Tag Archives: medicaid

Colorado health insurance exchange / marketplace: Obamacare enrollment

Colorado health insurance exchange / marketplace: Obamacare enrollment

Connect for Health Colorado reported that 141,639 people signed up for qualified health plans, including about 47,000 consumers who were new to the marketplace in 2015.

The lack of Medicaid reimbursement is nothing short of a travesty…

The four other state-run exchanges with similar enrollment totals all receive at least a third of their funding – and as much as more than half of their funding – from Medicaid.  But Connect for Health Colorado doesn’t get any funding from Medicaid (and agents/brokers who enroll people in Medicaid through Connect for Health Colorado don’t receive any compensation, unlike other states).

The exchange can request reimbursement from CMS for expenses incurred to enroll people in Medicaid, and the 2016 revenue projection includes $2.5 million in recouped funds from CMS.  That still pales in comparison with the $15 million to $29 million that other similarly-sized exchanges are reimbursed annually by Medicaid.

There’s plenty of incompetence to go around, but Colorado Medicaid stands out as both arrogant and incompetent.

 

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Treating Medicaid patients is charity work.

Treating Medicaid patients is charity work. This bill proves it..

The enthusiasm for expanding Medicaid coverage to the previously uninsured seems misplaced. Improved “access” to the health care system via Medicaid programs surely cannot result in lasting coverage. In-network physicians will continue to dwindle as their office overhead exceeds meager reimbursement levels.

In reality, treating Medicaid patients is charity work. The fact that any physicians accept Medicaid is a testament to their generosity of spirit and missionary mindset. Expanding their pro bono workloads is nothing to cheer about. (emphasis added) The Affordable Care Act’s “signature accomplishment” is tragically flawed – because offering health insurance to people that physicians cannot afford to accept is not better than being uninsured.

After all, improved access to nothing … offers nothing. Inviting physicians to work for less than minimum wage so that politicians can crow about millions of uninsured Americans now having access to health care, is ridiculous. Medicaid expansion is widening the gap between the haves and the have-nots. The saddest part is that the have-nots just don’t realize it yet.

To the consumer, Medicaid seems like a gift. It will work for awhile until it breaks. Also, the consumer is very trusting that their past medical health is a good predictor of their future health. If for some reason, that turns out not to be the case, do you believe you or your spouse or children are getting the best treatment from the Medicaid system?

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Avoid the health exchange if you’re NOT subsidy eligible… Here’s why

Video: ObamaCare exchange not allowing addition of newborns to policies « Hot Air.

Let’s just say it’s one giant PITA.

Actually, no it wouldn’t be “more affordable” for families already paying for family coverage, which would likely be most of those seeking to add a newborn to their policy. And if they don’t qualify, then it’s a moot point anyway. That eligibility could have been determined through the ObamaCare exchange, had it been properly designed to deal with additions of newborns.

Instead, thanks to the run-around Healthcare.gov requires, families end up running out of time to add their newborns to their policies — and health insurers can’t step in and assist them any more:

Sure enough, CHIP denied her baby. Now when she turns to the marketplace to try and add her daughter, they turn her away.

“They denied us, saying we went over our time limit and there was no evidence we tried adding her to our insurance,” Maggie said.

Maggie says she protested sending marketplace workers copies of their own emails promising to extend the window but it did no good.

One executive from a Utah insurer says anyone who gave birth in 2014 will have the same problem, and it’s mystifying to Shaun Greene. “Insurance companies have been doing that for years,” Greene told KUTV about adding newborns to policies. “It’s not difficult.” Not until government takes it over, that is. (emphasis added)

I have not endured this particular situation in Colorado but have had some that are similar. However, I can say that Connect for Health Colorado is pretty good at creating incident numbers and allowing enrollment once the situation is resolved.

In Colorado, and apparently with healthcare.gov, almost any issue that isn’t a “straight enrollment” ends up being delayed. In the minds of the consumer, they are dumbfounded by the apparent incompetence. I have had two cases of adding family members, neither one has gone smoothly. In one situation, the family member was added the day after the enrollment was done. It took over 40 days and a plea to Connect for Health management to get this resolved.

This Rube Goldberg of a healthcare law boggles the mind.

If you’re not subsidy eligible, DO NOT use the exchange. In this case, it serves no purpose. However, if you are subsidy eligible or you might be, you MUST use the exchange if you want to preserve you eligibility. Even if you don’t want an advanced subsidy (monthly payments), you must use the exchange to claim your subsidy at the end of the year on your tax return.

 

 

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Connect for Health 1st month open enrollment statistics

Connect for Health recently (Dec 17) released enrollment statistics for the 1st month of the 2015 open enrollment period (Nov 15 – Dec 15). They are as follows:

  • Total enrollment: 136,315
  • Medicaid: 7,306   27,306 (corrected 12/29 @ 18:24p)
  • CHP+: 932 (Medicaid for Children)
  • Connect for health (Commercial insurance): 108,077

Although beside the point, I sure wish I know why Connect for Health Colorado calls private individual insurance “commercial” insurance. Never once have I ever told a client I am selling them “commercial” insurance.

Moving on…

I call out the CHP+ enrollment number as bogus. Why? Because the discrepancy between Medicaid and CHP+ is too large. For an adult to qualify for Medicaid, the family (or individual) income must be < 133% of the Federal Poverty Level (FPL). However, for children to qualify for CHP+, the family income only has to be less than 250% of the FPL. Thus it is substantially easier for children to qualify for CHP+ then it is for adults to qualify for Medicaid. In the real world what occurs for families with income between 133% and 250% of the FPL is the children are enrolled in CHP+ and the adults receive a subsidy and select coverage through Connect for Health Colorado.

If the CHP+ enrollment numbers are “bogus” that places the validity of the other enrollment numbers into question as well.

 

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Warning, Medicaid payment cuts may affect access to healthcare

As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care – NYTimes.com.

 The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average.

Medicaid works fine as long as everyone is healthy. Color me cynical, but somehow I don’t believe my daughter would have received the same level of care at Children’s Hospital for her 7 admissions if she had been on Medicaid.

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Medicaid “Gravy Train” Comes to an End

Doctors face steep Medicaid cuts as fee boost ends – Yahoo Finance.

To improve access for the poor, the health law increased Medicaid fees for frontline primary care doctors for two years, 2013 and 2014, with Washington paying the full cost. The goal was to bring rates up to what Medicare pays for similar services. But that boost expires Jan. 1, and efforts to secure even a temporary extension from Congress appear thwarted by the politically toxic debate over “Obamacare.”

Not that it was much of a gravy train, but it’s a lot less going forward.

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Obamacare Enrollment Increases come from where?

Can you say Medicaid expansion? The Real Story on How Much Obamacare Increased Coverage.

What we’ve learned is that the Obamacare gains in coverage were largely a result of the Medicaid expansion and that most of the gain in private coverage through the government exchanges was offset by a decline in employer-based coverage. In other words, it is likely that most of the people who got coverage through the exchanges were already insured.

With low reimbursement rates, can Medicaid insured’s expect the same level of coverage as those who have coverage that is paying providers substantially more?

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Do the math, a Dr. Shortage is coming

Why the Doctor Can’t See You: Newsroom: The Independent Institute.

The introductory portion of the article documents how preventive care alone has the ability to create full employment for doctors. In other words, demand exceeds supply…

When demand exceeds supply, doctors have a great deal of flexibility about who they see and when they see them. Not surprisingly, they tend to see those patients first who pay the highest fees. A New York Times survey of dermatologists in 2008 for example, found an extensive two-tiered system. For patients in need of services covered by Medicare, the typical wait to see a doctor was two or three weeks, and the appointments were made by answering machine.

However, for Botox and other treatments not covered by Medicare (and for which patients pay the market price out of pocket), appointments to see those same doctors were often available on the same day, and they were made by live receptionists.

As physicians increasingly have to allocate their time, patients in plans that pay below-market prices will likely wait longest. Those patients will be the elderly and the disabled on Medicare, low-income families on Medicaid, and (if the Massachusetts model is followed) people with subsidized insurance acquired in ObamaCare’s newly created health insurance exchanges.

John Goodman concludes…

I predict that in the next several years concierge medicine will grow rapidly, and every senior who can afford one will have a concierge doctor. A lot of non-seniors will as well. We will quickly evolve into a two-tiered health-care system, with those who can afford it getting more care and better care.

In the meantime, the most vulnerable populations will have less access to care than they had before ObamaCare became law.

They call it Obamacare.

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Doctors grade Obamacare

Why doctors give Obamacare a failing grade | TheHill.

  •  You can keep your doctors – NOT
  • Medicaid, not so great
  • Deluge of paperwork and reporting requirements

So what grade would doctors give Obamacare?

The Physicians Foundation made shockwaves last month when it released its 2014 Survey of America’s Physicians. The survey’s top-line finding: Of the 20,000 doctors surveyed, almost 50 percent stated that Obamacare deserves either a “D” or an “F.” Only a quarter of physicians graded it as either an “A” or a “B.”

Let’s take a closer look as to how Obamacare has affected Medicaid. Many of my (potential) clients are delighted if they qualify for Medicaid or if their children qualify for CHP+. Perhaps CHP+ offers better services than Medicaid for adults but I’m doubtful.

No matter which option they chose, Obamacare forced my patients to make trade-offs between pricing, access, and quality of care.

Obamacare’s Medicaid expansion exacerbated this patient crisis. Arizona, the state in which I practice, expanded Medicaid in 2013 under the assumption that it would give the poor better access to medical care. Yet many of the new Medicaid enrollees—perhaps as many as 80 percent of them, according to one recent study—were merely forced off their private insurance plans and into Medicaid.

Several of my patients experienced this first-hand. They have found that Medicaid offers sub-standard health care compared to the private insurance they used to have. Their choice of doctors has been severely curtailed, even more so when it comes to specialists. Often they resort to the local emergency room rather than waiting weeks to get medical attention in a doctor’s office. An Oregon study revealed a 40 percent increase in ER visits among new Medicaid enrollees.

Unsurprisingly, patient health suffers when illnesses and diseases remain untreated, hence Medicaid’s persistently poor ratings on patient health. Unfortunately, my patients were forced into this broken system without a second thought.

Perhaps it was without a 2nd thought or perhaps it was with malice. The government creates a problem and then only they can fix it. Of course, with their recent displays of incompetence, they may have overplayed their hand.

Let me also comment on Medicaid. Under Medicaid, reimbursement to doctors is much less than that of regular insurance or even Medicare. I don’t care how you slice and dice it, from a big picture point of view, if the doctors don’t believe they are being fairly paid, the qualify of care dispensed is going to decrease.

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ER visits up under Obamacare

 

More patients flocking to ERs under Obamacare.

It wasn’t supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month.

That 12 percent spike in the number of patients — many of whom aren’t actually facing true emergencies — is spurring the Louisville hospital to convert a waiting room into more exam rooms.

“We’re seeing patients who probably should be seen at our (immediate-care centers),” said Lewis Perkins, the hospital’s vice president of patient care and chief nursing officer. “And we’re seeing this across the system.”

That’s just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Ahh… those unintended consequences. The apparent reason(s)…

Experts cite many reasons: A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won’t accept Medicaid. And poor people often can’t take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.

Plus, some patients who have been uninsured for years don’t have regular doctors and are accustomed to using ERs, even though it is much more expensive.

“It’s a perfect storm here,” said Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physician group.”We’ve given people an ATM card in a town with no ATMs.” (emphasis added)

Which brings up the point about Medicaid. If you go to an ER with no insurance, if you qualify, the Hospital will automatically start the enrollment process for Medicaid. Why? For Medicaid eligible patients, that’s the only way the hospital can reasonably expect any reimbursement, no matter how miniscule, at all. The article references doctors not accepting Medicaid. It’s real simple to read between those lines…. “low reimbursements”.

I suggest reading some of my other posts on Medicaid starting with: Medicaid is a type of insurance but is their coverage?

And the general Medicaid blog tag.

 

The article goes on to explore issues with Medicaid, why ER is the first stop for many patients and the primary care doctor shortage. It concludes…

Doctors and hospital officials said ER staff members try to let people know when it’s appropriate to use the department, when they should use immediate care centers and when they should seek care at a doctor’s office. They also refer patients to providers such as Family Health Centers for follow-up.

Mason said another promising solution is “care coordination,” in which primary-care doctors work with high-risk patients to help them control illnesses and navigate the health care system. She pointed to a study showing care coordination helped reduce ER visits by 9 percent from 2011 to the first half of 2013 among Oregonians in the pre-ACA expanded Medicaid program.

Mason said letting nurse practitioners practice and prescribe on their own also may help by giving people another treatment alternative.

But Mason and others said such efforts may not immediately alleviate the crunch on ERs.

“It will continue to go up if we don’t build our primary-care capacity,” she said. “It will continue to go up if we don’t support alternatives such as retail clinics. And it won’t get better if we don’t educate the public about the correct use of emergency departments.” (emphasis added)

To reduce the shortage of primary care doctors will take incentives and better pay. What it won’t take is more rules, regulations and paperwork/computerwork.

The rise of the “mini-clinic” may also be quite helpful, but that model will also be put under financial strain from low Medicaid reimbursements.

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Medicaid? Read this first…

Especially for the children – Zane Pollard: The Bureaucrat Sitting on Your Doctors Shoulder – WSJ.com.

Obamacare is designed to steer children of lower income families (< 250% of the Federal Poverty Level, $59,000 for a family of 4) onto Medicaid. Before you blindly allow the government to make that choice for you please read the above article.

Yes, it’s so very tempting. You can either put your children on Medicaid at basically zero cost, or you can put them on your plan and receive no subsidy for their portion of the total family premium.

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Medicaid is a type of insurance but is their coverage?

Denver area has plenty of doctors, but few accepting Medicaid, says study – Denver Business Journal.

Adams, Denver and Arapahoe counties have the third-, fourth- and fifth-worst ratios of Medicaid enrollees to doctors who accept the lower-reimbursement insurance, all with less than one primary-care physician taking the insurance for every 2,400 enrollees.
And those numbers are likely to be exacerbated further as more people sign up for Medicaid.

If you are applying for premium assistance under Obamacare, if you fall under 133% of the Federal Poverty Level (FPL) you will be funneled into Medicaid in the states that have enacted enhanced Medicaid. Can you avoid Medicaid? Yes, you can elect to op-out of the Medicaid system. Is their a downside to opting out? Yes and it may be significant. You are NOT eligible to receive any premium assistance. That means paying full price for Obamacare coverage you want, very likely an unaffordable option.

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Coverage gap in states that didn’t expand Medicaid

Millions Trapped in Health-Law Coverage Gap – Yahoo Finance.

Bob Miller for The Wall Street Journal Hair stylist Ernest Maiden doesn’t make enough money to qualify for federal subsidies to buy health insurance but also is ineligible for Medicaid.

The 2010 health law was meant to cover people in Mr. Maiden’s income bracket by expanding Medicaid to workers earning up to the federal poverty line—about $11,670 for a single person; more for families. People earning as much as four times the poverty line—$46,680 for a single person—can receive federal subsidies.

But the Supreme Court in 2012 struck down the law’s requirement that states expand their Medicaid coverage. Republican elected officials in 24 states, including Alabama, declined the expansion, triggering a coverage gap. Officials said an expansion would add burdensome costs and, in some cases, leave more people dependent on government.

The decision created a gap for Mr. Maiden and others at the lowest income levels who don’t qualify for Medicaid coverage under varying state rules. The upshot is that lower-income people in half the states get no help, while better-off workers elsewhere can buy insurance with taxpayer-funded subsidies.

This is not an issue with states that expanded Medicaid, of which Colorado is one.

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Expanded Medicaid: Be careful out there

Expanded Medicaid’s fine print holds surprise: ‘payback’ from estate after death | Local News | The Seattle Times.

As fine print is wont to do, it had buried itself in a long form — Balhorn’s application for free health insurance through the expanded state Medicaid program. As the paperwork lay on the dining-room table in Port Townsend, Prins began reading.

She was shocked: If you’re 55 or over, Medicaid can come back after you’re dead and bill your estate for ordinary health-care expenses.

The way Prins saw it, that meant health insurance via Medicaid is hardly “free” for Washington residents 55 or older. It’s a loan, one whose payback requirements aren’t well advertised. And it penalizes people who, despite having a low income, have managed to keep a home or some savings they hope to pass to heirs, Prins said.

Washington state is trying to fix the law but long term, anything is possible…

“People will think this is wonderful, this is free insurance,” Orient said in an interview. “They don’t realize it’s really a loan, and is secured by any property they have.”

Even states that are now limiting estate recovery, she warned, can change the rules again if budget problems become more intense.

Keep in mind, if you qualify for Medicaid, you don’t qualify for a subsidy…

One reason this snafu has become so troublesome is that ACA rules appear to give those who qualify for Medicaid little choice but to accept the coverage.

People cannot receive a tax credit to subsidize their purchase of a private health plan if their income qualifies them for Medicaid, said Bethany Frey, spokeswoman for the Washington Health Benefit Exchange.

But they could buy a health plan without a tax credit, she added.

For someone age 55 to 64 at the Medicaid-income level — below $15,856 a year — it’s quite a jump from free Medicaid health insurance to an unsubsidized individual plan. Premiums in King County for an age 60 non-tobacco user for the most modest plan run from $451 to $859 per month.

I predict an industry will form to assist people in “gaming the system”.

 

 

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Young Adults, Low Income Least Familiar with Healthcare Reform

Young Adults, Low Income Least Familiar with Healthcare Reform.

The Affordable Care Act is intended to benefit those with lower incomes, who are more likely to be uninsured than those with higher incomes. But at this time, lower-income Americans are less familiar with the law than those with higher incomes.

They are just not interested. It’s doubtful outreach and marketing will change that. We’ll find out.

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