Medically Fragile Kids In California To Stay In Current Program, For Now, As State Postpones Managed Care Move
Meanwhile, 12 states participating in a test program are evaluating its success for managing the costs and care for Americans who are eligible for both Medicaid and Medicare.
Kaiser Health News:
California Passes Bill Delaying Transfer Of Fragile Kids Into Managed Care
California legislators passed a bill postponing a controversial plan that would have shifted tens of thousands of medically fragile children into Medi-Cal managed care plans. ... At issue was the fate of the California Children’s Services program, which serves an estimated 180,000 children younger than 21 with serious medical conditions, including spina bifida, cancer, cystic fibrosis and sickle cell disease. (Ostrov, 9/7)
Modern Healthcare:
Some States Iffy On Extending 'Duals' Demo
This summer the Obama administration conceded it would need more time than expected to evaluate a large-scale test to better manage benefits and care for low-income and disabled Americans. The states participating in the initiative appear willing to stick with it, although two big ones expressed significant reservations. Twelve states have rolled out three-year demonstrations under the Affordable Care Act to better coordinate health benefits provided to Americans who are eligible for both Medicare and Medicaid, and as a result, currently receive splintered care at extremely high costs to both programs. (Dickson, 9/7)
State Medicaid and children's health program news also comes from Florida, Iowa, Idaho, Kansas and South Carolina -
Tampa Bay Times:
Doctors Say Children's Health Suffers As Medicaid Lawsuit Lingers
Dr. Marcy Howard, a pediatrician with a small practice in rural Citrus County, felt a sense of relief in December when a federal judge ruled Florida's Medicaid program was shortchanging needy children. ... But eight months later, the high-profile case is once again tied up in court. U.S. Circuit Court Judge Adalberto Jordan has yet to issue a final judgment mandating changes to the Florida health insurance program that covers thousands of poor and disabled children. Meanwhile, Howard and other pediatricians say the problems have gotten worse. (McGrory, 9/5)
Des Moines Register:
Iowa To Medicaid Losers: Complaints Based On Hearsay
Iowa has rejected three requests that it reconsider its selection of companies that will privately manage the state’s $4.2 billion annual Medicaid system, setting the stage for possible and multiple lengthy legal battles. Three corporations allege in documents filed last month that nepotism and biases among members of the review committee contributed to the selection of the four winning bidders. ... Iowa Department of Human Services Director Chuck Palmer this week sent letters to the companies that reject the requests. Palmer’s reasoning was direct, criticizing some of the companies for the introduction of “multiple layers of hearsay” and for offering no evidence for some of the allegations. (Clayworth, 9/6)
The Des Moines Register:
Companies Seeking Iowa Medicaid Contracts Kept Bid Details Secret
Hundreds of pages were initially redacted or missing from bid documents made public last week in which private companies competing to run Iowa's $4.2 billion Medicaid program detailed their proposals and why they deserved the lucrative state contracts, a Des Moines Register investigation has found. The magnitude of the information blacked-out or omitted from the proposals made it impossible to directly compare the bids or evaluate the companies' claims of services they would provide 560,000 of Iowa's most vulnerable residents. (Clayworth, 9/7)
Idaho Statesman:
Idaho Medicaid Keeps Paying Fraudulent Providers
Idaho paid six providers about $820,000 in Medicaid payments after those providers had been cut off from other states’ Medicaid programs for reasons including “fraud, integrity or quality,” according to a federal report. ... Idaho wasn’t alone. Its payments made up a fraction of the millions of dollars paid out nationally to disqualified providers. (Dutton, 9/6)
The Kansas Health Institute News Service:
KDADS Investigates Waiting List Discrepancy
The Kansas Department for Aging and Disability Services is reviewing a waiting list for developmental disability services after counties reported discrepancies between how many residents they have waiting and how many are on the state’s list. There are more than 3,000 Kansans with intellectual and developmental disabilities (I/DD) on the KDADS waiting list for Medicaid-covered support services meant to allow them to remain in their homes and communities rather than live in institutions. (Marso, 9/4)
The Associated Press:
State Medicaid Agency Reviewing Potential Fraud By Providers
South Carolina's Medicaid agency is reviewing dozens of private providers for possible fraud after payments for certain behavioral health services skyrocketed. The agency says it has referred seven cases so far to the attorney general's office for potential prosecution. A review of records suggests providers over-billed on hours, billed for services not given and provided unnecessary services. (Adcox, 9/4)
