Tag Archives: medicaid

Looking at questions that remain behind the enrollment numbers

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo by Thomas Hawk via Flickr.com.

Photo by Thomas Hawk via Flickr.com.

We put up a tip sheet the other day on how to interpret sign-up vs enrollment numbers. This piece by Carol Ostrom of The Seattle Times asks a lot of good questions as she looked at enrollment in her state.

Washington does a better job than many states in separating who paid versus who signed up, but there are other essential questions about enrollment. Who gained coverage? Who switched coverage? How many people’s plans were cancelled? Did they end up in the exchange or in another private plan? How do they feel about it a few months into the new system?

And how do we measure the success of the law?  Especially given its cost. Continue reading

Hospitals rethink charity for those passing on Obamacare

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

columbiahospitalThe basic calculation uninsured people had to make this first open enrollment season in the ACA is whether to  get covered – or take the risks of going without health insurance and pay a penalty (unless they are exempt.)

After all, some of them probably figure, they have managed to get discounted or charity care in the past. Why should that change?

It might.

Some hospitals are pondering changes in their policies about how to treat the uninsured, according to an interesting article by Melanie Evans that appears in Modern Healthcare.

The changes they are thinking about won’t affect emergency care; under the Emergency Medical Treatment & Labor Act (EMTALA) hospitals have to stabilize someone coming in with an emergency. But it does affect what they may charge people for care, and how and when they provide non-urgent care.

Continue reading

HHS moves to block chain of dental clinics from receiving Medicaid

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

David Heath

David Heath

Small Smiles, one of the nation’s largest dental chains, is facing exclusion from Medicaid, David Heath of the Center for Public Integrity reported this week.

The chain has been accused of performing unnecessary treatments on children to boost profits. With Medicaid dental providers in short supply in many communities, the ouster of Small Smiles from the program could send thousands of poor families in search of new dentists.

“The inspector general of the Department of Health and Human Services notified the chain last week that after years of monitoring, the company remains out of compliance with the terms of a 2010 settlement of a whistleblower lawsuit brought by the Justice Department,” Heath wrote in his March 11 report. Continue reading

S.C. adults may gain dental benefits as part of Medicaid plan

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Image by sunnyviewdental via flickr.

Image by sunnyviewdental via flickr.

Adult dental benefits would be added to South Carolina’s Medicaid program under a plan being considered by the state legislature.

Preventive and restorative dental benefits for poor adults are part of a package of proposed Medicaid enhancements that also includes health screenings and weight-loss help, Seanna Adcox reported in a Feb. 5 story for The Associated Press.

The new benefits were part of state Medicaid Director Tony Keck’s budget presentation before a House Ways and Means panel, Adcox wrote. The initiatives would cost $15.3 million from state taxes and $52 million total when including federal money.

Currently, the state Medicaid program covers only emergency tooth extractions in specific cases of medical necessity. Continue reading

Two new resources offer myriad story ideas

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.


The recently released 2014 work plan sets up how the Inspector General’s office of U.S. Department of Health and Human Services will scrutinize claims CMS pays to hospitals, nursing homes, and home care agencies, as well as for prescription drugs, medical equipment and other care services. Continue reading

Colo. advocates predict newly insured patients will overwhelm dentists

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Hundreds of thousands of adults and children in Colorado will soon get dental coverage thanks to health care reform efforts in the state.

But many of these new beneficiaries may have trouble finding a dentist to treat them, writes Michael Booth in a good story for The Denver Post, “Flood of new dental patients in Colorado meets trickle of caregivers.”

“A new dental benefit for adults with Medicaid, coupled with an Obamacare expansion of eligibility and pediatric benefits required on the state exchange, will balloon the number of paying patients,” he explains.

“About 335,000 current Medicaid adults gain access to dental care in the spring, and tens of thousands more will join Medicaid rolls under the Affordable Care Act expansion. Added to them will be potentially thousands of privately insured children with dental care included under “essential benefits” minimums of the state health exchange.”

But health advocates warn that if just a quarter of the newly enrolled Coloradans start using their dental benefits, the system will be strained. Continue reading

HealthCare.gov issues affect Medicaid enrollment

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Here’s another HealthCare.gov problem – and a workaround – that haven’t gotten much attention.

People can apply for Medicaid (traditional or expanded) via the federal HealthCare.gov website. But the applications still have to get transferred to the states which have to process them to finalize enrollment in the actual state program. And it’s supposed to be done by Jan. 1.

Guess what? That was a problem. With all the website woes, the feds weren’t able to process that  information and had pushed back deadlines. Then, quietly, on the Friday of Thanksgiving weekend, CMS offered a transitional “administrative” fix through this federal policy guidance.

The states are allowed to use the minimal information on the so-called “flat files” to finalize the Medicaid status. The flat files had been pretty bare bones but CMS says expanded files will “include data elements such as: date of birth, Social Security number, eligibility category used for assessment or determination, and verification inconsistencies. The file will identify individuals who have been assessed or determined eligible for Medicaid and CHIP on the basis of modified adjusted gross income (MAGI).”

It would be good to check in with your state’s Medicaid director. Is this enough? Too little, too late? Will people be correctly enrolled in Medicaid by Jan. 1 – or will some be left uncovered, even if they did their part of the application process correctly?

Here’s a list of state Medicaid directors from the National Association of Medicaid Directors.

Seniors lacking in dental care according to state-by-state scorecard

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Image by U.S. Pacific Air Forces via flickr.

Image by U.S. Pacific Air Forces via flickr.

Judi Kanne, a registered nurse and freelance writer for Georgia Health News took a look at dental care for seniors and found that her state, and many others, have been coming up short.

She interviewed elderly patients who sought care at Mercy Care, a downtown Atlanta charity clinic.

One of them was 71-year-old Johnnie Collier who told her he went there to get a tooth extracted that had been hurting him for years.

Despite the work of such charity clinics, Kanne wrote, millions of older adults are unable to get the dental services they need.

Then she offered a good summary of the predicament. Continue reading

History gives perspective to changes in health care system

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

While most of us are focused on the opening of the insurance marketplaces on Tuesday, Catherine Hollander, in the National Journal, takes a broader look at the history of changes in our health care system and how the Affordable Care Act might change things over time.

She asserts that the ACA is not the first or even biggest transformation of our health care system:

“Two overhauls were more radical than Obamacare will be next year: the dramatic rise of employer-sponsored insurance during the World War II era, and the adoption of Medicare and Medicaid in 1965.

A look forward at what health reform could mean for the country explains the coverage gaps left by the decisions to expand or not expand Medicaid in the states. The system will experience insurance reforms, more patients for doctors to see, innovations designed to save money and improve care and possibly a change in perception of people being rated on the state of their health.

Hollander, putting things into perspective, points out there is still a lot we don’t know about how Obamacare is going to play out and whether it can shift the entire health care system.

(Hat tip to Phil Galewitz)

Series explains health reform through people’s stories

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo by Thomas Hawk via Flickr.com.

The Tennessean recently ran a six-part series by Tom Wilemon, who was a 2012-13 AHCJ Regional Health Journalism Fellow, showing the faces of the Affordable Care Act.

The series, accompanied by video, a set of helpful fact boxes, and an invitation to email Wilemon with questions about the law, broke down the jargon and, as Wilemon wrote, showed “what the law means for a young invincible, a part-time job juggler, a 50-something, an entrepreneur, a poverty worker and an immigrant.” (I confess that initially I read that as a “juggler” not a “job juggler” and was hoping for the first article on “Obamacare goes to the circus,” but alas, I had just read it too quickly.)

The unifying theme was that the Tennessee population – like much of the country – was just not quite sure what this health reform law could offer them (other than political fighting). And that they needed help.

As he wrote in the overview:

The countdown is on until the Affordable Care Act’s mandates take effect.

It’s a law intended to bring health coverage to uninsured Americans, including about 900,000 in Tennessee. They range from healthy young people who think they don’t need coverage to desperate 50-somethings with pre-existing conditions who can’t get a policy.

However, few people understand exactly what the law means for them, even though three months from now they can start signing up to buy coverage on a federal insurance exchange.

The pieces were short and clear but conveyed a lot of information: I was particularly struck by the simple vivid opening sentences that brought the various segments of the population to life and zeroed in on their concerns. Continue reading