Tag Archives: Medicaid
Former Sacred Heart physician gets 2 years for role in kickback scheme
http://www.chicagotribune.com/news/ct-sacred-heart-hospital-sentencing-met-20160812-story.html
Venkateswara Kuchipudi, right, walks with his lawyer Theodore Poulos outside the Dirksen U.S Courthouse on Aug. 12, 2016, after Kuchipudi was sentenced to two years in prison for his part in a fraud scheme at the now-shuttered Sacred Heart Hospital.
Is UC Davis Medical Center Skimping On Care For The Poor?
For at least 20 years, Leslie Love relied on the UC Davis Medical Center’s hospital and clinics for her health care. Her children and grandchildren went to the same doctors there.
“They cared about me,” said Love, a 57-year-old teacher’s assistant who lives near the academic medical center, which is located in Sacramento. “There’s people there that I can trust.”
But that trust was recently broken: Love has been fighting for follow-up care since her knee surgery at UC Davis in 2014. Love’s current Medi-Cal managed care plan, Health Net, ended its contract with the UC Davis Health System in January 2015. As a result, Love could no longer see the physicians there who had treated her knee.
The pullout, which affected an estimated 3,700 patients at the time, means that Health Net’s now nearly 123,000 Medi-Cal managed care enrollees in Sacramento County can no longer seek primary care at UC Davis.
Ever since, tension has been building over what some critics say is limited access for Medi-Cal patients at UC Davis’ health clinics.
Because it is financed partly by state taxpayers, the UC Davis Health System — like all University of California hospitals and clinics — is considered a public institution with a mandate to care for the poor.
That’s why some patients and their advocates are frustrated. They say UC Davis is not fulfilling its mission as a public hospital because the health system generally no longer accepts primary care patients covered by Medi-Cal managed care contracts. Medi-Cal patients still can receive specialized and emergency room care, as well as in-hospital stays.
A state-by-state breakdown of 71 rural hospital closures
More than 70 rural hospitals have closed since 2010 — and many more may be headed down the same path.
Rural hospitals are facing a myriad of financial challenges, and those in states that have not expanded Medicaid are feeling the most financial pressure. Sixty-three percent of hospitals vulnerable to closure are in states that have not expanded Medicaid, according to a report from iVantage Health Analytics, a firm that compiles a hospital strength index based on data about financial stability, patients and quality indicators.
Here are 25 states that have closed at least one rural hospital since 2010, according to research from the North Carolina Rural Health Research Program. For the purposes of its analysis, the NCRHRP defined a hospital closure as the cessation in the provision of inpatient services. Although all of the facilities listed below no longer provide inpatient care, many of them still offer services, including outpatient care, imaging, emergency care, urgent care, primary care or skilled nursing and rehabilitation services.
What will happen with healthcare policy under President Trump … or … Clinton?
http://www.modernhealthcare.com/article/20160723/MAGAZINE/307239984
The November elections surely won’t end the nonstop, eight-year political war over the shape of the U.S. healthcare system. But the ballot results likely will determine whether the changes driven by the Affordable Care Act continue in the same direction or the system returns to its less-regulated, pre-ACA contours.
Heading into this week’s Democratic National Convention, Hillary Clinton has promised to preserve and expand the ACA’s coverage expansions and delivery system reforms. Donald Trump, who accepted the Republican nomination last week, says he wants to repeal them, without offering much detail about what he would put in their place. The fate of the victor’s proposals, however, will depend heavily on the partisan makeup of Congress.
The clearest scenario is if Trump wins and his party retains control of both the House and the Senate, which would enable conservatives to repeal or roll back the ACA and implement at least some of the proposals outlined in the GOP party platform and the recent House Republican leadership white paper on healthcare. But there are divisions even among conservatives over issues such as Medicare restructuring and how to help Americans afford health insurance. And Senate Democrats almost certainly would use their filibuster power to block major ACA changes.
If Clinton wins and Democrats take control of both the Senate and the House—which is considered unlikely—she might be able to push through proposals such as increasing funding for federally qualified community health centers. But Senate Republicans also could use the filibuster to foil her. In the more likely scenario of a Democratic-controlled Senate and a GOP-controlled House, it’s not clear how much Clinton could achieve through the legislative process.
Could Trump loss spur ACA deal with Clinton?
With Donald Trump’s presidential campaign faltering, Republican health policy experts are gaming out Plan B for working with a Hillary Clinton administration to achieve conservative healthcare goals.
Their focus is on a possible “grand bargain” that would give conservative states greater flexibility to design market-based approaches to make coverage more affordable and reduce spending in exchange for covering low-income workers in non-Medicaid expansion states. A key element, conservative experts say, would be for a Clinton administration to make it easier for states to obtain Section 1332 waivers under the Affordable Care Act. Those waivers allow states to replace the law’s insurance exchange structure with their own innovative models.
While none are ready to sign on yet, congressional Republicans would have to agree to shore up the ACA’s struggling exchange markets by paying insurers for enrolling sicker populations and continuing to help low-income enrollees’ with cost-sharing responsibilities. House Republicans are challenging the cost-sharing subsidies in court.
How rural healthcare organizations are faring in non-Medicaid expansion states.
Hospitals in rural areas of the country are feeling a sharp financial pinch in states that have not expanded their Medicaid programs under the Patient Protection and Affordable Care Act.
Community hospitals in rural counties of Tennessee, one of the states that have opted not to embrace Medicaid expansion, are facing financial pressure that could be relieved if more of their low-resource patients had Medicaid coverage. “In our health systems, they manage it. They have figured it out. Where it’s really hitting is our rural hospitals,” says Craig Becker, president of the Tennessee Hospital Association. “We’ve lost six rural hospitals in the last year, and we’re going to lose another one this year.”
In economically disadvantaged Tennessee communities, many nonelderly adults are either reliant on Medicaid for their health coverage or fall into the “self-pay” category, Becker says. “We only get about 5% of payment for self-pay patients.”
Medicaid is a public form of medical insurance jointly funded by the states and the federal government. Under the PPACA, states can expand their Medicaid programs with federal financial assistance to include all adults in families with incomes below 138% of the federal poverty level.
3 possibilities for the future of the ACA exchanges
With health insurers struggling to turn a profit on the Affordable Care Act exchanges and premiums likely to rise, many have wondered what the future will hold for this prominent feature of the Obama administration’s healthcare reform law.
This week, Aetna became the latest major insurer to indicate it will re-evaluate its participation in the ACA marketplaces amid climbing financial losses that mirror those experienced by UnitedHealth, Humana and much smaller consumer operated and oriented plans.
What’s more, the cost of the ACA’s “benchmark” silver plan will increase by a weighted average of about 9 percent in 2017, compared to a 2 percent average increase in 2016. And in some areas of the country, insurers have requested steep rate increases–as much as 60 percent–for their exchange plans.
Long-term care costs force many seniors into Medicaid
Donna Nickerson spent her last working years as the activity and social services director at a Turlock, California, nursing home.
But when she developed Alzheimer’s disease and needed that kind of care herself, she and her husband couldn’t afford it: A bed at a nearby home cost several thousand dollars a month.
“I’m not a wealthy man,” said Nickerson’s husband Mel, a retired California State University-Stanislaus professor. “There’s no way I could pay for that.”
Experts estimate that about half of all people turning 65 today will need daily help as they age, either at home or in nursing homes. Such long-term care will cost an average of about $91,000 for men and double that for women, because they live longer.
In California and across the U.S., many residents can’t afford that, so they turn to Medicaid, the nation’s public health insurance program for low-income people. As a result, Medicaid has become the safety net for millions of people who find themselves unable to pay for nursing home beds or in-home caregivers. This includes middle-class Americans, who often must spend down or transfer their assets to qualify for Medicaid coverage.
Medicaid, known as Medi-Cal in California, was never intended to cover long-term care for everyone. Now it pays for nearly 40 percent of the nation’s long-term care expenses, and the share is growing. As Baby Boomers age, federal Medicaid spending on long-term care is widely expected to rise significantly — by nearly 50 percent by 2026.
HENRY KOTULA 