Kaiser Daily Health Policy Report Highlights News Coverage of State Medicaid Developments

Main Category: Medicare / Medicaid / SCHIP
Article Date: 16 Sep 2005 - 0:00 PDT

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The following summarizes news coverage of recent state Medicaid developments...

• Connecticut: The state Supreme Court has ruled 3-2 to reverse a state Appellate Court decision denying Medicaid reimbursement to a hospital for treating an undocumented immigrant with leukemia, the Hartford Courant reports. In its ruling, the court adopted a new definition of medical necessity that qualifies a provider to receive Medicaid reimbursement. According to the new definition, medical necessity involves a condition "must be manifested by acute, rather than chronic, symptoms ... and necessitate treatment, without which the patient's physical well-being would likely be put in jeopardy or serious physical impairment or dysfunction would result." Two justices dissented, saying they doubted that the new definition -- based on a federal term -- was "intended to encompass a condition" that includes "severe symptoms but requires longer term treatment and, therefore, reasonably may be characterized as chronic" (Tuohy, Hartford Courant, 9/13).
  
  
• Florida: Medicaid beneficiaries now can obtain prescription drugs for certain mental health conditions without receiving special authorization, the St. Petersburg Times reports. Officials at the state Agency for Health Care Administration said newly negotiated discounts with manufacturers have allowed them to add Zyprexa, Depakote ER, Keppra, Lamictal, Trileptal and Zonegran to Medicaid's preferred drug list (St. Petersburg Times, 9/13).
  
  
• Georgia: Despite allegations of favoritism, the state will uphold its decision to award contracts worth $360 million to Atlanta-based companies Southeastrans and LogistiCare for scheduling and transporting Medicaid beneficiaries in nonemergency medical situations, the Atlanta Journal-Constitution reports. However, state officials said they would review the decision if an investigation of allegations of collusion and bid rigging by the state of Missouri results in charges or sanctions against LogistiCare. Other companies that bid on the contracts alleged the state showed favoritism to the two companies, and at least one of the losing bidders, Ohio-based First Transit, said it would appeal the decision (Miller, Atlanta Journal-Constitution, 9/13).
  
  
• Maine: John Hall, deputy commissioner of the state Department of Health and Human Services on Saturday told physicians that the amount of interim Medicaid payments to providers -- inexact payments made instead of correctly processed claims -- has decreased weekly and is down to about $5 million per week, the Bangor Daily News reports. Because of problems implementing the state's computerized Medicaid bill-paying system, some physicians have stopped accepting new Medicaid beneficiaries and other providers have threatened to discharge beneficiaries. Hall, who has been working to fix problems with the system, said he expects to phase out interim payments over the next seven to eight weeks (Bangor Daily News, 9/12).
  
  
• Michigan: State officials last week announced a proposal to reduce Medicaid costs by offering incentives for healthy behavior, rather than eliminating benefits for some residents, the Detroit News reports. Under the plan, adults who do not traditionally qualify for Medicaid but the state chooses to cover would be eligible for lower copayments or additional benefits, such as expanded prescription coverage or dental services, if they practice good health by, for example, quitting smoking, keeping physician appointments and maintaining a normal weight. The plan would require permission from the federal government (Hornbeck, Detroit News, 9/13).
  
  
• Missouri: Health policy experts on Monday proposed several cost-reducing changes to Missouri's Medicaid Reform Commission, including offering incentives to beneficiaries who adopt healthier lifestyles, the St. Louis Post-Dispatch reports. Other proposals included limiting beneficiaries' ability to obtain brand-name prescription drugs and tighter restrictions on asset transfers by elderly patients to obtain benefits. The state also is seeking bids from companies to manage care for about 22,000 disabled and elderly beneficiaries with chronic conditions in an effort to reduce hospital and emergency department visits (Young, St. Louis Post-Dispatch, 9/12).
  
  
• Ohio: A 10-member state House-Senate subcommittee on Monday declined to stop proposed cuts to Medicaid payments to hospitals, the AP/Akron Beacon Journal reports. Hospitals have said they will have to reduce staff and free clinic hours, and patients will have longer emergency department waits when the cuts take effect in January. The Ohio Hospital Association testified that the proposed changes to the payment formula would cut $168 million in state and federal funds and hospitals already are dealing with $140 million in Medicaid cuts. The Ohio Department of Job and Family Services said the proposed formula is based on information submitted by hospitals (AP/Akron Beacon Journal, 9/13).
  

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