R.I. overhauls Medicaid payments for elderly, disabled; Medicaid delays reported in Kansas

May 12 2010

Stateline.org: Rhode Island received a waiver from the Bush administration to revamp its Medicaid program for the elderly and disabled, despite concerns from "community health activists [who] feared that it would push some of the neediest onto waiting lists or worse — throw some poor people off the Medicaid rolls altogether. But it hasn't worked out that way. ... The new system has indeed helped save the cash-strapped state millions of dollars already, although nowhere near the $60 million originally envisioned for this year alone. But most important, hundreds of the state's most vulnerable residents are getting care in their homes or in assisted-living centers, rather than the more costly nursing homes, where few people want to be, but where Medicaid typically places them. ... The crucial question is whether the program will be able to continue operating once the federal health care overhaul takes full effect in four years. The overall intent of the law is to create a consistent national health care system, not to encourage states to strike out on their own" (Prah, 5/11).

Kansas Health Institute: "Federal officials have asked the Kansas Health Policy Authority to explain why thousands of Medicaid applications haven't been processed in a timely manner. According to a April 22 letter from the Centers for Medicare and Medicaid Services (CMS), approximately 8,100 Medicaid applications and roughly 5,300 renewals have been 'pending' for more than 45 days. States are subject to penalties when Medicaid applications and renewals sit for more than 45 days. Both are subject to eligibility review, a process that involves confirmation of citizenship, income and family size. Medicaid beneficiaries must apply annually. The CMS letter asked the health policy authority to confirm the counts and provide an 'action plan' for expediting the process for determining eligibility. ... For much of the past year, health policy authority officials have warned legislators that budget cuts were hindering their ability to keep pace with ever-increasing numbers of people - parents and pregnant women, mostly - applying for Medicaid or HeathWave on behalf of their children. The House-passed budget bill approved Monday by the Senate did not address the delays in processing" (Ranney, 5/10).

Minneapolis Star Tribune: Officials from Minnesota's hospital, nurse and doctors' groups Monday urged state leaders to enact a bill that would shift about 137,000 low-income patients from a slimmed down state assistance plan called General Assistance Medical Care (GAMC) to the state's Medicaid program, called Medical Assistance. Although legislators have endorsed such a move, Gov. Tim Pawlenty has threatened to veto that effort. "A revamped GAMC is scheduled to start June 1, but only four of 17 key hospitals have agreed to participate. The four hospitals are scrambling to assemble 'comprehensive care delivery systems' to deliver all levels of medical care instead of solely more expensive emergency room treatment. … Pawlenty planned to eliminate GAMC this spring after removing its funding last year, and in March he vetoed a bill to continue it. He later struck a compromise with [opposition legislators] requiring hospitals to cover the GAMC population for a fixed sum of money, less than half the $400 million allocated last year, and argued that it would reform health care by forcing hospitals to invent efficient ways to treat " (Wolfe, 5/10).

Meanwhile, Kansas Health Institute reports in a separate story that a lawsuit brought by 17 states alleges that the drug company Wyeth "failed to pay hundreds of millions of dollars in rebates to state Medicaid programs. ... Kansas Attorney General Steve Six announced Monday that Kansas was joining Colorado, Kentucky, Maine, South Dakota and a dozen other states seeking remedy to Wyeth's alleged failure to pay rebates on the drugs Protonix Oral and Protonix IV, proton pump inhibitors used to suppress stomach acid. … According to Six, under the Medicaid Drug Rebate Program, drug makers must report to the government certain prices they charge customers, including the 'best price' offered for their drugs." Medicaid rebates are then supposed to be based on the prices offered to other large customers (5/10).