Medicaid

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There’s a growing problem with Medicare prescription drug coverage for seniors who take high-priced specialty drugs: there’s no cap on how much they pay.

As The Denver Post reports, each prescription drug plan is structured a little differently, but people with very high drug costs almost inevitably enter what’s called the “catastrophic” phase of coverage. Then, they pay 5 percent of the list price of their drug, which is no small sum in an age of $10,000-a-month cancer drugs

President Trump has pledged to not make cuts to Medicare, the federal insurance program for seniors, but Seema Verma, administrator of the Centers for Medicare and Medicaid, acknowledges that changes are needed.

One of the program’s main funds, the Hospital Insurance Trust Fund, is expected to be depleted in 11 years.

On Monday, Verma was in Olathe, Kansas to talk with seniors about Medicare and encourage them to take part in Medicare open enrollment, which runs from October 15 through December 7.

State Medicaid officials on Friday formally started the process of renewing KanCare, the privatized Medicaid program launched by Republican Gov. Sam Brownback in 2013.

The two state agencies that oversee the private contractors that manage the program released a draft of the plan they intend to submit for federal approval after a public comment period that runs through November.

The federal agency that oversees Medicaid has agreed to a one-year extension of Kansas’ $3.2 billion KanCare program, which provides managed care services to the state’s Medicaid population.

The overhaul of the Kansas computer system for processing welfare and Medicaid applications recently went through its final implementation phase. State officials say the process went smoothly, especially compared to the system's initial rollout that delayed thousands of Medicaid applications.

$1.25 million.

That’s the size of the bill that could have shuttered the only public hospital in rural Pemiscot County, Missouri in August 2013.

$750,000 for payroll. $500,000 for a bond payment. $1.25 million total. One August day in 2013, the hospital’s CEO Kerry Noble had to face facts: The money just wasn’t there. It took an emergency bailout from a local bank to keep their doors open. For now.

Low-income Kansans are less likely to have health insurance than their counterparts in other states, according to an analysis of new data from the U.S. Census Bureau.

The health care plan unveiled last month by the Republican-controlled U.S. Senate met with fierce opposition from hospital, doctor and patient advocacy groups. Among them was the National Rural Health Association, which is based in Leawood, Kansas, and represents doctors, nurses and hospitals in rural areas nationwide. 

Three weeks after Blue Cross and Blue Shield of Kansas City said it will pull out of the Affordable Care Act exchange in 2018, Centene Corp. says it plans to offer coverage through the exchange in Missouri and Kansas.

The St. Louis-based insurer already has a presence in both states administering Medicaid plans, but the move to sell individual and small group health plans is new.

A bill to replace funding for Medicaid and the Kansas mental health system lost to budget-balancing cuts last year is headed to Gov. Sam Brownback.

Senate substitute for House Bill 2079 would increase a fee that health maintenance organizations, or HMOs, pay to do business in Kansas from 3.31 percent to 5.77 percent. HMOs are a type of health insurance that typically has lower premiums but only covers care within a network of doctors and hospitals. 

Another poll has found strong majorities of Kansans support expanding Medicaid, but some political experts say it isn’t likely to make a difference this legislative session.

The latest Medicaid expansion poll found about 68 percent of Kansans surveyed said they supported expanding the program to non-disabled adults who earn up to 138 percent of the federal poverty line, or annual income of about $16,600 for an individual and $33,400 for a family of four. About 60 percent of Republicans polled said they also supported expansion.

A third of the way to an end-of-year deadline, Kansas officials still do not have federal approval to extend KanCare.

In January, the federal Centers for Medicare and Medicaid Services denied the state’s request for a one-year extension of the waiver that allowed it to privatize its Medicaid program. The denial letter said neither the Kansas Department of Health and Environment nor the Kansas Department for Aging and Disability Services was doing enough to hold the three private companies that run the program responsible for providing services accountable to Medicaid rules.

Editor’s note: This story was updated at 11:20 a.m. Tuesday, March 28.

Buoyed by the failure of Republicans in Congress to repeal the Affordable Care Act, the Kansas Senate on Tuesday gave final approval to a Medicaid expansion bill in a 25-14 bipartisan vote.

The Senate vote sends the bill to Republican Gov. Sam Brownback, whose spokeswoman reaffirmed his opposition to expansion in tweets during nearly three hours of Senate debate Monday but did not say whether he would veto it.

Kansas lawmakers are now a step away from what could be a showdown with Republican Gov. Sam Brownback on the political football issue of Medicaid expansion.

KCUR

A bill that would have expanded Medicaid in Kansas was tabled Monday by the House Health and Human Services Committee.

As The Wichita Eagle reports, the action effectively ends chances that the bill will be passed this session under legislative deadlines.

Feds reject Kansas' request to extend KanCare

Jan 23, 2017
KanCare.ks.gov

Federal officials have rejected Kansas’ request to extend KanCare, the state’s privatized Medicaid program, saying it has failed to meet federal standards and risked the health and safety of enrollees.

As reported by The Wichita Eagle, federal investigators reviewed the state’s Medicaid plan in October and found that Kansas is “substantively out of compliance with Federal statutes and regulations, as well as its Medicaid State Plan,” according to a letter sent to the state Jan. 13 from the Centers for Medicare and Medicaid Services (CMS).

AP PHOTO

In his State of the State address Thursday, Colorado Gov. John Hickenlooper proposed boosting rural access to high-speed Internet.

To boost economic development in rural areas, one of the governor’s proposals is to create an office focused on expanding broadband Internet access to the 30 percent or so rural households in the state that don’t have it, with an overall goal of ensuring that 100 percent of rural houses have it by 2020.

According to a recent study, Obamacare’s expansion of Medicaid coverage to people living just above the poverty line may be responsible for more disabled people getting jobs.

As Reuters Health reports, prior to passage of the Patient Protection and Affordable Care Act (ACA), Obamacare, in 2010, people with disabilities and low income jobs were often unable to afford their expensive medical care. Many opted for unemployment in order to qualify for Medicaid coverage.

Kansas Medicaid backlog is growing once again

Dec 20, 2016
Health by Got Credit / Flickr Creative Commons

Delays in processing Medicaid applications in Kansas have put financial strain on nursing homes and threatened coverage for thousands of Kansans and the backlog is on its way back up.

KCUR

 Gov. Sam Brownback cut Medicaid reimbursements by 4 percent earlier this year, as part of budget cuts aimed at covering the revenue shortfall in Kansas, and legislators see restoration of that cut as a top priority going into the next session.

Shefali Luthra / Kaiser Health News

If you’re a low-income Texas woman, the state might now pay for you to have an IUD put in, reports The Texas Tribune.

Todd Wiseman / Texas Tribune

Last year, Texas announced that it would slash $350 million in Medicaid benefits to disabled children. In response, a group of concerned Texans filed a lawsuit seeking to block the cuts. But this week, The Texas Tribune reports, the Texas Supreme Court allowed the cuts to move forward.

The money was going toward speech, physical and occupational therapy providers and the families of children who receive those services.

Public Domain

A backlog in Medicaid applications is costing Kansas more than two million dollars a year, reports The Lawrence Journal-World.

According to a recent state audit, the massive number of unprocessed first-time applications is weighing on the state budget. The audit also discovered that the state has stopped reviewing renewal applications for now.

NewsOK.com

Oklahoma’s state Medicaid director has resigned, reports NewsOK.com.

Nico Gomez announced his exit on Monday in a letter to the Oklahoma Health Care Authority board. The news comes after Gomez spent 20 years in public service, including 16 years at the Health Care Authority.

Hewlett Packard Enterprises

Kansas has signed a deal to upgrade the Medicaid computer system that tracks patient claims and payments to providers.

As member station KCUR reports, Hewlett Packard Enterprises has entered into a $215 million contract with the state to provide the system.

Texas Tribune

Last year advocates for the disabled in Texas became enraged when the state legislature instituted sweeping budget cuts to a state-funded children’s therapy program. Last week those advocates received some good news, reports KVUE.

On Friday the Texas Supreme Court delivered a temporary, last-minute victory to families of children with disabilities. The cuts were scheduled to take effect July 15, but the Supreme Court’s order will delay those cuts.

Stephen Koranda / Kansas Public Radio

From the Kansas Health Institute:

Kansas officials have borrowed a record $900 million from the state’s investment fund but still may need to implement a series of emergency measures to end the 2016 budget year in the black.

Flickr Creative Commons

Last week HPPR reported on Texas’s plan to slash $350 million in funding for pediatric therapy services for children with disabilities. The idea was proposed by GOP lawmakers as a way to cut spending in the state. Now Democrats in the Texas House of Representatives have asked the federal government to step in and stop the cuts, reports The Texas Tribune

Health by Got Credit / Flickr Creative Commons

From the Kansas Health Institute:

Accenture faces $750,000 fine for incorrect reporting of application backlog.

News of a mistake that dropped several thousand Kansans from state Medicaid backlog reports has advocates and Democratic lawmakers questioning the state’s oversight of the contractor blamed for the error.

v1ctor / Flickr Creative Commons

From the Kansas Health Institute:

A broad proposal by Medicare to change the way it pays for some drugs has drawn intense reaction and lobbying, with much of the debate centering on whether the plan gives too much power over drug prices to government regulators.

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