The Trump administration announced Thursday it would allow states to impose work requirements on “able-bodied” adults who receive Medicaid. In New Mexico, it’s not clear if the Martinez administration will pursue such requirements, but if so, it would likely take months to go through the process. “Medicaid needs to be more flexible so that states can best address the needs of this population,” Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said in a statement. That center is part of the U.S. Department of Health and Human Services. “Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction.”
States would need to do so through a specific waiver with CMS.
New Mexico has been stopped from imposing such requirements in other programs. In 2016, a federal judge stopped the state from requiring people to work who receive Supplemental Nutrition Assistance Program (SNAP) benefits because of a long-running federal lawsuit over the state’s inability to process aid.
Last week, Colorado became the first state to notify families that children who receive health insurance through the Children’s Health Insurance Program are in danger of losing their coverage. Nearly 9 million children are insured through CHIP, which covers mostly working-class families. The program has bipartisan support in both the House and Senate, but Congress let federal funding for CHIP expire in September. The National Governors Association weighed in Wednesday, urging Congress to reauthorize the program this year because states are starting to run out of money. In Virginia, Linda Nablo, an official with the Department of Medical Assistance Services, is drafting a letter for parents of the 66,000 Virginia children enrolled in CHIP.
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.
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.
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.
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.
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.
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.
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.[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The state’s best political coverage. [/perfectpullquote]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.
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.