State cuts squeezing the elderly poor and their doctors, By Thanh Tan, March 8, 2012, New York Times: “After Dr. Javier Saenz completed his family-medicine residency in 1985, he returned home to the Rio Grande Valley to open a practice in the impoverished town of La Joya. Today, Saenz Medical Center treats up to 150 patients a day. Dr. Saenz is the volunteer physician for the local high schools and their football teams. A middle school is named after him. Despite his success, Dr. Saenz, 56, said he feels nothing like a hero these days. His practice, he said, is hanging by a thread. His troubles reflect a statewide problem for doctors who treat a disproportionately high number of the reported 320,000 low-income Texans who are dually eligible for Medicare, the federal insurer of the elderly, and Medicaid, the joint state-federal health care program for indigent children, disabled people and the very poor. On Jan. 1, the state reduced its share of co-payments for such patients. Physicians who treat them are seeing less revenue. Many, like Dr. Saenz, are not sure they can make enough money to stay in business…”
TennCare hospital reimbursements vary widely, By Tom Wilemon, March 9, 2012, The Tennessean: “Some Tennessee hospitals are questioning why they should continue paying a self-imposed tax to prop up the state’s Medicaid program because competitors are getting back much more in reimbursements while they lose money treating TennCare patients. Hospital executives were shocked to learn that insurance contractors for TennCare, the state health-care program for the poor, were paying more than four times as much to some hospitals as to others for outpatient procedures. In some cases, the disparities amounted to millions of dollars – enough to make or break a hospital’s budget…”
Last-minute plan would let FSSA cut Medicaid, By Chris Sikich, March 9, 2012, Indianapolis Star: “As today’s adjournment for the General Assembly quickly approaches, lawmakers are debating a last-minute plan to give the Family and Social Services Administration broad powers to reduce Medicaid spending. In 2011, the General Assembly approved a measure to help the agency cut $212 million from Medicaid to balance spending. The FSSA was granted emergency powers to quickly cut funding or alter or eliminate certain Medicaid programs. The action allowed the agency to bypass public hearings and legislative oversight. Just how long those powers should last has been a matter of debate…”
Medicaid cut would hit Florida’s poorest patients, hospitals, By Mary Shedden, March 8, 2012, Tampa Tribune: “Doctors and hospitals treating Florida’s poorest patients face significant pay cuts in the state’s nearly final budget. Legislators will vote by Friday on a $70 billion budget that includes $304 million less to reimburse hospitals. A Florida Hospital Association analysis released Wednesday projects the state’s hospitals will receive $642.8 million less for treating poor children, pregnant women and disabled adults in 2013. This second consecutive year of Medicaid cuts will force hospitals to quickly decide what services to reduce or eliminate, said Kimberly Guy, chief operating officer at St. Joseph’s hospitals for women and children, where the cuts could total $7.3 million…”
State scales back Medicaid shortfall by $300 million, By Jason Stein, January 3, 2012, Milwaukee Journal Sentinel: “In a bit of good news for the state’s strained budget, Gov. Scott Walker’s administration is scaling back by more than $300 million the two-year shortfall projected for state health programs for the poor. But a state health department spokeswoman said that to ensure the state health programs remain affordable, the Walker administration will still seek to proceed with a half-billion dollars in proposed cuts affecting tens of thousands of recipients. In a letter to lawmakers Tuesday, the head of the Department of Health Services said that the shortfall through June 2013 is now expected to be $232 million in state and federal money, down from the $554 million that was projected in September. The change in the projections amounts to about 2% of the funding in the program, Health Services Secretary Dennis Smith wrote in a letter to members of the Joint Finance Committee…”
Medicaid payment backlog cripples supportive living centers, By Dean Olsen, January 3, 2012, State Journal-Register: “Medicaid payment delays of up to six months are causing fits for supportive living centers throughout Illinois, and some owners are worried they may have to close if the situation doesn’t improve soon. ‘It’s a crisis for us because reserves and lines of credit are being exhausted,’ Wayne Smallwood, executive director of the Springfield-based Affordable Assisted Living Coalition, said last week. ‘This is the worst we’ve seen, and there’s no relief in sight.’ Illinois’ festering budget problems, the sagging economy and the end of the federal economic stimulus program in June have contributed to growing payment delays that also hamstring nursing homes, hospitals, doctors and other medical providers…”
Nowhere to go, patients linger in hospitals, at a high cost, By Sam Roberts, January 2, 2012, New York Times: “Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing. As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost…”
Ruling: AHCCCS copays break law, By Mary K. Reinhart, August 25, 2011, Arizona Republic: “A federal appeals court ruled Wednesday that mandatory copayments charged to Arizona’s poorest residents violate federal law. The three-judge panel of the 9th U.S. Circuit Court of Appeals said federal health officials failed to show how the copays, imposed in November after a seven-year court battle, served any purpose besides cutting the state’s Medicaid budget. Federal law gives the U.S. Health and Human Services secretary discretion to approve state Medicaid ‘waivers’ as long as the programs have a ‘research or demonstration value.’ Raising copayments for more than 200,000 of Arizona’s poorest residents and making them mandatory, the judges said, helped balance the state budget but didn’t meet that federal standard…”
Illinois Medicaid’s managed care effort stumbles, By Judith Graham, August 26, 2011, Chicago Tribune: “It can take years for people with cerebral palsy, autism, schizophrenia or Down syndrome to find trusted physicians to oversee their health. Now, families and advocates say, those medical relationships are being threatened as Illinois rolls out a new program of HMO-style care for people with serious disabilities. Many doctors and hospitals are refusing to join the new Medicaid program, which the state hopes will better coordinate care and lower costs for some of its neediest recipients. The providers’ rationale: They dislike the bureaucratic hassles and cost-cutting measures associated with managed care. The ranks of those who have said no, for the moment, include prominent medical centers and physician practices with a long track record of serving the disabled, among them Northwestern Memorial Hospital, Rush University Medical Center, the University of Chicago Medical Center, Children’s Memorial Hospital and Loyola University Health System. Because of the situation, hundreds if not thousands of vulnerable, chronically ill individuals are being forced to find new doctors, some of whom appear ill-equipped to handle their needs, according to consumer advocates and families…”
