Archive for March, 2016


Beware Medicaid Block Grants, Analysis Suggests

When the federal government turns housing, health, and social services programs into block grants, funding for such programs erodes over time, according to a new analysis by the Center on Budget and Policy Priorities.

The study found that

Policymakers advancing these proposals often accompany them… with assurances that the new block grant would get the same overall amount of funding as currently goes to the individual programs that it would replace.  This new analysis of several decades of budget data strongly suggests, however, that even if a new block grant’s funding in its initial year matched the prior funding for the programs merged into the block grant, the initial level likely wouldn’t be sustained.  History shows that when social programs are merged into (or created as) broad block grants, funding typically contracts — often sharply — in subsequent years and decades, with the reductions growing over time.

Of 13 such transitions from appropriation to block grant status in recent years, 11 of the programs shrunk in inflation-adjusted terms, some of them significantly so, with a median decline for the 13 of 26 percent to date.

The analysis also found that

The marked deterioration in block-grant funding over time controverts the

Medicare to Test “You Get What You Pay For” Initiative in Nursing Homes

Medicare is launching a demonstration program in which it pays skilled nursing facilities more money to provide more services to see if providing that additional care reduces hospital admissions among nursing home residents.

In the “Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents” pilot program, Medicare will work with six health systems that serve dually eligible (Medicare and Medicaid) nursing home residents to test whether providing more care will reduce hospital admissions. The program will focus on six conditions that together account for approximately 80 percent of what are considered avoidable hospital admissions among nursing home residents: pneumonia, congestive heart failure, dehydration, skin ulcers, urinary tract infections, and asthma.

The problem the program seeks to address, according to CMS, is that

…research on Medicare-Medicaid enrollees in nursing facilities found that approximately 45% of hospital admissions among individuals receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided, accounting for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005.

To learn more about Medicare’s Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents program, see this CMS overview of the program.…

Tracking Medicare Disparities

Tracking disparities in medical conditions and outcomes will be easier with the help of a new “Mapping Medicare Disparities Tool” created by the Centers for Medicare & Medicaid Services’ Office of Minority Health.

The new disparities tool identifies disparities in utilization, outcomes, and spending by race, ethnicity, and geographic location. It tracks 18 chronic medical conditions along with ER use, readmissions, and other measures, providing data according to state, county, gender, age, dual eligibility status, race, and ethnicity.

To learn more about the Mapping Medicare Disparities Tool, go here to see a CMS news release describing the tool and go here to see and experiment with the tool itself.…

States Seeking Job Search as Condition for Medicaid Expansion

A number of states that have resisted expanding their Medicaid programs are now attempting to do so by linking expansion to requiring new participants to enroll in job search and training programs.

The Centers for Medicare & Medicaid Services, which must approve Medicaid expansion plans, has rejected proposals from Indiana, Montana, and New Hampshire that had such requirements and is currently reviewing a similar proposal from Arkansas. Arkansas already has expanded its Medicaid program but is threatening to drop its expansion unless CMS permits it to modify its current approach.

CMS does not prevent states from incorporating job search and employment training into their Medicaid programs but so far has not permitted them to make participation in such efforts mandatory.

For a closer look at this issue, including what states are proposing and how CMS is responding, see this CQ Roll Call report presented by the Commonwealth Fund.…

Traditional vs. Section 1115 Medicaid Expansion

While most states that took advantage of the Affordable Care Act to expand their Medicaid programs did so simply by expanding the population eligible to participate in the program, some expanded through the use of what are known as section 1115 waivers, which are defined as “experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs.”

Most of those waivers involve the use of new delivery systems, such as greater use of managed care, and six states implemented their Affordable Care Act Medicaid expansion through section 1115 waivers.

Why the alternative approach? While for some states it simply is a matter of trying new delivery systems, a recent post on the Health Affairs Blog suggests another motive:

These waivers are not clearly being sought because different states have different populations or demographics in need of different benefit packages. Rather, they are being sought for other reasons, because of the political concerns at work in many of these states, rhetoric around values including personal responsibility, and the desire to minimize additional spending on Medicaid populations.

The Health Affairs Blog post takes a closer look at what section 1115 waivers involve, why states use them instead of …