Kaiser Daily Health Policy Report Highlights State Medicaid Developments
Four newspapers recently published articles about Medicaid developments in South Dakota; Utah; Washington, D.C.; and West Virginia. Summaries of the coverage appear below.
- South Dakota: A decision by the South Dakota Legislature to grant a 3% inflation increase in reimbursement rates to hospitals and nursing homes contradicts a state Department of Social Services payment plan submitted to CMS that is based on the consumer price index, the Sioux Falls Argus Leader reports. "The state is trying to pay these providers more than [the consumer price index] is allowing," state Rep. Deb Peters (R) said. The Legislature has "been out of compliance for several years ... on legislative audit findings," Secretary Deb Bowman said. DSS has submitted an amendment to CMS to clarify the 3% increase, according to Larry Iversen, assistant administrator of the Office of Medicaid Services in DSS (Woster, Sioux Falls Argus Leader, 7/23).
- Utah: Pharmaceutical costs are the fastest-growing expenditure of Utah's Medicaid program, according to pharmaceutical industry experts and representatives from the state Department of Health, the Salt Lake City Deseret Morning News reports. In a meeting on Friday with state lawmakers, the group also discussed the potential impact of the 2005 Deficit Reduction Act, which will change the Medicaid reimbursement rate formula for pharmacies. Reid Barker, executive director of the Utah Pharmacists Association, said that the change in policy, which will take effect in October, might result in a low reimbursement rate for several pharmacies in the state, causing some pharmacies to close. Barker and others suggested that the state increase the dispensing fee paid to pharmacies to limit the effect of the federal law (Marshall, Salt Lake City Deseret Morning News, 7/23).
- Washington, D.C.: Virginia-based Maximus on Monday agreed to pay $30.5 million to end a Department of Justice investigation into whether the company falsified tens of millions of dollars in Medicaid claims while working for the district government, the Washington Times reports. Maximus, one of the country's largest government consulting companies, was hired to help the district recoup Medicaid funds for services provided to children within the D.C. Child and Family Services Agency. DOJ began investigating the firm after former company manager Benjamin Turner filed a False Claims Act lawsuit, alleging that the company "created billing documents" when city documents were missing or incomplete. Jeffrey Taylor, U.S. attorney for the district, said Maximus admitted its responsibility for causing "Medicaid dollars to be spent for undocumented services that likely were never provided to some of the neediest residents" in the district (McElhatton, Washington Times, 7/24).
- West Virginia: Few eligible West Virginia residents have enrolled in a state Medicaid program that operates in three counties and is designed to encourage healthy lifestyles, the AP/Idaho Statesman reports. Under the program, called Mountain Health Choices, beneficiaries are eligible to receive enhanced benefits in exchange for signing contracts that pledge healthy behavior, such as regular physician visits and use of necessary medications. The program offers options to help beneficiaries maintain a healthy lifestyle through weight management, cardiac rehabilitation and nutritional education programs. The goal of the program is to improve state residents' overall health and reduce the long-term costs of Medicaid. According to the state Medicaid agency, out of 2,236 eligible residents, 64 adults and 216 children have enrolled in the program from February to July 18. State Medicaid spokesperson Shannon Riley said that as more beneficiaries learn about the program, the number of residents enrolled likely will increase (Breen, AP/Idaho Statesman, 7/21).