MHA Press Room

CMS issues Medicaid/CHIP reports on children’s health care quality

The Centers for Medicare & Medicaid Services on Dec. 19 released its annual report summarizing state and national information on health care quality for children in the Medicaid and Children’s Health Insurance Program (CHIP). Required by the CHIP Reauthorization Act of 2009, the report provides information on state Medicaid/CHIP quality reporting as well as CMS quality initiatives.

CMS also issued a separate report describing efforts by the agency and state Medicaid programs to improve maternal and infant health outcomes by reducing early elective deliveries without a medical reason.

Mississippi has 559,653 children enrolled in Medicaid and CHIP.

New Brief Examines Coverage of Preventive Services for Adults in Medicaid

A new brief from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) highlights data from a new survey of coverage of 42 recommended preventive services for adults in Medicaid fee-for-service programs as of October 2010. Medicaid programs must cover preventive services for children as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, but generally are not required to cover such services for adults.

The Affordable Care Act (ACA) provides states the opportunity to earn a one percentage point increase in their federal matching rate starting January 1, 2013, if they cover recommended immunizations and preventive services without charging beneficiaries cost-sharing for these services. The survey, fielded by KCMU and Health Management Associates, found that preventive services were generally well-covered by state Medicaid programs in 2010.

While there was some variation in which services were covered, each preventive service was covered by at least half if not two-thirds of states.

Forum on Medicaid expansion, previously closed to press, now open

The Association of Health Care Journalists worked with the Obama administration to resolve questions about whether reporters can dial in to an open door forum today about the Medicaid expansion. Originally, the administration’s notice said that the event was open to stakeholders and other interested parties, but was closed to the press. That runs counter to the administration’s policy about such events.

HHS and CMS have now confirmed to us that reporters can indeed call in to listen to the forum (details are availabe from AHCJ here).

Study: Most ED visits by Medicaid patients are for serious symptoms

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a study released July 11 by the Center for Studying Health System Change. Based on data from the 2008 National Hospital Ambulatory Medical Care Survey, the study found that about 10% of ED visits by Medicaid patients under age 65 are for non-urgent symptoms, compared with about 7% for privately insured nonelderly people.

Just over half of Medicaid and private insurance visits were categorized as emergent (needing immediate attention) or urgent (needing attention within an hour). Nonelderly Medicaid patients do use EDs at higher rates than nonelderly privately insured patients, but most of the higher use is for symptoms that need prompt medical attention, the authors said.

Dual eligibles account for varying share of Medicaid enrollees by state

The proportion of state Medicaid beneficiaries who are also enrolled in Medicare varies from a low of 10% in Arizona and Utah to 26% in Maine, according to a new report by the Kaiser Commission on Medicaid and the Uninsured.

“These variations reflect a state’s demographic profile as well as state policy choices in Medicaid eligibility and coverage,” the report notes. “In general, states in the East – which tend to have older overall populations – have a higher share of Medicaid enrollees who are dual eligibles than those in the Midwest and West. However, states with a relatively low share of Medicaid enrollees who are duals (such as California and Illinois) may have a much higher number of dual eligibles enrolled in Medicaid than states with a higher share, since these states have larger overall populations.”

Mississippi is one of the 19 states with the highest percentage of dual eligibles (18% and over). According to the report, 26 states are developing proposals for a federal demonstration to integrate Medicare and Medicaid services and financing for dual eligibles.

Minorities would be hard hit by Medicaid cuts, study warns

Blacks and Latinos would be among those hardest hit if Medicaid funding were cut as part of a deficit-reduction package, according to a new report released Oct. 14 by Families USA, the National Association for the Advancement of Colored People and the National Council of La Raza, among others. In these communities, more than one in four people rely on Medicaid, the shared federal-state health program for the poor, compared with fewer than one in eight whites.

GAO reports on access to physician care for children in Medicaid, CHIP

Eighty-four percent of physicians in the Medicaid and Children’s Health Insurance Program report difficulty referring enrolled children to specialty care, according to a study released by the Government Accountability Office. Cited reasons include a short supply or long waiting list for specialists, specialists not accepting or limiting Medicaid and CHIP enrollees, low reimbursement rates and administrative issues associated with the programs, GAO said.

The findings are based on a national survey of physicians by GAO in 2010, which found 83% of primary care physicians and 71% of specialty physicians are enrolled as Medicaid and CHIP providers and serve children in those programs. According to GAO, the Department of Health and Human Services stated in comments that the report will be of value as the Centers for Medicare & Medicaid Services works with states to ensure beneficiary access to care.

The CHIP Reauthorization Act of 2009 required GAO to study children's access to care under Medicaid and CHIP.

New report highlights impact of Commitment to American Prosperity (CAP) Act

All eyes in Washington are on the approaching Aug. 2 deadline for raising the debt ceiling. Failure to do so would push the U.S. into default on its existing financial obligations, which experts claim would have a catastrophic effect on our economy.

Vice President Joe Biden has been leading talks with leaders from both parties to try to hammer out an agreement that would increase the debt limit while taking significant steps to reduce the deficit through spending cuts and/or tax increases. While specifics have not yet emerged, reductions to Medicare and Medicaid, which comprise more than 20 percent of all federal spending, remain on the table. Given that, on average, the programs account for around 55 percent of hospital revenues, any agreement almost certainly will have significant implications for the hospital field.

Many of the proposals in the mix call for across-the-board spending cuts based on arbitrary caps or targets. The American Hospital Association, AARP, American Medical Association, American College of Cardiology and LeadingAge sought to understand the real-world impact such across-the-board spending cuts in federal programs could have on some of our nation's most vulnerable, including the elderly, children and low-income families.

The groups released a study detailing the potential impact of one such proposal, the Commitment to American Prosperity (CAP) Act. This bill would limit federal spending to about 20.8 percent of Gross Domestic Product and automatically cut spending across all federal programs in any year where spending is projected to exceed the spending cap.

The study, conducted by The Lewin Group, found that under the proposal by 2021:

• 5.1 million individuals would lose their health insurance
• Cuts to hospitals would force most hospitals to operate in the red, jeopardizing access to care
• Dramatic reductions in fees for physician services could lead to fewer physicians participating in Medicare
• Up to 1.3 million health care workers could lose their jobs
• Social Security benefits would be cut by nearly 20 percent
• Cuts to Social Security and other income support programs would force 3.8 million people into poverty - 2.1 million of them seniors, a 45 percent increase
• Cost shifting of federal payment shortfalls to private employers could lead to a nearly 5 percent increase in health insurance premiums

While the CAP Act may not be the final approach brought to a vote, similar consequences could result from any across-the-board measure that sets specific limits on spending.

To read the study, click here.

Explaining Health Reform: The New Rules for Determining Income Under Medicaid in 2014

A new issue brief from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) explains the new rules governing the way that states determine eligibility for Medicaid and CHIP under health reform, and specifically the changes in how income and household size are defined in order to determine eligibility for those programs as well as for the exchange premium credits. The brief also describes the differences between the new rules and the current income counting rules used in Medicaid and CHIP.

The issue brief is available online.

Families USA report assesses impact of proposed Medicaid cuts on Mississippi

Some policy makers at the state and federal levels, seeking to close budget gaps, are looking to cut Medicaid, the state and federally funded program that provides health coverage to many low-income people. At the federal level, there is talk of making significant cuts to Medicaid, as well as of changing Medicaid into a block grant or capped program, with significantly reduced funding, which would also result in cuts to eligibility and to services that are covered by Medicaid.

States are considering direct cuts to Medicaid services. They are also requesting relief from the Medicaid maintenance of effort (MOE) requirement in the health care law, the Affordable Care Act. Read the Families USA report on how this will affect Mississippi.