Medicaid Privatization – Iowa

Medicaid firms spending less on care for Iowa’s poor, disabled, By Tony Leys, March 15, 2017, Des Moines Register: “The three private firms running Iowa’s Medicaid program have found ways to trim spending on care for the poor or disabled Iowans they cover, a new report suggests. But all three continue to lose tens of millions of dollars on the controversial project.  The companies’ per-member monthly spending on health care for adults fell by as much as 28 percent from the three months ending in September 2016 to the three months ending in December 2016, the new report shows…”

State Medicaid Programs

  • Feds OK Medicaid privatization, with another delay, By Tony Leys and Jason Clayworth, February 23, 2016, Des Moines Register: “Gov. Terry Branstad gained federal approval Tuesday for his controversial plan to turn Medicaid over to private managers, but not until April 1.  Branstad originally planned to make the massive shift on Jan. 1. Federal administrators determined in December that Iowa was not ready to turn the 560,000 poor or disabled people who use the program over to three private management companies. They ordered the state to wait until at least March 1…”
  • New twists as Maine lawmakers again consider Medicaid expansion, By Joe Lawler, Feburary 23, 2016, Portland Press Herald: “Sen. Tom Saviello’s Medicaid expansion bill received a chilly reception from his fellow Republicans and the LePage administration Tuesday. The Wilton lawmaker received support from Democrats, however, and remained undeterred…”
  • Bill would block Medicaid expansion for another two years, By Laura Hancock, February 23, 2016, Casper Star-Tribune: “The state Legislature, which recently defeated Medicaid expansion, is debating a bill that would create a two-year state study of health coverage for low-income Wyomingites – a measure critics call a delay tactic for helping the poor and the hospitals who serve them.  But Sen. Charlie Scott, one of the sponsors of Senate File 86, said the measure is a compromise to Medicaid expansion, since the Legislature appears unwilling to extend the federal program to 20,000 low-income Wyoming adults under the Affordable Care Act.

Medicaid Privatization – Iowa

Will Iowa’s poor face Kansan fate of Medicaid denials?, By Jason Clayworth, January 10, 2016, Des Moines Register: “Two of the corporations Iowa has picked to manage its Medicaid program face new accusations of trying to pad their profits by systematically denying payments to medical providers serving poor and disabled people in Kansas. Similar allegations of denied payments and unjust delays hounded both companies for years in other states.  The companies — UnitedHealthcare and Amerigroup — have each paid tens of thousands of dollars to settle similar problems in other states, a Des Moines Register Investigation has found.  But the new accusations in Kansas are particularly relevant to Iowa because the model used by Gov. Terry Branstad’s administration for privatized Medicaid management is similar to the Kansas plan in many ways, critics contend…”

Child Welfare Systems – Michigan, Arizona

  • Michigan foster care ‘a persistent and dire problem’, By Justin A. Hinkley, July 2, 2015, Lansing State Journal: “A girl was injured during an unsupervised visit with the parents she’d been taken away from. Kids with a history of inappropriate sexual behavior were placed in homes with younger children. A child ran away and police weren’t notified for days. A decade ago, the death of Williamston 7-year-old Ricky Holland at the hands of his adoptive parents revealed fatal flaws in the state’s safeguards for foster kids. Seven years ago, a class-action lawsuit in federal court mandated improvements.  Still, Michigan continues to fail hundreds of kids a year, court-appointed monitors say…”
  • Foster care will not be privatized, officials say, By Justin A. Hinkley, June 29, 2015, Lansing State Journal: “Despite official statements to the contrary, state employees and some private providers suspect Michigan is working toward fully outsourcing foster care services in the state. Currently, the more than 12,000 foster care cases in Michigan are split about evenly between private providers and the more than 700 foster care workers at the state Department of Health & Human Services. The division varies by county, but state employees and others look to Kent County — where recent legislation fully privatized foster care case management and established a pilot program for a performance-based funding model — as one of several clues that 100% outsourcing is coming down the pike…”
  • Arizona child-safety agency struggles with staff turnover, rising child removals, By Mary Jo Pitzl, June 28, 2015, Arizona Republic: “A year ago Arizona’s governor and a united Legislature agreed that to save the state’s troubled child-welfare agency, it had to be razed and rebuilt.  They pulled the child-welfare office out of the mammoth state Department of Economic Security and made it a stand-alone agency that reports directly to the governor. They also boosted its budget by $94 million to give it the firepower to reduce a backlog of 13,000 reports of child abuse and neglect, as well as to hire more caseworkers for the increasing number of new reports. And they made transparency a key criteria to hold the agency accountable…”

Child Welfare System – Michigan

Kent County developing model to privatize foster care; state may follow plan, By Rick Wilson, October 11, 2013, Grand Rapids Press: “Kent County is on its way to being the first entity in the state to completely privatize child welfare services – possibly creating a model for the rest of Michigan – with the hope of improving the lives of children in the foster care system. The plan, outlined during a Thursday, Oct. 10 presentation to the county commission, is based on streamlining services for abuse and neglected children by relaying on the five private, non-profit agencies that already provides foster care in the county…”

Child Support Services – Kansas, Ohio

  • Administration defends child support privatization, By Andy Marso, August 20, 2013, Topeka Capital-Journal: “A spokeswoman for the Kansas Department for Children and Families struck back at critics of the agency’s drive to privatize child support services Tuesday, saying the bidding process was completely on the up-and-up and state workers weren’t ‘set up to fail’ to pave the way for privatization…”
  • Counties’ efforts to collect child support find mixed results, By Laura Arenschield, August 18, 2013, Columbus Dispatch: “Almost a year into a statewide push to collect more child support from parents who owe it, Delaware County is leading central Ohio, recouping about 15 percent more than the state average. Other central Ohio counties, including Franklin, have not been as successful…”

Medicaid and Children’s Dental Care – Utah

Will privatizing Medicaid’s dental program hurt Utah kids?, By Jennifer Dobner, July 10, 2013, Salt Lake Tribune: “Laura Privett is worried about the future of her children’s very expensive mouths. Her eldest, 16-year-old Wade, got his first filling before he turned 4. Her youngest, 6-year-old Kayden, was born with a partial cleft lip and had his first dental x-rays at five days old. He’s already had cranial facial surgery, six fillings and six caps. His jaw is so overcrowded with aching teeth that sometimes he can’t eat. ‘If it wasn’t for Medicaid, my kids would not have access to those dental services,’ the Kearns mother said. The care the Privetts rely on may change under a state plan to hire private managed care organizations to run the Medicaid dental program. Utah pediatric dentists fear the move will mean less access to care for children and smaller payments for dentists…”

Medicaid Reform – Florida

Fla. gets final OK for Medicaid privatization, By Gary Finehout and Kelli Kennedy (AP), June 14, 2013, Miami Herald: “Federal health officials have given final approval to a plan to overhaul Florida’s safety net health insurance program. Gov. Rick Scott announced the decision on Friday, saying it would allow the state’s Medicaid program to ‘to provide Medicaid users with quality, value-based and patient-centered care…'”

State Medicaid Programs

  • McCrory plan would open state’s Medicaid business to private companies, By Lynn Bonner, April 4, 2013, News & Observer: “Gov. Pat McCrory wants to overhaul the state’s Medicaid program by having managed care companies offer health care plans for poor, elderly and disabled people. The overhaul, unveiled by administration officials Wednesday, would diminish the role of a nationally recognized nonprofit agency while opening the state’s Medicaid business to private companies that now provide such services in more than half the states in the country. McCrory said Wednesday that the change would benefit health care providers and the state by bringing predictability to Medicaid expenses, which the state has trouble estimating from year to year…”
  • States saying ‘no’ to Medicaid expansion, but low-income citizens, patients worried, By Halimah Abdullah, April 5, 2013, CNN: “Bettina Cox battled cervical cancer in 2012. A year later, the Texas native feels that narrowly qualifying for a Medicaid-sponsored program for low-income and uninsured female cancer patients saved her life. She now wants her governor and state legislature to support an expansion of Medicaid — part of President Barack Obama’s Affordable Care Act — that she feels could save the lives of thousands of other women in her state by helping them detect diseases much earlier. But if Texas lawmakers have their way — as well as governors and legislatures in Florida, South Carolina and nearly a dozen other states — low-income Americans like Cox may not have expanded access to funds needed for such procedures. Those states feel the expansion is an unnecessary government overreach at a time when spending should be limited, not expanded…”

Medicaid Expansion and Health Insurers

Medicaid insurers gear up for profit, By Phil Galewitz, March 8, 2013, USA Today: “After his back injury kept him out of work last year, Sergio Mera enrolled his family in Medicaid, the state-federal health insurance program for the poor. These days when they need a doctor, the Meras travel less than a mile from their home to a new clinic. ‘They take good care of you,’ says Mera, 37, as he sits in an exam room with his wife and two kids. The clinic, affiliated with Molina Healthcare, one of the nation’s largest Medicaid managed-care plans, is one of about a dozen facilities the company is opening across the country to handle a wave of new customers in 2014. That’s when about 10 million more people are expected to sign up for Medicaid managed care under the Affordable Care Act, and as states shift enrollees into private plans, according to trade group Medicaid Health Plans of America…”

Anti-Poverty Programs – Kansas

  • Poverty in Kansas: Some fear rules cast poor families adrift, By Eric Adler, January 5, 2013, Kansas City Star: “A crescent moon hangs in a clear sky above Deer Creek Village. It is a flat and treeless expanse of 92 townhouses where poor families with bedsheets as curtains live side by side in low-rent duplexes subsidized by the federal government. Some have a saying here: One way in, one way out. It is meant to describe the single road, Colonial Drive, shaped like a Q, that encircles the homes. Residents figure it was designed to make it easy for police to come in and hard for drug dealers to escape. Families here also know it refers to their lives and futures. One way in: Poverty. One way out: Jobs and education. These days, the notion occupying many who advocate for Kansas’ poor is that less than three miles away, near the Capitol dome, government officials led by Gov. Sam Brownback are making ‘getting out,’ rising out of poverty, all the more difficult…”
  • Kansas’ privatization, limit of welfare orgs worries advocates, Associated Press, January 6, 2013, Topeka Capital-Journal: “Advocates for the poorest Kansas residents say Gov. Sam Brownback’s administration is making it tougher for the state’s needy to rise out of poverty by cutting much-needed assistance. Brownback administrators, however, insist that stricter policies on who receives state assistance are forcing people to find jobs instead of relying on handouts. Ever since Brownback campaigned for governor in 2010, the conservative Republican has declared that lifting children out of poverty is a priority. But advocates for the poor argue that under Brownback’s administration needy residents are being cast adrift and that the coming years will be even worse, The Kansas City Star reported…”

Child Welfare Privatization – Nebraska

Foster care still reeling from privatization, By Martha Stoddard, December 1, 2012, Omaha World-Herald: “Nebraska’s child welfare system is still suffering from the instability caused by the state’s privatization experiment, according to a report released Friday. The Foster Care Review Office’s annual report on children in out-of-home care found concerning levels of caseworker turnover, missing documentation and a lack of complete case plans during 2011 and the first half of this year. All three problems worsened after the state attempted to turn over major responsibilities for managing child welfare and juvenile justice cases to private contractors…”

Medicaid Program – Florida

Fla. Medicaid program in limbo, By Kelli Kennedy (AP), October 7, 2012, Miami Herald: “Millions of uninsured Florida families and health care providers are in a purgatory of sorts. Gov. Rick Scott and the Republican-led Legislature want to privatize the state’s Medicaid program, but need the Obama administration’s permission. The Obama administration wants to make more low-income Floridians eligible for Medicaid, but needs Scott and the Legislature to agree. The sides have been negotiating a package deal for more than a year and won’t comment. Without a solution billions of federal dollars could go to other states and many uninsured Floridians will continue to receive their health care in emergency rooms – the most expensive, least effective place. Safety nets, like community health centers, say they don’t have enough funding to keep up as more uninsured patients end up in their waiting rooms…”

Probation Fees and Jail Time

Poor land in jail as companies add huge fees for probation, By Ethan Bronner, July 2, 2012, New York Times: “Three years ago, Gina Ray, who is now 31 and unemployed, was fined $179 for speeding. She failed to show up at court (she says the ticket bore the wrong date), so her license was revoked. When she was next pulled over, she was, of course, driving without a license. By then her fees added up to more than $1,500. Unable to pay, she was handed over to a private probation company and jailed – charged an additional fee for each day behind bars. For that driving offense, Ms. Ray has been locked up three times for a total of 40 days and owes $3,170, much of it to the probation company. Her story, in hardscrabble, rural Alabama, where Krispy Kreme promises that ‘two can dine for $5.99,’ is not about innocence. It is, rather, about the mushrooming of fines and fees levied by money-starved towns across the country and the for-profit businesses that administer the system. The result is that growing numbers of poor people, like Ms. Ray, are ending up jailed and in debt for minor infractions…”

State Medicaid Programs – Florida, Louisiana

  • Medicaid officials seek changes to Medically Needy Program, By Jim Saunders, May 8, 2012, Pensacola News Journal: “Florida Medicaid officials have asked the federal government to approve major changes in a program that serves tens of thousands of people with costly medical conditions, seeking to install a type of managed care and require monthly premium payments. The Agency for Health Care Administration, carrying out a 2011 law, requested changes in the state’s Medically Needy program. In a document sent to the federal government in late April, the agency said the proposed changes would improve care for beneficiaries…”
  • Private Medicaid providers enrolling in northwest Louisiana, By Melody Brumble, May 8, 2012, Shreveport Times: “Rhonda Matthews hopes Louisiana’s privately run Medicaid program, dubbed Bayou Health, brings more benefits than changes. Matthews quizzed representatives of five health plans at a recent enrollment meeting in Haughton before signing up with Amerigroup. Her sons, ages 16 and 5, have ADHD. She wants them to keep the same doctor and get the same level of care. She’s also covered by Medicaid. Louisiana started working to privatize its Medicaid program in 2010 primarily to save money. In theory, the health plans will provide greater access to preventive and prenatal care and specialists. The savings would come from keeping people with chronic illnesses out of the emergency room and babies out of newborn intensive care units…”

Child Welfare Spending – Nebraska

Child welfare spending to stay high, By Martha Stoddard, April 1, 2012, Omaha World-Herald: “Nebraska’s 2½-year experiment in privatizing child welfare services has yielded one clear result: It forced the state to put more resources into the care of abused and neglected children. Spending shot up when the State Department of Health and Human Services began contracting with private agencies to coordinate child welfare cases. Now, although four of the five contractors are gone and the state has resumed oversight of most cases, child welfare spending is budgeted to remain at a level $35 million higher than before privatization began. State Sen. Bob Krist of Omaha and others said more funding has long been needed for Nebraska’s child welfare system. ‘As an unintended consequence of our journey, we will do what we should have done from the beginning,’ he said, ‘but I think it’s been a too-expensive trip to get there.’ Nebraska officials went into privatization saying they would do it within existing resources. Instead, spending took a $20 million unplanned jump in the first year of the private contracts and grew another $10 million in the second year…”

Child Welfare System – Nebraska

  • Lawmakers debate ending child welfare privatization, By Martha Stoddard, February 29, 2012, Omaha World-Herald: “Nebraska lawmakers launched into debate Tuesday about whether to put the brakes on the state’s experiment in child welfare privatization. At issue is whether the state should take back responsibility for managing child welfare cases from the last remaining private contractor. Legislative Bill 961, introduced by the Health and Human Services Committee, would require the change. The bill was introduced before state officials announced that Kansas-based KVC was dropping out of the picture as one of the last two child welfare contractors. KVC stops managing child welfare cases for the state as of Wednesday, leaving the Omaha-based Nebraska Families Collaborative as the state’s only private contractor. Speaker of the Legislature Mike Flood of Norfolk warned colleagues to think hard before moving forward on the proposal…”
  • Senators advance four child welfare bills but question returning case management to state, By JoAnne Young, February 27, 2012, Lincoln Journal Star: “The Legislature focused Tuesday on repairing the state’s child welfare system. Lincoln Sen. Kathy Campbell set the tone for two days of debate on a set of five bills to overhaul child welfare reform. ‘Today, we begin the process of building a stable foundation and a bridge to the future for the benefit of the children and families of the state of Nebraska,’ she said. The Legislature proceeded to advance four of the bills — with no senator voting against them — and then, late in the day, started debate on a bill that would return all child welfare case management to the state. That last bill (LB961) could prove to be one of the toughest…”

Child Welfare System – Nebraska

Another blow to child welfare privatization, By Martha Stoddard, February 21, 2012, Omaha World-Herald: “Nebraska’s experiment in privatizing child welfare services suffered a major blow Tuesday when one of two contractors pulled out. Officials with the Kansas-based KVC announced that the company will stop managing child welfare cases as of Feb. 29. The Nebraska Department of Health and Human Services will take back the responsibility. KVC’s departure leaves the state with only one private contractor: the Omaha-based Nebraska Families Collaborative. The state and KVC ultimately parted ways over money…”

Hybrid Welfare Eligibility System – Indiana

With Marion County on board, Indiana’s welfare system is now fully ‘hybrid’, By Mary Beth Schneider, February 20, 2012, Indianapolis Star: “Marion County today becomes the final county in the state to move to the so-called ‘hybrid’ welfare eligibility system. The change represents the final and perhaps biggest challenge for the state’s Family and Social Services Administration since the new system was implemented in January 2010. The number of people receiving benefits in Marion County is 20 percent of all welfare cases in the state. About 125,000 people in Marion County receive various services, including Medicaid and other health programs, food stamps and job training. Starting today, they’ll not only be able to visit the welfare offices as they are accustomed to doing — though some are in new locations — they also will be able to access records online and call a 24-hour, seven-days-a-week toll-free number to check benefits or report changes to their status. People now will be able to enroll online or walk into an office, without an appointment, to get help…”

State Medicaid Programs – New Hampshire, Florida, Kentucky

  • Medicaid overhaul leaves questions, By Benjamin Yelle, February 13, 2012, Keene Sentinel: “A plan to change the way Medicaid services are delivered in New Hampshire has service providers and family members searching for answers – and time is running out. Gov. John H. Lynch and the N.H. Executive Council are scheduled to act in March on contracts for so-called ‘managed care’ of Medicaid clients. Medicaid is a federal program that provides medical and social services to low-income Americans. It has two components: acute care, which is similar to health insurance, and covers things like doctor’s visits, and long-term or chronic care, which covers permanent developmental disabilities, acquired brain injuries and other serious or recurring ailments. In the Monadnock Region about 1,000 people receive such services. The state Legislature voted in 2011 to send Medicaid services out to bid to private, for-profit companies to take over administration from the N.H. Department of Health and Human Services…”
  • Feds deny part of Fla. Medicaid proposal, By Kelli Kennedy (AP), February 11, 2012, Miami Herald: “Republican lawmakers’ quest to expand a Medicaid privatization program statewide was dealt a blow this week after federal health officials said the state could not impose $10 monthly premiums on Medicaid beneficiaries. The Centers for Medicare and Medicaid Services also denied the state’s proposal to charge $100 co-pays for any non-emergency ER visits, according to a letter sent Thursday. Federal health officials said the fees violated several statutes designed to protect nearly 3 million of state’s most vulnerable…”
  • Medicaid managed care companies defend their efforts in Kentucky, By John Cheves, February 13, 2012, Lexington Herald-Leader: “Three companies hired last year to manage most of the state’s Medicaid program on Monday defended their efforts thus far and said they’re working to resolve problems. Lawmakers on the Program Review and Investigations Committee quizzed executives with Coventry Cares, Kentucky Spirit and WellCare of Kentucky, which manage Medicaid outside of the Louisville area under a cost-cutting plan implemented in November by Gov. Steve Beshear…”