Category Archives: Obamacare
How the ACA Has Redefined the Threshold for “Credible Allegation of Fraud” and Does It Violate Due Process?
I believe that everyone would agree with me that The Affordable Care Act (ACA) has done more to impact health care legally…probably since 1966 when Medicare was established. Whether you think the impact is beneficial or negative, it does not matter. The impact exists nonetheless.
One of the changes the ACA has yielded is the threshold for suspending Medicare and Medicaid payments to providers based on credible allegations of fraud is lower.
While CMS regulations authorized the suspension of Medicare and Medicaid payments prior to the enactment of the ACA, § 6402(h) lowers the standard the government must meet in order to suspend payments based upon suspected fraud.
The lower standard for a state to suspend Medicaid and Medicare payments nip…nay, I say…bite at the fabric of due process.
First, what is a “credible allegation of fraud?”
Credible allegation of fraud means an allegation from any source, such as data mining, whistleblowers, and/or fraud hotline complaints. Quite literally, you could be accused of having credible allegations of fraud because an ex, disgruntled employee calls the fraud hotline.
The definition of “credible” is equally as scary. If there is “indicia of reliability,” it is credible. I have no idea what “indicia” means, but it does not sound like much. So if there is indicia of reliability when your ex, disgruntled employee calls the fraud hotline, there may be credible allegations of fraud against you.
When you have credible allegations of fraud against you, your Medicaid/Medicare payments are suspended. Without an opportunity to rebut the allegations. Without you even knowing from where the allegation came.
I make the analogy (albeit, admittedly, a poor one) of my law license. Or an M.D.’s license. Or a teacher’s license. We do not have a right to a law license. But, I argue, once you go through the process and pass the necessary tests and are awarded a law license (or M.D. license or teacher’s license), you have a protected property right in continuing in the profession.
There is a good cause exception and you should try to assert the exceptions, but this blog concentrates on the suspension and the due process (or lack thereof) involved.
CMS states that providers have “ample opportunity to submit information to us in the established rebuttal statement process to demonstrate their case for why a suspension is unjust.”
However, think of this…in Medicare, notice to the provider is not required prior to the suspension. So, I ask you, how can you plead the suspension is unjust when you have no notice? Obviously, only after the suspension has been put into place. Due process violation?
In Medicaid, the agency must notify the provider of the suspension within 5 days of taking the action. Although it can be extended to 90-days upon request of a law enforcement agency.
Even though the Medicare suspension statutes do not require notice, the Medicare statutes are a bit more provider-friendly when it comes to the length of time during which you may be suspended. For Medicare providers, the suspension can last a period of 180 days. However, the 180 days can be extended.
Conversely, for Medicaid providers, there is no scheduled period of suspension.
In my cursory review of case law, I found one case in which the Medicaid provider had suffered suspension of Medicaid reimbursements for over 4 years. Obviously, the company had closed and staff had been terminated. You cannot maintain a business without revenue.
So, is the suspension of Medicare and Medicaid payments upon a credible allegation of fraud a violation of due process?
Do not even get me started on the importance of due process. In fact, I have blogged about the importance of due process before in this blog. “NC Medicaid and Constitutional Due Process.”
Due process is generally described as notice and an opportunity to be heard. But due process does not apply to everything. For example, you do not have due process rights to your drivers’ license. Certain infractions will cause you to lose your drivers’ license without due process. That is because driving is a privilege, not a right. You do not have a right to drive. Instead due process attaches when a liberty or a property right is deprived.
The right to vote (for some…not felons)
Freedom of religion
Freedom of speech
Obviously, in certain circumstances, those rights can be restricted (shouting fire in a crowded movie theatre, for example). But, generally, you have due process to the deprivation of any of your rights.
For purposes of this blog, we are concentrating on whether due process attaches to the deprivation of Medicare and Medicaid reimbursements. If someone takes away your Medicaid and/or Medicare reimbursements, are you entitled to due process…or notice and an opportunity to be heard?
Some courts have held that “health care providers have a constitutionally protected property interest in continued participation in the Medicare and Medicaid programs.”
Obviously, in the jurisdictions in which this view is followed, without question, you have a right to due process upon suspension of Medicaid and/or Medicare reimbursements.
However, the view that Medicaid and Medicare participation is a constitutionally protected right is not the majority view. Or, I should say, this particular issue has not arisen in all jurisdictions. Some jurisdictions have not even considered whether the participation in Medicaid and Medicare is a protected property interest.
To be completely clear, there is no protected property interest in procuring a Medicaid or Medicare contract. Only once you receive the contract does your interest in the contract become protected (in those certain jurisdictions).
North Carolina, for example, has not contemplated this issue (at least, not since after 10 NCAC 22F.0605 was enacted).
Interestingly enough, 10A N.C. A. C. 22F.0605 states “[a]ll provider contracts with the North Carolina State Medicaid Agency are terminable at will. Nothing in these Regulations creates in the provider a property right or liberty right in continued participation in the Medicaid program.”
So, one would think that, in NC, there is no protected property interest in continued participation in the Medicaid program.
However, in the Office of Administrative Hearings (OAH), this very issue was contemplated in a few contested case hearings and the Administrative Law Judges (ALJ) have decided that there is a protected property interest in the continued participation of the Medicaid program, despite 10A N.C. A. C. 22F.0605. The decisions are based on federal and state law.
“North Carolina statutes and rules provide procedural due process. Federal Medicaid regulations are replete with provisions that require that notice be given to the provider of the suspension or termination of Medicaid payment for services.”
”The Supreme Court has ruled that property rights can be created by administrative regulations and that the “sufficiency of the claim of entitlement must be decided by reference to state law.”‘ (Internal cite omitted). Bowens v. N.C. Dept. of Human Res., 710 F.2d 1015, 1017 (4th Cir. 1983). Our state statutes and rules have the procedural and substantive safeguards, indicating that the provider’s participation is not terminable at will.” (This opinion was written after 10A N.C. A. C. 22F.0605 was enacted).
While these OAH decisions have not undergone judicial review, at least, in OAH, providers may have a protected property interest in the continuation of participation in the Medicaid program. And analogous argument would exist for Medicare providers.
Who knows? Maybe NC will follow the view that providers have a protected property interest in continuing participation in Medicaid…
Just imagine if the government could snatch away law licenses…or M.D.’s licenses…or teachers’ licenses…without any due process. We would live in fear of losing our livelihoods.
BNA’s Health Care Policy Report:
Posted March 5, 2014
The Obama administration March 5 said consumers can keep their health plans that don’t comply with the Affordable Care Act for two more years, as part of a release of new ACA rules and policies.
The Department of Health and Human Services noted that in fall 2013, the administration extended through 2014 noncompliant health plans in the small group and individual health insurance markets, for insurers that received permission from their state to do so. Now, the department is extending its “transitional policy for two years,” to policy years beginning on or before Oct. 1, 2016.
“This gives consumers in the individual and small group markets the choice of staying in their plan or joining a new Marketplace plan as the new system is fully implemented,” the HHS said.
The HHS also issued a comprehensive ACA insurance markets rule (CMS-9954-F) called the Notice of Benefit and Payment Parameters for 2015. The regulation includes provisions on premium stabilization; open enrollment for 2015; annual limitations on cost sharing; consumer protections; financial oversight; and the Small Business Health Options Program, or SHOP.
For the temporary “risk corridors program,” which helps stabilize premiums when enrollees are much sicker or much healthier than expected, the HHS said it intends to operate the program in a budget-neutral manner, with payments coming in equaling the amount of money going out, “while helping to ensure that prices remain affordable in 2015 and beyond.”
The Treasury Department and the Internal Revenue Service also released final rules (TD 9661) March 5 to implement the information reporting provisions for insurers and certain employers under the ACA that take effect in 2015. Treasury said the final rules on information reporting by employers “will substantially streamline reporting requirements for employers, particularly those that offer highly affordable coverage to full-time employees.” Treasury also released final rules (TD 9660) to provide guidance for reporting by insurers and other parties that provide health coverage under the ACA.
An HHS bulletin on the plan extension is at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/transition-to-compliant-policies-03-06-2015.pdf. The HHS and Treasury rules are posted at the public inspection website: http://www.federalregister.gov/public-inspection.
Have you ever wondered about warning labels? I mean, some of them are so ridiculous that you have to wonder who the person was that created the need for such a ridiculous warning label.
For example, the warning label on the sleep-aid Nytol warns, “May cause drowsiness.” I hope so!
This weekend my husband and I let friends borrow our chainsaw. The warning on the chainsaw says, “Do not hold on wrong side of chainsaw.” Really? What moronic person would grab a chainsaw by the saw blade? But the warning is there, so there must have been at least one person who held the chainsaw by the saw blade, turned on the saw and…you know.
Then comes my personal favorite…my egg carton from the grocery store states, “This product may contain eggs.” My egg carton! Really?
Medicaid cards should come with warning labels. Multiple warning labels. Such as:
“Warning: You may not be able to find a physician willing to accept Medicaid.”
“Warning: This may not be your card. Review the name prior to use.”
“Warning: This card could lead to you losing your home.”
For most people, your home is your biggest investment in your lifetime. Many people want to pass their houses down to children, or, at least, give the children the right to sell the home and keep the money. To some, the home is the biggest inheritance…maybe the only inheritance.
So how can NC take your home if you are on Medicaid?
According to NC Department of Health and Human Services (DHHS), the estates of Medicaid recipients may be subject to estate recovery if (1) The Medicaid recipient applied on or after October 1, 1994. (Considering it is 2014, I would guess that most people fall into this category); and one of the following:
(a) is under age 55 and an inpatient in a nursing facility, intermediate care facility for the intellectual developmentally disabled, or other medical institution, and cannot reasonably be discharged to return home; or
(b) is 55 years of age or older and is living in medical facility and receiving medical care services, or home and community-based services, or In Home Care Services (IHC).
Also, In Home Care Services (IHC) claims for SA recipients ages 55 and over are subject to Medicaid Estate Recovery.
This estate recovery is not new. Recently, I have seen a few articles on the internet that state that this estate recovery is a new addition to the Affordable Care Act (ACA). This is incorrect information. In 1965, estate recovery was optional and states could only recoup Medicaid costs spent on those 65 years or older. In 1993, Congress passed a budget bill that required states to recover the expense of long-term care and related costs for deceased Medicaid recipients 55 or older. The 1993 federal law also gave states the option to recover all other Medicaid expenses. The only change that the ACA made to the estate recovery rule is, by expanding Medicaid, providing more estates to be recovered.
“Warning: Medicaid can take your home!”
The estate recovery oddly seems to disproportionately affect people over 55 years of age.
DHHS does state that it will NOT seek a lien on your property while you are alive. DHHS only seeks the estate recovery after your death. DHHS also states that estate recovery is waived in some circumstances. What circumstances are those? And why wouldn’t those circumstances apply to everyone?
What exactly can the state seek to recover?
“At a minimum, states must recover amounts spent by Medicaid for long-term care and related drug and hospital benefits, including Medicaid payments for Medicare cost sharing related to these services. However, they have the option of recovering the costs of all Medicaid services paid on the recipient’s behalf. The majority of states recover spending for more than the minimum of long-term care and related expenses.” (emphasis added). See HHS’s website.
Isn’t Medicaid intended to be free health care for low-income and needy people? If the state can recover from a person’s estate after death, did that person really receive free health care? Or was the health care merely a loan?
Warning on the Medicaid card: “Warning! By accepting Medicaid, you are authorizing the state to recover from your estate, and, in some circumstances, your home.”
But the warning is very tiny print.
Study Shows the ACA Will Not Lead Physicians to REDUCE the Number of Medicaid Recipients, Supply and Demand, and Get Me My Pokemon Cards!
A recent “study” by Lippincott, Williams, and Wilkins is entitled “Doctors Likely to accept New Medicaid Patients as Coverage Expands.” (I may or may not have belly laughed when I read that title). See my blog “Medicaid Expansion: Bad for the Poor.”
The beginning of the article reads, “The upcoming expansion of Medicaid under the Affordable Care Act (ACA) won’t lead physicians to reduce the number of new Medicaid patients they accept, suggests a study in the November issue of Medical Care, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.”
The study was published October 16, 2013. (BTW: From what I can discern from the article, the title actually means that physicians will be forced to accept more Medicaid patients because there will not be additional physicians accepting Medicaid). Odd title.
According to this study, the ACA will not cause doctors to reduce the number of Medicaid patients. What does this study NOT say? Nothing indicates that the ACA, which will allow millions more of Americans to become eligible for Medicaid, will cause MORE physicians to accept Medicaid. Nor does the study state that the ACA will cause physicians to accept MORE Medicaid recipients.
Am I the only person who understands supply and demand?
Anyone remember the 1999 Toys.R.Us.com debacle? On-line shopping was just heating up. I was in law school, and I, as well as millions of others, ordered Christmas presents on-line from Toys R Us. I ordered a bunch of Pokemon trading cards for a nephew…remember those? Me either…I just bought them for my nephew. Toys R Us promised delivery by December 10th.
Toys R Us was, apparently, a very popular store that year, because Toys R Us is unable to package and ship orders in time to meet the December 10th deadline. Nor could Toys R Us meet the deadline of Christmas. Employees were working through the weekends. About two days before Christmas, and just in time to create last-minute havoc during Christmas time, Toys R Us sends out thousands of emails saying, “We’re sorry.”
Obviously, Toys R Us was slammed by the media, and thousands of consumers were highly ticked off…including me.
I had to go to the mall (a place to which I detest going) on Christmas Eve (the worst day to shop of the entire year, except Black Friday, which I also avoid) to get my nephew a present.
Toys R Us learned its lesson. It outsourced its shipping to Amazon.com, which, obviously, has the whole shipping thing down pat.
50 million people are currently eligible for (and receive) Medicaid services (these numbers are purely fictional, as I do not know the real numbers…I basically estimated 1 million per state, which, I am sure, is an underestimation). Say there are 3.5 million physicians that accept Medicaid (70,000/state, which is probably a high estimation, when we are considering only physicians and not health care providers, generally).
Our hypothetical yields 14.28 Medicaid recipients per physician. Or a ratio of 14.28:1.
Media state that, if NC expanded Medicaid, that 587,000 more North Carolinians would be eligible for Medicaid if NC expanded Medicaid.
Using NC as a state average, 29.35 million more people would be eligible for Medicaid if all states expanded Medicaid (obviously not all states are expanding Medicaid, but, in my hypothetical, all states are expanding Medicaid). This equals a total of 79.35 million people in America on Medicaid.
But….no additional physicians….
Because, remember, according to the Lippincott study, the upcoming expansion of Medicaid under the Affordable Care Act (ACA) won’t lead physicians to reduce the number of new Medicaid patients they accept. But the ACA does not lead more physicians to accept Medicaid or physicians to accept more Medicaid patients.
This brings the ratio to 22.67:1. 8 1/2 new patients per one physican…and, BTW, that one physician may not be accepting new Medicaid patients or may not have the capacity to accept more Medicaid patients. It’s a Toys R Us disaster!!! No one is getting their Pokemon trading cards!!!
Why not? Why won’t the ACA lead more physicians to accept Medicaid? Why won’t the ACA lead physicians to accept more Medicaid recipients?
Didn’t the ACA INCREASE Medicaid reimbursement rates? Wouldn’t higher reimbursement rates lead more physicians to accept Medicaid and physicians to accept more Medicaid recipients??? I mean, didn’t you hear Obama tout that Medicaid rates would be increased to Medicare rates? I know I did.
One average, Medicaid pays approximately 66% of Medicare reimbursement rates. Obviously, every state differs as to the Medicaid reimbursement rate.
The ACA, however, slashes the Medicare budget by 716 million from 2013 to 2022. The cuts are across-the-board changes in Medicare reimbursement formulas for a variety of Medicare providers, including hospitals, nursing homes, home health agencies, and hospice agencies. Furthermore, the ACA creates the Independent Payment Advisory Board (IPAB), which is intended to determine additional Medicare reimbursement rate cuts. IPAB will be creating a new Medicare spending target; it will be comprised of 15 unelected bureaucrats. The board will be able to make suggestions to Congress to reign in Medicare spending, and one of the biggest tools the IPAB has is cutting physician reimbursement rates.
It’s the old smoke and mirrors trick…We will raise Medicaid rates to Medicare rates…pssst, decrease the Medicare rate so we can meet our own promise!!
While I am extremely happy to hear that, at least according to the Lippincott study, the ACA will not lead physicians to reduce the number of Medicaid patients they accept, I am concerned that the ACA will not lead more physicians to accept Medicaid and physicians to accept more Medicaid recipients.
In fact, the study states that “[t]he data suggested that changes in Medicaid coverage did not significantly affect doctors’ acceptance of new Medicaid patients. “[P]hysicians who were already accepting (or not accepting) Medicaid patients before changes in Medicaid coverage rates continue to do so,” Drs Sabik and Gandhi write. I bet the Drs. did not ask, “Would you continue to accept Medicaid, if you knew that your practice would endure more audits, post-payment reviews, possible prepayment reviews, and, in general, suspensions of reimbursements if anyone alleges Medicaid fraud, irrespective of the truth?”
Which tells me…hello…more Medicaid recipients, not more doctors!! Even if the physicians already accepting Medicaid COULD accept additional Medicaid recipient patients, each physician only has a certain amount of capacity. To my knowledge, the ACA did not increase the number of hours in a day. Supply and demand, people!!
Where are my Pokemon cards???!!!
Representative David Price spoke as the Keynote Speaker at the North Carolina Society of Health Care Attorneys annual meeting yesterday morning. Since Representative Price was actually up in Washington D.C. during the shutdown, it was very interesting to hear him speak. His opinion, as one would expect from his ideology, was that the shutdown was idiotic and unnecessary.
What I found interesting was how he described the relationships between congressmen and women today versus in the 90s. Remember, he has represented NC in Washington for more than one decade. He described the relationships, even across party lines, as more cordial in the 90s than today’s relationships. I wonder why our legislative body has become more segregated.
In the afternoon session, Linwood Jones from the North Carolina Hospital Association spoke about recent legislative action. This legislature was not good to hospitals. As Linwood described the legislative session this year…”It was all about Medicaid.” (I know you were wondering how the NC Society of Health Care Attorneys annual meeting was going to be germane to Medicaid). According to Mr. Jones, the Medicaid budget was the primary factor in almost all budget cuts. And what entities get most of Medicaid funding?
Duh…Hospitals. Hospitals are the biggest providers in the state, and, in some areas, the biggest employers.
Our Medicaid budget is approximately $13 billion.
Remember…36 million a day is what we spend on Medicaid in NC.
How much of that $13 billion Medicaid budget goes to hospitals? According to Kaiser Family Foundation, 25.7% for inpatient care. Or $3.341 billion annually. Or $9.252 million a day!!
Including outpatient care? 38.7% Or $5.031 billion annually. Or $13.932 million a day!!
According to the handy-dandy Wikipedia website, North Carolina has 126 hospitals in 83 counties. For those of you who never went to 6th grade in North Carolina, we have 100 counties in NC. (In the 6th grade, if you grew up here, you learn all about North Carolina geography, which apparently didn’t stick, because I still get lost).
That is $13.932 million dollars a day going to 126 hospitals in NC. That is a lot of money!!!
Does Medicaid matter to hospitals?
Heck, yes!! Remember, a hospital cannot turn anyone away, including Medicaid recipients and uninsured. Add the fact that the mentally ill in NC are not getting medically necessary services because our managed care organizations (MCOs) have monetary incentives to NOT provide the expensive mental health services; PLUS the fact that Medicaid reimbursements are painfully low, which leads to many physicians not accepting Medicaid, and you get the sad sum of Medicaid recipients ending up in emergency rooms of hospitals.
Don Dalton, a spokesman for the Hospital Association, said that statewide about 46 percent of hospitals’ revenue comes from Medicaid. (See Rose Hoban’s article).
But, hospitals don’t make a huge profit. Especially on Medicaid recipients.
On average, Medicaid reimburses hospitals 80% of the actual cost for hospital services.
But this year, the General Assembly created a budget in which the 80% will be reduced to 70%.
Medicaid reimbursements were already bad. But now, the Medicaid reimbursements will be 10% worse. Subtract 10% from the $13.932 million dollars a day…
This is not a good thing for hospitals nor Medicaid recipients.
When Representative Price was speaking, a woman raised her hand with a question/vignette. She said that she and her friends had gotten on the health care exchange (Obamacare) (Healthcare.gov) website and “shopped” for health insurance. She said that all the people who signed up for health care exchange (because it is mandated and there is a penalty for not having insurance) had their premiums increase anywhere from 300%-800%. Although Rep. Price made a good point, that they all should have contacted Blue Cross Blue Shield (BCBS) and asked why BCBS dropped that particular insurance plan. Nonetheless, the woman harped on the fact that Obama had promised, “You like your insurance? You can keep it! You like your doctor? You can keep him/her!” (I added the “her.”)
So, here we are…with low Medicaid reimbursements to begin with, high medical costs, and the General Assembly reducing the Medicaid rates for hospitals by 10%.
Incentive to accept Medicaid recipients? I think not…but hospitals have no choice.
Physicians and other Medicaid providers have the choice as to whether to accept Medicaid patients, but hospitals? No choice there. Hospitals must accept Medicaid recipients. Mandatory!!!
In my opinion, the very first step toward fixing the Medicaid system is RAISING Medicaid reimbursement rates.
Sound counterintuitive? Yes, I agree it sounds counterintuitive. But think about Medicaid like this:
If you agree with me that Medicaid is an entitlement and that the Medicaid budget is way too high, but that all Medicaid recipients deserve quality health care…if you agree with all that…
And you also agree with me that it is drastically more expensive for Medicaid recipients to go to the emergency room (ER) for health issues that could be solved in a family physicians’ office…if you agree with all that…
Then we would save Medicaid dollars by increasing (drastically) the Medicaid reimbursements. If doctors had a monetary incentive to accept Medicaid, then more doctors would accept Medicaid (Logic 101). If more doctors accept Medicaid, then more Medicaid recipients have the ability to go see a doctor. If more recipients have more office visits then ER visits drop. If more unnecessary ER visits drop, then the State pays less money to the hospitals, which is an extremely higher rate (even with the 10% reduction) than a higher Medicaid reimbursement to physicians. Cut the $13.932 million a day to hospitals, not by decreasing the reimbursement rate, but by fewer Medicaid recipient going to the ER…instead have the recipients receive quality care outside the hospital, thus saving money…
By reducing the Medicaid reimbursements to hospitals, the legislature did decrease the Medicaid budget, but not in a way that intelligently attempts to fix the system. The same amount of Medicaid recipients will be going to hospitals. Since the hospitals cannot turn anyone away, reducing reimbursements to hospitals merely hurts the hospitals.
Want to decrease the Medicaid budget? Increase Medicaid reimbursements (drastically) to Medicaid providers. More providers accepting Medicaid means more recipients receiving quality care and NOT checking into the ER….
Money saved intelligently. Too bad the legislature didn’t ask my opinion prior to slashing Medicaid reimbursement rates.
On September 27, 2013, the Centers for Medicare and Medicaid (CMS) approved Arkansas’ request to begin a Private Option demonstration. Arkansas is the first state to receive approval for a “private option” as an alternative to Medicaid expansion.
Remember my “A Modest Proposal?” Providing Medicaid recipients with private insurance….
Basically, Arkansas will accept federal money for Medicaid expansion, but instead of expanding Medicaid, Arkansas will purchase private insurance for these “newly eligible” Medicaid recipients, adults who make $15,280 or less. Those individuals who earn up to 138 percent of the poverty line — or $15,415 per year — would purchase subsidized private insurance through the state’s insurance exchange. From my understanding, the federal funds will cover the newly eligible recipients’ premiums and any co-pays above the co-pays set by statute.
Coverage is to begin January 2014, although enrollment opened today.
Arkansas estimates that 225,000 individuals will be eligible for the demonstration project. Iowa has submitted a similar request for a “private option” program. CMS has not yet ruled on Iowa’s request. Likewise, Pennsylvania Governor Corbett submitted a request to CMS based of the Arkansas model.
It seems that some Republican governors are thinking outside the box to provide health care coverage for additional Medicaid recipients without merely providing the newly eligible simply a Medicaid card. Because, remember, receiving health care is completely different from receiving health insurance. Having insurance does not always allow Medicaid recipients to receive health care. Obviously, many provider refuse to accept Medicaid. But these newly eligible Medicaid recipients will have health care…with private insurance…just like I have…or you have….
And I ask you…What is more important….handing a person a Medicaid card?…Or providing that person with quality health care?
Who likes a tie (or a draw) in sports? Not me!
In the last few years, I have noticed that, increasingly, parents of young children in sports are not keeping score. You can go to a ten-year-old’s soccer game and ask the score, only to hear, “Oh, we don’t keep score. We believe that everyone is a winner.”
Without stepping up onto my soapbox, let me just say I think “scoreless games” are as worthless as the nonexistent scores themselves. I mean, come on, our country was founded on doing your best, working hard and receiving just compensation for hard work. (Not to mention that I grew up participating in competitive sports (gymnastics), and I truly believe that my participation in a competitive sport has contributed to my work ethic today).
Even Ashton Kutcher, during a recent Teen Choice Awards speech, surprised many with a speech about hard work and that opportunity looks a lot like hard work.
But, it is a different story when the teams actually keep score and the end result is still a draw. When you keep score and the result is a draw, generally, that means that two teams with similar ability played and both played hard and both kept one another at bay.
Like the 1996 hockey game between Colorado Avalanche and Buffalo Sabres…both teams bragged it had the best goalie. They played (and kept score) and recorded a shutout (0-0) tie game. Apparently, both goalies were equally great.
Going to Medicaid expansion. That’s an old topic for North Carolina, right? But not for the U.S…
Yes, Governor McCrory nixed NC Medicaid expansion in NC. Which, BTW, in my humble opinion, was a smart choice. But, before everyone starts screaming cuss words at the computer screen, read my blog: Medicaid Expansion: Bad for the Poor.
But, remember, other states are still wrestling with the idea of Medicaid expansion.
Decisions are being made every day. Just yesterday, Wyoming lawmakers announced that they were considering an alternative to Medicaid expansion. (As in, it would pretty much be Medicaid expansion, but named something else to avoid the appearance of concurring with the Affordable Care Act (ACA)).
So what is each state’s stance on Medicaid expansion?
Go figure….close to a tie.
Here is each state’s stance on Medicaid expansion as of July 26, 2013:
So the score is 28-22 (counting those states “leaning” as decided). Not exactly a tie, but pretty close.
The tie is especially interesting when you consider that the “score” of Republican to Democrat governors in the U.S. is 30-20.
The red states denote Republican governors; the blue states elected Democratic governors.
Although, remember, 18 states still have not decided whether to expand. Which means, the score could be 46-4 or 10-40. Whew….neither of those scores is a tie!
So what does this “close to a tie” in Medicaid expansion mean? Especially with the majority of governors nationwide affiliated as Republicans…Anything?
But, at least, we are keeping score. At least both teams are playing to the best of its ability. In the end, there will be a winner.
As there should be.
Hopefully, in the end, the winners will be the Medicaid recipients. (One can hope).
For anyone interested, the Triangle Business Journal, is hosting a Health Care symposium discussion, which will mainly revolve around the issues affecting employers, health care providers, insurance and benefits consulting companies as everyone gets ready for the implementation of federal health care law in 2014. I am sitting as a panelist for the discussion.
Here is the link: http://www.bizjournals.com/triangle/event/87901#eventDetails
Here is a description:
2013 Health Care Today
How will the upcoming health care changes affect small businesses and their employees? Join us to find out!
- When: Thursday, May 2, 2013,7:30am-9:30am Add to my calendar
- Where: Sheraton Imperial4700 Emperor Blvd. Durham NC 27703
- Suggested Dress: Business
Triangle Business Journal subscribers save up to 10% per ticket
|Ticket Type||Seats per ticket||Price per ticket||Quantity|
|1 2 3 4 5 6 7 8 9 10||Register|
2013 Health Care Today: Your Impact, Your Dollars
How will the upcoming changes affect small businesses and their employees?
The symposium discussion will mainly revolve around the issues affecting employers, health care providers, insurance and benefits consulting companies as everyone gets ready for the implementation of federal health care law in 2014.
Moderator: Triangle Business Journal Health Care Reporter Jason deBruyn
- Dr. Allen Dobson, President and CEO of Community Care of North Carolina
- Rick Kelly, Senior Vice President of Progressive Benefit Solutions
- Adam Searing, Director of Health Access Coalition for the North Carolina Justice Center
- Brad Wilson, President and CEO of Blue Cross and Blue Shield of North Carolina
- And me:) Knicole C. Emanuel, Medicaid Attorney
More panelists to be announced soon…
Join Triangle Business Journal as a panel of experts discuss these very important changes in the health care rules that could have a profound impact on our economy.
One week has passed since the infamous federal sequester deadline. Let’s re-assess: Does the Sequester Affect Medicaid?
Remember, according to the federal government, the Medicaid budget was exempt from the across the board slashes in budgets.
However, the following sequester cuts will have a direct effect on Medicaid:
- $44 million cut from the Centers for Medicare and Medicaid Affordable Insurance Exchange grants;
- $168 million cut from Substance Abuse and Mental Health Services Administration;
- $75 million cut from the Aging and Disability Services Programs;
- $17 million cut from Housing Opportunities for Persons with AIDS;
- $19 million cut from Housing for the Elderly;
- $57 million cut from the Health Care Fraud and Abuse Control;
- $51 million cut from the Prevention and Public Health Fund; and
- $27 million cut from the State Grants and Demonstrations.
Let’s analyze the first cut: $44 million from the Affordable Insurance Exchange. The Affordable Insurance Exchange grants is an intregal part of the Affordable Care Act (ACA). The ACA directs the U.S. Department of Health and Human Services (“HHS”) to provide states with funding to support planning, implementation and operation of state exchanges. Already every state except Alaska received an initial allotment of up to $1 million in planning grants in the fall of 2010. North Carolina already received $86,357,315.
As I am sure everyone is aware, NC has opted out of Medicaid expansion. However, the ACA requires an insurance exchange program. On February 12, 2012, Gov. McCrory announced NC’s intent to allow the federal government to operate the exchange.
So, now, our health care exchange program will be only as good as the federal government makes it, which is a scary prospect in my mind, especially in light of the near certain fact that the federal government is in such financial stress that it will not be able to uphold its end of the bargains under the ACA. Already?
I wonder if the states accepting the federal dollars for Medicaid expansion are re-thinking those decisions.
Last week, Charles P. Blahous, III, who has served as a public trustee for Social Security and Medicare since 2009, said there was a “near certainty” that the federal government would not provide the full level of Medicaid funding now scheduled under law.
Blahous also stated that “to return the federal budget to sustainable historical norms in the absence of any cuts in the growth of Medicaid and the new health exchanges would require all other non- interest spending to be cut by nearly one-quarter by 2037 relative to projected levels, and by roughly 15 percent relative to current levels in relation to GDP.”
And: “This is probably unrealistic.”
Despite the budget cuts due to the sequester, the federal government is STILL in severe financial stress.
So as to, the ultimate question posed in the beginning: “Does the Sequester Affect Medicaid?”
The answer: A resounding yes.
Summary: (Please note: The word “impact” should carry a pejorative connotation. When reading, feel free to add in “negatively” each time you read “impact.”)
The sequester impacts health care. Medicaid is health care. The sequester impacts Medicaid.
The sequester impacts the health care exchange program. The federal government is in financial stress. The federal government will control NC’s health care exchange. NC’s health care exchange will be in financial stress.