Medicaid expansion takes a bite out of medical debt

As the Trump administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger. On Nov. 7, Maine voters approved a ballot measure to expand Medicaid under the Affordable Care Act. Advocates are looking to follow suit with ballot measures in Utah, Missouri and Idaho in 2018. Virginia may also have another go at expansion after the Legislature thwarted Gov. Terry McAuliffe’s attempt to expand Medicaid.

Medicaid chief suggests feds are willing now to approve work requirements

The Trump administration signaled Tuesday that it would allow states to impose work requirements on some adult Medicaid enrollees, a long-sought goal for conservatives that is strongly opposed by Democrats and advocates for the poor. Such a decision would be a major departure from federal policy. President Barack Obama’s administration ruled repeatedly that work requirements were inconsistent with Medicaid’s mission of providing medical assistance to low-income people. The announcement came from Seema Verma, the head of the Centers for Medicare & Medicaid Services (CMS), who was scheduled to address the nation’s state Medicaid directors Tuesday. A press release issued in advance of the speech said allowing states to have work requirements is part of her plan to help give states more flexibility.

AG announces $18.5 million settlement in taxes owed by Presbyterian

The state of New Mexico and Presbyterian Healthcare Services agreed on a settlement to recoup millions in previously-unpaid Medicaid premium taxes. Attorney General Hector Balderas announced Monday his office came to the agreement with the healthcare company to repay $18.5 million to the state.  “I appreciate Presbyterian’s willingness to do the right thing and pay what they owe through this speedy resolution,” Balderas said. “Given the corporation’s ambitious future plans, I am optimistic Presbyterian won’t repeat its past missteps. However, I will continue to monitor Presbyterian’s compliance with the findings contained in the Examination Resources audit.”

His office said the $18.5 million settlement came as part of an agreement to pay back the $14.6 million in unpaid premium taxes.

Last-ditch effort by Republicans to replace ACA: 5 things you need to know

Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again. While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.)

They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.

Another thing disappearing from rural America: Maternal care

Maternity care is disappearing from America’s rural counties, and for the 28 million women of reproductive age living in those areas, pregnancy and childbirth are becoming more complicated — and more dangerous. That’s the upshot of a new report from the Rural Health Research Center at the University of Minnesota that examined obstetric services in the nation’s 1,984 rural counties over a 10-year period. In 2004, 45 percent of rural counties had no hospitals with obstetric services; by 2014, that figure had jumped to 54 percent. The decline was greatest in heavily black counties and in states with the strictest eligibility rules for Medicaid. The decrease in services has enormous implications for women and families, says Katy B. Kozhimannil, an associate professor in health policy who directs the Minnesota center’s research efforts.

Even without Congress, Trump can still cut Medicaid enrollment

 

After the Senate fell short in its effort to repeal the Affordable Care Act, the Trump administration is poised to use its regulatory powers to accomplish what lawmakers could not: shrink Medicaid. President Donald Trump’s top health officials could engineer lower enrollment in the state-federal health insurance program by approving applications from several GOP-controlled states eager to control fast-rising Medicaid budgets. Indiana, Arkansas, Kentucky, Arizona and Wisconsin are seeking the administration’s permission to require adult enrollees to work, submit to drug testing and demand that some of their poorest recipients pay monthly premiums or get barred from the program. Maine plans to apply Tuesday. Other states would likely follow if the first ones get the go-ahead.

AG sues Presbyterian over millions in alleged unpaid taxes

New Mexico’s Attorney General says one of the state’s largest healthcare providers committed fraud by deliberately underpaying taxes for over a decade by falsifying Medicaid deductions and credits. Attorney General Hector Balderas filed the claim in state court in Santa Fe Tuesday, alleging that Presbyterian Health Plan, Inc. and Presbyterian Healthcare Services filed claims for tax deductions and credits related to Medicaid for above what the company qualified for between 2001 and 2015.The suit refers to Presbyterian’s actions as “systemic and deliberate.”

“When insurance providers break the rules, they must face consequences,” Balderas said in a statement released by his office. “My office is working with the State Auditor to make sure that Presbyterian—and any other companies that engaged in similar fraudulent conduct—are held responsible for the serious injuries imposed on New Mexican taxpayers.”

Meanwhile, a separate audit of premium tax collections continues, State Auditor Tim Keller said in a statement. In a statement to NM Political Report, a spokeswoman said Presbyterian is “confident that we have acted in good faith and with the intent to comply with our legal obligations and responsibilities” and said the company “vehemently reject[s] the allegations made today and we look forward to a positive resolution to this matter.”

“We are genuinely alarmed and surprised by the timing and nature of these allegations,” the emailed statement from Communications Manager Melanie Mozes said. “The premium taxes paid by Presbyterian Health Plan have been audited multiple times by independent firms and state agencies.

The slow-motion unraveling of New Mexico’s Medicaid crackdown

There’s no getting around it. Four years after Gov. Susana Martinez’s administration charged 15 behavioral health organizations with potentially defrauding the state’s Medicaid program, its case has experienced a slow-motion unraveling. No Medicaid fraud was ever found. And those eye-popping estimates that added up to $36 million the organizations had overbilled Medicaid? In the summer of 2017, the Human Services Department (HSD) is seeking drastically lower reimbursements for overbilling the public health insurance program for low-income residents, a review of public records and state court documents has found.

Special master: HSD staff shakeup needed to address SNAP problems

LAS CRUCES—A year-old scandal involving alleged systemic fraud with the state’s management of federal food aid benefits was the elephant in the federal courtroom Thursday. Both Kenneth Gonzales, a federal district judge, and Lawrence Parker, a court-appointed “special master” who is tasked with guiding the New Mexico Human Service Department (HSD) in its federal compliance with Medicaid and Supplemental Nutrition Assistance Program benefits, alluded to the scandal at the hearing. “What nobody wants to see, and you especially, is a culture that allows this to happen,” Gonzales told HSD Secretary Brent Earnest. Parker emphasized that “many of those same people” who were alleged in 2016 to have instructed HSD employees to falsify SNAP applications to meet federal quotas “are still in place” at the department.Parker raised the question of why the department’s management has largely remained the same since the shocking allegations of fraud came to light last year. More than once, Parker recommended a staff shakeup.

State makes ‘shockingly little progress’ in mending SNAP scandal

More than one year after three top state officials refused to answer questions in federal court about fraud allegations and nine months after a federal judge held their cabinet secretary in contempt of court, the state Human Services Department (HSD) appears to still be seriously mishandling how it processes federal benefits to New Mexico’s poor. This includes an apparent department directive instructing caseworkers to limit interviews with those enrolled in and seeking federal benefits and lie to their superiors about it. Now, the advocacy organization representing plaintiffs in a decades-long lawsuit against HSD is asking a judge to impose monetary sanctions on HSD and its secretary, Brent Earnest. The call for sanctions comes over the department’s alleged failures to meet federal guidelines on processing Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits. Update: Special master: HSD staff shakeup needed to address SNAP problems

Medicaid is the federal health care program for the poor while SNAP, formerly known as food stamps, provides federal food aid to the poor.