• State Medicaid to quit paying for ER visits deemed unnecessary, By Carol M. Ostrom, February 7, 2012, Seattle Times: “Intent on cutting state budget health-care costs, Medicaid officials say the program will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they’re having an emergency. The rules - arguably more drastic than an earlier proposal to limit Medicaid patients to three visits per year for nonemergency conditions - would block payment for ER visits for about 500 different conditions. They would apply to all adults and children on Medicaid, with no exceptions, such as someone being brought in by ambulance or from a nursing home, or when patients have neurological symptoms or unstable vital signs. The new rules are to begin April 1, but a statewide group of emergency doctors, backed by the Washington State Medical Association and the Washington State Hospital Association, are pressing lawmakers to stop the plan, arguing it would shift costs to hospitals and ER doctors and deny care to people with real emergencies…”
• Medicaid may stop covering visits to ER later deemed ‘unnecessary’, By Jordan Schrader, February 8, 2012, Tacoma News Tribune: “Medicaid soon might stop covering emergency-room treatment that state officials decide afterward was ‘not medically necessary.’ A state Health Care Authority rule putting a three-visit limit on unnecessary ER use by poor patients was blocked in court on procedural grounds. The agency has replaced it with a new policy planned to take effect April 1 that would reduce the number of conditions deemed non-emergencies but would forbid even a single unnecessary visit. The doctors and hospitals who sued over the old rule blasted the new plan Tuesday, saying it would leave it up to a ‘faceless bureaucrat’ to decide what’s an emergency. They weren’t ready to say they’ll go to court again over it…”

• Maine Governor LePage backs nation’s toughest Medicaid cuts, By Christine Vestal, February 6, 2012, Stateline.org: “Medicaid spending is a matter of urgency almost everywhere in the country right now, but in few places is the urgency as palpable as it is here, where the governor refers to the federal-state health insurance program for the poor as ‘welfare,’ says it’s necessary to eliminate coverage for 65,000 adults, and wants to stop paying room and board for some 2,000 elders who live in group homes. All these ideas are part of Republican Governor Paul LePage’s plan to close a $220 million hole in the state’s biennial Medicaid budget. ‘If we are to bring our welfare system to a manageable level that Maine can afford,’ LePage insists, ‘we must make the necessary structural changes … The state can no longer use gimmicks to fill the hole.’ The size of Maine’s Medicaid shortfall is substantial, but it pales in comparison to gaps in many other states. In fact, health experts in Maine say the program has survived far bigger shortfalls in recent years without cutting the rolls. Still, LePage argues that the program can no longer provide a ‘free lunch’ to poor 19- and 20-year olds, or to healthy adults responsible for the care of others…”
• Obama administration rejects Medi-Cal copayments, By Judy Lin (AP), San Francisco Chronicle: “Federal health officials on Monday said California cannot force Medi-Cal recipients to make a co-pay for doctor visits and prescription drugs, a decision that brings relief to low-income patients but complicates the state’s effort to close a $9.2 billion budget deficit. A letter from the Centers for Medicare & Medicaid Services said agency officials were ‘unable to identify the legal and policy support’ for the state’s request. The decision is the latest in a string of legal and regulatory challenges that have made it difficult for the state to reduce spending and balance its budget. Gov. Jerry Brown and lawmakers were planning to save $511 million a year in the health insurance program by requiring low-income patients to pay a share of their medical costs…”

• Louisiana Medicaid overhaul begins its first day in operation, By Bill Barrow, February 1, 2012, New Orleans Times-Picayune: “The first leg of Gov. Bobby Jindal’s Medicaid overhaul goes live today, with more than 180,000 southeast Louisiana residents, most of them children, being shifted from the state-run insurance program to private insurance networks. Jindal’s signature health care initiative, the Bayou Health rollout involves the south shore of Lake Pontchartrain from St. Bernard Parish to Jefferson Parish, and the north shore parishes of St. Tammany, Washington, Tangipahoa, St. Helena and Livingston…”
• Medicaid managed care system draws sharp complaints, By Deborah Yetter, February 2, 2012, Louisville Courier-Journal: “Complaints about the state’s new Medicaid managed care system boiled over Wednesday at a legislative meeting, where a top Medicaid official acknowledged major problems since the state hired three outside companies to provide services. ‘It is a drastic change to the system,’ Neville Wise, the state’s acting Medicaid commissioner, told the Senate Health and Welfare Committee. ‘We didn’t expect the level of issues that we had.’ Lawmakers voiced growing dissatisfaction with managed care, citing complaints about lack of payments for medical services, difficulty in getting patient medications approved and delays in authorizing services…”

• State Medicaid programs face $141 million shortfall, report says, By Jason Stein, January 31, 2012, Milwaukee Journal Sentinel: “Wisconsin’s health programs for the poor have a $141 million shortfall in state money over the next year and a half, new estimates show. So far, GOP Gov. Scott Walker’s administration has saving plans that would more that cover that potential deficit in the state’s Medicaid health programs. But a new report by the Legislature’s nonpartisan budget office questions whether all of the saving will materialize. With costs in the program still substantial and the saving uncertain, the Legislative Fiscal Bureau found in its new report that the finances of the health programs will need careful monitoring. The report comes ahead of new estimates expected next week that should shed more light on the overall condition of the state’s strained budget…”
• Medicaid rolls rose even as Pa. disqualified many, new calculation shows, By Don Sapatkin, January 26, 2012, Philadelphia Inquirer: “The Pennsylvania Department of Public Welfare’s stepped-up efforts over the summer to target waste, fraud, and abuse quickly bore fruit in the fall. Adult Medicaid enrollment alone was down 109,000 through November. Cause and effect seemed clear. Advocates for the poor and disabled were outraged. Now, DPW has suddenly changed its reporting method. Revised calculations show a decline of just 6,000 participants for the same period. And when December is added in, enrollment is up by 23,000 since August - a time when officials agree that tens of thousands of people lost benefits after overdue reviews found they were ineligible. DPW says the new reporting method is just as accurate as the old one, merely different. But it will not disclose its new method or recalculate the latest Medicaid data using the old formula…”
• Medicaid copays could increase in South Dakota, By Megan Luther, January 31, 2012, Sioux Falls Argus Leader: “Medicaid recipients in South Dakota will face larger copays for their medication if the federal government signs off on a state plan designed to drive down costs in the program that provides health care to poor people. Requiring the larger copays is one of 11 recommendations put forth by the Medicaid Solutions Work Group, an assembly of health care providers, lawmakers and state employees assigned with finding savings the the program. The group began work last year at the request of Gov. Dennis Daugaard…”
• Medicaid change to cut pharmacy payments in Texas, By Jim Fuquay, January 28, 2012, Fort Worth Star-Telegram: “When Marwan Hattab opened Wedgwood Pharmacy just over a year ago, he knew from his previous years in the business how much it costs to fill a prescription. And he knows it’s quite a bit more than he’ll be paid under a new reimbursement system for Texas’ Medicaid program. The state’s move to managed care for Medicaid prescriptions goes into effect March 1, and Hattab and other independent pharmacists say they stand to lose money on every prescription they write for the federal/state healthcare program for the poor. A coalition of Texas pharmacies said last week that the dispensing fee that pharmacists receive for filing a Texas Medicaid prescription will plunge from about $6.50 to as little as $1.35. The change is part of legislation passed last year that aims to save the state an estimated $100 million over the next two years…”

Without dental coverage, patients seek pain relief in ER, By Alison Bath, January 28, 2012, Shreveport Times: “Louisiana spent $1.7 million on Medicaid patients who visited statewide emergency rooms seeking pain relief from toothaches during fiscal year 2010-11. The year before, the state paid $1.66 million for the same reason, according to Department of Health and Hospitals data. Those hospital visits didn’t solve the problem. Unlike dentists and oral surgeons, ER doctors and other physicians can’t pull a tooth. So, the thousands of Medicaid and other government health program recipients who visit an ER each year in Louisiana seeking help for toothaches, tooth abscesses and other dental emergencies receive only palliative care and a referral to an oral surgeon…”

Medicaid dispute pits ’shared responsibility,’ care of poor, By Michael Booth, January 29, 2012, Denver Post: “Colorado policymakers are wrestling to bring the burgeoning Medicaid budget under control, as critics fear health insurance for the poor will consume the state budget. But even the smallest cuts or cost-shares raise protests from patient advocates and objections that such measures will prove more expensive in the long run. ‘Sharing responsibility’ by raising co-pays and enrollment fees for public health care actually discourages patients from seeking care until they require budget-busting emergency or specialty help, researchers say. ‘There is indisputable evidence that when you ask poor people to pay more for medical care, some of them cannot afford it, so they avoid seeking the doctor or cannot afford their medications,’ said Leighton Ku, director of the Center for Health Policy Research at George Washington University. Some of those patients, Ku said, will eventually require ‘the most expensive forms of care at emergency rooms or in hospitals.’ The constraints inherent in Medicaid - a tangled web of mandates, entitlements and patients’ behavior - frustrate critics, who see the program growing even more onerous. Federal health reform and expansions from a state hospital fee will add hundreds of thousands of people to public insurance rolls who are unlikely to ever leave…”

• Feds confirm high hurdle for DHHS cuts; LePage officials prepared to take case to D.C., By Steve Mistler, January 27, 2012, Lewiston Sun Journal: “The federal agency that will decide whether some of Gov. Paul LePage’s proposed Medicaid cuts qualify for waivers to make the reductions legal reaffirmed Thursday that the exemptions face long odds. In a written response to the Democratic leads on the Legislature’s budgetary committee, the federal Centers for Medicare & Medicaid Services confirmed that legislative action was not a consideration in whether the agency will grant a waiver from the federal health care law…”
• Kansas governor has no plans to slow Medicaid overhaul, By John Hanna (AP), January 26, 2012, Kansas City Star: “Kansas asked the federal government Thursday to waive some of its rules so that the state can overhaul its $2.9 billion Medicaid program, despite concerns among legislators that Gov. Sam Brownback is moving too quickly to turn all of it over to private health insurance companies. Brownback expects the state to issue contracts this year to three companies to manage the program, which provides health coverage to poor families and disabled and elderly Kansans. The contracts would take effect Jan. 1, 2013, and Kansas wants federal officials to issue a waiver so the state can include services for the disabled and elderly and build in financial incentives for improving services while controlling costs…”

State steps up health care coverage for kids, By Deborah Barfield Berry, January 18, 2012, Montgomery Advertiser: “Alabama’s successful efforts to increase the number of children with health care coverage has made it a standout in the region, according to a national study released Wednesday. The study by the Kaiser Commission on Medicaid and the Uninsured lists Alabama among four states that are regional leaders in making gains in children’s health care. The others are Iowa, Massachusetts and Oregon. Alabama recognizes the importance of health care coverage for kids, said Trisha Brooks, a co-author of the report and a senior fellow at the Georgetown University Center for Children and Families…”

Investigator finds overpayments in food-stamp system, By Jason Stein, January 15, 2012, Milwaukee Journal Sentinel: “In just two months, private investigators found nearly a half-million dollars in overpayments and cost savings in two state aid programs for the needy in Milwaukee County, with much more expected to be added up in the coming weeks. The findings of fraud in public food assistance and health care programs come after budget cuts left such investigations painfully neglected in many parts of the state, including Milwaukee County - the state’s largest urban area. For the past year, the Journal Sentinel has been reporting about fraud and other problems in the FoodShare program. The contractor looked at 111 suspicious cases in FoodShare and Medicaid health programs such as BadgerCare Plus and found overpayments in every case. So far, the total overpayments have been tallied up in only 62 of those cases, or just over half. But the total overpayments and future cost savings will likely come close to $1 million when it’s all added up, with most of that due to fraud, said Ed O’Brien, who heads the investigative firm O’Brien & Associates…”

• After a contentious political year, Republicans may moderate their approach, By John Gramlich, January 9, 2012, Stateline.org: “From the moment he took office last year, Florida Governor Rick Scott made clear that a new and unabashedly conservative administration had taken power in Tallahassee - just as it had in state capitals around the country following an historic election haul for Republicans in 2010. Scott, a Tea Party-backed Republican, stood before a cheering crowd and introduced a state budget that contained more than $4 billion in tax cuts for corporations and property owners, even as it slashed funding for K-12 education…”
• Washington and the states: a year of uncertainty and foreboding, By Pamela M. Prah, January 10, 2012, Stateline.org: “A long siege of deadlock and dysfunction in Washington has left states frustratingly unclear what to expect from the federal government in the coming year. About the only thing they know for sure is that it is not going to be a year of generosity. In fact, it’s likely to be quite the opposite. As a result of last summer’s deal to raise the federal debt ceiling, and the consequent failure of the congressional ’super committee’ to decide on budget cuts, states are bracing for automatic across-the-board cuts in education, social welfare and other programs for the upcoming 2013 fiscal year. Those cuts would come atop federal cuts in 2011 and 2012, not to mention the continuing wind-down of federal stimulus aid…”
• Medicaid: a year of excruciating decisions, By Christine Vestal, January 11, 2012, Stateline.org: “In health care history, 2012 will be remembered for the U.S. Supreme Court’s upcoming decision on the Obama administration’s health overhaul. But in the states, 2012 will likely be remembered less as an historic turning point than as a gradual continuation of their longstanding struggles to get Medicaid costs under control. That’s not to say the states aren’t watching the Supreme Court closely. The case set to be heard in March and decided in June was brought by 26 states who argued the federal law’s ‘individual mandate,’ as well as a massive expansion of Medicaid in 2014, were unconstitutional. While the outcome could have long-term consequences for states, it likely won’t change their most pressing short-term budget considerations…”
• Unions adapt to new rules, even as they fight to reverse them, By Ben Wieder, January 12, 2012, Stateline.org: “It took nearly a year for Dale Kleinert to negotiate his first teachers’ contract. When Kleinert started his job as schools superintendent in Moscow, Idaho, the talks were already underway. Then, discussions reached an impasse. There were disagreements over pay and health care costs, and the pace slowed further when first an outside mediator and later a fact-finder didn’t render a decision. It wasn’t until May of 2011 that Kleinert and his union counterparts finally reached an agreement. Just before then, while Kleinert and the teachers were still stuck, Republican lawmakers in Boise were finishing work on plans to take away much of the leverage that Idaho teachers had long enjoyed in these kinds of negotiations. So for Kleinert’s next round of talks with Moscow’s teachers, which began pretty much right after the previous ones wrapped up, the rules were very different…”
• At last, a state budget year when the sky is not falling, By Daniel C. Vock, January 13, 2012, Stateline.org: “During the depths of the Great Recession, states had to do many unsavory things to balance their budgets. But few things left a more bitter taste than Arizona’s decision to sell off the office space of its state Capitol complex. It helped lawmakers close a gap in one year’s budget, even though it meant taxpayers would essentially have to pay rent on the property for the next two decades. Now, Arizona’s budget outlook is showing some improvement: For the first time since 2006, the state finished its last fiscal year with a surplus, which came as a surprise to state financial forecasters…”

Medicaid rolls in Colorado at “all-time historical high” in November, By Tim Hoover and Kristen Leigh Painter, January 5, 2012, Denver Post: “Nearly 615,000 Coloradans were on Medicaid in November, by far a record high, officials said Wednesday, attributing the vast bulk of the growth to economic hard times rather than recent eligibility expansions. ‘We’ve had a mushrooming of clients,’ Sue Birch, director of the state Department of Health Care Policy and Financing, told members of the legislature’s Joint Budget Committee. Birch said the 614,146 Coloradans enrolled in Medicaid in November represented a 57.7 percent increase over January 2007. ‘This is an all-time historical high,’ she said. Added to the 71,988 children and pregnant women covered under the state’s CHP+ program - a 42 percent increase over January 2007 - it means roughly 13 percent of all Coloradans are covered by state health-insurance programs. The spike hasn’t gone unnoticed in the benefits line…”

• State scales back Medicaid shortfall by $300 million, By Jason Stein, January 3, 2012, Milwaukee Journal Sentinel: “In a bit of good news for the state’s strained budget, Gov. Scott Walker’s administration is scaling back by more than $300 million the two-year shortfall projected for state health programs for the poor. But a state health department spokeswoman said that to ensure the state health programs remain affordable, the Walker administration will still seek to proceed with a half-billion dollars in proposed cuts affecting tens of thousands of recipients. In a letter to lawmakers Tuesday, the head of the Department of Health Services said that the shortfall through June 2013 is now expected to be $232 million in state and federal money, down from the $554 million that was projected in September. The change in the projections amounts to about 2% of the funding in the program, Health Services Secretary Dennis Smith wrote in a letter to members of the Joint Finance Committee…”
• Medicaid payment backlog cripples supportive living centers, By Dean Olsen, January 3, 2012, State Journal-Register: “Medicaid payment delays of up to six months are causing fits for supportive living centers throughout Illinois, and some owners are worried they may have to close if the situation doesn’t improve soon. ‘It’s a crisis for us because reserves and lines of credit are being exhausted,’ Wayne Smallwood, executive director of the Springfield-based Affordable Assisted Living Coalition, said last week. ‘This is the worst we’ve seen, and there’s no relief in sight.’ Illinois’ festering budget problems, the sagging economy and the end of the federal economic stimulus program in June have contributed to growing payment delays that also hamstring nursing homes, hospitals, doctors and other medical providers…”
• Nowhere to go, patients linger in hospitals, at a high cost, By Sam Roberts, January 2, 2012, New York Times: “Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing. As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost…”

State efforts put more children on health insurance rolls, despite economic downturn, By N.C. Aizenman, December 27, 2011, Washington Post: “Publicly funded programs have enabled 1.2 million more children to gain health insurance since 2008 - at least in part due to extra work by many states to ensure that more of the children who are eligible for the programs are actually signed up, Obama administration officials plan to announce Wednesday. Twenty-three states are to be awarded federal performance bonuses totaling nearly $300 million for these efforts. Maryland and Virginia have qualified for the two largest amounts - $28.3 million and $26.7 million, respectively - under an incentive plan aimed at improving child enrollment rates in Medicaid and the Children’s Health Insurance Program, or CHIP…”

State cuts to Medicaid reduce care for patients, force doctors to reconsider participation, By Shannon McCaffrey (AP), December 27, 2011, Chicago Tribune: “Just as Medicaid prepares for a vast expansion under the federal health care overhaul, the 47-year-old entitlement program for the poor is under increasing pressure as deficit-burdened states chip away at benefits and cut payments to doctors. Nearly every state has proposed or implemented a plan in its current budget to rein in costs, and many are considering additional cuts in the year ahead. For the tens of millions of poor and disabled who rely on the program - approaching nearly one in five Americans - the cuts translate into longer waits for doctors, restrictions on prescription drugs, a halt to vision and dental care, staff cuts at nursing homes and dwindling access to home health care…”

• Private contractors play increasing role in Medicaid, audit finds, By Jason Stein, December 20, 2011, Milwaukee Journal Sentinel: “As the state’s health programs for the poor have ballooned in recent years, the state relied increasingly on private contractors to run its health programs for the poor and completed fewer investigations into potential fraud, a new audit has found. The report released Tuesday by the Legislative Audit Bureau found that as of June there were at least three times as many contract workers working on Medicaid health programs as there were state workers. Over the past four years, payments to private vendors for Medicaid have nearly doubled, the audit found…”
• Utah’s budget debate: transportation and Medicaid, By Kirsten Stewart, December 19, 2011, Salt Lake Tribune: “Unveiling his budget for next year, Utah Gov. Gary Herbert last week bemoaned the growing share flowing to Medicaid. The health insurance program for low-income people consumes 17.6 percent of Utah’s budget, hurting the state’s ability to fund other priorities such as public schools, said Herbert, sounding a theme popular among conservatives. But advocates for the poor say the national strategy of pitting Medicaid against public schools doesn’t reflect reality in Utah. They point to another familiar budget boogeyman: transportation…”

Feds: Florida can continue 5-county Medicaid pilot, By Kelli Kennedy (AP), December 15, 2011, Miami Herald: “Federal officials on Thursday approved the expansion of a five-county Medicaid privatization pilot program that allows for-profit providers to determine the health care of recipients, but there’s no indication whether a statewide expansion will be allowed. The Centers for Medicare and Medicaid Services was insisting on new protections, more accountability and quality reporting, spokesman Alper Ozinal said…”

• 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…”

• Maine gov seeks Medicaid cuts to bridge budget gap, By Glenn Adams (AP), December 6, 2011, Boston Globe: “Saying Maine cannot afford one of the country’s most generous Medicaid programs over the long term, Gov. Paul LePage on Tuesday proposed tougher eligibility standards and other changes that would leave more than 60,000 people without coverage they are now receiving. In a news conference Tuesday, LePage said an analysis of state spending in current fiscal year, which ends in June, shows a shortfall of $120 million in Medicaid, known in the state as MaineCare. The shortfall for the 2012-13 fiscal year is an additional $101 million ‘that we know of,’ he said, creating a $221 million gap. The 361,000 people now on Medicaid ‘is pushing one-third of our population,’ said the Republican governor, while the national average is about 20 percent…”
• Medicaid, seniors’ tax break loom over Colorado’s next budget, By Tim Hoover, December 11, 2011, Denver Post: “Gov. John Hickenlooper helped end a standoff over the state budget between Democratic and Republican lawmakers in the last legislative session, but a fiscal fracas shaping up for 2012 may prove much harder to quell. That’s because this time the Democratic governor himself is squarely in the middle of it, recommending a 2012-13 budget that would suspend a property tax break for seniors that would cost the state $98.6 million. The Senior Homestead Exemption allows Coloradans 65 and older who have lived in their homes for at least 10 years to exempt 50 percent of the first $200,000 of the property value of their homes from taxes. But Republicans say they don’t want to delay the tax break for additional years. Instead, they say, Hickenlooper should be trying to seek a federal waiver to trim the cost of Medicaid, the state and federally funded health care program for the poor that takes nearly a third of the state’s general fund…”
• State Medicaid cuts concern clients, By JoAnne Young, December 10, 2011, Lincoln Journal Star: “Ron and Laura Trautman tried to have a baby for 10 years before Christopher and Adam were born May 17, 2007. One of the twins, Christopher, was born with multiple birth defects. His physical problems kept him in Omaha Children’s Hospital for 15 months. So far, he’s had 29 surgeries, with more to come. At 4, he still has a tracheostomy and eats through a gastrostomy button feeding device. He’s about three years behind in development. ‘With all the surgeries he’s had, we’re lucky to have him,’ his dad said. Medicaid helps the Waverly family with nursing care for Christopher so the parents can work and go to school…”

Feds OK some Medicaid changes, but thousands could lose coverage, By Patrick Marley and Jason Stein, December 9, 2011, Milwaukee Journal Sentinel: “Federal officials on Friday gave preliminary approval to some of Gov. Scott Walker’s proposed cuts to Wisconsin health-care programs for the poor but said they likely couldn’t decide on other cuts before the new year - an outcome that could force tens of thousands of people off BadgerCare Plus next year. On Nov. 10, the state asked President Barack Obama’s administration to sign off on spending cuts to Medicaid programs like BadgerCare Plus to relieve a $554 million deficit in state and federal money through June 2013. State lawmakers this summer gave the Walker administration broad authority to balance the health-care budget but said if the federal government didn’t approve the state’s plan by Dec. 31 the state must remove 53,000 childless adults from the program by July to save money…”

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…”

Drugs used for psychotics go to youths in foster care, By Benedict Carey, November 20, 2011, New York Times: “Foster children are being prescribed cocktails of powerful antipsychosis drugs just as frequently as some of the most mentally disabled youngsters on Medicaid, a new study suggests. The report, published Monday in the journal Pediatrics, is the first to investigate how often youngsters in foster care are given two antipsychotic drugs at once, the authors said. The drugs include Risperdal, Seroquel and Zyprexa - among other so-called major tranquilizers - which were developed for schizophrenia but are now used as all-purpose drugs for almost any psychiatric symptoms…”

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…”

Medicaid expansion seen covering nearly all state prisoners, By Christine Vestal, October 18, 2011, Stateline.org: “The federal health law’s controversial Medicaid expansion is expected to add billions to states’ already overburdened Medicaid budgets. But it also offers a rarely discussed cost-cutting opportunity for state corrections agencies. Starting in 2014, virtually all state prison inmates could be eligible for Medicaid coverage of hospital stays-at the expense of the federal government. In most states, Medicaid is not an option for prison inmates. But a little known federal rule allows coverage for Medicaid-eligible inmates who leave a prison and check into a private or community hospital. Technically, those who stay in the hospital for 24 hours or more are no longer considered prison inmates for the duration of their stay…”

• 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…”

FSSA hopes new hybrid system aids service, By Dorothy Schneider, October 16, 2011, Lafayette Journal and Courier: “Richard Graves has had his share of frustration in dealing with the local office for the Indiana Department of Families and Social Services Administration. He can recount tales of lost paperwork and unreturned phone calls, as he has worked to oversee his granddaughter’s Medicaid coverage. ‘I haven’t talked to the caseworker in two years,’ Graves said. Complaints about the state’s FSSA case management are nothing new, but Indiana officials are hoping they lessen as ongoing improvements to the application system are rolled out across the state…”

• 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…”

Ineligible Medicaid recipients cost Va. millions, By Jim Nolan, October 13, 2011, Richmond Times-Dispatch: “Errors by local Department of Social Services caseworkers in enrolling ineligible Medicaid recipients are responsible for the greatest number of improper payments in Virginia’s share of the program, according to an extensive review by the legislature’s watchdog agency. It found that the state’s administration of the Medicaid program is overly complex and not automated. It also needs investments in technology and greater oversight to guarantee it is not overpaying managed-care organizations for services. Errors in enrolling ineligible recipients could have cost the state somewhere between $18 million and $263 million in fiscal 2009, according to the report - requested by lawmakers in 2010 and presented Tuesday to lawmakers by the Joint Legislative Audit and Review Commission…”

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…”

• 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…”

• 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…”

• Legislators: State could save millions if prison officials seek Medicaid funding for inmates, By Sebastian Kitchen, September 19, 2011, Montgomery Advertiser: “Republican and Democratic lawmakers in Alabama, who have not agreed on much in recent months, are questioning why the state prison system is not seeking reimbursement for medical treatment of Medicaid-eligible prisoners — a change they believe could save the state millions during tough economic times. The prison commissioner in Mississippi, Christopher Epps, told the Montgomery Advertiser his state has saved $10 million through the program since implementing it in 2009 and that Mississippi has fewer inmates than Alabama. State legislators have pushed corrections officials and the administrations of Gov. Robert Bentley and former Gov. Bob Riley to adopt the program, in which a vendor qualifies eligible inmates for Medicaid reimbursements…”
• State delays implementation of Medicaid overhaul until Nov. 1, By Beth Musgrave, September 20, 2011, Lexington Herald-Leader: “After hearing concerns from Kentucky hospitals, the state announced this week that it will delay implementing an overhaul of the state’s Medicaid program until Nov. 1. The state announced in July that it was hiring three companies to manage care for 560,000 people on the health insurance program for the poor and disabled. The controversial move is expected to save the state $375 million over the next three years. Managed care was scheduled to begin Oct. 1 in Kentucky…”
• Feds give Utah’s Medicaid overhaul mixed reviews, By Kirsten Stewart, September 19, 2011, Salt Lake Tribune: “Utah’s plan for reforming Medicaid is getting mixed reviews from the Obama administration. Like many states, Utah is looking to redesign its Medicaid program to contain costs. A blueprint submitted in July for federal approval calls for moving Medicaid patients into managed care networks that would pay providers to keep patients healthy, instead of for more tests and treatment. The meat of the proposal - its payment reforms - has been well received, said Utah Medicaid Director Michael Hales. But officials with the Centers for Medicare and Medicaid Services (CMS) have indicated they don’t support a controversial provision that would impose higher co-payments and deductibles on pregnant women and children enrolled in the low-income insurance program…”

• Medicaid change delayed, By Dale Wetzel (AP), September 16, 2011, Jamestown Sun: “A chronically delayed new computer software system to handle North Dakota’s Medicaid bills, which was to be finished in nine months, will not be working until mid-2013, an executive told state legislators Thursday. The project was originally scheduled to be finished two years ago. Last summer, a vice president for the software’s developer, Affiliated Computer Services Inc., promised it would be functioning by June 2012. ACS is a unit of Xerox Corp…”
• Utah explores extending Medicaid to inmates, By Kirsten Stewart, September 15, 2011, Salt Lake Tribune: “Utah health officials are exploring expanding the state’s Medicaid program to cover inmates’ hospital stays and doctors’ office visits. Inmates have traditionally been barred from the state-federal health insurance program, which caters to the poor and disabled. Currently, the Department of Corrections contracts directly with the University of Utah’s hospital and clinics for procedures that cannot be handled at the prison infirmary, and the state picks up the tab. Moving inmates onto Medicaid would shift most of the funding burden onto the federal government, explained state Medicaid director Michael Hales on Thursday at an advisory board meeting. In the past, the U.S. Centers for Medicare and Medicaid Services has been loathe to shoulder what has long been a state obligation, said Hales. But the agency has recently signaled a willingness to bend the rules…”
• Calif. Medicaid expansion: A lifeline for ex-convicts, By Sarah Varney, September 13, 2011, National Public Radio: “California has embarked on an ambitious expansion of its Medicaid program, three years ahead of the federal expansion that the health law requires in 2014. At least half a million people are expected to gain coverage - mostly poor adults who never qualified under the old rules because they didn’t have kids at home. Among those who stand to benefit right now are ex-offenders. Inmates often leave California prisons with no consistent place to get medical care. But that’s changing…”

• Reduced state dental benefits create dire situation for patients, By Anna Gorman, September 12, 2011, Los Angeles Times: “Little surprises Nagaraj Murthy, a dentist in Compton for the past 32 years. He has seen patients who have suffered toothaches for years. Others who haven’t been to the dentist in a decade. Some who can’t chew hard food. But in the two years since California sharply reduced dental benefits for roughly 3 million Medi-Cal recipients, he and other dentists say the situation has become dire for patients who are waiting until their infections land them in an emergency room or their rotted teeth have to be immediately pulled…”
• Lower-income Northern Virginians struggle to get dental care, report finds, By Lena H. Sun, September 7, 2011, Washington Post: “In Northern Virginia, 16 percent of lower-income adults have not gone to a dentist in more than five years, according to a report that looks at disparities in oral health in one of the most prosperous regions in the country. Among lower-income adults who have health coverage, only one-fourth have coverage that includes dental care, compared to 64 percent for higher-income adults. Those were among the key findings in a survey of oral health in Northern Virginia released Thursday. The survey was commissioned by the Northern Virginia Health Foundation, a nonprofit group that focuses on health-care safety nets…”

• 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…”