Report: Medicaid expansion in 10 states would cover 2.3M people
If the 10 states that have yet to expand their Medicaid programs did so in 2024, more than 2.3 million Americans would gain health coverage, according to a new report by the Urban Institute and Robert Wood Johnson Foundation. Researchers used the Urban Institute’s Health Insurance to estimate the recent impact of Medicaid expansion on health coverage and costs. They found the uninsurance rate would drop by 25 percent if Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming expanded their Medicaid programs.
The study also found:
- Medicaid enrollment would increase by five million people, an increase of nearly 32 percent.
- An additional 2.3 million people with incomes of up to 138 percent of the federal poverty level will switch from the marketplaces to Medicaid coverage.
- Groups with the highest gains in coverage would include non-Hispanic Blacks, young adults, and women, particularly women of reproductive age.
- Federal spending on Medicaid and the state marketplaces would increase by about $24 billion, a 17.5 percent increase. However, this would be partially offset by $731 million in federal government savings on uncompensated care.
- State spending on Medicaid in those states would increase by $1.5 billion, or three percent. This would be partially offset by $457 million in state and local government savings on uncompensated care.
CMS allows consumers to preview ACA marketplace options before open enrollment
HealthCare.gov consumers can now preview their health care coverage options for 2024 ahead of the open enrollment period that begins November 1.
For the third consecutive year, premiums will remain stable and consumers will have more choices, according to the Centers for Medicare & Medicaid Services (CMS). For plan year 2024, 96 percent of HealthCare.gov consumers will have access to three or more health insurance issuers, up from 93 percent in plan year 2023. In addition, CMS has created policies that aim to ease “choice overload” and provide consumers with meaningful plan choices. As a result, the average number of plans per enrollee decreased.
More people will also be able to qualify for health purchasing health insurance coverage due to the Inflation Reduction Act. Four out of five HealthCare.gov consumers will be able to find a plan for $10 or less per month due to expanded financial assistance.
“We are making it easier for consumers to shop for coverage options by offering standardized plans, or ‘easy pricing’ plans on HealthCare.gov,” CMS said in the announcement. “These plans offer the same deductibles and cost-sharing for most benefits and the same out-of-pocket limits as other standardized plan options within the same health plan category but make it easier for consumers to see what benefits these plans provide. This allows consumers to more easily compare different ‘easy pricing’ plans available to them and select the plan that best meets their needs. Standardized plans also offer coverage for many popular benefits before a consumer meets their deductible.”
The Marketplace Open Enrollment Period on HealthCare.gov generally runs from November 1 to January 15. Consumers who enroll by midnight on December 15 (5 a.m. EST on December 16) can get full-year coverage that starts January 1, 2024. In 2024, January 15 is a federal holiday; accordingly, consumers will have until midnight Tuesday, January 16 (5 a.m. EST on January 17) to enroll in coverage. Consumers who enroll after December 15 but before the deadline in January will have coverage that starts February 1, 2024.
Nurse practitioner pleases guilty to $6.1M health care fraud conspiracy
Kristen Bolling, 40, of Sheridan, Wyoming, has pleaded guilty to conspiracy to commit health care fraud in Idaho, the Department of Justice announced.
- According to court records, from April 2017 through October 2019, Bolling, who was licensed and practiced as a nurse practitioner in Idaho, was recruited to work for multiple companies to generate fraudulent medical orders for durable medical equipment (DME), including braces, and cancer genomic (CGx) testing. During the conspiracy, Bolling received at least $204,007 in kickbacks for fraudulent medical orders. The medical orders that Bolling signed, and which the companies sold, were used to fraudulently bill Medicare resulting in payments of over $6.1 million for DME and CGx tests that were not medically necessary and for which the medical orders were procured through the payment of kickbacks and bribes. She is scheduled to be sentenced on January 9, 2024 and faces a maximum penalty of 10 years in federal prison.
“By engaging in kickback arrangements, this defendant knowingly put personal profit before legitimate patient needs. This illegal behavior undermines the integrity of federal healthcare programs and costs taxpayers millions of dollars,” said Steven Ryan, special agent in charge at the U.S. Department of Health and Human Services, Office of Inspector General, in the announcement.
KFF report: States increase Medicaid payment rates in response to home care workforce shortages
Almost every state reported increasing Medicaid payment rates for home- and community-based services to recruit and retain workers as part of their strategy to address long-standing workforce challenges, according to a new KFF report from a survey of state officials administrating those programs. Most states also report developing or expanding worker education and training programs and offering incentive payments to recruit or retain workers.
All surveyed states reported shortages of care workers and most (43 states) experienced permanent closures of providers over the last year. Staff shortages were most common among direct support professionals, personal care attendants, nursing staff, and home health aides. Closures were most common among adult day health programs (32 states), group homes (29 states), and assisted living facilities (27 states).
Even with increased payment rates, among the 34 states that reported time-based payment rates for personal care providers, 20 pay less than $20 per hour. Based on survey results, KFF estimates that median Medicaid payment rates to home- and community-based service providers are $19 per hour for personal care providers, $28 for home health aides, and $43 for registered nurses providing home and community-based care.
ISA, HHS issue cybersecurity took kit for health care
The Cybersecurity and Infrastructure Security Agency (CISA) and the Department of Health and Human Services this week released a cybersecurity tool kit that includes resources tailored for the health care and public health sector. The toolkit includes cyber hygiene services, health industry cybersecurity practices, and a cybersecurity framework implementation guide.
“We have seen a significant rise in the number and severity of cyber attacks against hospitals and health systems in the last few years. These attacks expose vulnerabilities in our health care system, degrade patient trust, and ultimately endanger patient safety. The more they happen, and the longer they last, the more expensive and dangerous they become,” said HHS Deputy Secretary Andrea Palm in the announcement. “HHS is working closely with CISA and our industry partners to deliver the tools, resources, and guidance needed to help health care organizations, especially our under-resourced hospitals and health centers, mount a strong cyber defense and protect patient lives.”
As health care organizations increasingly rely on digital technologies to store patient and medical information, carry out medical procedures, and communicate with patients, they are exposed to greater risk. However, hospitals, health centers, and clinics, especially those that are under-resourced, are coping with a wide range of challenges making it harder to invest the necessary resources into cybersecurity.
Over the past year, CISA, HHS and Health Sector Coordinating Council (HSCC) Cybersecurity Working Group have been working together to deliver tools, resources, training, and information that can help organizations within this sector. A key part of this effort is a new Cybersecurity Toolkit for Healthcare and Public Health that was unveiled at today’s roundtable. This toolkit may be navigated online at www.CISA.gov/healthcare.