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When Craig Thiele, MD, chief medical officer of Dayton, OH-based CareSource, the state's largest Medicaid managed care plan, thinks of 2014, he remembers the need to "be sure, from the sheer aspect of supply and demand, that we don't get into trouble."
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While opting out of Medicaid altogether doesn't seem to be a realistic option for states currently, Stan Rosenstein, MPA, principal advisor at Health Management Associates in Sacramento, CA, and former California Medicaid director, doesn't think the issue has gone away.
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There are probably some states that wouldn't mind if their Medicaid program was taken over by the federal government, according to Leslie Hendrickson, PhD, principal of Hendrickson Development, an East Windsor, NJ-based consulting group which helps to develop and strengthen long-term care programs
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Medicaid and the Children's Health Insurance Program (CHIP) will have roughly 16 million additional enrollees as a result of the Patient Protection and Affordable Care Act (PPACA), according to the Congressional Budget Office in Washington, DC, but how quickly will these individuals enroll? According to Jocelyn Guyer, co-executive director of Georgetown University's Center for Children and Families in Washington, DC, "If there is an expectation of people having coverage, that will happen more quickly and be more widespread."
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States should implement a one-time, high-volume enrollment push at the launch of health reform, recommends Beth Morrow, director of health information technology initiatives for The Children's Partnership, a child advocacy organization with offices in Washington, DC, and Santa Monica, CA. To streamline the enrollment process, she says, states can build on the innovative efforts undertaken by Louisiana and Alabama.
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The Centers for Medicare & Medicaid Services (CMS) and Congress will be under significant political pressure to roll back the maintenance of effort (MOE) requirements included in the Patient Protection and Affordable Care Act (PPACA), according to Michael Miller, director of policy at Community Catalyst in Boston, "either wholesale, or via individual waiver applications such as that filed by Arizona."
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The states with the largest expected Medicaid enrollment growth are the very ones that have the fewest number of primary care physicians, according to a March 2011 report.1 Temporary increases in Medicaid reimbursement are unlikely to make much of a difference in states facing the biggest enrollment increases, says study author Peter Cunningham, PhD, a senior fellow and director of quantitative research at the Center for Studying Health System Change in Washington, DC.
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The Medicaid expansion will pose a major challenge in terms of where the newly insured will be able to receive care in 2014, according to Daniel R. Hawkins, senior vice president for public policy and research at the National Association of Community Health Centers in Washington, DC.
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At Valley Health System in Ridgewood, NJ, two major goals are to obtain more authorizations and to do them in advance of the inpatient stay or procedure, says Maura Corvino, MSOL, RN, CEN, assistant vice president for emergency services and patient access.
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No one ever asked me for money before," was a common response when registrars started collecting ED copays at Evanston, IL-based NorthShore University HealthSystem, reports Cindy Geaslin, director of patient registration.
