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Medicaid rolls set to be slashed under Trump-approved work rules
Medicaid rolls set to be slashed under Trump-approved work rules
The thousands of people who lost Medicaid coverage this month in Arkansas for not following newly implemented work requirements may be a sign of what’s to come in other GOP-led states.
Indiana and New Hampshire are slated to implement their Medicaid work requirements next year, and a slew of other states are awaiting approval from the Trump administration.
Arkansas has served as a test case of sorts since it was the first state to implement work requirements, and this month it became the first state to kick off beneficiaries for not following them.
The state removed more than 4,000 people from the Medicaid rolls, with some estimates saying that number could climb to 50,000 when the requirements are fully implemented in 2019.
“I think other states should be thinking seriously about the warnings that Arkansas’ experience has for their states,” said Erin Brantley, a senior research associate at George Washington University’s Milken Institute of Public Health.
While many people in Arkansas’ program are exempt from reporting their activities to the state because they’re already working, others are not, meaning they need to file monthly reports through an online portal to show they are meeting the requirements.
Of those who lost coverage this month, about 95 percent didn’t file the necessary documents with the state. That led to their removal from Medicaid, though some may have been working working the required 80 hours a month.
It’s unclear why those participants didn’t file reports, especially if they were working, though some say it could be due to confusion, an inability to access a computer or general unawareness about the new requirements.
The state said it conducted “extensive” outreach that included sending more than 136,000 letters and emails and making more than 150,000 phone calls from April through August.
“It seems that [the state] is doing some outreach, but a lot of individuals still don’t know about the new requirements and are not setting up their accounts,” said Robin Rudowitz, associate director of the Kaiser Family Foundation’s program for Medicaid and the uninsured.
“There are many lessons to be learned about online reporting, and communication, and having individuals understand what the requirements are,” Rudowitz said. “The changes to these programs are difficult to communicate.”
In a report published in the journal Health Affairs this month, the author conducted interviews with 18 Medicaid recipients in northeast Arkansas and found that a dozen had not heard about the state’s new requirements.
Seema Verma, head of the U.S. Center for Medicare and Medicaid Services, which is responsible for reviewing state requests for work requirements, characterized Arkansas’ recent removal of Medicaid recipients as a positive step.
“I’m excited by the partnerships that Arkansas has fostered to connect Medicaid beneficiaries to work and educational opportunities, and I look forward to our continued collaboration as we thoroughly evaluate the results of their innovative reforms,” Verma said in a tweet the same day that 4,000 recipients lost coverage.
The work requirements have prompted lawsuits in Kentucky and Arkansas by advocates who say they are harmful to those in need. The judge that blocked a similar program in Kentucky earlier this year will also preside over the Arkansas case.
The Trump administration says “able-bodied” adults on Medicaid should work if they’re able to. In all three states, the work requirements apply only to those who gained coverage through ObamaCare’s Medicaid expansion, which allowed for covering more low-income adults.
It’s unclear how the work requirements will impact beneficiaries in Indiana and New Hampshire when they are rolled out next year, but both states are planning to rescind coverage for those who don’t meet the new work rules.
Beneficiaries in Indiana will have to work at least eight months each year, and an 80-hour-a-month requirement will be gradually phased in over an 18-month period. Compliance with the requirements will be checked annually instead of monthly, like in Arkansas.
New Hampshire beneficiaries subject to the new requirements must work 100 hours a month beginning in January. Enrollees who don’t meet the threshold for one month will have their coverage suspended.
Some argue that the true purpose of Medicaid work requirements is to cut spending for the federal program, a priority of conservatives for years.
“This policy is clearly not designed to help people find work. It’s designed to take them off Medicaid,” said Joan Alker, executive director of the Center for Children and Families at the Georgetown University School of Public Policy, referring to the Arkansas policy.
“It’s nothing to do with promoting work, supporting work — it’s about creating red tape for folks who are not able to jump over these bureaucratic hurdles for one reason or another — no internet access, they may not know, may be homeless, may not get the letter,” she said. “Those are the ones that will lose coverage.”
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5 Revenue Cycle Trends to Watch
https://www.healthcareitleaders.com/blog/5-revenue-cycle-trends-to-watch/
When we think of healthcare and hospitals, we primarily think of the patient experience as it relates to individual health and wellness. However, another important part of the patient experience involves the finance and billing departments of healthcare organizations. The moment a patient checks in for an appointment, they enter into this system of payment and processes and the journey ends when all claims and patient payments have been received either from the patient or from their insurance company. This sounds like a simple, linear process, but it’s much more complicated than that. To help organize these financial processes, organizations rely on healthcare revenue cycle management and software to process this constant influx of important data.
As the healthcare industry continuously changes, revenue cycle management policies and software are changing with it. Healthcare IT Leaders Revenue Cycle Lead, Larry Todd, CPA, discusses the changes happening in the industry and the trends to watch in 2018 with revenue cycle management.
Mergers driving new implementations
Healthcare systems are getting bigger as more organizations are merging. Many legacy systems are beginning to sunset, and there is a need for organizations to implement a new system to support the growth of the organization. “It’s important for organizations to consider how they will sunset their legacy system and embrace the new system during a revenue cycle implementation,” says Todd. “Organizations need to take a step back before the implementation to consider how to build a holistic system. Without proper integrations, many organizations will be challenged to manage their reimbursement processes.”
Organizations seek to improve denial and reimbursement processes
Claim denials and documentation to support appeals are areas where the revenue cycle marketplace continues to struggle, says Todd. “Organizations are seeking innovative ways to improve these processes and reduce denial rates, through either third-party systems, or, if possible, within the host system.”
CFOs must stay engaged in implementations
“Any implementation will affect the revenue of the organization so it’s very important for CFOs to be involved in the implementation project and to be informed of key parts of the project that could put the organization and its revenue at risk,” says Todd.
As a former CFO and trained accountant, Todd says it’s a mistake for CFOs to disengage once an implementation is underway. “These are highly technical projects, so there is a tendency to hand over the reins to IT or the software vendor, but financial executives need to stay engaged throughout the project, including weekly implementation status updates.”
Clients should form a revenue cycle action team that includes the CFO and puts all of the revenue cycle stakeholders at the table, including clinicians, says Todd. Having the CFO involved in this process ensures critical executive oversight regarding decisions that impact AR and Cash.
User training and adoption are critical
As healthcare organizations transition from a legacy system to a new system, they need to consider how they will handle the change management for their staff. “Some employees have been using these systems for more than 10 years. Properly training employees on the new system is a top concern for executives and managers,” says Todd.
Organizations will rely on outside expertise for implementations and integrations
As organizations integrate their new system and implement changes, a key recipe for success is to hire experts who understand the technical and operational aspects of the the software and organizational processes. “It’s very valuable to work with a consulting firm that employs real consultants – people who have worked in operations for years and truly understand the unique challenges of implementing revenue cycle solutions” says Todd. “At Healthcare IT Leaders, we all have unique perspectives and experiences that we bring to the table thanks to this approach.”
The Health 202: The rate of people without health insurance is creeping upward
THE PROGNOSIS
New Census Bureau data on the number of uninsured Americans is either a testament to the resiliency of the Affordable Care Act or a sign that President Trump’s anti-ACA rhetoric and policies are starting to work.
As our colleague Jeff Stein reported Wednesday, there was a slight uptick in the number of Americans without health insurance in 2017 compared to 2016, even though that number essentially remained statistically flat. Still, the fact that uninsured rate went up at all, by about 400,000 people, marks the first time since the ACA’s implementation that the uninsured rate didn’t drop.
Supporters of the ACA worry the news marks the beginning of a trend, especially when some of Trump administration policies intended to circumvent the ACA go into effect next year.
Ahead of open enrollment last year, the Trump administration dramatically decreased funding for any Obamacare outreach or advertising, limited resources for “navigators” who help people find an insurance plan, and shortened the window for people to sign up for insurance from three months to six weeks in states that use a federally run marketplace.
“Even with all of that, health coverage stayed steady. But at the same time, we’d like to see further progress in the rate of the uninsured,” said Judith Solomon of the Center on Budget and Policy Priorities.
It’s part of a pattern to weaken the 2010 health-care law known as Obamacare. After the GOP Congress failed to repeal and replace the ACA last summer, the Trump administration moved to dilute the law in other ways: including signing off on a plan to eliminate the individual mandate penalty next year; allowing individuals to buy skimpier, short-term health plans without certain coverage requirements under Obamacare; and seeking to allow states to put conditions on Medicaid coverage.
Some of the most prominent health care organizations in the country came together this morning to voice their disapproval of those short-term plans — including the American Cancer Society Cancer Action Network, the American Heart Association, Planned Parenthood Federation of America, the National Women’s Law Center, the , American Academy of Family Physicians, the American Academy of Pediatrics and Families USA.
“The Administration’s decision to expand short-term health plans will leave cancer patients and survivors with higher premiums and fewer insurance options,” said Dr. Gwen Nichols, chief medical officer of the Leukemia & Lymphoma Society.
The groups’ statements, compiled and released by Sen. Tammy Baldwin (D-Wis.), are in support of the senator’s effort to have Congress rescind the White House regulation. Nearly every Democratic senator has signed a resolution of disapproval to overturn it.
The census data reflects trends that started last year, when the administration’s policies had yet to be implemented. Fourteen states saw their uninsured populations rise in 2017. The only three states that didn’t see a spike in that number were New York, California and Louisiana. The first two aren’t surprising given those states’ robust efforts to enroll their own residents, while Louisiana expanded Medicaid in June 2016 so its decrease represents those low-income individuals who now have government coverage.
Medicaid expansion in most of the 33 states and D.C. that have done so under the ACA has predictably decreased the number of people without coverage. The uninsured rate last year in states with an expanded Medicaid program was 6.6 percent compared to 12.2 percent in non-expansion states — a gap that has only continued to grow since 2013.
To be fair, as Larry Levitt, senior vice president at the Kaiser Family Foundation, pointed out on Twitter: the uninsured rate started leveling off before the Trump administration started its work. But Levitt suggested the uninsured rate may really rise in 2019 when elimination of the individual mandate penalty takes effect. Moreover, states are increasingly taking the White House up on its suggestion to add work requirements to their Medicaid programs — in just the first three months of it being implemented in Arkansas, more than 4,000 people were jettisoned from the rolls for failure to comply.
Matthew Fiedler, a health-policy expert at the Brookings Institution, agreed with Levitt’s assessment, noting that the bulk of the people who were uninsured pre-ACA have already been enrolled in the program. He contended that if policy had remained static, there would likely have been a modest decline instead of similar increase in the uninsured rate — though not a dramatic one. The real effects, he said, of the Trump administration’s efforts to chip away at the ACA are still to come.
“I don’t think the right takeaway is that none of the policy changes will have a negative effect. I think they will going forward, we just haven’t seen that yet,” he said. “I think if your goal is to evaluate the ACA, I think the right takeaway is that there was a lot of progress, but more policy progress to be made.”
Of course, Democrats and Republicans have disparate views on how to get there. Democrats are now pushing for a public option or a universal health care system in which the government would foot the bill for many health-care costs. A lot of them feel the ACA “got us roughly 40 percent there and established a framework for lawmakers to make that progress going forward,” Fiedler said. That’s why we’re now seeing so many Democratic candidates and lawmakers embracing some iteration of a “Medicare for all” program.
Republicans still criticize the ACA as vast government overreach and are vowing they will take another stab at repealing it should they maintain the congressional majorities after the November midterms.
“We made an effort to fully repeal and replace ObamaCare and we’ll continue,” Vice President Pence said while campaigning for Baldwin’s opponent, Leah Vukmir, if the GOP performs well in the midterms.
One additional interesting data point from the census is ages at which there was the greatest increases or decreases in the uninsured rate. As highlighted in the chart above, rates of those without insurance rose at ages 18 and 19 — when children are no longer eligible for the Children’s Health Insurance Program; and for those between ages 25 and 26 — when children no longer qualify for their parents’ insurance. The uninsured rate dropped, however, for those aged 64 and 65 — when adults are eligible for Medicare.
The greatest spike in those without insurance was documented for 26 year olds. That’s likely because young adults are typically healthier and feel less urgency to pay for insurance when they lose coverage under their family’s plan.
As noted by the New York Times’ Margot Sanger Katz on Twitter, these stats show just how crucial government programs and laws have been in providing health coverage to Americans:
HENRY KOTULA 