TOPIC: Centers for Medicare & Medicaid Services

What’s wrong with Medicare? Here’s another Prime example

Remember the kwashiorkor plague striking Northern California — where the African childhood disease was spreading like wildfire, but only amongst seniors with Medicare getting treatment at hospitals affiliated with Prime Healthcare?

Well, according to Christina Jewett and Stephen K. Doig of California Watch, in a story published in today’s San Francisco Chronicle, in addition to a chronic case of upcoding, Prime Healthcare is also apparently hospitalizing patients who should be discharged, in an effort to maximize bills to Medicare and various H.M.O.’s. (more…)

Feds block Illinois’ money-saving Medicaid tweak

Here is what looks to be an unintended consequence of the federal health care reform law. The Chicago Sun-Times Abdon M. Pallasch reports that, “The federal government is refusing to allow a new process passed by bipartisan majorities in Illinois that requires medical patients here to show that they live in Illinois and earn little enough to qualify for Medicaid.” The federal Center for Medicare & Medicaid Services is saying no because (more…)

Grapes of Wrath? You can’t afford ‘em

Can a California family of three survive on $480 a month? The 1.5 million recipients of CalWORKs, the state’s welfare-to-work program, are about to find out. (more…)

Scott Walker turned down on privatization

The Wisconsin state legislature did away with two major attempts by Gov. Scott Walker to privatize local administration of federally-funded social services. Jessica Vanegreen of the Madison Capital Times reports that Walker had wanted to use private workers to run Wisconsin’s food stamp program, Food Share, and also to run Medicaid. Walker’s idea was that residents would no longer apply in person for Food Share or Medicaid services, but instead use hotline numbers. The Obama administration threatened to remove federal funding if these proposals got enacted.

But even when Walker loses, he partly wins. The state legislature did agree to consolidate staff at centers that administer food stamp benefits.

Indiana v. Planned Parenthood…and Obama

House Republicans ultimately failed to include a ban on federal Medicaid funding for Planned Parenthood in the last-minute 2011 federal budget. But the Republican effort to deny Medicaid funds to Planned Parenthood Medicaid lives on at the state level, particularly in Indiana. As Wisconsin did with public employee unions, Indiana Republicans have used state government as a laboratory to weaken Democratic-leaning institutions. (more…)

More borrowing for Illinois?

When not searching the couch cushions and glove compartment for loose change, Illinois Gov. Pat Quinn tends to make controversial proposals to ensure his state pays overdue Medicaid bills — and therefore keeps getting millions in federal Medicaid funds. First, Quinn wanted the state to borrow $8.75 billion, but the state legislature was cool to the idea. Now, the Springfield State Journal Register’s Dean Olsen reports that Quinn wants the Illinois Finance Authority to borrow $750 million from private investors like banks and then repay the banks with interest.

Given the state’s massive short and long-term deficit, further borrowing sounds bad. But other alternative to make state payments are worse: like freezing state income tax money that goes to municipal governments (many of which, like Chicago, are doing just as badly as the state).

Hiding from infection data at Chicago hospitals

For the first time, the Center for Medicare & Medicaid Services has released a comprehensive study of “adverse events” caused by mistakes or incompetence at hospitals. The American Hospital Association, unsurprisingly, fought the release of a report that shows hospital errors cause 100,000 deaths each year.  One source of this resistance is coming from Chicago. Judith Graham of the Chicago Tribune reports that “Chicago’s top medical centers appear on the list of hospitals with safety issues, to one extent or another.” But officials at some of these hospitals question the government’s method of counting infections and claim the government report doesn’t take into account corrective changes the hospitals have made.

Borrowing to pay the doctors bills

Gov. Pat Quinn wants Illinois to borrow $2 billion in order to pay for the state’s Medicaid program, reports Yvette Shields at Bond Buyer. At issue are two facts: A.) Illinois has a colossal, monstrous, record short-term deficit even with a major tax increase and B.) the federal reimbursement rate for Medicaid costs drops from 57 percent to 50 percent July 1st, when the stimulus bill extension expires.

Enrollment in Medicaid jumped during the Great Recession, but until now the increased federal reimbursement covered this cost. Absent this borrowing, it’s not clear what the state can do besides cut other programs or reduce Medicaid services. They can’t really reduce eligibility levels: A reduction would deny Illinois heavy federal Medicaid subsidies that start in 2014 under the national health care reform law.

HHS nursing home report raises new fears

Long synonymous with the fear of reaching an advanced age and becoming unable to protect yourself, the words “nursing home” are once again striking fear into the hearts of older Americans and their relatives.   Christina Jewett of CaliforniaWatch exposes findings of a report by the federal Health and Human Services Inspector General that is almost certain to raise anxiety on a question that already makes people anxious. (more…)

Streamlining Medicaid costs

Micah Maidenberg of Progress Illinois reports on implementation of an Illinois law to curb Medicaid costs. Maidenberg finds instances of waste and inefficiencies in the system, like the federal and state government paying an insurance company $243 million between 2000-2004 to participate in Medicaid. The insurance company then didn’t provide health care to pregnant women or unhealthy patients.

But the big picture problem is that, thanks to the recession, both more poor people in Illinois are Medicaid eligible and fewer federal and state dollars are available to provide health services. This dilemma will likely end in 2014 when, under the national health care reform law, the federal government will pay for the health care of every adult who lives at less than 133 percent above the poverty level.