Ohio eases access for Medicaid-eligible patients

Ohio eases access for Medicaid-eligible patients
By Ann Sanner
The Associated Press
Posted Jun 06, 2012 @ 03:00 AM

COLUMBUS — State officials are hoping to more easily grant uninsured pregnant women and children in Ohio access to health care services under Medicaid, if they are likely to qualify for the program that provides coverage to the poor and disabled.
A pilot program slated to start next week would let certain health care providers in Ohio presume the patient’s eligible for Medicaid after an initial screening test. Children and expectant mothers would have to prove residency and provide other biographical details. The patients then could access the Medicaid-funded services immediately for 60 days while they apply for the program.
Determining whether a person is eligible for the Medicaid program can take as long as 45 days, state officials said. Case workers must evaluate applicants against more than 150 separate categories to make eligibility determinations.
The state wants to ease that enrollment time by allowing certain health care providers to presume Medicaid eligibility for children and pregnant women, the state’s Medicaid director said Tuesday. That way, patients will get the medical services they need faster and could be on a healthier path sooner.
In general, potential beneficiaries do get served by some health care providers, but the delay in their Medicaid eligibility prevents them from getting prescriptions and any needed follow-up care, said Ohio Medicaid director John McCarthy.
“What we’ve done is change that,” McCarthy told reporters at the news conference in Columbus.
The state has been doing a limited version of presumptive eligibility for children, but that could only be granted at county job and family services offices, limiting the effectiveness for individuals with immediate medical needs.
Under the pilot program, providers could perform an eligibility check and grant immediate medical assistance to both children and pregnant women where they receive their health care.
A test run for the presumptive eligibility program will start at Nationwide Children’s Hospital in Columbus, MetroHealth System in Cleveland and the Community Action Committee of Pike County.
The state hopes to expand the pilot program statewide by January.
About 2.2 million Ohioans are enrolled in Medicaid. Roughly 1.2 million are children, and 30,000 are pregnant women, McCarthy said.

Kentucky AG recovers nearly $2.3M in Medicaid case

June 6, 2012 12:00 PM


From CBS Moneywatch

Kentucky AG recovers nearly $2.3M in Medicaid case

FRANKFORT, Ky. — Attorney General Jack Conway has recovered nearly $2.3 million for the Kentucky Medicaid program in a settlement with Aventis Pharmaceuticals Inc. and Aventis Behring LLC.

Conway announced the settlement on Tuesday.

It was the latest in 17 settlements in lawsuits against some of the nation’s largest pharmaceutical companies in a dispute over whether the firms overcharged the Medicaid program for prescription drugs for the state’s elderly, poor and disabled.

Since 2008, the attorney general’s office has recovered nearly $235 million in legal settlements for the state and federal Medicaid programs.

Mike Leavitt pick may be signal on exchanges

Mike Leavitt pick may be signal on exchanges
By: Jason Millman, Politico blog
June 5, 2012 11:21 PM EDT

The selection of Mike Leavitt to lead Mitt Romney’s transition team doesn’t mean the Affordable Care Act’s health insurance exchanges are here to stay. But it is a reminder of how some Republicans, regardless of the ACA, have already been circling behind the exchange concept.

It also gives the health care world an idea of how exchanges could look under a Romney administration. In all likelihood, they’d be portals — the way Leavitt’s home state of Utah did them — and not much like the more active marketplaces of the Affordable Care Act.

News over the weekend of Leavitt’s involvement in a would-be Romney administration sent some on the right into near apoplectic shock that Romney would pick someone who’s profiting from ACA implementation. Leavitt’s firm is making millions advising states on how to design exchanges, the ACA’s state-based marketplaces that will deliver federal subsidies to purchase insurance and enable about half of the law’s coverage expansion.

But a President Romney would obviously still be the guy calling the shots, and of course he’s repeatedly stressed his dedication to blowing up the health care law on Day One and starting from scratch. His campaign again made that much clear following some weekend chatter over Leavitt’s role.

If a Romney replacement plan does surface, though, it’s possible that exchanges — an idea that has Republican roots — could be in the mix of options. And if exchanges were to be resurrected, they wouldn’t look very much like those in President Barack Obama’s health care law, if Leavitt’s and Romney’s own history with exchanges is any indication.

What’s more, that would be welcome news to some red states that for some time have liked the exchange concept but not its association with “Obamacare” or the prescribed requirements now coming almost weekly from Washington.

“Exchanges are going to be part of the future no matter what,” Leavitt told POLITICO in February. “The Affordable Care Act didn’t invent the exchange — we’ve been trying since the ’70s to get the small and individual group markets to buy insurance like a larger group. That has always been the problem, and the exchange will always be the solution.”

So what would a Romney/Leavitt exchange look like? Think “Utah” much more than “Massachusetts.”

In the same POLITICO interview, Leavitt said he would encourage states to pursue “free market” exchanges, like the one created in his home state of Utah, as a way for states to move forward.

That means throw out the individual and employer mandates. Scrap the federal subsidies to help people purchase individual coverage with a mandated set of health benefits.

The exchange would be a portal for employers to let their workers shop for and compare health plans with some premium assistance from their firm. Further, any health plan that met the state’s minimum requirements would be able to sell on the exchange. The so-called Utah model, which predates the federal law, has drawn considerable interest from Republican states.

That’s also the vision Romney had for small businesses to participate in Massachusetts’s exchange, which also predates the 2010 federal law and is considered the liberal bookend to the Utah exchange. Yes, Romney owns the state’s individual mandate. But as governor, Romney had vetoed the employer penalty for not providing insurance — which the Democratic-dominated Legislature in Massachusetts overrode — and he wanted employees in the exchange to choose their own health plan.

“Gov. Romney had envisioned the small-employer exchange to be more of a defined-contribution model, where employers would pay a certain amount of money and their employees could choose any plan they want,” said Amy Lischko, who served as Romney’s health care commissioner when the state’s 2006 health care reform law passed. Instead, the Massachusetts law was broadly written to leave major decisions to be made after Romney left office, and the exchange board opted against the employee-choice approach.

Even as Republican governors are hesitant to commit to an exchange before the Supreme Court renders its decision on the ACA, they have expressed support for the exchange concept. It’s easy to see how states could take on their own efforts even if the court throws out the national law.

Idaho Gov. Butch Otter, who launched a website to tout the many ways he’s “fighting ‘Obamacare,’” had pushed state lawmakers this year to establish an exchange, an idea that he says he favored well before the national law.

“Long before the passage of the law, Idaho was exploring ways to create its own exchange emphasizing free-market principles and creating a competitive marketplace that would improve access to coverage and keep insurance decisions between Idaho patients and insurance providers,” Otter wrote in December.

Michigan Gov. Rick Snyder is another Republican that favors a “free-market” exchange, with or without the federal law.

“Even if the act of establishing a health insurance exchange were not mandated by the ACA, I would still be in favor of utilizing technology to create a better customer service experience for Michiganders,” Snyder said in September. “Done right, the [exchange] legislation will allow customers and small businesses to make more-efficient and better-informed decisions about buying health insurance coverage.”