Posts tagged: medicaid
An appeal from the state of Idaho over a court decision that required the state to increase its Medicaid reimbursement rates to private-sector health care providers to keep up with the rising cost of services is among cases the U.S. Supreme Court has decided to hear, the AP reports. A 2009 lawsuit argued that the state was unfairly keeping Medicaid reimbursement rates at 2006 levels despite studies showing that the cost of providing care had risen. A federal judge agreed, as did the 9th U.S. Circuit Court of Appeals; the increased reimbursements cost the state an additional $12 million in 2013.
Click below for a full report from AP reporter Sam Hahanel in Washington, D.C. Twenty-seven states are supporting Idaho, which is arguing that the Constitution's supremacy clause doesn't allow private parties to bring this type of lawsuit against a state. The justices will take up the appeal next year.
Idaho Attorney General Lawrence Wasden is asking the U.S. Supreme Court to consider a lawsuit the state lost over Medicaid provider reimbursement rates for services to the developmentally disabled, contending both the U.S. District Court in Idaho and the 9th Circuit U.S. Court of Appeals erred when they ruled against the state.
The lawsuit, first filed in 2009 by five service providers, contended that Idaho's Department of Health & Welfare was wrong to keep reimbursement rates at 2006 levels when studies showed the cost of providing services was going up. The courts agreed and ordered increases in reimbursement rates that last year cost the state $12 million. “We’re asking the Supreme Court to take up this case because the 9th Circuit’s decision incorrectly permits private parties to interfere with the administration of the state’s Medicaid program and the Legislature’s choices regarding that program,” Wasden said in a news release. “As it stands now, the 9th Circuit’s decision creates enormous administrative and financial consequences for Idaho and every other state in the circuit.”
The U.S. Supreme Court takes up only a tiny portion of the appeals it receives; click below for Wasden's full announcement.
Idaho must restore $16 million a year in services to Medicaid clients with developmental disabilities, under an injunction issued by a federal judge, the AP reports. The cuts were made in 2011; the order from U.S. District Judge B. Lynn Winmill requires them to be reversed immediately, and also lets an ACLU lawsuit on behalf of disabled Idahoans proceed as a class-action case. The suit isn't seeking monetary damages. “We're suing just to fix this system and fix it as soon as possible,” said ACLU of Idaho Legal Director Richard Eppink said. Click below for a full report from AP reporter Katie Terhune.
“We hope that this decision is a wake-up call for the Department of Health and Welfare,” Eppink said. “Our investigations show that the very same constitutional due process problems the court found in this program are found in virtually every other Idaho Department of Health and Welfare program. Those will be the next lawsuits.” You can read the judge's ruling here.
A tea party legislative candidate from Canyon County has become the target of national online derision, the Idaho Statesman’s Dan Popkey reports, after news surfaced that while he opposes Obamacare and will pay a penalty rather than participate, he has 10 kids on Medicaid, the government-funded health care program for the poor and disabled. “I attracted all the attention of all the people who hate Republicans and the tea party,” Greg Collett, a 41-year-old freelance software developer and University of Idaho alum, told Popkey. “I've also attracted the attention of a lot of people in the liberty movement that don't want to see anybody on welfare.” Things got so bad, Collett said, he had to clean up his Facebook account and remove contact information from his campaign website.
The two-time GOP legislative candidate, who’s planning to run again, made the news because he was one of 1,503 people who answered a Kaiser/NBC poll in September about attitudes about the Affordable Care Act, and he told the pollsters he'd be willing to talk to a reporter. He ended up as the first person quoted in an Oct. 4 NBC story, “Health care holdouts: uninsured but resisting.” It went viral.
“I'm OK taking whatever I can from the government that's available to me,” Collett told Popkey. “I'm not going to lie and scam the system, but I'm OK with redirecting that money away from morally reprehensible things and direct it towards me.” Popkey’s full report is online here, along with links to some of the national stories and Collett's online response.
Idaho Attorney General Lawrence Wasden announced today that the state has recovered more than $28 million, as a result of six years of litigation regarding overcharging by major drug manufacturers who sold prescription drugs to Idaho’s Medicaid program. Idaho has settled with 33 drug companies – three of those without litigation – and also won price disclosure concessions Wasden says will prevent such improperly inflated price reporting in future years. “In negotiating these settlements, we tried to look forward as well as backward,” Wasden said. “We recovered a significant amount of money to compensate the state for past practices. But equally as important, the state will receive pricing data from these companies going forward. That element of the settlements will help protect the taxpayers from future pricing abuses.” That data would otherwise have been confidential.
Until July 1, 2011, prescription drug prices paid by Idaho’s Medicaid program relied on companies’ reports of the “average wholesale price,” or AWP, as a basis for determining the acquisition cost to pharmacies. Wasden said, “One of them indicated that ‘AWP’ stands for ‘ain’t what’s paid.’”
While other states also have sued drug manufacturers over the issue, Wasden took a different approach, first calling all of them in for a meeting. As a result, three settlements were reached without the state even having to sue. The litigation led to reforms in how drug pricing for Medicaid is calculated, which state Health & Welfare Director Dick Armstrong said are now “saving over $10 million a year for the citizens of Idaho,” saying Idaho has now “completely changed the way drugs are priced and paid for” through its Medicaid program.
Because the federal government pays 70 percent of the costs of Medicaid in Idaho, which provides health coverage for the state’s poorest and disabled residents, the feds will get $13.56 million of the recovery, in the form of credits against future federal Medicaid payments to Idaho. The state’s share of the settlements, $7.2 million, was deposited in the state’s general fund for appropriation by the Legislature. The rest of the money went to cover the costs of the investigations and litigation; you can read my full story here at spokesman.com.
Wasden filed the first lawsuits in 2007; the first settlements were reached in 2005, 2006 and 2008, and the last one, with Novartis Pharmaceuticals Corp. for $750,000, was reached last month.
A group of Medicaid patients with severe disabilities who sued the state last year over cuts in their care are now seeking class-action status for their lawsuit, on behalf of about 3,600 people who receive care through a waiver program for people with developmental disabilities. The AP reports that a federal judge already had ordered the state to reinstate the plaintiffs' benefits or make other changes, but the plaintiffs said the state made the changes only for the 13 plaintiffs, and continued to follow its disputed practices for everyone else on the program.
If the judge agrees to make the case a class-action lawsuit and restore the coverage to all 3,600 patients, the state could have to spend $3.1 million more on the program in state dollars, and more than $10 million when the federal match is added in; click below for a full report from AP reporter Rebecca Boone. All of the plaintiffs have multiple medical or mental health problems or developmental disabilities, and all of them need supervision. Some require 24-hour care.
After years of relentless growth, Idaho lawmakers received a budget request for the state’s Medicaid program Tuesday that’s nearly flat in state funds, and just a 7.6 percent increase overall - even though the program is expected to add roughly 70,000 new recipients next year due to changes in federal laws. You can read my full story here at spokesman.com. The slower growth is mainly because Idaho’s caseload numbers in the health care program for the poor and disabled have stopped climbing so quickly as the state’s come out of the recession; it’s also because federal funds are up, meaning the state can spend less. Idaho’s federal matching rate for next year is going up, to the tune of $11.8 million.
It also in part reflects an overfunding of the program last year, when more growth was anticipated than actually came through. That prompted the program to turn back $46 million to the state general fund unused; officials say a new claims system is now allowing more accurate forecasts.
Sen. Shawn Keough, R-Sandpoint, vice-chair of the Joint Finance-Appropriations Committee, welcomed the slowing in the program’s growth, but cautioned, “The devil’s always in the details.” She said, “My focus tends to be less on the numbers, and more on the delivery of services to those who need it.”
Gov. Butch Otter's Medicaid expansion working group is receiving a report from consulting group Milliman this morning on the potential impacts to the state. “On a purely financial basis, it would make sense to expand,” Justin Birrell of Milliman told the working group. “You save $6.5 million if you expand. It would cost you $284 million if you don't.” That's over a 10-1/2 year period starting in the second half of state fiscal year 2014. Added the firm's Ben Diederich, “The state and local offsets are what's very unique to Idaho.”
That's because of how Idaho currently funds health care for the indigent; through the state's medical indigency/Catastrophic Health Care program, the money comes entirely from the state general fund and from local property tax money. This afternoon, the working group is scheduled to decide on its recommendation to Otter on what the state should do; under the national health care reform law, states have the option of expanding their Medicaid programs largely at federal expense.
The Idaho Legislature's Health Care Task Force, a joint committee of 14 senators and representatives, is hearing updates this morning on the progress of two working groups looking into how Idaho should proceed under the national health care reform law on two fronts: A health insurance exchange, and expansion of Medicaid. State Insurance Director Bill Deal told the lawmakers that the exchange working group will hold its final meeting this Friday, and will settle on its report and recommendations to Gov. Butch Otter on how to proceed.
State Health & Welfare Director Dick Armstrong told the task force that the Medicaid expansion working group is working through three options: Don't expand Medicaid and keep Idaho's current medical indigency/catastrophic health care fund as-is; don't expand Medicaid and revise the CAT fund system; or expand Medicaid. The no-change option would lead to very fast-growing costs both for the state and for county property taxpayers, Armstrong said. Forecasts show county costs would rise from $29.6 million a year today to $39.6 million a year in 2020, and state costs to the state's general fund from $39 million this year to $52.5 million in 2020.
Revising the CAT program likely would save only about 2 percent on costs, he said, with a new, standardized claims-processing system costing between $1.5 million and $3.5 million. Medicaid expansion, combined with other expected increases in Medicaid, would push Idaho's Medicaid program from the current 229,000 participants to an estimated 453,000 in 2020. Costs would be almost entirely borne by the federal government, though Armstrong warned that that could change in the future if federal policies change.
Sen. Dan Schmidt, D-Moscow, said the three options don't include one he's been hearing questions about when he goes door-to-door campaigning for re-election: Don't expand Medicaid and eliminate the CAT program, and just say Idaho won't pay for indigent people's medical costs. “Could the state of Idaho just say we're not going to pay for indigent health care?” Schmidt asked. “People argue that that's something we should consider.”
Armstrong responded, “Well, then the bad debt would fall on the hospitals and the providers. My first-blush guess is all of us that pay for our own hospital care through insurance, that difference would be immediately transferred. It would be an immediate cost shift to anybody and everybody that's paying for health care - they would have no choice.” He added, “It would mean all of the dollars would then end up moving to another pocket.”
As the governor's Medicaid working group wrapped up its meeting today, Idaho Health & Welfare Director Dick Armstrong said it was “nice to hear such agreement on many of these principles - that's very encouraging.” He said he'll work on “simple graphic illustrations of costs and impacts” to bring to the panel at its next meeting Oct. 23rd. “I believe we have added to our information base and understanding,” he said, including today's point that administrative costs of the current county medical indigency system haven't yet been included in cost estimates. “We're going to try to put a dollar savings to that, so that was a good find today,” he said. The next meeting may be the group's final one, Armstrong said, but it'll reserve a date for an additional meeting just in case. “It depends on what happens with the November election - we may be back,” he said.
Members of the governor's Medicaid expansion working group are now each sharing “guiding principles” they want to see help guide the panel's future decision on how to proceed. Rep. Fred Wood, R-Burley, a physician, said the group needs clear, easily understood graphics comparing the costs of each option. “If we really believe that it's going to cost us less in the future, we have to be able to show that,” he said. He said there's concern about “creating an adverse business environment in the state of Idaho because we won't expand Medicaid,” to the point that a business considering relocating to the state might say, “Wait a minute, you want me to come to the state of Idaho and pick up a part of your indigent care? We're not coming.”
Susie Pouliot of the Idaho Medical Association said the IMA physicians took a policy position in July in favor of expanding Medicaid in Idaho. She said their hope was not only to get patients into “the appropriate care … at a more appropriate cost,” but also to make the move part of a transformation of health care in Idaho, into a more managed-care type environment, with a medical home model, with community care networks, so that “coordination and transitions are managed in a way that produces good health results.”
Sen. Patti Anne Lodge, R-Huston, said this summer she's received more letters, emails and personal contacts than ever before in a campaign season, and they're on this issue. Lodge said many of her constituents are telling her “they don't like Obamacare and they don't want anything that has anything to do with it,” and it's challenging to explain to them the issues involved. “We are not doing a good enough job … to show the taxpayers and the citizenry what the costs are going to be,” she said.
Gooding County Commissioner Tom Faulkner said, “I think we do want to make the point that we want to promote a strong business environment by minimizing the taxes and the costs to the citizens of the state. That is a big deal.” He added, “Part of the problem with our health care is our providers are going through the roof with the costs … just because they could get away with charging us whatever they want to charge us.”
Dan Chadwick, head of the Idaho Association of Counties, said of the existing medical indigency program, “They're unsustainable numbers. We cannot afford those any longer. And those same people that are going to the county now for assistance are the ones that are paying those increased property taxes or state taxes.” He said the current system “puts incredible pressure on county governments trying to keep up with those costs, simply because they're not predictable.”
Mike Baker of the Idaho Primary Care Association is now briefing the governor's Medicaid working group on Option 3: Expanding Medicaid in Idaho. “You look at the numbers, and this thing, this problem is just ginormous,” he told the panel. But, he noted, “We're paying for a lot of these things right now. They're coming out of inefficient systems, they're probably being paid at higher rates. … I don't think we're working as smart as we could.”
He noted a reference earlier in the day to Idaho's medical indigency program as a type of “debtors' prison.” “There's funding available to help these folks in our community access the care that they need, and it's up to us to figure out how do we utilize what we're paying now … to cover the gap,” Baker said. “There are all these holes in the system.”
He said, “We all know at the end of the day we're going to have some folks that fall through the holes, no matter what program we put together, but the goal here is to reduce the number of people falling through those cracks. … reduce the cost of their care … and stop requiring other folks in the community” to cover the costs through cost-shifting.
Baker, who noted that he sees patients who are part of this population every day at the Kootenai County community health center where he works, said, “This really can work, and get us closer to the day where we can say, 'Access to health care is not a problem.'” He said, “We have 65 percent of patients in our clinic are uninsured.”
He shared data that for Idaho's mentally ill patients, 95 percent could be shifted to an expanded Medicaid, saving $11 million in state general funds. About 75 percent of AIDS Drug Assistance Program clients would qualify for the Medicaid expansion, saving the state about $800,000. Shifting the uninsured population from the state's indigency program to Medicaid would save millions both for the state and for county property taxpayers. “We know cost-shifting is occurring,” Baker said. “This should be a no-brainer decision.”
He told the panel, “If your neighbor is healthy and they're able to work, your community starts getting better.”
Idaho Association of Counties head Dan Chadwick briefed the governor's Medicaid expansion working group on what's been designated Option 2 - Don't expand Medicaid, but redesign Idaho's medical indigency program. “I've talked to my peers around the country and they all scratch their heads,” Chadwick said. “There is no other state that does it the way we do it.”
He said there's no simple way to redesign Idaho's program - he describes it as a “scraper,” that would have to be scrapped and a new system developed from scratch. Possible elements of redesign could include standardizing claims processing and expanding utilization management and medical review, he said. But possible savings would be difficult to estimate - perhaps coming to 2 percent from efficiencies. Because the indigency program is incident-based, not eligibility-based - meaning a person is eligible for benefits only if their medical bills from a particular incident are more than they could pay off in five years - it's very difficult to predict costs, because there's no way to know when someone will get sick or be in an accident. “It's a really unique system,” Chadwick said.
“I don't think anyone think there is a silver bullet or a magic wand that's going to change this program,” Chadwick said. “Many of the providers and the counties really don't like this system. I think we'd all be happy to see it go away. … It's a difficult system to administer, and we don't know even where to start in terms of capturing the administrative costs for this.” You can read my full story here on the program, from the Sept. 9 Spokesman-Review.
The working group is now headed on a lunch break, and will discuss Option 3 - expanding Medicaid - when it reconvenes at 1:15.
Discussing the first option before the Medicaid expansion working group today - no expansion of Medicaid, and no change to the current medical indigency program - state Health & Welfare Director Dick Armstrong noted, “Clearly no expansion … does not mean no work. There's a significant amount of effort that has to take place.” The current indigency program is facing fast-rising costs, he noted, with a significant offsetter of costs, the pre-existing conditions insurance program, or PCIP, expiring in 2014. Current estimates show the indigency program, now at roughly $60 million a year between state and county taxpayer funds, would rise to $92.2 million by 2020.
Armstrong said those estimates are conservative, particularly because Idaho's household income has fallen for the last three years, even as inflation has continued. “So households today simply are not able to support themselves as they have in the past.”
Sen. Dan Schmidt, D-Moscow, a physician, asked if those figures include administrative costs, and the answer was no. “These are the direct benefits paid, and not any of the administrative costs,” said Dan Chadwick, head of the Idaho Association of Counties. Armstrong said, “That's a great question. Right now, there are approximately 100 county employees engaged in this process of indigency, and that's a cost we have not thought about until just recently, and needs to be folded into some of these other scenarios.” Administrative costs include everything from processing applications to placing liens on applicants' property and collecting on those liens, when possible, to offset benefits paid out. Hospitals, too, are facing significant administrative costs for participating in the program, said Steve Millard of the Idaho Hospital Association.
Chadwick said, “Fifty-three hearings are being held today on indigent claims in our neighboring county. That includes hospital staff, county staff, attorneys, county commissioners, sitting there listening to all these claims. That's a whole lot of time and effort putting in for just one day. It's a big deal. It's a large cost.”
Armstrong noted, “Sixty percent of the cases that come before the counties are not accepted.” Millard said, “The costs don't go away, just because the state doesn't pay for them, or the indigent program doesn't pay for them.” Unreimbursed costs drive up premiums and costs for everyone, he said.
Three options are up for examination at the governor's Medicaid expansion working group's all-day meeting today: Don't expand Medicaid and keep Idaho's current medical indigency/Catastrophic Health Care Fund program as-is; Don't expand Medicaid and redesign the existing indigency/CAT program; and the third option: Expand Medicaid. The population currently served by the state-county indigency program would virtually all be covered by a Medicaid expansion, which would be largely federally funded; the current CAT program is funded entirely with local property taxpayer and state general tax funds, to the tune of roughly $60 million a year.
Though each of the three options will be explored today, the panel won't pick one; that'll come later. First, today, the group is hearing a presentation on the Leavitt Partners report on the potentially eligible population. Still in the works is a report from Milliman, another consulting group, on the costs of each of the options. The working group will meet again Oct. 23 to get the numbers from the Milliman report.
State Health & Welfare Director Dick Armstrong asked the working group members to keep in mind the advantages and disadvantages of all three options today. Pros and cons of each option will be recorded and put into a spreadsheet for review. When those considerations plus the numbers from the Milliman report are before the working group, Armstrong said, “We will then be moving to recommendations.”
Gov. Butch Otter's Medicaid expansion working group meets today from 9 to 3 p.m. at the state capitol, to hear a presentation on a newly completed study and discuss Idaho's options on a possible Medicaid expansion. You can listen live here, and see the agenda here.
Every Tuesday morning at 9, they file in, some crying, some defiant - all with big medical bills they can't pay, pleading with Kootenai County commissioners for help. “It's at times frustrating, and at times gut-wrenching,” said Commissioner Dan Green, “especially when I have people that really need the help and then they don't qualify for the program, and then I see people that we are forced to help that think it's some sort of entitlement.” The scene is repeated in each of Idaho's 44 counties, which state law makes the last resort for uninsured patients who can't pay their medical bills.
Idaho's unique system for paying the catastrophic medical bills of indigent patients - which relies solely on local property taxes and the state's general fund - may make it the state that would benefit the most from the expansion of Medicaid under the federal Affordable Care Act, which would expand the federal-state medical insurance program for the poor to cover the same population that now is thrown on the mercy of county commissioners - and do it almost entirely with federal funds.
If Idaho were to replace its current system with a Medicaid expansion, the state and its county property taxpayers could save hundreds of millions of dollars over the next six years, according to a Spokesman-Review analysis of current and projected costs. But some prominent Idaho politicians already have come out against the move, saying they want no part of “Obamacare.” You can read my full story here from Sunday's Spokesman-Review.
Three guardians for developmentally disabled Idaho residents have dropped their lawsuit against the state over Medicaid changes, reports AP reporter Rebecca Boone; click below for her full report. The attorney for the group said the shift to a single provider of residential habilitation services for such patients statewide will result in more work for law enforcement and emergency rooms.
A group of severely disabled Idahoans is suing the state after the Idaho Department of Health & Welfare cut their Medicaid benefits by as much as 40 percent, then refused to tell them why, saying its formula for the benefits is a “trade secret,” and therefore exempt from release under the Idaho Public Records Law, the AP reports; the secrecy makes it nearly impossible for the patients to appeal the decisions. Click below for a full report from AP reporter Rebecca Boone.
Idaho is docking its payment to a Medicaid claim processing company, Molina Medicaid Systems, by $3 million because of the major problems the company had implementing its new system last year, the Associated Press reports; meanwhile, the state is still trying to recover nearly $10 million in double payments that were made to Medicaid-covered health care providers amid the chaos. Nevertheless, the state says Molina is improving and has made progress toward fixing the problems. Click below for a full report from AP reporter Rebecca Boone.