More Women Than Men Are Insured, Thanks To Medicaid Pregnancy Care
But Axios notes that the coverage can be short-lived, since Medicaid coverage ends after 60 days postpartum. Other news is on Medicaid expansion in North Carolina, the quality of Medicaid Advantage plans, the Medicare Physician Fee Schedule and more.
Axios:
More Women Have Health Insurance Than Men Due To Medicaid
Fewer women are uninsured (10.5%) nationally than men (13.4%), due in large part to Medicaid providing pregnancy coverage for low-income women. 16.1% of women are on Medicaid, compared with 12.7% of men, according to census data analyzed by the Kaiser Family Foundation. Large swaths of the South still have restrictive Medicaid coverage or didn't expand Medicaid under the Affordable Care Act, leaving 1 in 5 women without insurance in states like Oklahoma and Texas. (Herman, 10/9)
In updates on Medicaid expansion in North Carolina —
North Carolina Health News:
Six Republican Counties Support Medicaid Expansion. What’s Changed?
Nearly an hour into the August meeting of Macon County’s board of commissioners, Casey Cooper approached the podium. Cooper is the CEO of the Cherokee Indian Hospital. In addition to running the hospital, Cooper serves on a handful of different boards and has three kids — in other words, he’s busy. “In the interest of efficiency, I will just jump right to the punchline,” he began. “It’s my hope that at the conclusion of this presentation tonight that you will feel compelled to support a resolution to help close the coverage gap in North Carolina.” (Donnelly-DeRoven, 10/11)
In news about Medicare Advantage —
Axios:
90% Of Medicare Advantage Enrollees Enrolled In Highest-Quality Plans
Nine out of 10 Medicare Advantage members are enrolled in plans that earned the government's highest quality marks for 2022, according to new federal data. Health insurers were quick to tout the quality scores in press releases. But the federal government went easy on the grades during the pandemic, and experts have long considered MA's quality system to be "flawed and inconsistent." (Herman, 10/11)
Modern Healthcare:
Medicare Advantage Star Ratings Increase As Consumer Options Grow
Nearly four times as many Medicare Advantage plans scored the highest quality rating possible for 2022 as compared with the year before, according to data released by the Centers for Medicare and Medicaid Services on Friday. Seventy-four Medicare Advantage plans with prescription drug coverage earned five out of five stars, up from 21 in 2021, CMS said. Plans with a five-star rating are allowed to market their product all year, giving them a leg-up on competitors limited to advertising their product during open enrollment, which runs from Oct. 15 to Dec. 7. By earning a rating of four stars or higher, these highly ranked health insurers also receive a 5% quality bonus increase to their benchmark payment, which is the maximum amount the federal government will pay plans and accounts for about $6 billion in Medicare expenditures each year, according to the Medicare Payment Advisory Commission. (Tepper, 10/8)
Skilled Nursing News:
Nursing Facilities Need To Weather The ‘Reimbursement Storm’ Of Medicare Advantage
With Medicare Advantage revenue “significantly lower” than fee-for-service reimbursement, a new Zimmet Healthcare Services Group analysis says, skilled nursing facilities need to weather today’s “reimbursement storm” in order to make it to the incoming wave of baby boomers that will need facility services. In the meantime, Zimmet suggests operators utilize facility data to improve MA performance. “Most MA claims were submitted by SNFs with at least a three-star rating, but in areas with less bed-saturation, two-stars were not uncommon,” the report said. “There was no correlation between 5-Star rating and episodic revenue, while the 30-day hospital readmission rate explained less than 20% of payment variation.” (Stulick, 10/10)
Miami Herald:
What Medicare Covers, Versus Medicare Advantage Plans
If you’re one of the 64 million Americans enrolled in Medicare, what you decide in the next two months could make a huge difference in your wallet and your healthcare. Open enrollment, the time for changing plans, runs Oct. 15 -Dec. 7. “We know from Open Enrollment that a very small percentage actually change,” said Jane Sung, senior strategic policy adviser with AARP. In fact, 57 percent of recipients don’t even review their coverage annually, reports the Kaiser Family Foundation. That could leave you unable to see your favorite doctor or paying hundreds of dollars more for a vital prescription drug. “It’s in their interest to take a look at their options,” Sung said. (Foster, 10/10)
In other news about Medicare and Medicaid —
Modern Healthcare:
Some Hospitals Will Opt To Pay Fine For Not Publishing Prices, Lawyers Say
While most providers say they agree with the intent of the price transparency law, smaller hospitals are struggling to gather the data and present them in a useful format. Hospitals were required as of Jan. 1 to post machine-readable files of the rates they negotiate with payers, gross charges and discounted cash prices, which the Centers for Medicare and Medicaid Services hopes will curb higher-than-average prices. CMS recently sent a second round of warning letters to hospitals that haven't disclosed the rates of 300 "shoppable services" in a consumer-friendly form, threatening a maximum yearly fine of more than $2 million for larger hospitals and almost $110,000 for those with fewer than 30 beds. (Kacik, 10/8)
Modern Healthcare:
Physician Groups Lobby Congress For Pay Hike With Hopes For Bigger Reform
A quiet but intense lobbying effort is hitting Congress for a one-time spend of billions of dollars on Medicare Physician Fee Schedule clinician pay raises. It would be a short-term fix to what medical groups and some lawmakers say is a flawed system of paying physicians, but if Congress doesn't act by the end of the year, some specialties will see cuts to their rates. Physicians are once again taking issue with the PFS' budget neutrality requirement. Pay increases authorized by the Centers for Medicare and Medicaid Services for one group of clinicians can mean decreases for others. (Hellmann, 10/8)
Modern Healthcare:
ONC To Set Data Standards With CMS, CDC Through Interoperability Program
The Office of the National Coordinator for Health Information Technology on Friday launched a new effort to support federal agencies in standardizing data. The new initiative, dubbed USCDI+, builds on the U.S. Core Data for Interoperability, a standardized set of data elements developed by ONC. USCDI+ will set standards that can be helpful for federal agencies who have domain- or program-specific needs, but that ONC doesn't think need to be included in the core USCDI. (Kim Cohen, 10/8)
