Will Medicaid Expansion Stick in Ohio?

Kasich’s Back-Door Plan Requires Reauthorization — And Political Support
A battle is brewing in Ohio.

University Hospitals Chief Executive Officer Tom Zenty warned a Cleveland audience that the state’s Medicaid expansion may not be permanent. “In July of next year, if there is no intervention, Medicaid expansion in the state of Ohio disappears,” Zenty said, during a recent panel discussion.

Following the U.S. Supreme Court decision about the Affordable Care Act in 2012, states could choose whether they wanted to expand Medicaid to people with incomes up to 138% of the federal poverty level, or about $16,100 for an individual enrolling in 2015.

For months, Ohio’s Gov. John Kasich, a Republican, met with state lawmakers and tried to convince them that expanding the health coverage to more uninsured residents was good for both the state budget and the wellbeing of people.

He failed. Kasich never won approval from the full state legislature for expansion. Yet, Ohio expanded Medicaid.

It turns out, Kasich could take a backdoor. Unlike other states, Ohio has a Controlling Board, which is made up of a smaller bipartisan group of state lawmakers who oversee adjustments to the state budget.

Kasich defied his party and asked the board to accept $2.5 billion in extra Medicaid funds […]

By |October 17th, 2014|Medicare/Medicaid|Comments Off

40% of payments value-oriented

The share of private insurance payments that are “value-oriented” leapt to 40 percent among respondents in an ongoing national scorecard.

The Catalyst for Payment Reform (CPR), which had sought to push 20 percent of payments to hospitals and physicians toward a value basis by 2020, concluded that 40 percent of payments had reached that point among the insurers that responded to its queries. Value-oriented payment methods, which CPR defines as payment methods designed to improve quality and reduce waste, leapt from 11 percent of payments in the 2013 scorecard.

The finding that two-fifths of commercial health insurance payments were no longer fee-for-service drew skepticism from one healthcare finance expert.

“Although we do believe that provider organizations are increasingly entering into nontraditional payment arrangements and moving away from fee for service, we are surprised at the large increase in reported results,” said Todd Nelson, director, healthcare finance policy, operational initiatives for HFMA. “As the study acknowledges, some of the potential explanation for the jump in responses could be due to a different pool of respondents from prior years, higher concentration of larger plans who may be more ready to leverage these types of arrangements, and the voluntary nature of survey participation, such that […]

By |October 17th, 2014|Health Reform, Industry News|Comments Off

Renewals and new customers bring flood of HIX complexity

It’s almost game day for the second season of ACA insurance exchanges, and insurers need to get ready to handle all sorts of consumer inquiries and administrative tasks.

The Centers for Medicare & Medicaid Services is hoping to avoid another technology flop with the HealthCare.gov marketplace. Regulators say they’re ready to work with health plans to re-enroll millions of buyers from last year and sign up millions of new ones.

CMS has set an early October launch for the visual redesign of HealthCare.gov’s navigational section for returning enrollees, and notices from the exchange will go out October 15, a month before renewal notices from insurers.

The federal marketplace, serving consumers in more than 30 states, will be sending enrolled exchange members letters and a series of email reminders ahead of open enrollment, as well as sponsoring multimedia outreach and promoting help over the phone via call centers.

The exchange’s outreach and support, along with help from health plans and enrollment assister, may not necessarily ensure a smooth consumer experience, given the technology involved and the complexity of individual cases.

In the presentation, CMS outlined four likely scenarios that insurers and enrollment assisters are likely to see. One is an enrollee who authorized the exchange […]

By |October 15th, 2014|Health Reform|Comments Off


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