Calif. readies Medicaid changes for dual-eligibles, adult day care program; Other Medicaid news from the states

Mar 30 2012

California is revamping its adult day health care program as well as its program for people who are eligible for both Medicare and Medicaid. In Florida, a judge orders the Medicaid program there to cover autism therapy, and Georgia prepares to restructure its program.

California Healthline: Ironing Out Details of Duals Conversion 
State officials met with stakeholders in Sacramento yesterday to answer questions and work out the final details of the duals demonstration project -- an ambitious plan to enroll an estimated 700,000 dual-eligible Californians in 10 counties into Medi-Cal managed care. Enrollment will be mandatory for beneficiaries eligible for both Medi-Cal and Medicare. Jane Ogle, deputy director of health care delivery systems at the Department of Health Care Services, was quick to point out that beneficiaries would keep their own physician, even if that physician is not in the Medi-Cal network, and that beneficiaries have the power to opt out of the demonstration project, if they want (Gorn, 3/29). 

KQED/The California Report: Changes To Adult Day Health Care Coming This Weekend
On April 1, adult day health care will be eliminated as a Medi-Cal benefit. A scaled-down version of the program called Community Based Adult Services will take its place. But days ahead of the transition, advocates for the disabled have filed a contempt motion against the state (Varney, 3/28). 

Health News Florida: Judge Orders Medicaid To Cover Autism Therapy 
In a case that could jolt Medicaid programs across the country, a federal judge in Miami has ordered Florida officials to cover behavioral therapy for autistic children. ... Her order applies to more than 8,000 low-income children in Florida who are enrolled in Medicaid (Gentry, 3/28). 

The Miami Herald: Florida Must Pay For Autism Therapy For Poor Kids, Judge Says
Florida healthcare regulators have left autistic children from impoverished families at risk of "irreversible" harm by refusing to pay for a critical therapy that can help them lead more normal lives, a Miami federal judge has ruled. U.S. District Judge Joan Lenard, in an order signed this week, required the state's Medicaid insurance program for needy families to begin paying for a psychological program, called applied behavioral analysis, designed to improve the behavior, language and cognitive development of autistic children (Miller, 3/28).

Georgia Health News: Lawmakers Get Update On Medicaid Restructuring 
The current timeline for a decision on restructuring Georgia Medicaid may not be feasible, a state official indicated to lawmakers Wednesday. ... The hearing focused on a recent state-commissioned report on the future of the Medicaid and PeachCare programs. That report, by the consulting firm Navigant, calls for Georgia to consider adopting an enhanced managed care system that would cover aged, blind and disabled Medicaid beneficiaries (Miller, 3/28). 

The Connecticut Mirror: In Court's Shadow, Others Connect Health To Housing 
Because the law expands Medicaid eligibility to those earning at or below 133 percent of the poverty level, a lot more public housing residents will be eligible for health insurance. ... In addition, as its now written, the law pumps nearly $11 billion into community health centers over the next five years. These centers will be looking for new clients to serve, and now they'll have a new base of clients with health insurance (Satija, 3/28). 

In Iowa, Medicaid officials are investigating a charity for alleged Medicaid fraud --

Des Moines Register: Medicaid Probe Targets Des Moines Charity
A Des Moines charity that counsels troubled youths and families at taxpayer expense is under investigation for potential Medicaid fraud. The charity, called A New Beginning, is being examined by the Iowa Medicaid Fraud Control Unit and the U.S. attorney's office. The investigation is the result of two separate, recent referrals from Magellan, a company that processes Medicaid payments to privately run -; but publicly funded -; agencies providing counseling, mentoring and other community-oriented services (Kauffman, 3/28).