Getting into Gear for 2014: Shifting New Medicaid Eligibility and Enrollment Policies into Drive

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The ability to electronically transfer individual accounts between state Medicaid/CHIP agencies and Marketplaces to coordinate enrollment is in various stages of development. Among the 17 states with State-based Marketplaces (SBMs), all but two (2) have an integrated or linked technology system that determines eligibility for all insurance affordability options and facilitates the next steps for enrollment. However, in states using the Federally-Facilitated Marketplace (FFM), electronic transfers of individual accounts between the FFM and Medicaid/CHIP agencies are essential for coordinating enrollment. Due to ongoing technological challenges with the FFM, these transfers have been delayed and alternative strategies have been put into place. For example, until the FFM can begin transferring electronic accounts to state Medicaid and CHIP agencies, it is sending batches of basic data on individuals the FFM has determined or assessed as potentially eligible for Medicaid/CHIP. Similarly, if a state Medicaid/CHIP agency is unable to transfer an account to the FFM, it can direct individuals to apply directly through the FFM. Moving forward, implementing electronic account transfers will be key to minimizing burdens on consumers and ensuring they are successfully enrolled in the coverage for which they are eligible regardless of where they apply, providing “no wrong door” access to coverage envisioned by the ACA.
Source: kff.org

Video: Medicaid and Medicare: Too much income to qualify?

Policy Options to Sustain Medicare for the Future

We also conducted an extensive review of existing literature to identify potential options to sustain Medicare for the future. The report includes many options described or endorsed by the National Commission on Fiscal Responsibility and Reform (the Simpson-Bowles commission), the Bipartisan Policy Center Task Force on Deficit Reduction, the Medicare Payment Advisory Commission (MedPAC), the Congressional Budget Office (CBO), and many others. We also worked with a team of seasoned policy experts who fleshed out these concepts and ideas for inclusion in this report to present a thorough explanation of the context, impacts, and, when available, potential savings. In particular, we would like to acknowledge Robert Berenson for making significant contributions to several parts of this report, and Leslie Aronovitz, Randall Brown, Judy Feder, Jessie Gruman, Jack Hoadley, Andy Schneider, and Shoshanna Sofaer for their contributions to specific topic areas. We also would like to acknowledge Chad Boult, Susan Bartlett Foote, Richard Frank, Joanne Lynn, Robert Mechanic, Diane Meier, Peter Neumann, Joseph Ouslander, Earl Steinberg, George Taler, and Sean Tunis for their participation in small-group discussions related to specific topics covered in this report, and Actuarial Research Corporation (ARC) for providing cost estimates and distributional analysis of several options. Technical support in the preparation of this report was provided by Health Policy Alternatives, Inc. We are indebted to Richard Sorian for bringing to this project his keen policy insight and skillful editorial assistance.
Source: kff.org

Krieg DeVault Health Care: OMPP changes to Indiana Medicaid Eligibility

Other changes effective January 1, 2014 are that: (1) Hoosier Healthwise Package B (Pregnancy Coverage) will be used only for the Hospital Presumptive Eligibility (HPE) program; and (2) individuals eligible for aid category MA 14: Former Foster Children will no longer be enrolled in Care Select, but rather will be eligible for Hoosier Healthwise Package A.
Source: kdhealthlaw.com

How to Control Entitlements, Especially Medicare

Despite this uncertainty about what actual spending will be, I have a couple of suggestions to slowdown the growth of Medicare spending. The first one is the easiest in principle to implement; namely to raise the age of eligibility for Medicare (and for social security as well) to age 70. Social security was introduced in the 1930s when life expectancy at age 65 was more than seven years below what it is now. Moreover, the quality of life after age 65 was also much lower at that time since men and women were generally already “old” at age 65. Although Medicare was not introduced until the late 1960s, both the quality and quantity of life have also increased rapidly since then- for example, life expectancy at age 65 has risen by five years.
Source: becker-posner-blog.com

Daily Kos: Medicaid, CHIP enrollments surge under Obamacare

The undeniable success story so far of Obamacare is Medicaid expansion. According to a new report from the Centers for Medicare and Medicaid Services, more than 1.46 million people were approved for Medicaid or the Children’s Health Insurance Program in October, alone. Enrollment increases are happening in the 25 states that have accepted the Medicaid expansion plan under Obamacare, but in the other states, as well. In states that are not expanding Medicaid, applications to Medicaid and CHIP agencies increased 4.1 percent in October over the previous few months, and the total number of individuals determined to be eligible for Medicaid or CHIP was 697,019. In states that are expanding Medicaid, applications jumped 15.5 percent, and 757,991 new eligibility determinations were made. The overall total across all states was an 8.6 percent increase in applications and 1,460,367 new eligibility determinations. South Carolina, a state that has adamantly refused to expand Medicaid, enrollments are expected to jump 16 percent in the next year and a half, and Utah and Idaho are expected to see similar increases, even though they have refused the expansion. That’s just by virtue of people knowing they need to sign up for health insurance, and finding out that they meet the eligibility requirements.
Source: dailykos.com

U.S. Reps. Davis, Roskam Discuss The Future Of Medicare (VIDEO)

Attempting to address what challenges the Medicare program faces and potential solutions for those challenges, Matheis was joined for the panel discussion by U.S. Reps. Peter Roskam (R, IL-6) and Danny K. Davis (D, IL-7), and Richard Baehr, chief political correspondent of the daily conservative online magazine, American Thinker. The Union League Club of Chicago, at which the panel was held, and WLS 890 AM, a broadcast radio station in Chicago, sponsored the event.
Source: progressillinois.com

Maine Writer: An Obamacare Overview

Since 2010, the ACA has lifted lifetime limits on coverage; children up to 19 years old are covered without exclusions for pre-existing conditions; children can receive coverage under their parents’ private insurance plans up to 26 years of age Enrollment in the health insurance exchanges for individuals required to receive coverage in 2014, began October 1, 2013. The envollment period extends until March 31, 2014. Coverage starts as soon as January 1, 2014. Medicare beneficiaries are not impacted by the Affordable Care Act. Mr. Cioppa explained where the nation and Maine are at regarding the costs of providing health care. Cost of providing health care in the USA is nearly 20 percent of the Gross Domestic Product (GDP), but this isn’t an indicator of quality. For example, Japan has the world’s longest life expectancy but their expenditures on health care are lower than the USA. In 2009, Maine was number 5 in the nation reporting per capita health care costs. Less than half of Maine’s population receives health coverage through private insurance. Other coverage is provided by Medicare, Medicaid and the military. Additionally, 133,000 Maine people are uninsured. The breadth of the ACA affects all aspects of private health insurance.Everyone must be covered in 2014 or be subject to a penalty fee. Employers who provide coverage under the ACA law fall into two categories. Those with 50 or more employees are large groups; those with 49 and less are small groups. Beginning in 2015, employers with 50 or more full time equivalent (FTE’s) employees must make coverage available to their full-time employees and their dependents. Coverage must be affordable, meaning the employees’ share of premiums cannot exceed 9.5 percent of their income (based on the cost of the employee’s coverage only and not the cost of family coverage). A full time employee is defined as one who works 30 hours or more a week averaged over one month. Failing to offer the minimum coverage involves a penalty at $2000 per year times the number of full-time employees, minus 30. Employers determined to offer unaffordable coverage also invokes a penalty. Nevertheless, penalties are less than the cost of providing coverage. A Minimum Medical Loss Ration (MLR) requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement. It also requires them to issue rebates to enrollees if this percentage doesn’t meet minimum standards. MLR requires insurance companies to spend at least 80% of premium dollars on medical care for those who purchase individual plans; 80% for those enrolled in small group plans and 85 % for those in large group plans. Preventive care is 100 percent covered. Carriers for Maine’s Health Insurance Individual Marketplace are Anthem and Maine Community Health Option; small group market carriers are Anthem and Maine Community Health Options (MCHO); Large Group Market carriers are Anthem, Connecticut General, Harvard Group, Nationwide, Aetna Group and United Healthcare. Individuals are mandated to obtain minimum coverage beginning January 1, 2014. Access to coverage is offered via a “no wrong door” or single entry concept. Individuals are eligible for Modified Adjusted Gross Income (MAGI) subsidy based on a calculation of their income developed by the Federal government. The calculation also determines an individual’s eligibility to participate in the Medicaid and Children’s Health Insurance (CHIP) programs. This determination qualifies an individual for Medicaid, CHIP, premium tax credits or cost-sharing reductions. Dependents are indelible for subsidies if they’re covered by an employer plan. Tax status determines subsidies for those who fall between zero and 400 percent of the Federal poverty level. Subsidies are zero for those who fall over 400 percent of Federal Poverty level. If a beneficiary underestimates their income, a rebate is issued; but if income exceeds 400 percent of poverty level, the entire subsidy must be repaid. The only place where subsidies are available are through the insurance exchanges. Insurance rates are contingent on recruiting young and health people into the plans. Another provision to keep premiums affordable is the implementation of a Cadillac Tax, imposed when health insurance benefits exceed a certain threshold. This provision was put in place as an incentive for employers to reduce overutilization of health care. Insurers will offer “metal tier plans” at these actuarial values (AV) a. Bronze 60 % b. Silver 70 % c. Gold 80 % d. Platinum 90 % e. Catastrophic plans are available if premiums exceed 8 percent of a family’s income. Out of picket maximum expenses for co-pays and deductibles will not exceed $6,300 per year or double that amount for a family. Individual and small group health plans will cover essential health benefits to include at least these 10 categories: (a) ambulatory care (b)emergency services (c) hospitalization (d) maternity and newborn care (e) mental health and substance use disorder services including behavioral health treatment (f) prescription drugs (g) rehabilitative and habilitative services and devices (h) laboratory services (i) preventative and wellness services and chronic disease management and (j) pediatric services including oral and visual care.
Source: blogspot.com

Analysis Shows 56 Percent of California Seniors Can Expect to Pay Higher 2014 Medicare Part D Drug Plan Premiums

Posted by:  :  Category: Medicare

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Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large selection of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, healthcare professionals, advocates, advisers, caregivers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, California).
Source: lensaunders.com

Video: Young Again – Blue Shield of CA Medicare Advantage Plan TV Spot

CA Assembly GOP Puts Up Fake California Health Exchange Site

What we have here are elected officials intentionally trying to make California’s health exchange fail, and using taxpayer dollars to misinform taxpayers, using the standard fear and loathing tactics as their linchpin. While I expect nothing less from Republicans in general, it does gall me that they’re using “official mailings” to misdirect constituents and Assembly resources to register and build the website.
Source: crooksandliars.com

Obamacare Raiding Medicare

Obamacare took $700 billion from Medicare and $300 billion from Medicare Advantage alone for its own funding, according to the subcommittee. The cuts to Medicare Advantage beneficiaries will “begin to be fully realized in the next year,” according to the subcommittee.
Source: capoliticalreview.com

US Shutdown a Smokescreen for Assault on Social Security, Medicare

The partial or total shutdown of most departments other than the uniformed military and police/intelligence agencies such as the CIA, the FBI and Homeland Security is hitting broad layers of the population. Besides the closure of national parks and monuments, some 8.9 million low-income mothers and children are being denied food aid due to the shutdown of the WIC program; pension and veterans’ benefit checks are being delayed; preschool Head Start programs are closing; sick people, including cancer patients, are being turned away from National Institutes of Health clinical trials; and foster care payments, nutrition aid and financial assistance for hundreds of thousands of Native Americans are being halted.
Source: globalresearch.ca

California Chiropractor Pleads Guilty To Medicare Fraud

“Health care fraud in and of itself is a serious offense. Not content to stop there, however, Mr. Pavehzadeh sought to conceal that crime by committing yet another — filing a false police report,” said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the Office of Inspector General for the Department of Health of Human Services. “Those intent on breaking these laws should know that through the work of our special agents and auditors, OIG remains committed to seeking justice.”
Source: cacriminaldefenseblog.com

More on the 2010 Medicare Trustees Report

Posted by:  :  Category: Medicare

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The immediate physician fee reductions required under current law are clearly unworkable and are almost certain to be overridden by Congress. The productivity adjustments will affect other Medicare price levels much more gradually, but there is a strong likelihood that, without very substantial and transformational changes in health care practices, payment rates would become inadequate in the long range. As a result, the projections shown in the 2010 Trustees Report for current law should not be interpreted as our best expectation of actual Medicare financial operations in the future but rather as illustrations of the very favorable impact of permanently slower growth in health care costs, if such slower growth can be achieved. The illustrative alternative projections presented here help to quantify and underscore the likely understatement of the current-law projections shown in the 2010 Trustees Report. While the significant improvements in Medicare‟s financial outlook under the Affordable Care Act are welcome and encouraging, expectations must be tempered by awareness of the difficult challenges that lie ahead in improving the quality of care and making health care far more cost efficient. The sizable differences in projected Medicare cost levels between current law and the illustrative alternative scenario highlight the critical importance of finding ways to bring Medicare costs—and health care costs in the U.S. generally—more in line with society‟s ability to afford them.
Source: theglitteringeye.com

Video: Health Reform & Medicare (05/26/2010 Web chat)

St. Vincent’s HealthCare Battles Audit of $3.3M in Medicare Overpayments

Attorneys with Dentons, a global law firm representing St. Vincent’s HealthCare that also represented JFK Medical Center, said St. Vincent’s HealthCare should not have to repay any claims paid in 2009 because they fall outside the statute of limitations. Attorneys made the same case for JFK Medical Center. St. Vincent’s HealthCare also did not agree with the OIG’s statistical sampling, saying it could lead to repaying Medicare twice if recovery auditors, or RACs, go after the same claims at a different time.
Source: beckershospitalreview.com

Policy Options to Sustain Medicare for the Future

We also conducted an extensive review of existing literature to identify potential options to sustain Medicare for the future. The report includes many options described or endorsed by the National Commission on Fiscal Responsibility and Reform (the Simpson-Bowles commission), the Bipartisan Policy Center Task Force on Deficit Reduction, the Medicare Payment Advisory Commission (MedPAC), the Congressional Budget Office (CBO), and many others. We also worked with a team of seasoned policy experts who fleshed out these concepts and ideas for inclusion in this report to present a thorough explanation of the context, impacts, and, when available, potential savings. In particular, we would like to acknowledge Robert Berenson for making significant contributions to several parts of this report, and Leslie Aronovitz, Randall Brown, Judy Feder, Jessie Gruman, Jack Hoadley, Andy Schneider, and Shoshanna Sofaer for their contributions to specific topic areas. We also would like to acknowledge Chad Boult, Susan Bartlett Foote, Richard Frank, Joanne Lynn, Robert Mechanic, Diane Meier, Peter Neumann, Joseph Ouslander, Earl Steinberg, George Taler, and Sean Tunis for their participation in small-group discussions related to specific topics covered in this report, and Actuarial Research Corporation (ARC) for providing cost estimates and distributional analysis of several options. Technical support in the preparation of this report was provided by Health Policy Alternatives, Inc. We are indebted to Richard Sorian for bringing to this project his keen policy insight and skillful editorial assistance.
Source: kff.org

More Minn. doctors refusing Medicare patients over low reimbursements

A few years ago, Minnesota health officials created an initiative called “Health Care Homes” that provides financial incentives for doctors and clinics that adopt new practices to reduce costs. Since August, the initiative has signed up 39 health systems throughout the state. Another 100 are working toward certification.
Source: mprnews.org

Medicare and Medicaid Extenders Act of 2010 (2010; 111th Congress H.R. 4994)

Amends the Patient Protection and Affordable Care Act (PPACA) to apply to elections made on and after enactment of PPACA the 12-month special Medicare part B (Supplementary Medical Insurance) enrollment period (under title XVIII [Medicare] of the Social Security Act [SSA]) for military retirees, their spouses (including widows/widowers), and dependent children, who are otherwise eligible for TRICARE (the health care plan under the Department of Defense [DOD]) and entitled to Medicare part A (Hospital Insurance) based on disability or end stage renal disease (ESRD), but who have declined Medicare part B (Supplementary Medical Insurance).
Source: govtrack.us

Republicans Will Bring Back Medicare Attacks Against Democrats

This was entirely predictable. It was the GOPs main selling point in 2010 and I’m sure they’ll use it to great advantage this time too. Elderly people always vote and in off-year elections it makes a difference. The question will be if the 12 Democrats can come up with something that brings their people out to balance it out. So far, I haven’t seen what that’s going to be. The off year election in a president’s second term is rarely a good one for the president’s party, unfortunately.
Source: crooksandliars.com

Medicare Advantage 2014 Spotlight: Plan Availability and Premiums

While many organizations offer Medicare Advantage plans, a few – particularly Humana, United Healthcare, and the Blue Cross and Blue Shield (BCBS) affiliates – have particularly large geographic spread and these organizations historically account for a disproportionate share of enrollment. In 2014, 44 percent of available plans are being offered by one of these three firms or affiliates (Table A4).  Plans offered by these firms are available to most beneficiaries.  Nationwide, 83 percent of Medicare beneficiaries will have access to one or more Humana plans, 73 percent will have access to a BCBS affiliated plan (including BCBS plans offered by Wellpoint), and 68 percent will have access to a United Healthcare plan (Exhibit 5; Table A5).  The general availability of these firms’ products has not noticeably changed from 2013 to 2014.  However, the similarities in BCBS offerings from 2013 to 2014 obscure a decline in availability of BCBS branded Wellpoint plans (declining from 88 plans to 55 plans between 2013 and 2014), which is mostly offset by the growth in plans offered by other BCBS affiliates (growing from 205 plans to 233 plans between 2013 and 2014).
Source: kff.org

Medicare Advantage 2010 Data Spotlight: Plan Availability and Premiums

While the number of plans available in 2010 declined somewhat from 2009, the analysis finds that Medicare beneficiaries on average have 33 Medicare Advantage plans to choose from. For Medicare Advantage enrollees who stay in the same plan in 2010, monthly premiums will increase by 32 percent on average, with a steeper 78 percent average increase for enrollees in private fee-for-service plans who do not switch plans.
Source: kff.org

Sen. Mark Pryor ‘cut Medicare to pay for Obamacare,’ says Rep. Tom Cotton

The savings will come from reductions to Medicare Advantage, which represents a subset of Medicare plans run by private insurers. In additions, hospitals will be paid less if they don’t meet certain benchmarks for patient care. The law’s intent was to save money by making the system more efficient and without making reductions in benefits.
Source: politifact.com

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