On June 29, Families USA released a report examining Medicaid cuts outlined under U.S. Rep. Paul Ryan’s (R-WI) $3.5 trillion FY2012 budget proposal, approved by the U.S. House on April 15.  In addition to repealing most provisions of the national health care reform law, the budget would also convert Medicaid into a block grant program beginning in 2013, reducing state payments by 5 percent in 2013, 15 percent in 2014, and 33 percent in 2021.  Based on an economic modeling tool used by the U.S. Department of Commerce to assess the impact of major events on regional economies, Families USA’s analysis finds that the Medicaid cuts would risk a total of 35,210 jobs and $4.2 billion in economic activity.  The report estimates that the cuts would harm program enrollees, reduce business activity, and contribute to job losses.  The report also provides state-level estimates of the impact of each cut on business activity and jobs.

From the report:

The National Governors Association (NGA) and the National Association of State Budget Officers (NABO) released the Spring 2011 Fiscal Survey of States, finding that at least 33 states have plans to reduce Medicaid provider reimbursement rates for the fiscal year beginning July 1.  Facing tough financial climates and the elimination the increased Federal Medical Assistance Percentage (FMAP) funding through the American Recovery and Reinvestment Act (ARRA), on average, governor’s proposed FY2012 budgets include a 2.9 percent reduction in Medicaid funding.  However, states’ share of Medicaid is expected to increase by 18.6 percent as federal funding drops by 13 percent.  In FY2010, Medicaid accounted for an estimated 22 percent of states’ spending.

From the report:

On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP).  The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them.  The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care.  The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP.  Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP.  The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements.  The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.

From the report:

On July 7, the National Bureau of Economic Research (NBER) published a study examining the impact of providing health coverage to uninsured low-income individuals.  Focusing on the impact on health service utilization, health outcomes, and financial burden, the study examined the effects of a 2008 Oregon Medicaid expansion that used a lottery system to select 10,000 participants to enroll in Medicaid out of a pool of approximately 90,000 applicants.  NBER found that beneficiaries had statistically significantly higher health service utilization and better self reported physical and mental health than the control group, which was comprised of individuals not selected for Medicaid coverage in the lottery.  Additionally, the authors found statistically significantly lower out-of-pocket (OOP) medical spending and medical debt among beneficiaries when compared to the control group.  The study has implications for the impact of the national health care reform law’s Medicaid expansion on uninsured individuals.

Finkelstein, Amy et. al. (2011). The Oregon health insurance experiment: evidence from the first year. National Bureau of Economic Research, (17190). http://www.nber.org/papers/w17190

Authors: Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, and Katherine Baicker.

On July 12, the Government Accountability Office (GAO) released a report finding that the federal government’s current electronic health care fraud detection system is inadequate and underused.  Implemented in 2009, federal officials originally projected that the $150 million system would save $21 billion annually, but the GAO found that inadequate system operation prevents it from addressing the up to $90 billion in estimated annual health fraud.  The report notes that the system currently lacks Medicaid data, which officials from the Centers for Medicare & Medicaid Services (CMS) plan to integrate into the system by 2014.  Additionally, the report asserts that CMS is not conducting staff training on schedule for employees needed to operate the system.

From the report:

Mathematica Policy Research has released a brief examing managed care opportunities for childless adults under the national health care reform law's Medicaid expansion.  The law explains how the Medicaid expansion will work and who it will make eligible for Medicaid coverage.  The authors also examine opportunities and challenges for managed care under the expansion.

From the report:

Health care reform Medicaid expansion will result in many potential new enrollees for Medicaid MCOs.  High health care needs and costs for low-income childless adults will present significant challenges in terms of outreach, network development, care management, capitated rate setting, and quality monitoring.

Full report: Extending Medicaid Coverage to Low-Income Childless Adults: Opportunities and Cautions for Managed Care Plans (PDF | 149.96 KB)

Mathematica Policy Research.  (2011).  Extending Medicaid coverage to low-income childless adults: opportunities and cautions for managed care plans.  Verdier, J.