CMS Wants to Know - Can Medicaid Beneficiaries Find a Doctor?

The Centers for Medicare and Medicaid Services (CMS) is planning to conduct its first nationwide research effort to answer the question of whether adult Medicaid beneficiaries can find providers, and if factors such as being in managed Medicaid versus a fee-for-service offering aid or hurt the search. 

What it's likely to find, according to interviews conducted with state Medicaid officials and medical society officials in 20 states, is a mixed picture overshadowed by general concerns that reimbursement rates remain too low to entice many doctors to accept new Medicaid patients. Read the article in Modern Healthcare here.

Medicaid Dental Benefits Extended Further Beginning July 1

Beginning July 1st, Medicaid beneficiaries have access to more dental services under a benefit that became available April 1st.

The new benefit provides Medicaid adults age 21 and older with access to up to $1,000 in dental services per state fiscal year, according to a release from the Colorado Department of Health Care Policy and Financing (HCPF). "A healthy mouth and health body go hand-in-hand," said Susan Birch, Executive Director of HCPF in a statement. "We have already heard from many of our clients how grateful they are since the initial benefit began in April. Having this enhanced benefit in place will help our clients maintain good oral health and improve their overall health and quality of life."

The extended benefit covers basic preventive dental exams, diagnostic and restorative dental services including extractions, root canals, crowns, partial dentures, complete dentures, periodontal scaling, root planning and other procedures requiring prior authorization.

The expansion is funded through the federal and state government. Colorado's share of the funding comes from a state fund that formerly funded Cover Colorado.

Read the July 1 press release from HCPF here.    

Final Surge Pushes ACA Enrollment in Colorado

Enrollment for private health insurance coverage for this year ended Monday with a surge that led to 118,628 Coloradans signing up on the state exchange (Connect for Health Colorado). Some 12,000 people signed up during the last week of open enrollment.

Enrollments under the Affordable Care Act are expected to continue to climb over the next few weeks in Colorado. Those who started their applications prior to the deadline, but were unable to complete them, will be given more time.

Connect for Health Colorado reported yesterday (Tuesday) that between Oct. 1st and March 31st, more than 277,000 Coloradans obtained either commercial or public health insurance under the Affordable Care Act. Medicaid gained 158,521 enrollees. The federal program expanded under the law in Colorado to cover lower-income single adults as well as disabled people, mothers, pregnant women and children.

Read the article in the Denver Post here.

Newly Insured Begin Seeking Care: An Update on Colorado's Enrollment

According to Modern Healthcare, health systems are reporting a flood of phone calls as newly insured patients start seeking care. Approximately 2.1 Americans have signed up for insurance through an exchange, and another 3.9 million qualified for Medicaid, according to Health and Human Services. The roll-out has been uneven across the country, depending largely on the investment each state has made in setting up and promoting its own insurance exchange or whether it defaulted to the federal marketplace. Read the rest of the article here. 

Colorado's exchange, Connect for Health Colorado (C4HCO) achieved a total of 52,783 Coloradans signing up for health insurance on Colorado's marketplace between October 1, 2013 to December 31, 2013. Most of these enrollees began receiving health insurance benefits on January 1st of this year. October and November had a slow but steady pace of enrollees, then December saw a boom in enrollments. For example, on December 23, 2013, the final day of enrollment for coverage starting on January 1st, 5,354 people enrolled in just one day. Open enrollment continues through March 31st of this year. 

On the public insurance side, 86,432 Coloradans have successfully enrolled in Medicaid since October 1, 2013. “The enrollments in Medicaid and Connect for Health Colorado show that Coloradans are becoming more aware of the importance of having health insurance coverage,” said Susan Birch, Executive Director of the Colorado Department of Health Care Policy and Financing. “Whether Coloradans have health insurance coverage through private insurance or through Medicaid, health coverage is the first step to better health.

Mediator Coming to Help with Exchange Set Up

Sparring between Colorado Department of Health Care Policy and Financing (HCPF) and the Colorado Health Benefit Exchange Board (COHBE) prompted an outside analyst to recommend a third party to triage and manage the project.

Federal grants that Colorado received to launch its exchange require outside analysts to conduct independent reviews. According to a new report from outside analysts at First Data, squabbling between state and exchange managers over IT projects and other policy decisions has been slowing down progress on the exchange.Therefore, a mediator from the Robert Wood Johnson Foundation now will come to Colorado to help managers get the giant multi-million dollar project off the ground on time by October 1st when it’s slated to open to consumers.

Yen Pham, an analyst from First Data stated, “A number of policy decisions need to be resolved by both COHBE and HCPF; they include the approach to accommodate referrals, eligibility mixed households and life change events.” Read more in the Colorado blog, Health Policy Solutions. 

Policy Options to Cut Emergency Department Costs

For nearly 50 years, emergency rooms have been fingered as a major source of excessive healthcare costs. And while some newer research has challenged the idea that a large proportion of patients visit the emergency room for routine problems, many payers and policy makers continue to focus on these patients as a major source of wasteful spending.

For a new study published in The Journal of the American Medical Association, researchers reviewed the records from almost 35,000 patient visits to emergency departments across the country. In just 6 percent of cases, the patient was discharged and could have been treated in a healthcare provider’s office. 

History has shown that limiting payments based on discharge diagnoses has been largely unsuccessful. However, other policy options are being tested around the country. Beginning last summer, emergency departments in Washington state established programs to educate patients on how to access care, as well as other measures designed to improve care, including statewide guidelines on prescribing narcotics, shared electronic health and prescription information, and regularly updated reports on how emergency department resources are utilized. The policy has already resulted in significant changes and a projected savings of over $31 million by the end of the fiscal year. Read more here.

HCPF Hosting Stakeholder Meeting to Discuss Churn

Earlier this year, Governor Hickenlooper announced that Colorado will expand Medicaid for adults up to 133% of the federal poverty level as part of the Affordable Care Act. Colorado will also be running its own state health insurance exchange, where eligible individuals and families will be able to shop for subsidized health insurance coverage. In preparation for this expansion, the Department of Health Care Policy and Financing (HCPF) has been working with stakeholders, the Center for Health Care Strategies, SHADAC, and other states to understand the needs and characteristics of this newly eligible population. 

HCPF would like to invite you to join the conversation on Monday, March 18 from 11:00 am to 1:00 pm for a stakeholder meeting to discuss “churn” – the movement of individuals between Medicaid and the exchange. 

Stakeholders may join via webinar and phone. To register for the webinar, click this link. If you’ve never attended a GoToMeeting webinar before, you will need to click “run” when the program prompts you. The webinar will allow you to see the slides during the meeting, but to hear the facilitator, you will need to call into the conference line and enter the participant code below.  

Call-in: 877-820-7831
Participant code: 946029#

New Analysis of Colorado Children and Health Insurance

The Colorado Health Institute recently released its annual analysis of the number of eligible children in the state who are not enrolled in the Medicaid or Child Health Plan Plus (CHP+) public insurance programs.

According to the analysis, about 125,000 Colorado children, or 9.7 percent of all children, did not have health insurance in 2011. This was a decrease from the 132,000 uninsured children in 2010.

View the 2011 estimates from the Colorado Health Institute here in three new publications:

• A fact sheet that summarizes the high-level findings and maps county-level estimates. 
• A data supplement that includes detailed tables of county-level data. 
• A methodology document that outlines the assumptions and processes used to create the estimates.

Report Says Medicaid Expansion Will Boost Colorado's Economy

A new study of Medicaid expansion commissioned by the Colorado Health Foundation, and conducted by legislative budget analyst Charlie Brown and a team of economists, says expanding Medicaid to an estimated 275,000 additional people will cost Colorado less than the price of not adding them.  Brown and his team found that expanding Medicaid would be similar to a stimulus program for Colorado because millions of federal dollars will flow into the state to pay for the new patients’ care (federal taxes will pay 100 percent of the costs of Medicaid expansion from 2014 to 2016, then taper to 90 percent by 2020).

Key findings from the report include:

• In FY 2025-26, the last year of the study period, a comparison of the "no expansion" and "full expansion" options shows that the following economic impacts will occur as a result of the decision to fully expand Medicaid:
• The economy, as measured by state gross domestic product (GDP), will be 0.74 percent larger than if Colorado does not expand its Medicaid program. Expansion will result in just less than $4.4 billion in additional state economic activity in 2025.
• Average annual household earnings will be $608 more with full Medicaid expansion compared to no expansion.
• Colorado will have 22,388 more jobs in 2025 if the state fully expands Medicaid.
• While Medicaid expansion is not free, the combination of federal support for expansion populations and state savings in programs makes full expansion less costly to the General Fund than no expansion until FY 2020-21.
• By FY 2025-2026, state General Fund appropriations would be a cumulative $133.8 million less for full Medicaid expansion than if the state chose not to expand.
• The larger economy that would result from Medicaid expansion will generate more state tax revenue without an increase in tax rates. In FY 2025-26, tax revenue is projected to be $128 million higher due to a decision to expand Medicaid. In each year, the combination of the additional revenue generated from the larger economy and savings in other General Fund programs is sufficient to fund the state's share of the cost of Medicaid expansion.
• Compared to no expansion, Medicaid expansion will add an additional 275,000 Coloradans to Medicaid enrollment by FY 2025-26. Those added to Medicaid insurance include 209,000 newly eligible adults without dependent children, 44,000 newly eligible parents and an additional 22,000 currently eligible but not enrolled children and parents.
• Medicaid expansion will reduce the number of uninsured non-elderly Coloradans by 189,000 by FY 2025-26 and reduce the percentage of uninsured in the non-elderly population from 11.1 percent to 7.7 percent compared with non-expansion.

Read the press release from the Colorado Health Foundation and link to the full report here.

New Medicaid Estimates

According to a new cost-benefit analysis from the Colorado Health Institute, expanding Medicaid would cost Colorado about $1 billion over 10 years and add an estimated 240,000 to the state’s Medicaid rolls, including as many as 73,000 people who could switch from private to public health insurance. 

Colorado lawmakers expect to introduce a bill in the coming weeks that will outline the state's plans for Medicaid expansion.  Read the informative blog post from Health Policy Solutions here.

Anthem's Telemedicine Program Connects Members with Needed Services

Anthem Blue Cross’ telehealth network recently marked an important milestone. By providing over 50,000 specialty consults, they connected members in some of the state’s most rural underserved areas to needed healthcare services. Read about how they built their model from its original purpose as a vehicle to serve the growing Medi-Cal population, and how the program has grown over time to serve other Anthem members and even other health plans without a network of their own.

 

Infographic on Healthcare Access in Rural Colorado Released

Joe Sammen, Community Partnership Coordinator for the Colorado Coalition for the Medically Underserved (CCMU), blogged this week about policy options to improve access for rural Coloradans. His opinion piece accompanied CCMU's lastest brief in their infographic series, a series that explores health from the perspectives of different populations. Developed using health survey data, the series demonstrates Coloradans’ varying experiences of health and healthcare. Read Joe's opinion piece here on rural healthcare reform and opportunities for coverage, and view CCMU's rural health infographic with data on access and coverage for rural Coloradans here.

Roughly 12,000 Jobs to be Added Statewide with Expansion of Medicaid

A proposal to expand Medicaid to cover 160,000 more Coloradans will add roughly 12,000 jobs statewide, according to a rough estimate by economic development leader Tom Clark.  Legislators will be debating whether to accept the federal offer this session, which as part of the Affordable Care Act, offers states the option to expand Medicaid to persons living below 133% of the federal poverty level. Gov. Hickenlooper recently gave the expansion his support and estimated it would bring $12.28 billion in federal funds back to Colorado taxpayers over 10 years. Read more here.

Gov. Hickenlooper Announces Plans for Expansion of Medicaid in Colorado

Governor Hickenlooper announced this week his administration’s plans to expand Medicaid as part of federal healthcare reform.  This is a big win for rural Coloradans who typically earn lower wages than their urban counterparts and disproportionately experience unemployment. CRHC’s most recent policy survey shows members overwhelmingly support the expansion as a means to increase access to care for rural Coloradans, so this is exciting news for CRHC members and partners. 

The new eligibility standards will enable the state to cover an additional 160,000 adults. The federal government will cover 100% of the costs for the newly-eligible Medicaid population through 2016. After that, the federal match begins to taper down, and Colorado will be responsible for 10% beginning in 2020 (unless the law is changed).

The Governor’s press release can be found here.  Gov. Hickenlooper released a fact sheet and an FAQ with his announcement.  Click on the embedded links to read those documents. 

Don’t Miss This Important Meeting Hosted by HCPF to Discuss Distribution of Savings to RHCs, FQHCs, BHOs and RCCOs

The Department of Health Care Policy and Financing is beginning a series of ongoing discussions bringing together the Regional Care Collaborative Organizations (RCCOs), the Primary Care Medical Providers (including FQHCs and RHCs), and the Behavioral Health Organizations (BHOs), with HCPF acting as a mediator, to discuss an equitable distribution of savings for these parties. The first of these discussions will be held at the next Accountable Care Collaborative (ACC) Payment Reform Subcommittee meeting tomorrow, December 14th from 2:30 PM to 4:30 PM in the 1st floor conference room at 225 E. 16th Avenue. The agenda can be found here, and the call in information can be found below.

Call-in information:
Toll: 1-720-279-0026
Toll free: 1-877-820-7831
Passcode: 610450#
Mute/unmute: *6

HHS Says No Enhanced Match for Partial Medicaid Expansion

The Obama administration filled in a key detail of what states must do to receive full federal funding for an expansion of Medicaid under the 2010 health law. Health and Human Services Secretary Kathleen Sebelius said in a letter sent Monday to governors that states cannot partially expand their Medicaid programs and get full federal funding. In a blog post, Sebelius also outlined other points of the guidance being provided to states, and gave a conditional nod to exchange plans submitted by Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington. Click on the embedded links to read more.

Half of the States Are Implementing Patient Centered Medical Homes for Their Medicaid Populations

Medicaid agencies in 25 states have pursued initiatives to incentivize and support physician practices to become patient-centered medical homes, where clinicians and other health professionals team up to provide comprehensive, coordinated, accessible services to their low-income patient populations. Mary Takach, program director at the National Academy for State Health Policy, reviews the variety of reforms taking shape in the latest issue of Health Affairs. Read what initiatives other states are pursuing here. Read more here about what Colorado is doing to incentivize patient centered medical homes for Medicaid b.