WASHINGTON — The decision of some states not to expand Medicaid means that the nation's poorest — those the Affordable Care Act would have helped the most — may not receive any help at all.

 

 

That's because the 2010 law was written to provide Medicaid coverage for those making less than 100% of the federal poverty level, $23,550 for a family of four, in all 50 states. Because those Americans were to get Medicaid coverage, they were not made eligible for the federal tax subsidies that would help them pay for health insurance they will be required to buy.

 

 

However, when the Supreme Court ruled last year that the requirement for most uninsured Americans to buy insurance was constitutional, it also ruled that the states did not have to expand Medicaid to continue receiving federal funds for their ...

The Eighth Circuit Court of Appeals (one of the highest courts in the U.S.) has re-affirmed that Medicaid annuities are still a very important and powerful way to obtain Medicaid coverage for nursing home residents in all states including Texas.

 

 

This decision, just published today on the Court website, involved a married couple who purchased a $400,000 Medicaid annuity as a way of removing that amount of money from their "countable" assets for Medicaid purposes. As a result, the husband (in the nursing home) was able immediately to qualify for Medicaid and the at-home wife was able to receive the benefit of the $400,000 without having to "spend down" all that money. She will receive monthly payments of $2,735 for 13 years.

 

 

Although such planning with Medicaid annuities is most beneficial for married couples, there are a ...

Loans received in the past by a Texas Medicaid applicant, which are due and payable are not counted as income. However regular payments to the Medicaid applicant from family members over an extended period of time which are impossible to repay, given the applicant’s current and/or future financial status, are not considered loans by the State of Texas. They are instead treated as income.

AUSTIN — Texas’ refusal to expand Medicaid will cause private health insurance premiums to rise by an average of 9.3 percent for people who buy their own coverage, a new study finds.

 

 

GOP lawmakers, strongly encouraged by Gov. Rick Perry, decided not to add poor adults to Medicaid’s rolls. That means about 1.3 million fewer Texans will have health coverage by 2016 than if the federal Affordable Care Act were fully implemented in the state, according to the study by the nonprofit research organization Rand Corp.

 

 

About 320,000 adult Texans just above the poverty line will take advantage of the Affordable Care Act’s federal subsidies and buy coverage in the individual insurance market, the researchers said. Those are people who would have been enrolled in Medicaid as the federal law was written and before that part ...

Texas Dentists for Medicaid Reform have made available legal briefs for download on their website

Austin, TX (PRWEB) August 30, 2013

This past week attorneys for Houston-based Antoine Dental Center (ADC) and those representing the Texas Health and Human Services Commission Office of the Inspector General filed their closing arguments in the pending State Office of Administrative Hearings (SOAH) case (SOAH DOCKET NO. 529-13-0997).

 

 

The case challenges the 100% payment hold that has been in force against ADC since April 2020, the filings indicate. The court documents also show that the payment hold was levied against ADC by the Office of the Inspector General based on "credible allegations of fraud.”

 

 

Texas Dentists for Medicaid Reform have posted an article about the filings and made available the legal briefs for both ADC and OIG for download ...

The foundation affiliated with billionaire businessman and former presidential candidate Ross Perot has given $1 million to the Texas-based Planned Parenthood abortion business that was found to have engaged in millions in Medicaid fraud.

 

 

Texas Attorney General Greg Abbott announced on July 24 that his office had obtained a $1.4 million settlement against Planned Parenthood Gulf Coast for Medicaid fraud, with the settlement to be split between the state of Texas, the federal government, and the whistleblower who uncovered the fraud. But that hasn’t stopped the Perot Foundation from supporting the Texas arm of Planned Parenthood with a $1 million gift.

 

 

The total settlement is actually $4.3 million – almost $3 million more than previously known — meaning the amount of fraud the Planned Parenthood abortion company engaged in was likely a higher amount than that.

Health insurance rates for individuals purchasing private coverage could jump 8 to 10 percent in Louisiana, Florida and Texas where state political leaders have decided against expanding the Medicaid health insurance program for the poor under the Affordable Care Act, new research indicates.

 

 

In a new study from the nonprofit research organization RAND Corp., researchers said the lack of an expanded Medicaid program will force more lower income people into the individual insurance market via exchanges created by the health law to provide more private coverage. STORY

Under a provision of the Affordable Care Act, payments to primary care doctors under Medicaid — the joint state-federal insurer of children, the disabled and the very poor — are supposed to rise to the same level as rates for Medicare, the federal health program for the elderly. It's an increase intended to encourage more physicians to take on Medicaid patients.

 

 

But the increase, which was set to take effect in January, has been postponed in Texas and several other states because the federal government has not yet approved their strategies for boosting payments, said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission.

With key components of the Affordable Care Act set to take effect in January, state officials are worried that a change in the determination of Medicaid eligibility could increase costs and decrease efficiency in processing applications for Medicaid and other benefits programs.

 

 

Under the law, family incomes and sizes — used to determine if a family qualifies for Medicaid — will be determined based on tax filings, a different process than what is used for the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families, said Stephanie Goodman, a spokeswoman for the Health and Human Services Commission.

 

 

Because eligibility for Medicaid and the Children’s Health Insurance Program will now be calculated using different metrics than SNAP and TANF will use, HHSC could see an increase in workload, Goodman said, which could result in a delay ...

The federal government is open to expanding Medicaid coverage under the Affordable Care Act in a way that is more tailored to Texas’ preferences, Health and Human Services Secretary Kathleen Sebelius said Thursday while visiting Austin City Hall.

 

 

"We are eager to have discussions with Texas about a program that could look uniquely Texan,” Sebelius said. "But as far as I know, those conversations, at least with the state officials, are not taking place right now.”

 

 

The federal government has committed $90 billion to extend health benefits to adults below the federal poverty line through Texas’ Medicaid program, which currently provides coverage to poor children, the disabled and extremely poor parents. But that money won’t reach Texas unless Gov. Rick Perry and the state Legislature approve expanding Medicaid benefits to poor adults — a position ...

Among patients undergoing spinal surgery, Medicaid beneficiaries are at higher risk of experiencing any type of complication, compared to privately insured patients, reports a study in the journal Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

 

 

 

"Medicaid insurance status is a risk factor for perioperative complications," according to the research by Dr Jacques Henri Hacquebord of University of Washington, Seattle, and colleagues. They believe their study draws attention to the "often unacknowledged" problem of under-insurance.

 

 

Insurance Status Affects Spinal Surgery Outcomes

The researchers analyzed outcomes in a database of nearly 1,600 patients undergoing spinal surgery over a two-year period. Type of insurance was evaluated as a predictor of any type of complication or adverse outcome within two years after surgery.

Painkiller addicts hit Medicaid limits

Tо Mark Publicker, а doctor іn Portland, Maine, whо practices addiction medicine, it's а clear case оf discrimination. Yоu wouldn't deprive а diabetic оf insulin. Yоu wouldn't stop giving hypertension drugs tо а patient wіth high blood pressure аftеr successful treatment. Yоu wouldn't hold bасk а statin frоm а patient wіth high cholesterol.

Yеt Publicker's patients face severe limitations оn thе amount аnd duration оf medicines thеу tаkе tо fight thеіr addictions tо pain pills. And thе consequences оf thоѕе policies bу Medicaid аnd private insurers аrе аt lеаѕt аѕ dire аѕ thеу wоuld bе fоr thоѕе wіth оthеr ѕеrіоuѕ ailments іf thеу wеrе denied proven treatments, hе said.

"People wіll die," Publicker said.

Mаnу private insurance companies аnd state Medicaid agencies асrоѕѕ thе country impose ...

Under Gov. Rick Perry’s leadership, Texas will not expand Medicaid eligibility to poor adults. But enrollment in the state’s health program for indigent children and the disabled will still swell in 2014 under new rules created by the federal Affordable Care Act.

 

Texas’ health care provider safety net and the state agency that oversees Medicaid are preparing for the anticipated increase and other challenges that lie ahead.

 

 

The Texas Health and Human Services Commission projects 240,000 children currently eligible for Medicaid but not participating will enroll in 2014 and 2015, as families seek coverage to comply with the individual insurance mandate, which takes effect on Jan. 1. An additional 200,000 people could enroll in Medicaid as a result of other new requirements created by the law, according to state health officials. MORE...

TYLER (July 16, 2013)—The owner of five Texas hospitals, including one in Cameron, has been named in a federal indictment charging him with Medicare fraud.

 

 

 

Tariq Mahmood, 61, from Cedar Hill, on April 11 was named in the indictment by a federal grand jury in the court’s Eastern District of Texas, based in Tyler, and is charged with conspiracy to commit more than $1 million in health care fraud in nine separate counts.

Court records show Mahmood owns five hospitals in Texas, including the Central Texas Hospital, in Cameron, Cozby Germany Hospital in Grand Saline, Renaissance Terrell Hospital in Terrell, Community General Hospital in Dilley, and Shelby Regional Medical Center in Center.

Mahmood, who has denied the charges, appeared before U.S. Magistrate John D. Love in April and had a bond set at $25,000.

 

MORE......

Health Providers Bracing for Medicaid Enrollment

 
By BECCA AARONSON

Undеr Gov. Rick Perry’s leadership, Texas wіll nоt expand Medicaid eligibility tо poor adults. But enrollment іn thе state’s health program fоr indigent children аnd thе disabled wіll ѕtіll swell іn 2014 undеr nеw rules created bу thе federal Affordable Care Act.

Texas’ health care provider safety net аnd thе state agency thаt oversees Medicaid аrе preparing fоr thе anticipated increase аnd оthеr challenges thаt lie ahead.

Thе Texas Health аnd Human Services Commission projects 240,000 children сurrеntlу eligible fоr Medicaid but nоt participating wіll enroll іn 2014 аnd 2015, аѕ families seek coverage tо comply wіth thе individual insurance mandate, whісh takes effect оn Jan. 1. An additional 200,000 people соuld enroll іn Medicaid аѕ а result оf оthеr nеw requirements created bу thе law, ассоrdіng tо state health officials.

Thіѕ presents а challenge fоr health ...

Amerigroup Medicaid

Medicaid is America's publicly financed health care insurance program for low income American citizens and legal residents. Medicaid covers children, pregnant women and people with disabilities. Medicaid includes Family Care - providing health insurance for uninsured adults and parents of CHIP (Medicaid-eligible children).

Texas Medicaid can cover some people who are on Medicare, as well: low-income elderly and people with disabilities. These people are sometimes referred to as dual eligibles. For these individuals, Medicaid supplements Medicare-covered services by paying for Medicare premiums, members’ cost-sharing requirements and long-term services and supports (LTSS).

Amerigroup serves Medicaid members in 12 states including Texas and offers a wide range of benefits:

        Physician, hospital and pharmacy services for children and adults
        Services that many private insurers and Medicare do not cover, such as transportation and long-term care

As a business owner, would you sign a contract that requires you to purchase a product, give that product away and then request payment from a third party without knowing how much you’d receive? What if you also didn’t know how much you’d be reimbursed before signing the contract, and that the other party could change that reimbursement rates without notice?

That’s the situation facing Texas pharmacists participating in Medicaid managed care.

"The lack of transparency there makes it very difficult for an independent pharmacist to find out what they’re going to be reimbursed,” said state Sen. Charles Schwertner, R-Georgetown, a surgeon and fourth-generation pharmacist. MORE...

History of Medicaid - in Texas and other states

 

By Cindy Mann CMS Deputy Administrator and Director, Center for Medicaid and CHIP Services

CMS is committed to working in partnership with states in administering their Medicaid and Children’s Health Insurance Programs (CHIP) and to providing flexibility in pursuit of our shared goals.

Premium assistance has been a longstanding option in both Medicaid and CHIP and is one way to accomplish those shared goals.  CMS provided guidance in December of last year on how states might use these options to develop state-based solutions that meet both the state’s unique needs and requirements of the programs

In response to some questions that have been raised by states, today we are issuing some clarifying guidance.   Today’s Frequently Asked Questions explain the basic requirements that apply when a state chooses the premium assistance option and the guidelines we would apply when a state requests a waiver to implement premium assistance.  ...

WASHINGTON — Nearly 2 in 3 uninsured low-income people who would qualify for subsidized coverage under President Barack Obama’s health care law may be out of luck next year because their states have not expanded Medicaid.

An Associated Press analysis of figures from the Urban Institute finds a big coverage gap developing, with 9.7 million out of 15 million potentially eligible adults living in states that are refusing the expansion or are still undecided with time running short.

That a majority of the neediest people who could be helped by the law may instead remain uninsured is a predicament unforeseen by Obama and congressional Democrats who designed a sweeping extension of the social safety net. The law’s historic promise of health insurance for nearly all U.S. residents would not be fulfilled as envisioned.

July 2, 2013

The U.S. Department of Health and Human Services’ (HHS) has awarded nearly $3 million in grants to several Texas organizations that will work to identify and enroll eligible children for Medicaid and the Children’s Health Insurance Program (CHIP).

Community Action Corp. of South Texas will receive more than $820,000 in grant funding from HHS. Read more...

DALLAS -- Last August, News 8 discovered children were being lured into vans with cash and promises of pizza, taken to dentists offices, and injected with painkillers without their parents’ permission.

Then, records show, unneeded dental work was done on the children, and Medicaid was billed.

More than a dozen children were taken into the vans, with many going to All About Dentistry, a clinic in Mesquite. All About Dentistry is now closed. The dentist who performed the work was Dr. Seyed Masoud Shariati, a 2004 graduate of Baylor Dental College. MORE.....

The state of Texas is turning down billions of federal dollars that would have paid for health care coverage for 1.5 million poor Texans.

By refusing to participate in Medicaid expansion, which is part of the Affordable Care Act, the state will leave on the table an estimated $100 billion over the next decade.

 

 

 

Texas' share of the cost would have been just 7 percent of the total, but for Gov. Rick Perry and the state's Republican-dominated Legislature, even $1 in the name of "Obamacare" was a dollar too much.

"Texas will not be held hostage by the Obama administration's attempt to force us into this fool's errand of adding more than a million Texans to a broken system," Perry said.

 

Texas Republicans have moved steadily to the right — to where the very ...

AUSTIN, Texas (Reuters) - The Republican-majority Texas House and Senate on Sunday sent Governor Rick Perry a proposal to prevent the state from expanding its Medicaid program as outlined by President Barack Obama's healthcare reform law.

Perry, a Republican, notified the Obama administration last summer his state would not expand Medicaid, which provides healthcare for low-income people. He repeated his opposition in an April news conference at which he called expansion "foolish." Read more..

 

Announcements

Delta Dental no longer providing services for Texas Medicaid and CHIP Dental Services Program

On December 1, 2012 Delta Dental will no longer be a provider of dental services for the Texas Medicaid and CHIP Dental Services Program. Medicaid Providers: To find out what new dental plan the member has, please visit the Your Texas Benefits provider portal or ask the member for a dental plan ID card. You may have the member contact 1-800-964-2777 for information. Texas CHIP Providers: To find out what new dental plan the member has, ask the member for a dental plan ID card or call 1-800-645-7164.

Prior Authorization of NEW Orthodontia

Effective October 1, 2012, Delta Dental is unable to process prior authorization requests for NEW orthodontia cases for Texas Medicaid or CHIP Members. Providers should submit these prior ...