Archive for July, 2015


The Challenges Medicaid Faces

As it celebrates is fiftieth birthday, Medicaid now covers 70 million Americans at a cost of $500 billion a year. As the program continues to grow amid the expansion facilitated by the Affordable Care Act, Kaiser Health News has identified the five biggest challenges the program faces today:

  • controlling costs
  • getting all states to expand income eligibility
  • providing better oversight of managed care
  • ensuring access to doctors and dentists
  • meeting the growing demand for long-term care

For a closer look at these challenges and what they entail, see this Kaiser Health News article.…

CMS to Expedite Review of Some Medicaid Waiver Applications

The federal government will streamline the renewal process for state Medicaid waivers for demonstration programs that are established and achieving their goals and for which major changes are not being proposed.

According to an informational bulletin issued by the Centers for Medicare & Medicaid Services (CMS),

This process is designed to facilitate faster review of and federal decisions regarding state requests to extend established 1115 demonstrations, reducing administrative burden on states and the federal government.

This approach streamlines the extension process for those states with established demonstrations that are working successfully and who are not proposing to make major or complex policy changes to the demonstration. Timeframes for these reviews will be comparable to those CMS uses to make decisions on Medicaid section 1915 waivers or state plan amendments. This new approach provides for a more efficient federal review process, as well as a more effective assessment of demonstrations’ progress in promoting high quality, accessible, and affordable health care coverage to beneficiaries.

The length of time such reviews are taking was the subject of two recent congressional hearings.

The informational bulletin outlines how waiver application renewals qualify for this new process, how the fast-track process will work, and how long …

HHS Looks at LTSS Needs

A new issue brief from the U.S. Department of Health and Human Services (HHS) projects Americans’ future need for long-term services and supports (LTSS).

According to the brief, more than half of all Americans will need such services at least at one point in their lives and many will incur significant costs to pay for them because most such services are not covered by Medicare and private insurance and Medicaid covers them only for individuals who meet income requirements.

In the issue brief “Long-Term Services and Supports for Older Americans: Risks and Financing,” the HHS Office of the Assistant Secretary for Planning and Evaluation (APSE) projects how many people will need such services and how much they will spend meeting those needs. Find the report here.…

Medical Homes Pilot Doesn’t Produce Desired Results

A program launched by the Center for Medicare and Medicaid Innovation to test the “medical homes” concept at federally qualified health centers (FQHC) has not produced savings, an evaluation of the program has found.

The $57 million program sought to identify and serve high-risk Medicare beneficiaries and to improve their health and the quality of care they receive while saving money and producing better outcomes. The evaluation, however, found that those served by the program visited emergency rooms and were admitted to hospitals more often than similar patients who did not participate in the program.

The program’s failure is not viewed as an indictment of the medical homes concept. One theory is that the program identified people with pent-up medical needs living in areas with limited access to care. While there was some discussion about extending the program to see if its results might change after that pent-up demand was met, the Affordable Care Act, which created the innovation center, calls for terminating programs that are not saving money or improving care.

For a closer look at how the program worked and where it came up short, see this Kaiser Health News report or read this RAND Corporation evaluation of …

439,000 Added to PA Medicaid Rolls

150,000 Pennsylvanians have enrolled in Medicaid since the Wolf administration officially launched its HealthChoices expansion on April 27.

Added to the 289,000 who enrolled during the Corbett administration’s Healthy Pennsylvania program, that means about 439,000 Pennsylvanians have obtained Medicaid coverage since the state expanded its Medicaid program as authorized by the 2010 federal health care reform law.

To learn more about the latest Medicaid enrollments, their financial impact on the state, and how the HealthChoices expansion works, see this Wolf administration news release.…