• Low Medicare, Medicaid rates shift costs to insurers, study finds, By Guy Boulton, December 17, 2011, Milwaukee Journal Sentinel: “An estimated $851 million is added to the cost of commercial health insurance to make up for the lower fees that Medicare and Medicaid pay hospitals in southeastern Wisconsin, according to a study released last week. The study, commissioned by the Greater Milwaukee Business Foundation on Health, supports the long-standing position of the hospital industry that the government health programs don’t cover their share of costs and that the shortfall is passed on to employers and individuals through higher prices for commercial health plans. Yet that contention - widely held in the business community and among elected officials - is challenged by most health economists…”
• Medicare penalties for readmissions are likely to hit hospitals serving the poor, By Jordan Rau, December 19, 2011, Washington Post: “James Breedin cannot keep track of how often he has been admitted to Howard University Hospital for heart problems. ‘It’s been so many,’ said Breedin, a 75-year-old disabled former truck driver from Northeast Washington. One reason for his frequent returns, he says, is that he often can’t afford the medications his doctor prescribes, ’so I have to do without.’ Another is that he fears exercising outside because of neighborhood violence. Medicare is preparing to penalize hospitals with frequent potentially avoidable readmissions, which by one estimate costs the government $12 billion a year. Medicare’s aim is to prod hospitals to make sure patients get the care they need after discharge. But this new policy is likely to disproportionately affect hospitals that treat the most low-income patients, according to a Kaiser Health News analysis of data from the Centers for Medicare & Medicaid Services…”

• Bigger share of state cash for Medicaid, By Michael Cooper, December 13, 2011, New York Times: “Medicaid has steadily eaten up a growing share of state budgets over the past three years, while education has been getting a smaller slice of the pie. That is one of the changes that the lingering economic downturn and the changing American economy have wrought on state finances, according to an analysis of state spending over the last few years released Tuesday by the National Association of State Budget Officers…”
• State Medicaid spending soars, By Lisa Lambert, December 14, 2011, Chicago Tribune: “Spending by U.S. states on Medicaid, the healthcare program for the poor, soared last year and will likely continue growing despite measures to contain costs, according to a report released on Tuesday. Total Medicaid spending, excluding administrative costs, likely reached $398.6 billion in fiscal 2011, which ended in June for most states. That was up 10.1 percent from the year before, when spending rose 6 percent, the National Association of State Budget Officers reported. Medicaid was nearly one-quarter of all state expenditures in fiscal 2011, compared to elementary and secondary education, which accounted for 20 percent of all spending…”
• Medicaid money for Texas to jump, By Don Finley, December 13, 2011, San Antonio Express-News: “The federal government Monday granted Texas a waiver that could mean billions more in Medicaid dollars to hospitals over the next few years, in return for having them work together to provide better care for the poor. In Bexar County, that could mean new money to help keep the mentally ill from overusing crowded hospital emergency rooms, among other new services, one local official said. At the same time, federal officials slapped down a request from Texas to deny Medicaid patients access to family planning centers such as Planned Parenthood that also provide abortions - a plan that had drawn the anger of family planning advocates…”
• Medicaid waiver could be boon for Texas hospitals, By Don Finley, December 12, 2011, Houston Chronicle: “The federal government on Monday granted Texas a waiver that could mean billions more in Medicaid dollars to hospitals over the next few years in return for having them work together to provide better care for the poor…”
• Studies point to flaws in Florida’s Medicaid managed care, By Christine Vestal, December 14, 2011, Stateline.org: “Like many other states in fiscal duress, Florida sliced a large portion of its Medicaid budget this fiscal year, primarily by cutting payments to hospitals, nursing homes and other health care providers. Next year, Governor Rick Scott wants to double the size of reductions to the federal-state program - again by cutting provider fees. Within the next two years, however, the Republican governor expects to shave billions from the state budget by letting private health plans take over the care of all of Florida’s Medicaid patients - more than 3 million people. Scott’s plan is a statewide expansion of a controversial five-county managed care pilot started by Republican former Governor Jeb Bush in 2006. The state Medicaid office sought approval for the plan in August and a decision by the U.S. Department of Health and Human Services is expected soon…”
• Gov. Rick Scott’s proposed budget includes $2.1 billion cut in Medicaid, By Matt Dixon, December 12, 2011, Florida Times-Union: “When Gov. Rick Scott unveiled his proposed $66.4 billion budget last week, many people in the capital and around the state cast it as schools versus hospitals. Scott’s spending plan injected public education with a roughly $1 billion increase but cut $2.1 billion in reimbursements for Medicaid. The cut prompted a fast pushback from the Safety Net Alliance of Florida, a lobbying group that represents 15 of the state’s biggest hospitals. It estimates the cuts would cost its members $1.4 billion…”
• Maine Medicaid deficit mainly due to budget miscalculations, By John Richardson, December 13, 2011, Portland Press Herald: “A $120 million budget deficit projected for the fiscal year that began July 1 has set off an ideological debate over the future of Maine’s Medicaid program. The deficit itself, however, is mostly the result of a series of technical budgeting miscalculations, according to a report prepared by the LePage administration. Problems with a new claims processing system, a loss of federal funds that wasn’t accounted for, and a failure to budget for increases in federal Medicare premiums are among the biggest causes…”
• Proposed Medicaid cuts draw big protests in Maine, By John Gramlich, December 15, 2011, Stateline.org: “Earlier this year, it was Arizona that drew national attention for removing tens of thousands of its citizens from the Medicaid rolls. Now, Maine Governor Paul LePage wants to do the same, saying the state-federal health insurance program is becoming unsustainable. LePage is pushing a proposal that would eliminate 65,000 Mainers from Medicaid, as the Bangor Daily News reports. At a hearing on the proposal Wednesday (December 14), hundreds of protesters converged on the State House to voice their disapproval of the plan, which seeks to close a $220 million shortfall in the state health and human services budget…”
• Report on R.I’s Global Medicaid Waiver finds $22M in savings, By Richard Asinof, December 14, 2011, Providence Business News: “The long-awaited report by the Lewin Group on Rhode Island’s Global Medicaid Waiver was released on Dec. 13, finding that some $22.9 million in savings had been created over three years, far below the $100 million in savings claimed by Gary Alexander, former Secretary of the R.I. Office of Health and Human Services under former Gov. Donald L. Carcieri’s administration…”
• Pa.’s drop in Medicaid rolls stirs controversy, By Don Sapatkin, December 15, 2011, Philadelphia Inquirer: “Since August, the Corbett administration has cut off more than 150,000 people - including 43,000 children - from medical assistance in a drive to save costs. That purge far exceeds what any other state has tried, health policy experts say, and officials may be walking a fine line between rooting out waste and erecting barriers to care for the poor and disabled. When most states were experiencing flat or rising Medicaid enrollment from the economic downturn, stepped-up eligibility reviews in Pennsylvania began producing a decline over the summer. The pace of cuts picked up in November, with 90,000 cases, or 4 percent, dropped in a single month. In New Jersey, enrollment increased by 391 the same month…”

California’s healthcare spending per person among lowest in U.S., By Duke Helfand, December 7, 2011, Los Angeles Times: “For more evidence that the Golden State has lost some of its luster, consider this news from the federal government: California spends less per person on healthcare than all but eight states. New data show that total spending by insurers, government agencies and individuals amounted to $6,238 per resident in 2009, well below the national average of $6,815. That puts California on a bottom tier with Arkansas, Georgia, Texas, Utah, Nevada, Arizona, Colorado and Idaho. Healthcare analysts blame the low spending largely on the fact that the state has more than 7 million people who are uninsured, or about 1 in 5 Californians. As a result, many of these people seek medical treatment only when they are severely ill or injured.Healthcare analysts blame the low spending largely on the fact that the state has more than 7 million people who are uninsured, or about 1 in 5 Californians. As a result, many of these people seek medical treatment only when they are severely ill or injured…”

New Louisiana Medicaid system needs oversight board, watchdog group says, By Bill Barrow, December 8, 2011, New Orleans Times-Picayune: “The leaders of an independent public policy group raised questions Thursday about whether Gov. Bobby Jindal’s overhaul of the Louisiana Medicaid program can yield the predicted savings without curtailing needed health care services for beneficiaries. In a comprehensive report, the Louisiana Public Affairs Research Council called for the Legislature to take an active role in oversight of the Bayou Health program that will shift about 900,000 Medicaid recipients and about $2 billion annually to privately run managed-care networks. The PAR report prompted a quick rebuttal from Health and Hospitals Secretary Bruce Greenstein. Jindal’s top health care lieutenant framed the governor’s signature health care as nearly sure bet to improve health outcomes and said it is set up to operate with as much or more transparency an accountability as any state Medicaid system around the country…”

• Researchers warn proposed changes to Florida’s Medicad could drop 600,000 poor children from rolls, By Sonja Isger, December 7, 2011, Palm Beach Post: “Proposed changes to the state’s Medicaid program that would have parents pay a monthly $10 premium per person for coverage threatens to undo the strides Florida has made in getting health care to the state’s poorest children, researchers warned Wednesday. The premium, combined with several other changes state lawmakers approved last session but that await a federal OK, could lead to 800,000 parents and children leaving the program, concluded a team from the Health Policy Institute at Georgetown University. About 82 percent of those who would drop out of Medicaid coverage would be children, 98 percent of whom live below federal poverty levels, the report stated…”
• Study: Fla. Medicaid premiums too high, By Kelli Kennedy (AP), December 7, 2011, Miami Herald: “New premiums and copay proposals for Florida Medicaid beneficiaries, including $100 for every non-emergency ER visit, are among the highest in the country and a new study warns it could cause hundreds of thousands to drop out because they can’t afford to pay them, according to a report released Wednesday by Georgetown University…”

• Study: Even with more kids in poverty, number of uninsured children fell 14% over 3 years, Associated Press, November 29, 2011, Washington Post: “Even with more children living in poverty because of the rough economy, the number of children without health insurance in the U.S. has dropped by 1 million in the past three years, according to a report released Tuesday by Georgetown University. Many states have expanded eligibility for, and simplified access to, the children’s Medicaid program. This has helped shrink the number of uninsured children from 6.9 million in 2008 to 5.9 million in 2010. Experts say the Affordable Care Act, the federal health care overhaul that requires states to maintain income eligibility levels and discourages other barriers to coverage, has played a key role in the improvement…”
• Safety-net programs insure more Texas children, By Todd Ackerman, November 29, 2011, Houston Chronicle: “Houston-area children’s health insurance is increasingly being provided by government safety-net programs as employers cut jobs and benefits, according to a new study. The survey, sponsored by Texas Children’s Hospital, found that in the last three years, area children’s enrollment in Medicaid and the Children’s Health Insurance Program doubled as coverage through work-based plans decreased significantly. This shift comes in a state known for not embracing government health programs…”
• Number of uninsured Minnesota kids climbs, By Jeremy Olson, November 29, 2011, Minneapolis-St. Paul Star Tribune: “The number of children without health insurance rose sharply in the past two years in Minnesota, making it the only state to see a significant increase since 2008, according to a report released Tuesday. Uninsured Minnesota kids totaled 84,000, although that number could fall again as a result of changes enacted by the Legislature in 2009. The uninsured rate rose from 5.8 to 6.6 percent. While Minnesota’s rate remains better than the national average of 8 percent, the state is no longer among the nation’s best…”
• Utah lags behind other states in covering kids, By Kirsten Stewart, November 29, 2011, Salt Lake Tribune: “Even as unemployment and child poverty has grown, the uninsured rate for children nationally - and in Utah - has shrunk, an analysis of census data shows. From 2008 to 2010 the number of American children living in poverty rose 19 percent, while the number of uninsured children fell 14 percent, according to a report released Tuesday by Georgetown University’s Center for Children and Families. How, given the high cost of health care, is this possible? Two words, say Georgetown researchers: Medicaid and CHIP, the Children’s Health Insurance Program…”

California adult day healthcare centers get a reprieve, By Anna Gorman, November 18, 2011, Los Angeles Times: “Just weeks before the planned closure of adult day healthcare centers throughout California, state officials and disability rights attorneys reached a legal settlement Thursday that preserves services for those low-income seniors and disabled residents most at risk of being institutionalized. The state, which faces a $3.7-billion revenue shortfall, had targeted the centers as part of a plan to reduce spending on Medi-Cal, the government health program for the poor and disabled. Adult day healthcare centers provide nursing care, occupational therapy, physical therapy, meals and exercise to people with serious disabilities, brain injuries and chronic illnesses…”

Texas may cut Medicaid reimbursements to healthcare providers, By Darren Barbee, November 20, 2011, Fort Worth Star-Telegram: “Therapy and physician groups in Texas are alarmed about proposed cuts in government healthcare reimbursement rates that they say would hurt the sickest and poorest Texas patients, most of them children. Therapists stand to lose millions of dollars as Medicaid reimbursement rates for their services are slashed. The average reduction for home health providers, for example, would be 35 percent. All told, the state plan calls for cutting $150 million a year for therapists; that is 19 percent of the $792 million they received last year. The state would save millions more with cuts in co-payments to physicians for people covered by both Medicaid and Medicare. But doctors say the proposed change will further push doctors from wanting to practice in less affluent parts of the state…”

• State drafting a waiver to provide health insurance benefits in exchange for community service, By Wendy Leonard, November 17, 2011, Deseret News: “Community service in exchange for health insurance? It’s an idea that the Utah Department of Health is exploring to allow an otherwise economically challenged population to give back to their community. Based on income, some recipients of the state’s Medicaid health insurance benefit share in the cost by paying modest co-pays and premiums. A pilot program would offer the service option in exchange for health benefits for those who can’t afford to contribute toward cost of Medicaid. But the proposed program would first need approval by federal Centers for Medicare and Medicaid Services. UDOH has until the first of the year to submit a waiver to CMS that could change how Medicaid operates in Utah and allow the program…”
• Utahns: Mandated charity work for Medicaid is ‘demeaning’, By Kirsten Stewart, November 17, 2011, Salt Lake Tribune: “Annette Wright minces no words when asked about the prospect of having to do community service for her Medicaid coverage. It’s ‘crazy’ and ‘demeaning,’ because it presumes people on the low-income health care program don’t already give back, said the 54-year-old career actress. ‘Volunteering should come from the heart. It’s something you do because you want to, not because you have to. What they’re doing is more like coercion.’ Such was the prevailing sentiment Thursday at a public hearing on an experiment that, if approved by the federal government, would require fewer than 100 Medicaid recipients to do charity work in exchange for health insurance. The pilot program is meant to build a sense of community, not punish the poor, said its architect, Rep. Ronda Menlove, R-Garland…”

Many states cut Medicaid payments as stimulus ends, By Doug Trapp, November 16, 2011, San Antonio Express-News: “Fourteen states and the District of Columbia cut Medicaid physician pay for fiscal year 2011, down from 20 states in fiscal 2010. But continuing state budget deficits could lead to more new fee cuts than those already adopted for fiscal 2012, according to the Kaiser Family Foundation. The foundation’s 11th annual survey of state Medicaid programs concluded that continued Medicaid budget pressure on many states led them to expand cost-saving measures in 2011 and 2012. These moves included increasing enrollment in Medicaid managed care, reducing or ending optional benefits such as dental care, tightening prescription drug formularies, enacting or hiking co-payments and, most frequently, reducing Medicaid fees to doctors, according to the Kaiser report, released on Oct. 27…”

• Brownback’s administration rolls out Medicaid reform package, November 8, 2011, Wichita Eagle: “Gov. Sam Brownback’s administration unveiled a major Medicaid reform package Tuesday that will shift thousands of disabled, elderly and low-income residents into a managed care system that aims to reduce hospital visits and slow the growth of Medicaid spending over five years without reducing benefits. The ‘person-centered’ integrated care program is called KanCare. It will be managed by three companies that win state-issued three-year contracts. They will be evaluated and paid based on their outcomes, such as reduced emergency room visits…”
• Brownback seeks $850M in Medicaid savings, By Tim Carpenter, November 8, 2011, Topeka Capital-Journal: “Gov. Sam Brownback took a step Tuesday toward formation of a managed-care system for all Kansans on Medicaid that emphasizes coordination of services to improve health outcomes and cut costs by more than $850 million over a five-year period. Brownback said the cornerstone of the overhaul was an integrated care system - to be called KanCare - intended to improve the lives of 350,000 disabled, elderly and low-income Kansas. KanCare would take effect in January 2013 and begin to bend the cost curve of Medicaid down by engaging new partnerships with the state’s Medicaid provider community…”
• Lawmakers OK changes that could drop 65,000 from Medicaid, By Jason Stein, November 10, 2011, Milwaukee Journal Sentinel: “The Legislature’s nonpartisan budget office projects 65,000 people - nearly half of them children - would leave or be turned away from the state’s health programs for the poor, under a proposal passed by lawmakers Thursday. The Joint Finance Committee approved 11-4 a proposal by GOP Gov. Scott Walker’s administration to bridge the final part of a more than half-billion dollar budget gap in the rapidly growing health plans. All Republicans voted in favor and all Democrats against. The proposal must still win federal approval from President Barack Obama’s administration by the end of the year - a significant hurdle. The Medicaid health plans cover about one in five state residents - almost 1.2 million people - and provide everything from doctor visits for poor families to nursing home care for the elderly. To help control rapidly increasing costs in the programs, Walker’s administration wants to decrease benefits for a quarter of a million recipients, increase premiums for tens of thousands of others by up to tenfold, and drop coverage for adults and children for at least a year if the premiums aren’t paid…”

State budget cuts threaten day programs for thousands of seniors and the disabled, By Sandy Kleffman, November 8, 2011, Contra Costa Times: “State budget cuts that go into effect Dec. 1 will eliminate funding for day programs for thousands of seniors and the disabled, creating angst among relatives who say their lives will be turned upside down. Some fear they will have to send their elders to institutions. Others worry they will need to quit jobs to care for them. Unless a pending lawsuit blocks the plan, the state will halt $169 million in annual Medi-Cal funding for 35,000 people in 287 adult day health care programs throughout California, jeopardizing many of the programs…”

Medicaid cost cuts planned, By Guy Boulton, November 6, 2011, Milwaukee Journal Sentinel: “Wisconsin is not alone in dealing with the thorny task of trying to lower the cost of its health care programs for low-income residents. Massachusetts no longer pays for restorative dental care and dentures. Washington no longer covers eyeglasses and hearing aids. Minnesota no long covers chiropractic care. Illinois, Iowa and other states planned to require a $50 co-payment for unnecessary visits to emergency departments. And California has proposed a $50 co-payment for all visits to emergency departments and a co-payment of $100 for hospital stays that last one day and $200 for longer stays. Every state plans to implement at least one policy to control Medicaid spending this fiscal year, according to a survey by the Kaiser Family Foundation. In Wisconsin, the Department of Health Services has proposed dozens of changes in the BadgerCare Plus and Medicaid programs to close a $500 million gap in their budget…”

• U.S. approves managed care for Kentucky Medicaid, By Tom Loftus, October 31, 2011, Lousiville Courier-Journal: “Federal authorities have given final approval to the state’s new Medicaid managed care plans, allowing the program to be launched on Tuesday. The Beshear administration announced Monday that the federal Centers for Medicaid and Medicare Services notified Kentucky Friday that it was satisfied that Kentucky is prepared for the transition…”
• Walker adjusts plan to close $554 million gap in Medicaid programs, By Jason Stein, October 31, 2011, Milwaukee Journal Sentinel: “Gov. Scott Walker’s administration tweaked its proposals Monday to close a half billion-dollar budget hole in the state’s health plans for the poor as a deadline approaches for deciding whether the state will drop the health coverage of tens of thousands of state residents. The state Department of Health Services made the changes in a 238-page plan being sent for review to the Legislature’s budget committee, which is expected to take up the proposal next week. But a Democratic lawmaker said Monday he was concerned that there still wouldn’t be enough time for lawmakers and President Barack Obama’s administration to review the plan - action that is required to keep more than 50,000 state residents from losing their state coverage altogether at the end of the year…”

• California gets OK for large cuts to Medi-Cal, By Anna Gorman, October 28, 2011, Los Angeles Times: “The Obama administration will allow California to cut hundreds of millions of dollars from Medi-Cal, a move doctors and experts say will make it harder for the poor to get medical treatment. California plans to reduce rates by 10% to many providers, including physicians, dentists, clinics, pharmacies and most nursing homes, the Centers for Medicare and Medicaid Services announced Thursday. The cuts ‘will have a real impact on Medi-Cal patients’ because fewer doctors will be willing to see those covered by the program, which serves 7.6 million poor and disabled Californians, said Anthony Wright, executive director of Health Access, a consumer group. The head of the California Medical Assn., which represents doctors, echoed the concern…”
• Medicaid costs balloon for cash-strapped states, By Tami Luhby, October 27, 2011, CNNMoney.com: “As stimulus funds dry up, cash-strapped states are facing steep rises in Medicaid spending, forcing them to slash services and trim costs. States will have to spend another 28.7% on Medicaid this fiscal year — by far the largest increase ever, according to new data released by the Kaiser Family Foundation Thursday. Much of the increase comes from the loss of more than $100 billion in federal stimulus funds, which helped buffer states from the massive jump in Medicaid enrollment during the Great Recession. But those federal funds ran out in June, leaving states to shoulder the burden of covering nearly 60 million people on their own…”
• State spending on Medicaid up sharply, By N.C. Aizenman, October 27, 2011, Washington Post: “The expiration of federal stimulus funding for Medicaid has dealt a blow to states still struggling to recover from the economic downturn, according to figures released Thursday. To compensate for the loss of extra federal Medicaid dollars this June, states have increased their spending on the program by an average of 29 percent in the current fiscal year. Nearly every state also has turned to tough measures to trim Medicaid costs, such as eliminating benefits, reducing payment rates to doctors and hospitals, and increasing the co-payments they charge the poor and disabled served by the program. Even so, more than half of state officials surveyed said there was a 50-50 chance their Medicaid programs - which are financed with a combination of state and federal funds - would face a budget shortfall as enrollment continues to rise…”
• Survey: States counting on lower costs as Medicaid enrollment slows, By Christine Vestal, October 28, 2011, Stateline.org: “As states were drafting their 2012 Medicaid budgets this summer, they faced the biggest leap in general fund spending since the program began - a whopping 29 percent increase. That’s mainly because federal stimulus dollars for the program dried up, leaving states to shoulder their traditional share of the bill - about 50 percent. As a result, state lawmakers authorized only a 2 percent increase in overall spending for the federal-state health insurance program for low-income people - one of the lowest growth rates on record. That’s according to a 50-state survey released Thursday (October 27) by the Kaiser Family Foundation…”

Taking pulse of Medicaid costs, By Cathleen F. Crowley, October 25, 2011, Albany Times-Union: “Guy Amisano’s soda company sold cases of Pepsi all over Western New York, but he never could put his finger on which sales were the most profitable or whether his price discounts paid off. So in the 1980s, Amisano hired some computer geeks to build a software program to track sales and costs in real time. ‘I was able to see precisely what and to whom I should sell and at what price to achieve optimal profitability without losing volume,’ Amisano said. His profits rose 20 percent and his company grew significantly. Over the next 14 years, Amisano ran Pepsi-Cola Elmira Bottling Co. while selling his computer program on the side. More than half of the beverage industry bought it. In 2000, his family sold the Horseheads-based bottling company to focus on the visual datamining software under a business called Salient Management Company. Now New York’s Medicaid system — the largest in the nation — uses Salient’s software to track the public health program’s $52 billion annual budget, 4.7 million recipients and 60,000 health care providers. Medicaid is the public health insurance program for low-income and disabled people. For the first time, top health officials say they can see where Medicaid dollars are going in real time…”

• Optional Medicaid benefits face state cuts, By Phil Galewitz, October 23, 2011, USA Today: “States are using a variety of strategies to control rising Medicaid costs even as they look ahead to a massive expansion of the state-federal health insurance program for the poor beginning in 2014. The weak economy is driving more jobless Americans into Medicaid, increasing enrollment at the same time that medical costs keep going up. To deal with the higher costs, states are pushing Medicaid recipients into managed-care plans run by private insurers, cutting reimbursement rates to hospitals and doctors and reducing benefits…”
• More states limiting Medicaid hospital stays, By Phil Galewitz, October 23, 2011, USA Today: “A growing number of states are sharply limiting hospital stays under Medicaid to as few as 10 days a year to control rising costs of the health insurance program for the poor and disabled. Advocates for the needy and hospital executives say the moves will restrict access to care, force hospitals to absorb more costs and lead to higher charges for privately insured patients. States defend the actions as a way to balance budgets hammered by the economic downturn and the end of billions of dollars in federal stimulus funds this summer that had helped prop up Medicaid, financed jointly by states and the federal government…”

• Some states seek flexibility to push health-care overhaul further, By Sarah Kliff, October 16, 2011, Washington Post: “As far as health-reform boosters go, Oregon Gov. John Kitzhaber is among the most stalwart. ‘We want to show that health reform is something real, that it actually works,’ he said. ‘Oregon is a place that can actually make it happen.’ His state has aggressively implemented the health overhaul Congress passed last year, taking more than $100 million in federal funding to do so. But at the same time, the health-care law puts Kitzhaber (D) in a bind. This year, Oregon passed its own plan, which starts with changing how it pays doctors and eventually ends with allowing public employees to enroll in Medicaid, the federal insurance program for low-income Americans. There’s just one big obstacle: What Oregon wants to do would require the Obama administration to waive integral pillars of its signature legislative accomplishment…”
• Administration seeks to roll back hospital rules, By Robert Pear, October 18, 2011, New York Times: “The Obama administration moved Tuesday to roll back a number of rules governing hospitals and other health care providers after concluding that the standards were obsolete or overly burdensome to the industry. Among other things, the proposals would allow hospitals to save money by sometimes using qualified nurse practitioners and physician assistants in place of better-paid doctors, allowing doctors to focus more on patients and helping address ‘impending physician shortages.’ Kathleen Sebelius, the secretary of health and human services, said the proposed changes would save providers nearly $1.1 billion a year without creating any ‘consequential risks for patients.’ The proposed rules would apply to more than 6,000 hospitals…”
• ‘Supercommittee’ decision may lead to cuts funding for public health initiatives, By Marilyn Werber Serafini, and Mary Agnes Carey and Kaiser Health News, October 16, 2011, Washington Post: “Federal funding for medical research, disease prevention and a host of public health initiatives could be sharply reduced if the congressional ’supercommittee’ fails to agree on a deficit-reduction package, triggering automatic cuts. Public attention has largely focused on possible cuts to entitlement programs for seniors and the poor, Medicare and Medicaid, but health advocates are raising an alarm about many other smaller programs they say need to be protected…”

• Lower Medicaid dispensing fees may pressure pharmacies, By Claire Cardona, October 14, 2011, New York Times: “In Rio Grande City, Rene Martinez’s Starr Pharmacy has one line for Medicaid patients and another for non-Medicaid patients. On some days, most of his clients can be found waiting on the Medicaid line, a testament to the importance of that federal-state health insurance program in this poor city along the Texas-Mexico border - and to Mr. Martinez’s bottom line. His store is one of a number of independent pharmacies in Texas that may have to lay off workers and cut services like free delivery to homebound patients because of looming lower dispensing fees. Beginning in March, a new managed-care plan goes into effect that reduces the amount pharmacies receive for filling Medicaid prescriptions…”
• Medicaid stand-in rebuffed by feds, By Niki Kelly, Journal Gazette, October 1, 2011, Fort Wayne Journal Gazette: “The federal government on Friday rejected Indiana’s proposal to use its Healthy Indiana insurance plan in place of a Medicaid expansion beginning in 2014. The Centers for Medicare and Medicaid Services said in a letter that the state’s request was premature because rules related to the expansion have not yet been finalized and encouraged Indiana to apply again in the future…”
• Medicaid overhaul saves $600M, By Casey Seiler, October 6, 2011, Albany Times-Union: “The first phase of the state’s attempt to overhaul its health insurance program for low-income residents has achieved almost $600 million in savings in its first six months, according to a progress report released Wednesday. Gov. Andrew Cuomo’s Medicaid Redesign Team gathered at The Egg to hear team reports and receive a demonstration of the Medicaid Visual Data Mining system, which allows state officials and health care managers to track spending in a more targeted and quick-response fashion. ‘We are now live-managing the program,’ said Greg Allen of the state Department of Health, who demonstrated how the system could be used to track anomalies that could indicate possible fraud or other problems. State Health Commissioner Nirav Shah suggested the data tool could be used by hospitals to track re-admission rates due to infections or other phenomena…”

L.A. County expands no-cost healthcare, By Anna Gorman, October 9, 2011, Los Angeles Times: “In one of the largest expansions of health coverage to the uninsured, Los Angeles County is enrolling hundreds of thousands of residents in a publicly funded treatment program and setting the stage for the national healthcare overhaul. The county hopes to register as many as 550,000 patients and is assigning them to medical clinics for services at no cost to them. At the same time, the county is transforming its healthcare system to be less focused on acute care and more on primary care. The changes are expected to reduce costs, streamline care and attract patients. Under President Obama’s controversial healthcare overhaul, millions more uninsured Californians will be eligible for Medicaid - the healthcare program for the poor - beginning in 2014. Even as the debate over the law continues in Washington, California is starting that expansion now and using federal dollars to do so. Altogether, the state expects to receive $2.3 billion to expand and modernize its Medicaid program, known as Medi-Cal, now available only to certain low-income residents…”

Study: Worst hospitals treat larger share of poor, By Carla K. Johnson (AP), October 5, 2011, Salt Lake Tribune: “The nation’s worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research shows. Now, these hospitals, mostly in the South, may be at higher risk of financial failure, too. That’s because the nation’s new health care law punishes bad care by withholding some money, says the lead author of the study published Wednesday in the journal Health Affairs…”

• High court hears key Medicaid case, By David G. Savage, October 3, 2011, Los Angeles Times: “The Supreme Court justices opened their new term Monday by hearing a major healthcare case that tests whether judges can stop California and other cash-strapped states from cutting their payments to doctors and hospitals who serve low-income patients. The case heard Monday will probably affect how much money is available to pay for medical care for more than 50 million Americans, about half of them children, who depend on Medicaid…”
• For justices’ first day back, a knotty case involving Medicaid cutbacks, By Adam Liptak, October 3, 2011, New York Times: “The Supreme Court started its new term on Monday with arguments in a difficult and consequential case over California’s attempt to cut Medicaid payment rates. The justices were not focused on the ultimate question of whether state officials were entitled to address the budget crisis there by lowering payments to medical providers. Rather, they considered the threshold question of whether the providers and Medicaid recipients were entitled to sue over the move…”

• Studies: Medicaid vital to kids, seniors, By David Gulliver, September 28, 2011, Bradenton Herald: “More than a half-million Floridians rely on Medicaid to pay for cancer, diabetes, heart disease and other illnesses, and that federal safety net may be crucial as private health insurance costs rise far faster than wages. That picture comes from a pair of separate studies released Tuesday. Families USA examined Medicaid usage in major states, and found that in Florida, seniors and children are among its biggest recipients. The Kaiser Family Foundation surveyed employers and found that annual premiums for their family health plans increased 9 percent from the prior year, to about $15,073, greatly outpacing the 2.1 percent rise in workers’ pay…”
• State wants to shift some Medicaid recipients to lower-cost plans, By Jason Stein, September 30, 2011, Milwaukee Journal Sentinel: “To help address a half-billion dollar shortfall in the state’s health programs, Gov. Scott Walker’s administration is seeking to shift hundreds of thousands of state residents to lower-cost state plans or to private plans but not to leave them without coverage altogether, officials said. State officials said that there is now a $554 million estimated deficit - $110 million more than previously projected - through June 2013 in state Medicaid health programs, which provide everything from doctor’s visits for poor families to nursing home care for the elderly. That deficit could still grow further going forward, they warned. To close that gap and control fast-growing costs, state Health Services Secretary Dennis Smith said that the state would avoid dropping state residents with no other options for coverage and look instead at efforts like shifting 230,000 state Medicaid recipients into a lower-cost plan with fewer benefits…”

• State decides what’s not an emergency, By Jordan Schrader, September 26, 2011, Tacoma News Tribune: “State government is about to start refusing to pay for repeat visitors to emergency rooms whose conditions don’t truly rise to the level of emergencies. The trouble is all in how you define an emergency. Starting Saturday, Medicaid won’t pay for more than three ER visits in a year for a patient’s nonemergency conditions as defined by the state. A list of more than 700 diagnoses put into that category has drawn fire from hospitals and doctors’ groups over inclusions whose symptoms seem awfully similar to emergencies…”
• Wisconsin starts publishing Medicaid cut proposals, By Scott Bauer (AP), September 27, 2011, Sheboygan Press: “Gov. Scott Walker’s administration unveiled a website Monday that includes a handful of Medicaid cost-savings proposals intended to help it reach required cuts of about $444 million over the next two years. But there’s a long way to go. Most of what was released was either already known about or would make little progress toward what needs to be cut. Only three of the six areas of savings detailed Monday had not been previously announced. Those three total $6 million in savings in state money, just 3 percent of the $181.8 million that must be found under the two-year budget that took effect in July. The total amount of unspecified cuts that must be found, including federal funding and other sources, is $444 million…”

• Young adults gain health insurance under new law, By N.C. Aizenman, September 21, 2011, Washington Post: “Nearly 1 million more young adults have obtained health insurance since the 2010 health-care law began requiring insurers to let adult children stay on their parents’ plans until age 26, according to government data released Wednesday. The jump in enrollment caused the share of young adults who are uninsured to drop from 34 percent at the start of 2010 to 30 percent - or 9.1 million people - by March of this year, according to a national interview survey by the Centers for Disease Control and Prevention…”
• Young adults make gains in health insurance coverage, By Kevin Sack, September 21, 2011, New York Times: “Young adults, long the group most likely to be uninsured, are gaining health coverage faster than expected since the 2010 health law began allowing parents to cover them as dependents on family policies. Three new surveys, including two released on Wednesday, show that adults under 26 made significant and unique gains in insurance coverage in 2010 and the first half of 2011. One of them, by the Centers for Disease Control and Prevention, estimates that in the first quarter of 2011 there were 900,000 fewer uninsured adults in the 19-to-25 age bracket than in 2010. This was despite deep hardship imposed by the recession, which has left young adults unemployed at nearly double the rate of older Americans, with incomes sliding far faster than the national average…”

• States, unhappy with health-care overhaul, look to form compact, By Guy Gugliotta, September 19, 2011, Boston Globe: “State governors and legislators opposed to the federal health-care law are considering a novel approach to escape its provisions: joining an ‘interstate compact’ that would replace federal programs - including Medicare and Medicaid - with block grants to the states. To date, legislation has been drafted or introduced in 14 states and brought to the floor by lawmakers in at least nine. Three Republican governors - in Georgia, Oklahoma, and Texas - have signed the compact into law, while Governor Jay Nixon of Missouri, a Democrat, let the compact become law without signing it. Supporters say they hope to get 40 states to put it on the legislative calendar in 2012. If a significant number of states pass the compact, supporters plan to submit it to Congress for approval in the same way that the body approves interstate compacts regulating commerce, transportation, and resource conservation and development…”
• Study looks at who remains uninsured in Mass., By Chelsea Conaboy, September 19, 2011, Boston Globe: “Much of the discussion around the 2006 Massachusetts health law has focused on how far the state has come in providing coverage for the uninsured. Dr. Rachel Nardin, a neurologist at Cambridge Health Alliance and chair of the Massachusetts chapter of Physicians for a National Health Program, said sometimes it is important to take a different look — to look at the glass as half empty and ask, why? She and others at the Harvard-affiliated health system published a study online with the Journal of General Internal Medicine last week looking at why people remain uninsured in Massachusetts despite a law mandating that most residents have health insurance…”
• Pa. considering shift in Medicaid payments to help cut rising expenses, September 21, 2011, By Phil Galewitz, Philadelphia Inquirer: “Pennsylvania is considering paying Medicaid recipients as much as $200 as an incentive to visit higher-quality and lower-cost hospitals and doctors. Experts say the strategy has never been tried by other states. Gary Alexander, the state’s secretary of public welfare, said his agency hoped to launch the plan by early next year to help control rising expenses in the $30 billion Medicaid program…”

To help the poor, experts invent solar-powered hearing aids, motorcycle ambulances, Associated Press, September 12, 2011, Washington Post: “A bit of creativity never hurts, especially when it comes to solving health problems in developing countries. Instead of the usual donated medicines and health equipment, some experts are inventing new products for the poor, like a solar-powered hearing aid or a motorcycle ambulance. Both inventions were showcased at an engineering conference in London. And in a new report published online Monday in the journal Lancet, the United Nations highlights innovations like using text messages in South Africa to remind women with HIV to get their babies tested and tucking medicines into Coca-Cola crates to reach remote villages. Hundreds of thousands of replacement joints, surgical tools and other medical devices have been sent to poor countries over the years. But according to the World Health Organization, about 75 percent of the donated goods sit unused, either because they’re broken or no one knows how to use them…”

Healthcare costs rose while insurance coverage fell, studies show, By Noam N. Levey, September 8, 2011, Los Angeles Times: “U.S. workers whose wages stagnated over the last decade also saw their health insurance degrade, even as medical costs gobbled up a growing share of their income, two new studies show. An estimated 29 million adults who had health insurance lacked adequate coverage in 2010, leaving them exposed to medical expenses such as high deductibles that they couldn’t afford, according to a survey by the nonprofit Commonwealth Fund. That is up from 16 million underinsured people in 2003, the survey found, underscoring the rising burden that insurance plans are placing on consumers as the industry raises required co-pays and deductibles…”

After the hospital, a haven for homeless patients to recuperate, By Anna Gorman, August 28, 2011, Los Angeles Times: “A taxi dropped off Kim McAuliffe, clutching a plastic bag of medications, at a Los Angeles motel. She had just been discharged from Garfield Medical Center and had nowhere to go. ‘The hospital sent you here to rest after you’ve been sick,’ Roy Kaufman, a case coordinator, told her as she slumped into a chair. ‘We’re gonna take care of you.’ Everyone here has been in a hospital, is ill and homeless. Outside, the place looks like a standard motel, with a sign advertising color TV and air conditioning. Inside, nurses help homeless patients change bandages, take medication and recover from surgeries. Opened 10 months ago by the nonprofit Illumination Foundation, the Recuperative Care Center has 20 motel beds where homeless patients with acute illnesses or injuries recover after being released from local hospitals. The program and others like it dramatically reduce costly hospital stays and emergency room visits - often funded by taxpayers - and give hospitals a place to safely release patients without leaving them on the streets…”

• Federal subsidy for COBRA health coverage to expire, By Phil Galewitz, August 30, 2011, Miami Herald: “One of the key consumer benefits of the federal stimulus package - subsidies to help laid-off workers continue their health care coverage - draws to a close Wednesday, raising concerns about how the unemployed will cover those expenses. It’s a dilemma that Holly Jespersen knows firsthand. She lost her job twice in the past two years - both times losing her employer-paid health insurance. But the second time, she paid about $350 a month more for insurance than she had the first time because she didn’t qualify for the subsidy. ‘It made a huge difference for me,’ said Jespersen, 36, of Darien, Conn. ‘I wish I still had it.’ Jespersen was one of millions of laid-off workers to benefit from the federal subsidies for COBRA, a program set up under federal law that allows people who lose their jobs to keep the employer-provided insurance, typically for 18 months, if they pay the entire premium plus a small percentage for an administrative fee…”
• No more coverage for the unemployed, By Tim Darragh, August 31, 2011, Allentown Morning Call: “Hospital emergency departments may see a continued increase in the number of uninsured people they treat, now that a federal stimulus-funded benefit that helped underwrite health care coverage for the unemployed ended Wednesday. Deficit-conscious members of Congress last year decided to let the subsidy expire, leaving unemployed people who had been getting COBRA coverage the option of paying for it in full, finding a short-term policy or going without health insurance. Enrollment in the program ended in May 2010, and subsidies expired Wednesday for most eligible individuals. There is little doubt that many, if not most, of those people will go uninsured, said Antoinette Kraus, project manager of the Pennsylvania Health Access Network, a coalition of organizations working to expand health coverage for working people and the poor…”

• TennCare could take big hit, By Chas Sisk, August 31, 2011, The Tennessean: “Health care, children’s services and unemployment offices could bear the brunt of expected cuts in federal spending in Tennessee, according to planning documents released Tuesday. Spending on TennCare could be reduced by as much as 25 percent, and local health departments could lose as many as 278 jobs across Tennessee under a worst-case scenario prepared for state finance officials. Tennessee also may have to close as many 36 career centers, and reduce staffing for child welfare by nearly 700 people, if the federal government presses ahead with deep cuts to Tennessee. The planning documents give some insight into how sharp reductions in federal spending might affect Tennessee. About 40 percent of the state’s $30 billion budget comes from the federal government, which intends to reduce its spending by at least $1.2 trillion in a bid to reduce the national debt…”
• Colorado scaling back Medicaid after drastically underestimating numbers, cost, By Tim Hoover, August 31, 2011, Denver Post: “Two years after lawmakers expanded Medicaid to cover poor adults without children, the state is vastly scaling back the program because the number of people eligible for coverage is nearly three times as high as first projected and the cost of insuring them is almost nine times original estimates. The new coverage followed the 2009 passage of major health care legislation that allowed the state to impose a fee on hospitals while drawing down matching federal money to expand Medi caid coverage. House Bill 1293 was estimated to generate about $1.2 billion for Medicaid programs when fully phased in, and the measure called for expanding eligibility levels. A new eligibility class was created for adults without dependent children and whose income was up to 100 percent of the federal poverty level, or $10,890 per year for an individual…”

Wave of Medicaid cuts to begin, By Lynn Bonner, August 28, 2011, News and Observer: “New cuts to health services for the poor take hold in October, with the elimination of eye exams and glasses for adults on Medicaid. Medicaid recipients are receiving notices about reductions, eliminations or other changes to an array of health services in the next few months. The $354 million Medicaid cut in the state budget includes limits and other changes to services totaling $16.5 million. In addition to getting rid of routine adult eye care and glasses, the state plans to limit payments for deep cleaning dental treatments for people who have gum disease to once every two years from once a year. Outpatient physical therapy, occupational therapy and speech therapy for adults will be limited to three visits a year…”

Medicaid managed care is a growing but risky business, By Christopher Weaver, August 26, 2011, Washington Post: “Sanjuanita Espinoza, 55, doesn’t seem like a gold mine for private insurers. She’s disabled, has high blood pressure and has no family to help with her care. Yet, to some Texas insurers, she is an opportunity. In August, the state picked five health plans in South Texas to oversee care for people such as Espinoza who are enrolled in Medicaid, the state-federal program for the poor. This scenario is playing out across the country as states increasingly turn to private insurers to rein in the cost of Medicaid. But Medicaid managed care is a risky business. Many new enrollees are older and sicker than the people health plans typically cover. The political environment is fierce, and insurers face resistance from physicians, hospitals and perhaps patients…”

• Ruling: AHCCCS copays break law, By Mary K. Reinhart, August 25, 2011, Arizona Republic: “A federal appeals court ruled Wednesday that mandatory copayments charged to Arizona’s poorest residents violate federal law. The three-judge panel of the 9th U.S. Circuit Court of Appeals said federal health officials failed to show how the copays, imposed in November after a seven-year court battle, served any purpose besides cutting the state’s Medicaid budget. Federal law gives the U.S. Health and Human Services secretary discretion to approve state Medicaid ‘waivers’ as long as the programs have a ‘research or demonstration value.’ Raising copayments for more than 200,000 of Arizona’s poorest residents and making them mandatory, the judges said, helped balance the state budget but didn’t meet that federal standard…”
• Illinois Medicaid’s managed care effort stumbles, By Judith Graham, August 26, 2011, Chicago Tribune: “It can take years for people with cerebral palsy, autism, schizophrenia or Down syndrome to find trusted physicians to oversee their health. Now, families and advocates say, those medical relationships are being threatened as Illinois rolls out a new program of HMO-style care for people with serious disabilities. Many doctors and hospitals are refusing to join the new Medicaid program, which the state hopes will better coordinate care and lower costs for some of its neediest recipients. The providers’ rationale: They dislike the bureaucratic hassles and cost-cutting measures associated with managed care. The ranks of those who have said no, for the moment, include prominent medical centers and physician practices with a long track record of serving the disabled, among them Northwestern Memorial Hospital, Rush University Medical Center, the University of Chicago Medical Center, Children’s Memorial Hospital and Loyola University Health System. Because of the situation, hundreds if not thousands of vulnerable, chronically ill individuals are being forced to find new doctors, some of whom appear ill-equipped to handle their needs, according to consumer advocates and families…”

Hospitals seek more ER patients even as Medicaid tries to lessen demand, By Phil Galewitz, August 22, 2011, Washington Post: “Complaining of abdominal discomfort and chronic bronchitis, 22-year-old Toshia Johnson, an unemployed mother on Medicaid, went to a hospital emergency room in Bend, Ore., more than two dozen times in the year that ended in June 2010. She was never admitted to the hospital and used the ER for routine care because, she says, it’s near her home and the care was free. But in the first six months of this year, after entering a state-funded program designed to reduce unnecessary ER use by Medicaid patients in central Oregon, Johnson has gone to the ER just once, after breaking her tailbone. In the first half of this this year, ER visits by the 400 patients in this program have declined by more than half from the same period last year, saving Medicaid $1 million, officials say. Efforts to reduce unnecessary ER visits by patients in Medicaid, the joint state-federal health program for the poor and disabled, are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals’ aggressive marketing of ERs to increase admissions and profits…”

Medicaid pays less than Medicare for many prescription drugs, U.S. report finds, By Robert Pear, August 15, 2011, New York Times: “Medicaid gets much deeper discounts on many prescription drugs than Medicare, in part because Medicaid discounts are set by law whereas Medicare prices are negotiated by private insurers and drug companies, federal investigators said Monday in a new report. The report, from the inspector general of the Department of Health and Human Services, could be used by lawmakers trying to cut drug prices as Congress looks for ways to rein in the cost of Medicare under the new deficit-reduction law. Under existing law, the Congressional Budget Office estimates that the cost of Medicare’s outpatient drug benefit will increase an average of nearly 10 percent a year, to $175 billion in 2021, from $68 billion this year. Medicaid and Medicare receive discounts in the form of rebates, which are paid by drug manufacturers when their products are dispensed to people enrolled in the programs…”

Judge allows cuts to health care coverage for poor Arizonans, By Howard Fischer, August 10, 2011, East Valley Tribune: “A judge gave the go-ahead Wednesday for the state to deny free health care over the next year to about 135,000 poor people. Maricopa County Superior Court Judge Mark Brain acknowledged that voters mandated in 2000 that the state must provide care for everyone below the federal poverty level. And the Voter Protection Act, a provision of the Arizona Constitution, prohibits lawmakers from altering or repealing anything approved by voters without taking the issue back to the ballot. But Brain said that does not preclude lawmakers from refusing to provide enough money to the Arizona Health Care Cost Containment System, the state’s Medicaid program, to cover everyone who is eligible to enroll…”

Demand for safety-net care remains high in Massachusetts, By Noam N. Levey, August 8, 2011, Los Angeles Times: “Massachusetts, whose 2006 healthcare overhaul provided a template for the landmark national law signed by President Obama last year, has already demonstrated that it is possible to achieve almost universal health coverage. Now, the trailblazing state is providing another clue about what may happen when the federal government begins guaranteeing health insurance for all citizens starting in 2014. Massachusetts community health centers and so-called safety-net hospitals - originally created to serve the poor and uninsured - have seen no let-up in demand, even after the state’s reforms, according to new research published Monday in the Archives of Internal Medicine…”

‘Charity’ care, bad debt rise for Iowa hospitals, By Rod Boshart, August 2, 2011, Cedar Rapids Gazette: “The prolonged U.S. economic downturn has contributed to a rise in the level of uncompensated ‘charity care’ and unpaid medical debts that Iowa hospitals have incurred in recent years, officials said Tuesday. Overall, the 118-member Iowa Hospital Association provided more than $850 million worth of care last year for which the facilities were not fully compensated, association spokesman Scott McIntyre said. That level, based on a member survey, was up $54 million, or 6.8 percent, from 2009. The total stood at $252 million in 2000, he said…”

Deep Medicaid cuts suddenly on table in N.C., By Lynn Bonner, August 5, 2011, News and Observer: “The legislature set an aggressive target to cut more than $350 million from the state’s share of Medicaid spending this year, but chances for meeting the goal with the plan legislators approved were slim. It takes time to get federal approval for any changes in Medicaid services, so the state won’t see the impact of the legislature’s cuts for months. Under orders from the legislature to manage Medicaid with the money budgeted, Lanier Cansler, secretary of health and human services, has to squeeze more savings into less time. So Medicaid cuts may be deeper than anyone thought just a month ago…”

States save by moving vets from Medicaid’s rolls to VA’s, By Pamela M. Prah, July 18, 2011, Stateline.org: “A growing number of states are shifting health care costs to the federal government by finding military veterans who receive Medicaid and signing them up for medical benefits through the U.S. Department of Veterans Affairs. Arizona, California and Texas are among the states that are working to replicate a program first launched in Washington State. That program, begun in 2003, has moved some 9,500 veterans from the state’s Medicaid rolls to the VA’s. Washington State has avoided paying $27 million in health care bills this way - enough to make a small dent in a strained state budget. And veterans generally find that the benefits offered through the VA are more generous that what they were getting through the state…”

Medicare doesn’t cover many health-care expenses for low-income seniors, By N.C. Aizenman, July 18, 2011, Washington Post: “Helen Johnson gave a welcoming smile to the group of older men and women who had assembled at the senior center in the Maryland Eastern Shore town of Snow Hill on a recent evening. All of them were caregivers for spouses or parents with debilitating illnesses. ‘We’re very concerned about you,’ began Johnson, 74, who organizes support programs for a nonprofit agency serving the elderly. ‘You spend so much time tending to your loved ones, you don’t have time for your self.’ But Johnson’s comforting message masked worries of her own. There was the gnawing pain in her arthritic knee, which gets so bad by late afternoon that she can’t stand up for more than a few minutes at a time. There was her dread of the drive home after dark, which has become difficult as her eyesight has weakened. And perhaps most wearying, there was the knowledge that despite her dislike of working evening hours, she had no alternative. Nearly a decade after reaching retirement age and qualifying for Medicare, Johnson cannot afford to give up her job. Even with the paycheck it brings, her income is only a few notches above the federal poverty level…”

• State proposes increases in Medicaid co-pays, By Misty Williams, July 14, 2011, Atlanta Journal-Constitution: “Children could be among the hardest hit by proposed increases in co-pays for Medicaid enrollees and the creation of co-pays for families in the state’s PeachCare for Kids health care program starting this fall. A plan to double existing co-pays for inpatient hospital services to $25 is also among the changes proposed by the Georgia Department of Community Health that would save the state an estimated $4.2 million. Co-pays for prescription drugs, vision care and other services would also climb under the plan outlined at a department board meeting Thursday. Children ages 6 and older enrolled in PeachCare would be the most dramatically affected by the changes, which would take effect Sept. 1, since those families don’t currently have co-pays, said Jerry Dubberly, the state’s Medicaid division chief. PeachCare provides health care to more than 200,000 children through age 18 who don’t qualify for Medicaid and have family incomes up to 235 percent of the federal poverty level…”
• Fewer Utah doctors to treat Medicaid patients, By Kirsten Stewart, July 10, 2011, Salt Lake Tribune: “When people ask family practitioner Ray Ward if he does charity care, he likes to joke, ‘Yes, I take Medicaid.’ It means making less money, but the Bountiful doctor does it out of a sense of duty. ‘I still come out OK at the end of the year,’ he says. ‘So far, I haven’t had to turn anyone away. I still accept [Medicaid] patients.’ Physicians like Ward, however, are in increasingly short supply. In Utah the number of doctors who accept Medicaid has shrunk 25 percent in 11 years. This year, 3,166 doctors are certified to bill the low-income health program, down from 4,210 in 2000. That’s just over half of the state’s 5,844 practicing physicians. Meanwhile, Medicaid enrollment, now at about 244,470, is swelling with no immediate end in sight…”

How much do states really spend on Medicaid?, By Julie Rovner, July 1, 2011, National Public Radio: “July 1 is traditionally the day many new state laws take effect. This year it’s also the day the spigot officially turns off for $90 billion that Washington has been funneling to the states since 2009 to help them cope with the ballooning costs of the Medicaid program for the poor. You don’t have to look very far to find a governor complaining about the high cost of Medicaid or what it’s doing to his or her state’s budget…”

• Medicaid payments go under the knife, By Phil Galewitz, July 5, 2011, USA Today: “To curb rising Medicaid costs, about a dozen states are starting a new budget year by reducing payments to doctors, hospitals and other health care providers that treat the poor. Some health care experts say the cuts, most of which went into effect July 1 or will later this month, could add to a shortage of physicians and other providers participating in Medicaid. ‘Further depressing payment rates can only worsen the situation,’ says Sara Rosenbaum, chair of the health policy department at George Washington University. She says some states cutting rates - such as South Carolina- already have severe Medicaid physician shortages. Insurers and employers have their own concerns about the payment cuts. They say trimming the rates will prompt providers to raise their prices for patients who have private insurance…”
• Latest S.C. Medicaid cuts raise access fears, By Phil Galewitz, July 5, 2011, USA Today: “Medicaid patients in Spartanburg, S.C., face long odds in finding a new doctor. Most specialists in the city don’t see Medicaid patients, and primary care physicians generally will see only one new Medicaid patient a month, says Fran Kunda, a Spartanburg family doctor and chairwoman of the South Carolina Academy of Family Physicians. As the latest round of Medicaid cuts on doctors goes into effect Friday, Kunda fears access problems will only worsen in Spartanburg and other parts of the state. South Carolina, which reduced reimbursement rates to all Medicaid providers by 3% in April, is imposing an additional 2% cut on all doctors except obstetricians and neonatologists. It is one of nearly a dozen states that have opted to cut the Medicaid rates this month to doctors, hospitals and other providers to help limit spending in the federal-state health program for low-income and disabled residents…”
• Doctors shun Medicaid, By Kristen Consillio, July 5, 2011, Honolulu Star-Advertiser: “Hawaii’s chance to get a handle on the number of publicly insured residents denied access to primary care slipped away last week when the Obama administration shelved a plan for a mystery shopper program to measure access to medical services. A common complaint among patients covered by government health plans such as Medicaid is the difficulty in finding primary care doctors willing to accept public insurance, though there is no hard evidence to gauge the scope of the problem. The mystery shopper program, scrapped after doctors and politicians criticized it as government snooping, would have measured the level of access for patients insured in a public program versus higher-paying private insurance offered by companies such as Hawaii Medical Service Association. Local health care providers had hoped the short-lived proposal to survey difficulties in accessing care here and in eight other states - through people posing as patients with different kinds of insurance coverage seeking primary-care appointments - would have prompted government action, making it less burdensome for doctors to accept publicly insured patients…”

Administration offers health care cuts as part of budget negotiations, By Robert Pear, July 4, 2011, New York Times: “Obama administration officials are offering to cut tens of billions of dollars from Medicare and Medicaid in negotiations to reduce the federal budget deficit, but the depth of the cuts depends on whether Republicans are willing to accept any increases in tax revenues. Administration officials and Republican negotiators say the money can be taken from health care providers like hospitals and nursing homes without directly imposing new costs on needy beneficiaries or radically restructuring either program…”

Medi-Cal cuts sought as stimulus funds run out, By Victoria Colliver, June 30, 2011, San Francisco Chronicle: “Billions of federal stimulus dollars that boosted Medicaid programs for the past two years will run out Friday, while at the same time California is trying to get approval for a series of cuts to the health program for the poor. It could be a one-two punch for more than 7 million Californians enrolled in Medicaid, known here as Medi-Cal. California received about $12.4 billion of the $90 billion the Obama administration injected into Medicaid programs nationwide as a way to help ease the strain of unemployment and other impacts of the recession. The extra help meant the federal government matched California at 62 cents on the dollar instead of 50 cents. That ends Friday. As a result, Medi-Cal patients will pay more and receive fewer benefits…”

• Indiana law to cut Planned Parenthood funding is blocked, By Robert Pear, June 24, 2011, New York Times: “A federal judge ruled Friday that the State of Indiana could not cut off money for Planned Parenthood clinics providing health care to low-income women on Medicaid. The judge, Tanya Walton Pratt of the Federal District Court in Indianapolis, blocked provisions of a new state law that penalized Planned Parenthood because some of its clinics performed abortions. The law, she said, conflicts with the federal Medicaid statute, which generally allows Medicaid beneficiaries to choose their health care providers. Planned Parenthood provides services other than abortion, including family planning and screenings for cancer and sexually transmitted diseases. In issuing a preliminary injunction late Friday, Judge Pratt said the state law ‘will exact a devastating financial toll on Planned Parenthood of Indiana and hinder its ability to continue serving patients’ general health needs…’”
• Arizona Medicaid: New attempt made to block cuts, By Mary K. Reinhart, June 28, 2011, Arizona Republic: “Attorneys for low-income Arizonans filed a motion in Maricopa County Superior Court on Monday to stop sweeping cuts to the state’s Medicaid program from taking effect Friday. It may be the last chance for more than 135,000 people expected to lose coverage in the coming year under the Arizona Health Care Cost Containment System, which Gov. Jan Brewer and state lawmakers cut by more than $500 million to balance the budget. Attorneys for three public-interest groups argue that Brewer and lawmakers are violating the state Constitution and the will of voters, who in 2000 agreed to expand AHCCCS and extend health care to everyone earning less than the federal poverty level. The Arizona Supreme Court last Friday declined to accept a similar case, without explanation…”

• Medicaid health providers brace for new round of fee reductions, By Christine Vestal, June  27, 2011, Stateline.org: “There are only three ways a state can reduce its Medicaid burden, and two of them are highly problematical. Cutting the number of people served by Medicaid is generally prohibited by the new national health law. So is denying coverage to patients for visits to hospitals and doctors, although “optional” benefits such as prescription drugs and mental health treatment can be dropped. But the one Medicaid cost that states have usually been able to cut without worrying too much about the federal government is reimbursement to the providers themselves. And that is what most of them are doing this year…”
• Court refuses to stop Arizona from scaling back Medicaid program for poor, By Howard Fischer, June 24, 2011, East Valley Tribune: “The Arizona Supreme Court late Friday refused to block the state from scaling back its health care program for the poor next week. In a brief order, the justices rejected the petition by several public interest law firms to forbid the Arizona Health Care Cost Containment System from changing eligibility standards effective this coming Friday, a move that eventually would leave about 150,000 who otherwise are eligible without care. Vice Chief Justice Andrew Hurwitz, who signed the order, gave no reason for the ruling. But attorney Tim Hogan from the Arizona Center for Law in the Public Interest said he and others opposed to the cuts will make one more last-ditch effort on Monday to convince a lower court judge to issue an injunction…”

Finding help for high-cost patients key to trimming health care tab, By Michael Booth, June 24, 2011, Denver Post: “Ruby Gallegos knows she is high maintenance. She got used to dropping into emergency rooms for migraines. A nurse holds her hand during blood-pressure checks to help control the doctor-office anxiety that artificially spikes her readings. Gallegos, 42, suspects the origins of all pills. She asks her teenage son to swallow a Tylenol from the bottle before she does. Her panic attacks are getting better on shopping trips, but only in a relative sense: She can now shop alone in a crowded grocery store for 15 minutes while her husband waits in the car, a mark of progress from when he had to be within three aisles. Gallegos’ mental health issues, intertwined with high blood pressure, bowel trouble and obesity, make her a very expensive patient for the state of Colorado. As a high-risk Medicaid user, Gallegos personifies one of the maddeningly irreducible statistics of health care costs: The sickest 1 percent of patients spend nearly 30 percent of a health system’s money…”