Archive for June, 2012


Court Affirms Reform Law, Changes Medicaid Provision

The Supreme Court has upheld the constitutionality of the 2009 Affordable Care Act – including the much-disputed mandate that everyone obtain health insurance.

The court’s only disagreement with the reform law was with its provision requiring states to expand Medicaid eligibility as a future condition of obtaining federal Medicaid matching funds.  The court ruled that expanding Medicaid eligibility should be optional and that states that choose not to expand their Medicaid programs would still receive the federal matching funds to which they have always been entitled.

Under the Affordable Care Act, the federal government will provide enhanced matching funds for states that expand Medicaid eligibility:  100 percent federal funding from 2014 through 2016, 95 percent for 2017, 94 percent for 2018, 93 percent in 2019, and 90 percent thereafter.  Consequently, it will be interesting to see what the individual states decide to do in light of the enhanced federal matching funds available for those that choose to expand Medicaid eligibility.…

New Rules to Limit Hospital Collection Practices

The federal government has released new proposed rules governing how hospitals may go about collecting payments from patients who owe them money.

Under the new rules, hospitals would need to do more to explain to patients their policies governing charity care and reduced-cost care.  In addition, certain aggressive collection practices – like attempting to collect from patients waiting for care in emergency rooms – would be banned.

The proposed rules include provisions governing how hospitals may charge uninsured patients.

Learn more about the new rules and how they affect hospitals in this Treasury Department news release.…

MedPAC Reports to Congress

The Medicare Payment Advisory Commission (MedPAC), the federal agency that advises Congress on Medicare payment policy matters, has issued a new report to Congress.

This new report focuses on Medicare beneficiaries and focuses on three areas:  Medicare’s benefit design, coordination of care for fee-for-service participants, and coordination of care for dual-eligible (Medicare and Medicaid) beneficiaries.

MedPAC’s report, a news release accompanying the report, and a fact sheet describing the report and its findings and recommendations can be found here, on MedPAC’s web site.…

Supreme Court Decision Has Huge Medicaid Implications

When the Supreme Court rules on the challenge to the Affordable Care Act, its decision will have enormous implications for states, low-income and uninsured people, and health care providers.

Among the many features of the health care reform act on which the Supreme Court will rule is the single biggest expansion of eligibility since Medicaid was introduced in the mid-1960s.

As they await the court’s decision, many states already are laying the groundwork for the addition of between 15 million and 20 million people to the nation’s Medicaid rolls.

Hospitals, too, have a considerable stake in the court’s decision.  If the court finds the law constitutional or does not overturn its Medicaid component, hospitals may see a major new influx of Medicaid patients.  In some cases, those patients may be people who are new to the health care system.  In others, hospitals may find themselves being paid for care they provide to patients who in the past came to their doors without insurance.

The New York Times has taken a closer look at the stakes in the court’s upcoming decision.  Read that Times article here.…

States Ramping Up Medicaid Efforts

With a partial rebound of their tax revenues now in evidence, many states are taking advantage of the breathing room they have not had in recent years to pursue changes in how they serve their Medicaid populations and pay for that care.

Some states are still in cost-containment mode, cutting capitation rates and payments to hospitals and other providers, limiting ER visits and inpatient stays, introducing or expanding co-pays and Medicaid premiums, and attempting to tighten eligibility criteria.

Other states, meanwhile, are seeking new ways, often with the help of federal grant money, to better integrate physical and behavioral health services, serve the chronically ill, meet the needs  of elderly recipients, and build a stronger organizational infrastructure in anticipation of the expansion of Medicaid eligibility coming in 2014 under the Affordable Care Act.

Learn more about what the states are doing in this Stateline report.…