While most states expanding their Medicaid programs in response to the opportunity presented by the Affordable Care Act simply expand their existing Medicaid programs, six states have taken a different approach, obtaining Medicaid demonstration waivers so they could tailor their programs in different ways.

In addition, a number of states currently considering Medicaid expansion appear to be considering pursuing demonstration waivers, often referred to as section 1115 waivers, as well.

One area in which these demonstration programs differ from traditional Medicaid expansion is in the degree of financial responsibility new Medicaid beneficiaries assume. Typically, new Medicaid participants must pay more for the benefits they receive under their states’ Medicaid expansion through greater cost-sharing responsibilities.

In the new issue brief “How Will Section 1115 Medicaid Expansion Demonstrations Inform Federal Policy?” the Commonwealth Fund looks at the alternative approaches different states have taken and considers the implications of those different approaches for both beneficiaries and the states. Find that issue brief here.…

Extended hospital stays and not frequent visits to hospital emergency rooms constitute the greatest cost in caring for homeless Medicaid patients, a new analysis has found.

A review of 1100 homeless people served by the Boston Health Care for the Homeless Program found that while repeated visits to the ER do constitute a problem for caregivers, the cost of those visits is dwarfed by costs associated with the same patients spending long periods of time in the hospital.

According to the review, 30 percent of the group’s Medicaid costs were for hospital stays while only four percent were for ER services. The homeless frequently spend more time in the hospital because they are in such poor overall health.

In recent years, providers have focused much of their attention on frequent ER visitors – so-called “frequent flyers” or “super-utilizers” – but the experience of the Boston program suggests that conditions that lead to long periods of hospitalization among the homeless may need more attention as well.

For a closer look at the Boston program and what its leaders learned, see this Boston Herald article.…

Some doctors think so.

In a letter to the Centers for Medicare & Medicaid Services, the American Academy of Pediatrics, American College of Physicians, American Medical Association, and American Osteopathic Association suggest that two states have drastically cut their Medicaid rates, and others are contemplating doing so as well, in anticipation of implementation of a new Medicaid policy that requires states to track the impact of future rate reductions on access to care.

That requirement is part of a new rule addressing access to care that CMS issued last year.

By lowering rates now, the groups charge, states will establish a low baseline for future comparisons when analyzing the impact of rate reductions.

One of the states that lowered payments is North Carolina. When it cut physician payments 23 percent last year, a survey of pediatricians found that 25 percent of them began limiting the number of new Medicaid patients they serve.

To learn more about why the groups are so alarmed, go here to read their letter to CMS.…

They may not have shareholders, but non-profit hospitals often borrow money by issuing municipal bonds. Now, many are acting more like for-profit providers as they pursue investors for their bond offerings.

With the continuing consolidation in the hospital industry, those offerings are bigger than ever. Before they invest, potential bond buyers are seeking more financial information than ever from hospitals. In response to their demands, a growing number of hospital corporations are holding investor meetings and “shareholder” calls to brief potential investors on the state of their finances.

The Wall Street Journal recently looked at non-profit hospital corporations’ courtship of investors. See its report here.…

Offered an incentive to gain an additional tool in care management through a waiver of the three-day hospital stay for Medicare patients to qualify for post-discharge skilled nursing care, accountable care organizations appear to be saying “Thanks but no thanks.”

Effective January of next year, ACOs that participate in Medicare’s share savings program will be permitted, under certain circumstances, to apply for a waiver of the three-day stay requirement imposed on their hospitalized Medicare members who need post-discharge skilled nursing care. The rationale for the option, offered as part of Track 3 of Medicare’s shared savings program, is that this flexibility would enhance ACOs’ ability to manage their members’ care and offer a lower-cost option to continued hospitalization in some cases.

But months after the new approach was announced, few ACOs have applied to qualify to waive the three-day stay requirement on their members’ behalf.

Learn more about what Medicare’s shared savings program offers ACOs and why they may not be interested in this article in McKnight’s Long-Term Care News.…