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“Necessity is the plea for every infringement of human freedom. It is argument of tyrants.It is the creed of slaves.”–William Pitt in the House of Commons November 18, 1783

“The appropriation of public money is always is perfectly lovely until some one is asked to pay the bill..” President Calvin Coolidge–New York Herald Tribune, August 5, 1930.

 

In this Issue

 5 minutes or less Action Item

Information about the new Medicaid Expansion bill

I don’t know about you but I am getting tired of my Representatives trying to sneak in an expansion. To cut down on that and reduce state’s costs we should seriously consider renewing the conversation of a part time legislature.

Apparently ours legislators are trying to Expand Medicaid…Again

This time its not in the budget but a bill HB 4714  and IT has the same expansion language as the budget : Enroll nondisabled adults with an annual income level below 133% of the federal poverty guidelines who meet the citizenship provisions of 42 CFR 435.406(a)  § 435.406 Citizenship and alienage.

Major Budget Changes From FY 2012-13 YTD Appropriations
1. Medicaid Expansion
….. The expansion of the income criteria for Medicaid eligibility up to 133% of the federal poverty level (FPL) is estimated to qualify an additional 320,000 (THAT is a very  low estimate) Michigan residents in FY 2013-14. The assumed expansion start date is January 1, 2014.

Since the Dept of Community Health (DCH) will be using the Modified Adjusted Gross Income (MAGI) system to determine eligibility the numbers will be higher (and the Federal matching dollars.)

As the federal government has expanded Medicaid over the decades, state governments have had incentives to continuously expand the program as well. Since Medicaid is an open-ended federal matching grant, the states receive additional federal cash whenever they expand eligibility or covered services.

(“Under the law, the first 5 percent of income is not counted. The practical effect of this income “disregard” is to make the eligibility threshold 138 percent of poverty.) In fact, Assuming the ACA is implemented (Medicaid Expansion) as planned, Michigan could have approximately 600,000 new Medicaid enrollees by 2019—. “Medicaid Eligibility in Michigan: 40 Ways”

Action Item

Now there are some reforms thrown in this time to try and make it palatable, but as the saying goes, you can put lipstick on a pig and its still a pig.

I thought we made it clear, however apparently we need to make it CRYSTAL CLEAR…We do NOT want a Medicaid Expansion in any way, shape or form.

There is a Committee (Michigan Competitiveness) Meeting formerly http://www.house.mi.gov/publiccommitteeschedule/MeetingDisplay.aspx?BroadcastKey=3635 on this bill this Thursday at 2:30pm

 

IF you can show up to testify great! You do not have to speak but fill out a testimony card. IF you can not make it

You need to send ONE e-mail to these people. I will provide the contact information and then further information on the new bill if you wish to provide more detail

Copy and Paste e-mail addresses

Committee Clerk David Mead at dmead@house.mi.gov and ask that your email to be entered into the record as testimony.

Chairman of the Committee Rep. Mike Shirkey     -MikeShirkey@house.mi.gov

Committee Members: formerly http://www.house.mi.gov/mhrpublic/committeeinfo.aspx?comkey=234

KenYonker@house.mi.gov,GailHaines@house.mi.gov,KevinCotter@house.mi.gov,
FrankFoster@house.mi.gov,RayFranz@house.mi.gov,KenGoike@house.mi.gov,
DanLauwers@house.mi.gov,TomLeonard@house.mi.gov,DavePagel@house.mi.gov,
PaulClemente@house.mi.gov,JimTownsend@house.mi.gov,AndySchor@house.mi.gov,
HarveySantana@house.mi.gov,KateSegal@house.mi.gov

And House Speaker Jase Bolger since this is his endorsed plan  -JaseBolger@house.mi.gov

YOUR House Rep HERE

YOUR Senator  HERE

More about the new bill and Michigan Medicaid fraud

1. Everything depends on getting a waiver from the Feds because Medicaid although a voluntary program for the states is still a Federal program. A waiver is essentially a “mother may I” from the states to the Feds.

(a) If the department of community health is unable to obtain a waiver from the United States department of health and human services to implement the provisions

And this is why the only meaningful reforms can be done at a Federal level.

Federal laws and policies restrict how much cost-sharing states can impose on recipients. And while some states have conducted promising experiments with financial incentives — such as cash accounts managed by recipients — any state’s room to maneuver is limited by federal law.  (that’s why we need a waiver) ….the passage of Obamacare has only made it more difficult. Many of the most powerful lobbies … in state capitals will work against any effort to fix what ails this deeply flawed entitlement.

But the simple truth is that American taxpayers cannot afford the status quo. Even before Obamacare, the combined cost of Medicaid, Medicare, and Social Security was projected to consume nearly 15% of gross domestic product by 2030 — up from less than 10% today. These entitlements are already falling into the red, and have an unfunded liability of nearly $100 trillion through the end of the century. “How to Fix Medicaid”

Even though this bill offers some reforms (see below) they are bandages to the problem. The button line the real answer to Medicaid reform, is to get out of the Federal program, NOT expand it. Keep the money in our state and let Michigan design its own program (free markets, insurance and tort reforms, etc. ) free from the commands and the co-dependency of Federal dollars of  Washington D.C.

Instead of expanding and continuing to enable flawed, bloated, fraud ridden, tax payer money sucking big government program that does not provide the intended product, decent health care for the poor for temporary gain.

As chief Justice Robert’s noted in oral arguments on the Medicaid Expansion

 ” How willing they (the states) have been since the New Deal to take the Federal government’s money.. And it seems to me that they (the states) have compromised their status as independent sovereigns because they are so dependent on what the Federal Government has done, they should not be surprised that the Federal Government, having attached the — they (the states) tied the strings, they shouldn’t be surprised if the Federal Government isn’t going to start pulling them.”  – Supreme Court Health Care Law Oral Argument, Day 3, Medicaid Expansion

 

More information about the bill

— ask low-income non disabled adults to pay up to 5 percent of their income on health care — with a sliding scale — and require them to start paying monthly premiums.

However, that is based on “THE DEPARTMENT OF COMMUNITY HEALTH’S DETERMINATION OF THE NONDISABLED ADULT’S ABILITY TO PAY” So its likely that a number of “NONDISABLED ADULTS ENROLLED would not pay at all.

–48-month cap on benefits is for able-bodied adults

–create health savings accounts for recipients and let them choose whether to be under the traditional Medicaid system or buy their own coverage on a marketplace known as an exchange. This is similar to Gov. Walker’s plan except that Gov. Walker is NOT expanding Medicaid.

–lower premiums and co-pays if nondisabled adults quit smoking or lose weight, for instance, and follow their doctor’s orders.

D) DEVELOP INCENTIVES FOR HEALTHY BEHAVIOR AND FOR PROGRESS MADE TOWARD HEALTHY BEHAVIOR
(E) DEVELOP INCENTIVES FOR ELIGIBLE ENROLLEES WHO ASSIST THE DEPARTMENT OF COMMUNITY HEALTH IN DETECTING FRAUD AND ABUSE IN THE MEDICAL ASSISTANCE PROGRAM.

Speaking of fraud the Department of Community Health (DCH) could use some help in that area! In several audit reports on Michigan’s Medicaid program issued January of this year Michigan’s Auditor General found:

In the area of.Durable Medical Equipment, Prosthetics, Orthotics, and Supplies – Performance Audit – 391-0717-12 (DMEPOS)the auditor found that DCH was “moderately effective” and found improper payments of $997,000 (approximately $293,000 General Fund/general purpose)and potential improper payments of up to $1,600,000 (approximately $470,000 General Fund/general purpose). DCH issued $341,000 (approximately $100,000 General Fund/general purpose) in duplicate payments to the same provider that submitted a claim multiple times with a different modifier

DCH did not ensure that it prevented, detected,and recovered duplicate payments for DMEPOS

In another audit, Medicaid Pharmacy Services – Performance Audit – 391-0116-12

The auditor found:

DCH did not identify and recover Medicaid pharmaceutical drug payments made on behalf of beneficiaries who were Medicare eligible

We estimate that DCH could recover up to $15.3 million ($5.4 million General Fund/general purpose) in pharmaceutical claims that were originally paid by Medicaid but are the financial responsibility of Medicare (Federal)

For example:

DCH did not always ensure that it notified the PBM of deceased service providers. As a result, 324 pharmacies were reimbursed $89,000 ($31,000 General Fund/general purpose) for prescriptions written after the date of death of 82 deceased service providers

DCHs efforts to identify and recover payments for pharmaceutical drugs covered by Medicare were moderately effective

And the bill includes that the DCH  makes the reports about the new expansion program?!

BY NOT LATER THAN MARCH 1, 2015 AND ANNUALLY BY EVERY  MARCH 1 AFTER THAT, THE DEPARTMENT OF COMMUNITY HEALTH SHALL PROVIDE A REPORT TO THE LEGISLATURE

Another interesting addition in the bill is… ALLOW FOR SERVICES PROVIDED THROUGH TELEMEDICINE. Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance.

Telehealth is a major user of electronic health records (EHRs) and generator of digital data…and additionally would benefit from a Medicaid Expansion and this bill (archived)  And Telemedicine is not without it’s major problems, physicians and hospitals can be exposed to new potential liabilities, including providing less than optimal care for patients, if telemedicine is not well managed.

–Require the Feds to provide 100% of funds

THIS SUBSECTION FOR THE PURPOSES OF MEDICAL ASSISTANCE ELIGIBILITY. THIS SUBDIVISION DOES NOT APPLY …(ii) IF AT ANY TIME THE FEDERAL GOVERNMENT DOES NOT PROVIDE FUNDING AT A LEVEL OF 100% FOR IMPLEMENTATION AND ADMINISTRATION OF THIS SUBDIVISION.

Even though it nice to read a state bill that dictates to the Feds, this is highly unlikely because:

1. It’s the Feds program, they do the dictating

2. IF they Feds were to agree than how many other states would ask for the same 100% Federal funded deal?

3. And does a broke, in debt, fiscal cliff Federal government have the funds?

Further, Each state that declines to expand Medicaid relieves strain on the overall federal budget.

And State or Federal, its ALL our money!

And most likely in order to pass the bill would be a WATERED DOWN VERSION with reforms stripped out or severely compromised in order to get the Democrats to sign on.

“They can’t afford to pay 5 percent of their income for a mediocre health plan, or 48 month cap” Rep. Greimel formerly/http://029.housedems.com/news/article/greimel-calls-republican-medicaid-alternative-heartless-irresponsibleHouse minority leader

 

MORE INFORMATION ABOUT THE MEDICAID PROGRAM AND EXPANSION