Reform Update: Medicaid, CHIP could gain 18 million more enrollees if all states expanded programs, study says

By Steven Ross Johnson

Posted: August 6, 2013 – 2:00 pm ET

While a new report estimates millions of people could be added to Medicaid and the Children’s Health Insurance Program if all states expanded these programs as allowed under the Patient Protection and Affordable Care Act, a number of states have refused to expand their programs or cut their existing programs, leaving thousands of their residents without coverage.

The study conducted by the Kaiser Foundation and the Urban Institute estimated 18 million people could be added to the programs, and that the rate of uninsured in each state would fall below 15% if the ACA’s Medicaid were fully implemented in all states. Hospital leaders are in the forefront of pushing resistant states to expand Medicaid.

The ACA requires most Americans to have some kind of coverage by January. The law’s expansion of Medicaid, made optional by the U.S. Supreme Court last year, would open the program to an additional 20 million people, according to the CMS. The report estimated 18 million people would be added under the Medicaid expansion if it were implemented to all 50 states. The federal government would pay for the expanded coverage for the first three years, and for 90% of the costs after that.

Despite the numbers of low-income Americans who would benefit, only 23 states so far have agreed to expand Medicaid, which would cover those under age 65 with income up to 138% of the federal poverty level. Twenty-one states have declined to expand Medicaid, while six states have remained undecided.

Many states have gone through pitched political battles over the issue. In Maine, more than 15,000 of the state’s low-income residents could lose Medicaid coverage beginning in January in large part because of the state’s decision not to expand its program under ACA.

The Associated Press, via the Concord Monitor, reported that an additional 10,500 adults with no children and incomes less than $11,500 are expected to become ineligible as a result of state changes in its Medicaid program, despite being eligible under ACA criteria.

Maine’s Republican governor vetoed a bill to expand Medicaid, citing what he claimed were the unsustainable long-term costs to the state of the program expansion.

More than 11,000 residents were removed from Medicaid between February and May. While many would be eligible for federal subsidies to help purchase private coverage on the new state insurance exchange in January, as many as 10,000 adults who stand to lose coverage as a part of state cuts to the program would not be eligible to receive subsidies.

In Missouri, the Republican-led Legislature blocked an initiative led by the state’s Democratic governor to expand Medicaid that would provide health coverage for an estimated 250,000 low-income residents.

Similar efforts to expand the program have encountered roadblocks by legislatures in Ohio, North Carolina, Texas and Florida, while bills to pass expansion have been blocked by Republican governors in states such as Pennsylvania.

In Arizona, a law expanding Medicaid that was pushed through by Republican Gov. Jan Brewer has led to in-fighting between Brewer and members of her own party, who are seeking to repeal the measure through a ballot initiative this fall.

Aetna opts out of Connecticut health insurance exchange

One of the largest insurers in Connecticut has opted out of the state’s health insurance exchange because of differences over pricing, USA Today reports.

The move came after Aetna and the Connecticut Insurance Department failed to agree over how the insurer’s proposed rates were to be calculated under the exchange program.

Aetna is the second insurer to drop out of the Connecticut exchange. Last month, ConnectiCare Benefit decided not to participate.

Last week, the insurer canceled plans to join Maryland public health exchange after state regulators lowered the rates the company could charge consumers by 29%.

Report finds majority of N.Y. healthcare workers earning near poverty level

A new report conducted by the advocacy group Alliance for a Greater New York (PDF) found the majority of New York City’s home healthcare aides earn wages that are at or near the poverty level.

The study found that 62% of home healthcare aides surveyed had incomes that were less than $25,000 a year. Many of these workers are expected to qualify for expanded Medicaid or receive federal subsidies to buy health insurance on the New York Health Benefit Exchange starting in January.

The report said home healthcare is one of New York’s fastest growing industries.

Follow Steven Ross Johnson on Twitter: @MHSjohnson

Read more: Medicaid, CHIP could gain 18 million enrollees if all states expanded programs, study says | Modern Healthcare

Contractors hoping to win work marketing health care options

By Marjorie Censer, Published: August 4 Washington Post

With the technical part of building state and federal health insurance exchanges mostly complete, contractors are now hoping to find work communicating with potential customers.Companies from Adobe to Maximus are looking to work that will involve first-hand interaction with citizens, meaning they must prepare to combat misinformation and boil down complex decisions.

Adobe, which has a government-focused office in Tysons Corner, has already been working with state exchanges, which are online marketplaces that allow individuals to shop for insurance coverage. The company said it previously won work providing its digital signature technology to Rhode Island’s exchange, so that users can produce a legally binding signature even on an iPad, and has sold software to California that allows enrollees to automatically populate forms so that they save time.Now, said Michael Jackson, director of health care strategy and solutions at Adobe Systems, states and the federal government are directing attention to interacting with users.

“Within the last three to six months, a lot of attention has shifted to driving awareness, outreach to the citizens and various communities … to drive participation to the exchanges,” he said.

The Center for Medicare and Medicaid Services confirmed that it is gearing up for a public education campaign. The agency tacked $33 million onto an initial $8 million contract awarded to Weber Shandwick, a public relations firm, to handle media and digital outreach. Weber Shandwick did not return requests for comment.

The agency has also relaunched, a site meant to help consumers learn about their options. CMS said the site will add information and, by October, customers will be able to create accounts, fill out a single application and shop for plans on the site.

Even before the Oct.1 deadline for exchanges to go live, customer service centers are opening. Reston-based Maximus, for instance, opened its center in Maryland last week.

It’s too early for customers to enroll in insurance plans yet, but the center is available to handle residents’ questions, said Bruce L. Caswell, president and general manager of the company’s health services segment.

Maximus has won work managing seven state customer service centers, including that of the District and Maryland, as well as managing two federal centers as subcontractors to Falls Church-based General Dynamics.

For center representatives, “it’s important that they have good phone skills, good customer interaction skills,” Caswell said. “It’s a bit of the art rather than the science.”

These employees are trained on how to help customers as well as the details of the insurance plans available. Caswell said the centers often offer representatives who speak several different languages, as well as use an interpretation service to broaden that number.

Maximus is focused on “being able to meet consumers on their own terms,” Caswell said. “Being linguistically appropriate and culturally appropriate is super important to us.”

Hoping to handle social media outreach for the government, Adobe is pitching its experience providing these services for some commercial health care providers.

Adobe’s service includes responding to tweets that ask questions or share wrong information to promote the accurate message.

In the private sector, customers are becoming accustomed to tweeting at companies — from phone service providers to cable companies — for help.

“I do feel like the public sector is starting to learn from what’s happening in the private sector,” Jackson said.

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