State Medicaid Programs – New Jersey, Ohio

  • N. J. Medicaid fiasco: Thousands stranded without coverage, no fix in sight, By Kathleen O’ Brien, December 23, 2014, Star-Ledger: “The doctor was perfectly clear after examining Aurora Blackwell’s son this fall: The boy needed to get to an emergency room for his worsening digestive problems. Instead, Blackwell took the 4-year-old home and treated him herself — first with prune juice, then suppositories. Why would the devoted young mother of two ignore her pediatrician’s advice? Because the Burlington County woman knew that despite 10 months of phone calls, emails and letters, her family still lacked health insurance. ‘I feel helpless,’ she’d written two months earlier in a plea to Gov. Chris Christie. ‘How much longer do we have to wait?’ The meltdown of the federal government’s website tied to the Affordable Care Act has been well documented. But in New Jersey, something far worse was happening as the state expanded Medicaid access under Obamacare, an NJ Advance Media investigation has found…”
  • Medicaid extension again on Kasich agenda, By Catherine Candisky, December 23, 2014, Columbus Dispatch: “Nearly one year after Ohio expanded Medicaid coverage for poor adults, Gov. John Kasich again faces uncertainty as he seeks approval from the Republican-led legislature to extend new eligibility guidelines for two more years. The governor and other supporters say lives are at stake. As of October, more than 430,000 poor Ohioans had gained health coverage under the expansion paid through federal funding available through the Affordable Care Act…”

Medicaid Programs – Oregon, California

  • Oregon to use Kentucky Medicaid system, By Saerom Yoo, December 9, 2014, Statesman Journal: “The Oregon Health Authority will import Kentucky’s online Medicaid enrollment system, marking the second phase of the state’s transition in the face of last year’s Cover Oregon technology mess. OHA Medicaid Director Judy Mohr Peterson made the announcement to legislators in the Capitol on Monday, saying the Kentucky exchange system has been successful, that it has the kind of functionality Oregon needs and that the state has a similar Medicaid population to Oregon…”
  • California managed-care pilot program meets resistance, By Anna Gorman, December 6, 2014, Washington Post: “California’s initial efforts to move almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance. Many beneficiaries have received stacks of paperwork they don’t understand. Some have been mistakenly shifted to the new insurance coverage or are unaware they were enrolled. And a third of those targeted for enrollment through Nov. 1 opted out, indicating they will stick with their traditional coverage. Prompted by the Affordable Care Act, the federal government is trying to streamline services and cut costs for the 9 million Americans who are in both Medicare and Medicaid. A dozen states have received grants to launch pilot projects, and five are enrolling participants — Virginia, Ohio, Massachusetts, Illinois and California…”

Medicaid Program – Arizona

In Arizona, swings in Medicaid access show program’s impact, By Noam N. Levey, November 30 2014, Los Angeles Times: “Bad timing turned Karen Slone’s medical problem into a crisis. Slone, 53, a former administrative assistant with diabetes, followed doctors’ advice for years, getting regular checkups. Then, last year, she lost her job and her insurance, and stopped going to the doctor. When she spotted a sore on her foot, a common complication of diabetes, Slone tried Neosporin and Band-Aids. By the time she went to an emergency room weeks later, she had a raging infection. Surgeons had to remove bones in two toes. ‘It was awful,’ Slone recalled. ‘If I’d have been covered, I would have gone to the doctor sooner.’ For low-income adults like Slone, Arizona was once a trailblazer in healthcare, providing broad access to Medicaid, the government health plan for the poor…”

Health Insurance Coverage

  • For those who make too much — and too little — for health insurance, the options are limited, By Jordan Shapiro, October 9, 2014, St. Louis Post-Dispatch: “Beverly Jones, a 51-year-old St. Louisan with custody of her three grandchildren, is supposed to get her blood tested every few months to make sure the medicine she takes daily isn’t harming her kidneys. But she can only afford to make the trip to the doctor two times a year because she lacks health insurance. ‘It’s hard for me to accept that I put in so much work and so much time and now that I get sick there is no one that can help me,’ she said. ‘That doesn’t seem fair to me.’ Jones isn’t alone. She is one of nearly 300,000 Missourians who would qualify for government-funded health insurance if they lived across the Mississippi River in Illinois or in 26 other states that have decided to expand their Medicaid programs under the Affordable Care Act. But because Missouri hasn’t agreed to expand its program, Jones said she is forced to go without her blood tests and some of her prescriptions…”
  • Medicaid, often criticized, is quite popular with its customers, By Margot Sanger-Katz, October 9, 2014, New York Times: “Low-income people in three Southern states were recently asked whether they preferred Medicaid or private insurance. Guess which one they picked? A study published in the journal Health Affairs found that poor residents of Arkansas, Kentucky and Texas, when asked to compare Medicaid with private coverage, said that Medicaid offered better ‘quality of health care’ and made them better able to ‘afford the health care’ they needed. Medicaid, the federal-state program for poor and disabled Americans, is a frequent political target, often described as substandard because of its restricted list of doctors and the red tape — sometimes even worse than no insurance at all. But repeated surveys show that the program is quite popular among the people who use it…”
  • A quarter of Latinos are uninsured, By Teresa Wiltz, October 10, 2014, Stateline: “In the ‘sala de espera,’ or waiting room, at La Clinica del Pueblo, a community health center in Washington, D.C., signs in Spanish encourage patients to ‘Empower yourself!’ and sign up for insurance coverage through the Affordable Care Act. Adults slump in chairs, scribbling on application forms, texting friends, waiting. In a tiny office a few feet away, William Joachin, the center’s patient access manager, faces down the frustrations of trying to navigate the federal health care program for the thousands of mostly Central American immigrants who flood the clinic each year. He’s not alone. A year after open enrollment for the ACA began, one in four Latinos living in the U.S. does not have health insurance, according to new census data, more than any other ethnic population in the country—and most states have few backups in place to help those in the coverage gap…”

Hospitals and Medicaid Expansion

  • Hospitals see major drop in charity care, September 24, 2014, The Tennessean: “The number of uninsured patients admitted to hospitals has dropped markedly this year, reducing charity care and bad debt cases, particularly in states that have expanded Medicaid coverage under the new federal health care law, a government report released Wednesday found. The report from the Department of Health and Human Services said hospitals in states that have taken advantage of new Medicaid eligibility levels have seen uninsured admissions fall by about 30 percent. The report estimated that the cost of uncompensated hospital care will be $5.7 billion lower in 2014…”
  • Affordable Care Act reduces costs for hospitals, report says, By Robert Pear, September 24, 2014, New York Times: “The Obama administration increased the pressure on states to expand Medicaid on Wednesday, citing new evidence that hospitals reap financial benefits and gain more paying customers when states broaden eligibility. In states that have expanded Medicaid, the White House said, hospitals are seeing substantial reductions in ‘uncompensated care’ as more patients have Medicaid coverage and fewer are uninsured…”

Medicaid Expansion – Virginia

With Medicaid expansion blocked, McAuliffe unveils modest plan to insure more Virginians, By Laura Vozzella and Jenna Portnoy, September 8, 2014, Washington Post: “Gov. Terry McAuliffe (D), who vowed in June to defy the Republican-controlled legislature and expand healthcare to 400,000 uninsured Virginians, unveiled a much more modest plan Monday after being thwarted by federal rules and a last-minute change to state budget language. McAuliffe outlined measures to provide health insurance to as many as 25,000 Virginians, just a fraction of those he had hoped to cover by expanding Medicaid under the Affordable Care Act…”

Hospitals and Medicaid Expansion

  • Report: Hospitals in Medicaid-expansion states performing well, By Chelsea Keenan, September 8, 2014, Cedar Rapids Gazette: “Hospitals in states that expanded Medicaid are seeing higher revenues and a reduction in uninsured patients, according to a new report by PwC’s Health Research Institute. The report analyzed financial data from the country’s five largest for-profit health systems, which represent 538 hospitals in 35 states. ‘There were lots of debates in (Washington) D.C. around these issues,’ said Gary Jacobs, a managing director at PWC. ‘There were lots of promises and good intentions. But the jury was still out on how it would shape up.’ The growth in the 26 Medicaid expansion states and Washington, D.C., starkly contrasts the experience in the 24 states that did not expand the program, the report found…”
  • Hospital officials frustrated with financial losses since state did not expand Medicaid, By Shannon Muchmore, September 8, 2014, Tulsa World: “Tulsa hospital executives are frustrated at losing out on reimbursements because of what they say are purely political decisions. Hospitals in Oklahoma are projected to lose more than $4 billion in reimbursements between 2013-22 because the state chose not to expand Medicaid, according to a recent report by the Urban Institute…”

States and Medicaid Expansion

  • States that decline to expand Medicaid give up billions in aid, By Tony Pugh, September 2, 2014, The State: “If the 23 states that have rejected expanding Medicaid under the 2010 health care law continue to do so for the next eight years, they’ll pay $152 billion to extend the program in other states – while receiving nothing in return. This massive exodus of federal tax dollars from 2013 through 2022 would pay 37 percent of the cost to expand Medicaid in the 27 remaining states and Washington, D.C., over that time. Most of the money, nearly $88 billion, would come from taxpayers in just five non-expansion states: Texas, Florida, North Carolina, Georgia and Virginia. The findings are part of a McClatchy analysis of data from the Urban Institute, a nonpartisan research center that’s advised states on implementing the health care law, the Affordable Care Act…”
  • NC’s $10 billion Medicaid challenge: Pay for other states or take federal money?, By Ann Doss Helms and Tony Pugh, September 2, 2014, Charlotte News and Observer: “North Carolina taxpayers could spend more than $10 billion by 2022 to provide medical care for low-income residents of other states while getting nothing in return, a McClatchy Newspapers analysis shows. The federal health law tried to expand Medicaid to millions of low-income, uninsured adults. But many Republican-led states, including North Carolina, opted out of the plan championed by President Barack Obama…”

Medicaid Coverage

  • State’s low Medicaid payments pinch doctor practices in low-income areas, By Guy Boulton, July 19, 2014, Milwaukee Journal Sentinel: “Mohammad Qasim Khan, a primary care physician who oversees a private practice in a low-income neighborhood, well knows the discrepancy between what private insurance pays for his services and what the state’s Medicaid program pays. Khan, who works with another physician and three nurse practitioners at the Family Medical Clinic, 5434 W. Capitol Drive, estimates that the program’s payment rates are half — and in some cases, less than half — those of private insurance…”
  • U.S. hospitals get lift from surge in Medicaid sign-ups, By Susan Kelly, August 1, 2014, Philadelphia Inquirer: “U.S. hospitals are getting a stronger-than-expected benefit from a new influx of low-income patients whose bills are paid by the government’s Medicaid program, raising their profit forecasts as a result. The growing numbers of Medicaid patients helped hospital operator HCA Holdings Inc, the largest for-profit chain, post stronger earnings in the second quarter than initially forecast…”
  • CDC: Many kids with Medicaid use ER as doctor’s office, By Steven Reinberg, July 29, 2014, Lafayette Journal and Courier: “Children covered by Medicaid, the publicly funded insurance program for the poor, visit the emergency room for medical care far more often than uninsured or privately insured youngsters, a U.S. survey finds. And kids with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention…”

State Medicaid Programs – Oregon, North Carolina

  • Medicaid enrollees strain Oregon, By Gosia Wozniacka (AP), July 23, 2014, ABC News: “Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid. The problems come amid nationwide growing pains associated with the unprecedented restructuring of the U.S. health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion…”
  • Many low-income N.C. workers are locked out of Medicaid, By Karen Garloch, July 25, 2014, Charlotte News and Observer: “They’re construction workers, waitresses and cashiers. They care for our children and elderly parents, clean our offices and bathrooms. But they go without health insurance because their incomes aren’t high enough to qualify for federal subsidies and too high to qualify for North Carolina’s current Medicaid program for low-income and disabled citizens. More than half of the 689,000 uninsured adults North Carolinians who fall into this so-called “Medicaid gap” are employed in jobs that are critical to the state’s economy, according to a report released Thursday by the North Carolina Justice Center, the North Carolina Community Health Center Association and Families USA…”

Migrant Laborers

Migrant laborers slip through the tattered safety net in Texas, By Jay Root, June 30, 2014, Texas Tribune: “Along a street lined with warehouses on the east side of Houston, nine Mexican laborers working about 20 feet off the ground are tearing up a concrete roof with handmade pickaxes.They are chiseling it out, one mattress-size panel at a time, then shoving the debris onto the floor below. There’s a giant pile of rubble down there, a jumble of dirty insulation, tar-covered roof decking and fire-suppression water pipes ripped from the building’s interior. To call the work hazardous would be an understatement. The workers are standing on the very roof they are demolishing, and none of them is wearing so much as a hard hat, let alone fall protection equipment like harnesses and lanyards. Technically, federal authorities require that, but the chances of a surprise inspection — or any interference from a state government that brags about its light regulations. . .”

Medicaid Enrollment

Millions enrolling into Medicaid, now what? By Lisa Bernard-Kuhn, June 26, 2014, Cincinnati Enquirer: “In the coming days Charles McClinon will learn whether he’s a candidate for a potentially lifesaving surgery, a procedure the 50-year-old epileptic says is finally an option for him thanks to expanded Medicaid benefits in Ohio. ‘I’m so hopeful now,’ said the Roselawn resident, who four years ago suffered a serious fall during a seizure that sent him to the emergency room and then into the spiral of medical morass that eventually cost him his job, health insurance and Chicago home. ‘I had always been a very highly functional person living with epilepsy, but after the fall, my seizures had gotten so bad, I just didn’t have the strength and awareness to fight,’ said McClinon. Across the U.S., millions of Americans are tapping into newly available Medicaid benefits. Some, like McClinon, say the coverage offers the chance . . .”

ACA Sign-up Period

Study: Selling health insurance at Christmas is bad idea, By Louise Radnofsky, June 26, 2014, Wall Street Journal: “Tax preparers and some other advocates have complained for a while that the health law’s insurance sign-up period is timed wrong. Now they have a paper in the journal Health Affairs to back them up. Asking lower-income people to contemplate buying coverage around the holiday season is a bad idea, because their decision-making capacity is stretched too thin, say two health policy professors. Crafters of the Affordable Care Act originally envisaged the open enrollment period as a fall activity that would coincide with the sign-up periods for Medicare and also the time when many Americans who get coverage through their jobs have to renew their elections. . .”

Health Care Exchanges

Competition heats up on health care exchanges for 2015, By Jayne O’Donnell and Kaitlyn Krasselt, USA Today: “Insurance companies are gingerly moving onto health care exchanges in some competition-deprived states, and they are requesting rate increases that are largely in line with pre-Obamacare years, state filings show. A few big and many smaller insurers avoided the 2014 state- and federal-run health care exchanges that sold individual insurance plans as required under the new law. Some blame these insurer absences for higher rates than many people expected under the Affordable Care Act, but that’s likely to change for the 2015 plan year, experts say. ‘There’s a lot more competition now than there was prior to the advent of the ACA . . .”

Poverty and Health

Interplay between poverty, health is complex, By Lillian Thomas, June 14, 2014, Milwaukee Journal Sentinel: “Hundreds of plastic bins are stacked like jumbo shoe boxes, nearly scraping the ceiling of a bare-bones room in a former hospital. People sit nearby in rows of chairs, waiting to be matched with a pair of donated eyeglasses from the carefully labeled containers. It’s a slow process at City on a Hill, a nonprofit that runs a monthly free clinic on W. Kilbourn Ave. in Milwaukee. Many in the chairs look tired or anxious as they wait for their number to be called.Then John Patton Jr. shows up. He sprawls comfortably in his seat, throws his arms on the backs of the chairs next to him, and chats with those nearby. Then he focuses on the volunteer calling out numbers. . .”

Budget Cuts – Michigan

State’s health budget trims funding for infant mortality, public aid, By Kathleen Gray and Robin Erb, June 11, 2014, Detroit Free Press: “Harper and Hutzel hospitals lost out on $6.5 million in state money to help fund their infant mortality and high-risk pregnancy programs in Detroit, when the Department of Community Health budget was approved by a conference committee Tuesday without the funding. In addition, the Department of Human Services saw $287.6 million in cuts to the money it’s spending on public assistance for poor Michiganders as the economy recovers and more people reach the 48-month limit for benefits and are kicked off welfare rolls. These are the cuts that hurt the most vulnerable people, said social service advocates at a time when the state’s unemployment rate still remains among the nation’s highest at 7.4% and poverty rates are increasing, especially among children. . .”

Medicaid Enrollees

Cook County releases 1st snapshot of new Medicaid patients, By Peter Frost, June 2, 2014, Chicago Tribune: “New data released in May offer the first look at the health, habits and demographics of about 100,000 new enrollees in Cook County’s expanded Medicaid program under the Affordable Care Act. The picture it paints is bleak. More than half the new patients covered by Cook County’s Medicaid expansion program haven’t seen a doctor in the past 12 months. Eighty-five percent of them are unable to obtain needed medications. Nearly one-fourth have spent time in a hospital in the past six months and an additional 1 in 5 are worried about finding a place to stay in the near future. They suffer from heart disease, high cholesterol. . .”

State Medicaid Expansion

  • Medicaid surge triggers cost concerns for states, By Ricardo Alonso-Zaldivar, May 26, 2014, Associated Press: “From California to Rhode Island, states are confronting new concerns that their Medicaid costs will rise as a result of the federal health care law. That’s likely to revive the debate about how federal decisions can saddle states with unanticipated expenses. Before President Barack Obama’s law expanded Medicaid eligibility, millions of people who were already entitled to its safety-net coverage were not enrolled. Those same people are now signing up in unexpectedly high numbers, partly because of publicity about getting insured under the law. . .”
  • Hearings set for Healthy Indiana Plan expansion, By Associated Press Staff, May 25, 2014, Miami Herald: “Two public hearings are scheduled this week on Gov. Mike Pence’s plan to use Medicaid funds to expand the Healthy Indiana Plan to provide insurance under the federal health care overhaul. The Family and Social Services Administration said the hearings will be held Wednesday and Thursday on the state government campus in downtown Indianapolis. Wednesday’s hearing begins at 9 a.m. in Conference Center Room B at the Indiana Government Center South. Thursday’s begins at 1 p.m. in Room 156-B at the Statehouse. The FSSA also announced Friday that it has posted a draft of the proposed Medicaid waiver to pay for the HIP expansion and other related documents on the Healthy Indiana Plan website at http://www.hip.in.gov/ . . .”

Safety Net Hospitals

An Obamacare winner: Safety-net hospitals, By Phil Galewitz, May 24, 2014, USA Today: “At Seattle’s largest safety-net hospital, the proportion of uninsured patients fell from 12% last year to an unprecedented low of 2% this spring — a drop expected to boost Harborview Medical Center’s revenue by $20 million this year. The share of uninsured patients was cut roughly in half this year at two other major safety net hospitals — Denver Health in Colorado and the University of Arkansas for Medical Sciences Hospital (UAMS) in Little Rock. One of the biggest beneficiaries of the health law’s expansion of coverage to more than 13 million people this year has been the nation’s safety-net hospitals. . .”

Medicaid Patient Health

Poorer Health of Surgery Patients on Medicaid May Alter Law’s Bottom Line, By Robert Pear, May 17, 2014, New York Times: “Surgery patients covered by Medicaid arrive at the hospital in worse health, experience more complications, stay longer and cost more than patients with private insurance, a new study has found. The study, by researchers at the University of Michigan, may offer a preview of what to expect as millions of uninsured people qualify for Medicaid under the Affordable Care Act. Although Medicaid patients in the study were generally younger than the privately insured patients, they were twice as likely to smoke and had higher rates of conditions that made surgery riskier. Those conditions, which can arise from years of poor health habits, include diabetes, lung disease and blood vessel blockage. . .”