE

Revenue, administration, and authority over the Program for All-Inclusive Care for the Elderly, previously under the Department of Elder Affairs, will move to AHCA. AHCA Secretary Simone Marstiller said the move would streamline administrative processes and that AHCA was better suited to oversee PACE, as it is a health care program.


Department of Children and Families (DCF)

Total legislative budget request (federal and state): $3.8 billion

  • Replacing federal foster care funds: $32.5 million in general revenue

Due to changes in eligibility, Florida may not receive federal matching funds for Title IV-E foster care services and would need to use general revenue instead.

  • Stabilizing Children’s Legal Services Workforce: $4.8 million 

DCF would use funds to increase pay for 600 legal staff that manage court child welfare cases across the state. Staff turnover in this field has increased from 21% in 2017 to 49% this past year, according to Tony Lloyd, DCF assistant secretary for administration.

  • Comprehensive Behavioral Health Services: $109.7 million in trust fund authority

Federal funds from the American Rescue Plan, COVID-19 Relief, and the Substance Abuse and Mental Health Block Grant will expand behavioral health and substance use disorder services within the department, which have waiting lists of 2,000 and 1,000 people, respectively. 

  • State Opioid Response (SOR) Grant Budget Authority: $24.6 million in trust fund authority

Continued funding for this program has provided substance use disorder services for over 15,000 individuals in the last three years.


Department of Health (DOH)

State legislative budget request (general revenue and trust fund authority): $49.3 million

  • Infant Mortality and Prevention: $2.8 million in general revenue

Services would address the top two causes of infant mortality: sleep-related infant death and drowning. 

  • Office of General Counsel – Litigation: $2 million in general revenue

DOH will contract outside legal counsel due to “additional lawsuits arising from enactment of new laws and adoption of new rules governing the Department.” This request raised concern from Rep. Carlos Guillermo Smith (D – Orange), who filed a lawsuit in August over the department’s refusal to release daily COVID-19 data.

  • Group Care Program (GCP) Services: $3.8 million in general revenue

State funds would cover gaps between funding from county health departments and the GCP’s actual expenditures for group homes, schools, and other care services. 

  • Workload Medical Quality Assurance: $1.1 million in trust fund authority/19 FTE

DOH requests 19 positions due to an increase in applicants and high staff turnover rate for the Board of Nursing and the Board of Pharmacy.

  • Office of Medical Marijuana: $24.8 million in trust fund authority

This includes the creation of 85 positions within the department to serve additional patients and licensed Medical Marijuana Treatment Centers, accounting for nearly half of DOH’s budget request. 

Rep. Kelly Skidmore (D – Palm Beach), also expressed concern over DOH’s LBR, and asked why no COVID mitigation requests were included. DOH Deputy Secretary for Operations, Michele Tallent, responded that this was due to the department receiving over $3 billion in federal COVID support funds. 


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Appeals court upholds Tennessee’s Medicaid reimbursement cap

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The TN rule designed to reduce spending on inappropriate ED spending has been upheld.


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 Court of Appeals in Nashville, Tenn., ruled that TennCare, the state’s Medicaid program, did not violate a state law when it imposed a $50 reimbursement limitation for nonemergent medical services provided by emergency department physicians, according to court documents filed Oct. 7.

Emergency Medical Care Facilities, a company that provides services in Tennessee emergency departments, said TennCare did not follow the correct procedure for making the $50 cap rule under the Uniform Administrative Procedures Act. The case required the appeals court to determine whether the rule falls under the UAPA.

The trial court had determined that the $50 cap rule is defined as a “rule” by the UAPA, is subject to the law’s requirements, and that TennCare did not comply with the law’s requirements for rule-making.

TennCare appealed the decision. The appeals court determined that the $50 cap rule is not subject to the UAPA because it falls under the internal management exception in the 2009 version of the law, reversing the trial court decision.


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NY- DSS director: No relief in sight from New York State to alleviate county’s Medicaid burden

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NY counties continue to pay increasing Medicaid costs that they cannot directly impact.


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.


Genesee County is on track to spend more than $9 million on Medicaid this year and New York State is doing very little to help alleviate this local obligation, according to the director of the county’s Department of Social Services.

Presenting his departmental review at Monday’s Genesee County Legislature Human Services Committee meeting, David Rumsey (photo above) said the county has little input over the government-financed health insurance program for eligible people.

Approximately 3,000 county residents are on Medicaid, he said, and that number continues to increase.

“The transition of Medicaid administrative functions from the county to the state remains unchanged. There has been no additional movement by the state to take over the Medicaid administrative functions,” he said.

Rumsey also mentioned the inordinate amount of time spent on determining people’s eligibility in light of the required five-year lookback period for chronic care (nursing home) cases.

“The Medicaid assistance programs have the greatest burden to the county, but for which we have little control,” he added, reporting that projected spending by the county for Medicaid in 2021 is $9,052,134.

In his report, Rumsey touched upon other programs and services offered by DSS as well as its budget status.


Anticipated 20 percent cuts in state aid did not occur, he said, keeping the DSS budget on track for 2021.

“The pandemic continued to bring uncertainty about the projected funding streams and allocations, and it still does,” he said.

Rumsey said he is monitoring state training school expenses since the number of youths currently in detention will need to be budgeted for in 2023 (two-year billing cycle). 

He also reported that required training for new employees hired over the last year was put on hold at the state level.

“The state is currently formulating a plan to move the virtual training back to in-person, but this plan is reliant on the continued safety for the trainees that attend,” he said.


— Temporary Assistance (Public Assistance): This unit provides cash assistance to individuals or families, with benefits provided based on eligibility and on-going case monitoring.

“The overall monthly caseload is trending downward with a decrease in both Family Assistance and Safety Net,” he said. “There has not been a significant increase in homelessness noted yet.  The eviction moratorium is extended through January 15, 2022 which may change this trend.”

— Emergency Rental Assistance Program (ERAP):  This was rolled out by the Office of Temporary and Disability Assistance to assist renters and landlords, but the start was “slow and not successful,” Rumsey said.

He said most of the funds went to renters, while assistance to landlords lagged behind.

“A lot of landlords had property damaged,” he said. “Now, they are getting a few more rights.”

— Fraud: The DSS Fraud Department has been very busy, Rumsey said, with its two investigators following up on Font End Detection System referrals, Intentional Program Violations, prison matches, and allegations of welfare fraud.

— Child Support: Federal guidelines strive for a minimum collection rate of 80 percent; DSS is at 78.94 percent, well above the state average of 67.20 percent, Rumsey said.

“This unit continues to work to ensure right sized orders are established and appropriate modifications to existing orders is occurring,” he said. “The COVID-19 pandemic caused delays in the operations of this unit as the Child Support Court was temporarily closed.”

Other programs include Home Energy Assistance and Supplemental Nutritional Assistance.


— Family First: In a move that will save the county money, the state is requiring the local DSS offices to reduce the number of residential placements by 12 percent.

“The Family First initiative is also requiring us to have at least 30 percent of our total foster care population in a certified Kinship (relative) foster home, and we are currently meeting both requirements,” Rumsey reported.

He also said that the Family First Prevention Act reforms federal financing to prioritize family-based foster care, preferably with kin, over residential care by limiting federal reimbursement for certain residential placements.

— Foster Care: The DSS foster care unit has certified nine new foster homes this year, with three more pending by the end of the year, Rumsey said. Of the nine, three were “kinship” and six were regular foster care. DSS also was able to certify one new cluster foster home, increasing that number to four.

Rumsey said the county saved money this year through a reduction in voluntary agency therapeutic foster care placements and utilizing certified county foster homes.   

— Preventive Services: Mandated preventive services are provided to assist families and children in meeting their needs and keeping the youth out of foster care placements. Rumsey said that through August, DSS has worked with 222 children with only five being placed outside of the home.

— Child Protective Services: Through August, DSS has handled 646 cases of suspected child abuse and maltreatment, he said, with investigations taking place within 60 days as mandated by New York State. For September, there were 32 more CPS cases compared to September 2020.

“Moving forward these cases will be harder to determine because there is the movement from needing just credible evidence to having a preponderance of the evidence, which is a higher standard that must be met,” Rumsey advised.

— Adoptions: DSS assisted in the adoption of four children with expectations that another three will be finalized by the end of the year.  Of the 54 youth in foster care, 10 are freed for adoption, he said.

Rumsey said that 115 children are currently receiving adoption subsidy payments.

The current annual adoption subsidy rates are basic $7,800, special $9,358 and exceptional $12,453.

“The other concern is that once a foster family adopts children, they rarely continue as foster parent resources for other children who are placed,” he said. “Permanency for children often results in shortages of foster parents.”

— Adult Services: Currently, DSS has 155 Adult Preventive and Protective Services for Adults cases, with 33 of those personal care cases being monitored.

“DSS continues to partner with the Office for the Aging, the District Attorney, the Sheriff and Lifespan in a coordinated Enhanced Multi-Disciplinary Team to work together to assist our elderly Genesee County residents in combating elder abuse and financial exploitation,” he reported.

— Detention: In 2021, five youths were placed into OCFS State Training Schools, which are very costly to the county, Rumsey said. The current detention rate is $468.17/day.

Photo by Mike Pettinella.


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FL- County votes 3-2 to levy Medicaid special assessment

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A Florida county is developing a new type of property tax to get enhanced federal funding for Medicaid services.



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.



County commissioners Tuesday voted 3-2 to levy a non-ad valorem special assessment for enhanced Medicaid payments for local services.


Matthew Beck Photo Editor

County commissioners Tuesday voted 3-2 to levy a non-ad valorem special assessment for enhanced Medicaid payments for local services.

Except for indirect benefits, the move means little to Citrus County residents. But it does allow Citrus Memorial Hospital and Bayfront Health Seven Rivers to draw in more federal money to increase their Medicaid revenues.

Commissioners Ron Kitchen Jr. and Scott Carnahan voted against the measure.

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Citrus Memorial and Bayfront Health provide millions of dollars of uncompensated care to Medicaid patients. That’s because Medicaid typically only covers 60% of the costs for health care services provided by the hospitals.

That leaves CMH and Bayfront Health with substantial uncompensated costs, sometimes called the Medicaid shortfall, or gap.

The two local hospitals combined in 2020 pulled in $316 million in Medicaid revenues. 

This does not cost Citrus County taxpayers more. What it does do is ensure that the county’s two hospitals are financially healthier and — down the road — it could benefit residents by seeing improvements to their buildings and services.

Kitchen said this only fattens the pocketbooks of the hospitals and wanted to follow the advice of their own attorneys and staff who recommended denial of the assessment over indemnification concerns.

Since the start of the COVID-19 pandemic in March 2020, Medicaid enrollment has increased from 3.8 million to 4.6 million, and Medicaid enrollment is expected to increase, according to Florida TaxWatch, a Tallahassee nonprofit taxpayer research institute

“As more enrollees seek additional care, the cost to administer and deliver medical services to Medicaid beneficiaries throughout the state will increase,” said TaxWatch. “By fiscal year 2021-22, Medicaid expenditures are expected to increase to $32.6 billion with the state’s share of costs increasing by nearly $2 billion and the federal share of costs decreasing by around $1 billion.”


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FL- County throws lifeline to hospitals drowning in Medicaid

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Miami is now operating a “provider tax” program to maximize federal dollars for hospital Medicaid revenues.


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.



Miami-Dade County now has a Medicaid Hospital Directed Payment Program (DPP) to give local hospitals financial relief made necessary by unreimbursed Medicaid costs.
The ordinance by Commissioner René García, unanimously approved Sept. 1, would take effect in ten days. The program would provide financial relief to Miami-Dade hospitals, which incur $524 million in unreimbursed Medicaid costs each year.
Currently, Miami-Dade has nearly 17% of the state’s Medicaid enrollees, a memo from Chief Financial Officer Edward Marquez says.
The DPP is a Medicaid matching program funded through local non-ad valorem special assessments on local hospitals. The revenue generated through this special assessment is placed in a local provider participation trust fund and is matched with federal funds to provide hospitals with supplemental Medicaid reimbursement.
“The passage of this ordinance will ensure that our community’s low-income patients benefit from enhanced healthcare services, and hospitals are able to improve their facilities and patient care through the creation of this program, which ensures Miami-Dade County and its residents receive their fair share of federal Medicaid funding,” said Commissioner García in a press note.
Commissioner Rebeca Sosa expressed similar sentiments at the meeting. “When hospitals face staggering losses, they cannot provide the care necessary for the population, those losses prevent or delay upgrades to facilities and staff, and they can create pressure on public facilities. So, it’s a pleasure to join our senator Rene García and all my other colleagues in this item.”
At the July 8 commission meeting, four representatives from local hospitals spoke in favor of the now-approved ordinance. Gino Santorini, CEO of Mount Sinai, said Medicaid comes at a loss in terms of covering the costs, so “this is an opportunity to unlock some federal funds, which would bring about $300 million down to offset that which will really help to benefit all the hospitals, the employers and the county health in general.”
Dawn Javersack, chief financial officer (CFO) of Nicklaus Children’s Health System, said “seven out of every 10 patients that we see are Medicaid beneficiaries and they represent some of the most vulnerable population… This is really important in terms of the care that’s provided to those patients.”
Sanjay Shetty, president of Steward Health Care North America, and Dawn White, vice president of Government and Community Relations for Baptist Health, also expressed support for the creation of the program.
“I am so pleased that the county commission unanimously supported this innovative mechanism for drawing down more funding to cover the costs of care for our low-income residents,” said Mayor Daniella Levine Cava in a press release. “Our local hospitals treat patients with professionalism and compassion. They deserve our support so they can meet the healthcare needs of Miami-Dade families.”


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Georgia Medicaid agency requesting nearly $500 million more in health spending

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GA budget officials are notifying the Governor that Medicaid spending needs to go up while state employee benefit funds are decreasing.


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The agency that provides health care to about 2 million Georgians is requesting an increase of almost $500 million in its state budget over the next year and a half.

Enrollment growth in Medicaid — the state-federal health care plan for the poor and disabled — and rising usage and costs will continue to put a bigger dent in government coffers, officials said Thursday,

Meanwhile, Lisa Walker, chief financial officer of the Department of Community Health, said the health care plan for more than 650,000 teachers, state employees, retirees and their dependents could see two-thirds of its reserve drained by 2024 as expenses outpace revenue from premiums and government subsidies.

Both have become common scenarios for the government programs that fund health care for about a quarter of the state’s population: Heath care costs continue to rise in Medicaid, and that means a larger infusion of taxpayer money into the system. The State Health Benefit Plan for teachers and state employees is regularly projected to run a shortfall in coming years.

Gov. Brian Kemp last month told state agency directors not to request spending increases in the coming year, but he made exceptions for programs that expected to see a rise in usage and expenditures. As in past years, a vast majority of that increase will be in k-12 schools, colleges and the Department of Community Health, which runs the Medicaid and State Health Benefit Plan programs.

Enrollment in some health plans run by the DCH spiked during the initial months of the COVID-19 pandemic as Georgians lost jobs both during and after the economic shutdown.

At the same time, many of those in the program delayed care due to the fear of infection or other reasons. DCH officials expected Medicaid recipients to return to the doctor for treatment this year as COVID-19 vaccinations became more available.

The federal government pays for the majority of the DCH’s $17 billion budget, although the state also chips in several billion dollars. The DCH’s budget, when including federal funding, is the largest part of the state government’s spending.

The DCH has to ask for a big increase in funding pretty much every year as health costs rise. Walker said the department is requesting $122 million more in the midyear budget — which runs through June 30 — and $359 million more in fiscal 2023, which begins July 1.

The agency’s request now goes to Kemp, who will decide what to include in the budget proposal he will deliver to the General Assembly in January.

Besides presenting the DCH budget proposal, Walker on Thursday gave the agency’s board a briefing on the financial status of the State Health Benefit Plan.

Money for the program comes from employee/retiree premiums and the government.

The Community Health board earlier this month froze premiums for members for the third time in four years.

Walker said expenses outpaced revenue by $89 million last fiscal year and would do so by about $337 million this year.

The program currently has about $3 billion in reserve, but that could fall to $1 billion by the end of fiscal 2024 as losses escalate. The trend could be reversed by higher premiums, increased government subsidies, reduced expenditures or changes in the heath coverage.

The teachers, state employees and retirees on the program keep a close eye on its finances because lawmakers raided the reserve during the Great Recession to help the state balance its books. That led to higher premiums and attempts to change benefits to build back the reserve.

DCH officials have projected massive shortfalls in the past, so teacher groups have expressed skepticism about the estimates.


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State funds for Oklahoma Medicaid expansion remain untouched

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OK now has $164M in a savings account it had planned on using for expansion but doesn’t need to because of enhanced COVID funding from CMS.


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OKLAHOMA CITY (AP) — The $164 million appropriated by the Oklahoma Legislature to pay for the state’s share of Medicaid expansion remains untouched in a state agency savings account, state legislators learned Monday.

Oklahoma Health Care Authority CEO Kevin Corbett told House and Senate members that the agency has used savings generated from the Medicaid expansion, along with enhanced federal COVID-19 relief funds for states, to pay for the expansion so far.

The savings were generated by shifting about 65,000 Oklahomans whose health care costs were previously funded through the state’s Insure Oklahoma plan or other sources to the expanded Medicaid population, where the federal government covers 90% of the costs.


Corbett told lawmakers an estimated 700 to 800 Oklahomans are qualifying each day for health coverage under Medicaid expansion, although he expects that number to slow down in the coming months. As of Monday, Corbett said about 170,000 people have qualified for Medicaid under the expansion. The Health Care Authority has projected about about 215,000 residents would qualify for expanded Medicaid, and Corbett says those projections are likely still accurate.

After a decade of Republican resistance to expansion in Oklahoma, voters narrowly approved a constitutional amendment last year to expand eligibility for benefits. Now, an individual who earns up to $17,796 annually, or $36,588 for a family of four, qualifies for Medicaid health care coverage. By contrast, the median income limit for parents in states that didn’t expand their program is about $8,905 for a family of three, according to the Kaiser Family Foundation.


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