I don’t know about you but I would have a reaction of sheer terror if I were told that I suddenly owed $433 million due to an error in classifying Medicaid eligible members over two years. That is what the State of Florida and the federal government now face.
This is strange to me because a lot of Medicaid MCOs do extensive analysis in preparation for premium rating season where negotiations w/the State Medicaid Agency occur. the MCO typically will analyze member’s claims experiences including diagnosis codes to determine the spend and severity of each category of member premiums.
I’d hate to be that person who was responsible for that.
Those of us who have worked w/State Medicaid Agencies (SMAs) know the MMIS infrastructure is showing quite a bit of wear and tear over the years. CMS has announced some news that most of us would cheer, from increasing Medicaid IT funding to implementing more of an incremental systems approach rather than a ‘big bang’ implementation that inherently has more risks and is prone to lengthy delays.
In an ever-changing sign of the times away from fee for service (FFS) payment models, NC has announced its intention to move away from FFS and to a blend of managed care and ACOs to help lawmakers come up with a more predictable way to measure Medicaid expenditures. Will other states follow?
Read more here.
As Medicare and Medicaid turn half a century old (what a geezer!), these two programs have weathered quite a lot during this time. While Medicare is a politically sensitive subject and seen as a third rail in politics, Medicaid has a different political meaning to politicians and therefore lawmakers. Here are some key challenges as Medicaid moves on along in her now 50th year of existence.
This is surely to never be a topic on a Trivial Pursuit card (how fun would that be????). Many of us who have been in healthcare for a while know some basic tenants of Medicare and Medicaid but how well do we really know them? Here are some fascinating tidbits:
- Former President Truman was the first Medicare enrollee;
- Medicare was instrumental in desegregating hospitals across the country;
- Medicare coverage was greatly expanded during President Nixon’s term;
- President Clinton’s term in office saw the creation of CHIP (Child Health Insurance Program) where Medicaid covered low-income children;
- In 2001 under President George W. Bush’s term, HCFA (Health Care Financing Administration) that regulates Medicare and Medicaid was renamed the Centers for Medicare and Medicaid or CMS.
- There are 4 parts to Medicare currently. Parts A and B are considered ‘original’ Medicare and administered by the federal government and Parts C and D are run by private industry.
- Medicaid is the largest coverage source for Americans with over 64 million lives covered. A little under half are children under the age of 18.