See more on Iowa's managed care disaster here.
Showing posts with label Privatization. Show all posts
Showing posts with label Privatization. Show all posts
Thursday, September 13, 2018
Monday, November 6, 2017
Iowa privatization of Medicaid generates complaints
*************************
As Medicaid Managed Care Proliferates, So Do Complaints
by Clay Masters, Iowa Public Radio | November 6, 2017
Iowa is one of 38 states that radically changed the way it runs Medicaid over the past few years. The state moved about 600,000 people on the government-run health program into care that is managed by for-profit insurance companies.
The idea is that the private companies would save the state money, but it has been a rocky transition in Iowa, especially for people like Neal Siegel.
Siegel is one of six Iowans with disabilities suing the state, alleging that Medicaid managed care, as it is known, deprives thousands of Iowans with disabilities the right to live safely in their homes.
by Clay Masters, Iowa Public Radio | November 6, 2017
Iowa is one of 38 states that radically changed the way it runs Medicaid over the past few years. The state moved about 600,000 people on the government-run health program into care that is managed by for-profit insurance companies.
The idea is that the private companies would save the state money, but it has been a rocky transition in Iowa, especially for people like Neal Siegel.
Siegel is one of six Iowans with disabilities suing the state, alleging that Medicaid managed care, as it is known, deprives thousands of Iowans with disabilities the right to live safely in their homes.
Medicaid serves people with disabilities, low-income people and people in nursing homes. A combination of federal and state funds pays for it. It covers 74 million people across the country these days, about half of whom are in Medicaid managed care.
Siegel, a former financial consultant, was in a hit-and-run bicycle crash four years ago that left him with a severe brain injury. He uses a wheelchair and can barely speak.
“I would probably put Neal at about 98 percent cognitive (awareness) of what’s going on around him, but unfortunately (he’s) not able to articulate it,” said Siegel’s girlfriend, Beth Wargo. “So it’s being trapped inside your own body.”
After the accident, Siegel qualified for Medicaid. He lived in a rehabilitation center for a while, and the lawsuit, filed in U.S. District Court in June, says he was the victim of abuse and neglect while living there.
Eventually he moved home with Wargo, where he’s totally reliant on caregivers to assist him with all activities of daily life.
Then last year, Wargo said, they got a letter in the mail from AmeriHealth Caritas, the company that manages his care. Siegel’s budget for home help had been slashed by 50 percent, Wargo said. Siegel’s face lit up as Wargo talked about the lawsuit, and he managed to say, “Oh yeah,” when she mentioned how happy they were that they could be part of it.
Cyndy Miller is the legal director with Disability Rights Iowa, the advocacy group that spearheaded the lawsuit.
“The system is too stressed right now with the way it’s being managed, and it’s not healthy for individuals with chronic or serious disabilities,” said Miller.
According to the lawsuit, the company claimed that spending on Siegel’s case was cut because it had exceeded a limit set in state policy. A spokesman for AmeriHealth Caritas said the company could not comment on ongoing litigation. The state has asked for the lawsuit to be dropped.
In addition to the suit, complaints about Medicaid from hospitals, doctors and patients have spiked in Iowa.
Iowa’s Department of Human Services Director Jerry Foxhoven defended moving the entire Medicaid population to managed care. He said more taxpayer dollars will be saved under private management.
But he said his agency is willing to make changes, especially for people like Neal with serious disabilities.
“Everything’s always on the table. We’re always looking at everything to say, ‘How do we best serve the people we’re trying to serve and be the best stewards of taxpayer dollars?'” Foxhoven said.
For their part, the three companies with contracts in Iowa said in statements that the first 18 months of Medicaid managed care have been successful. But they also have said to state officials that reimbursement rates were based on deeply flawed cost estimatesprovided to them before the project began.
They are now negotiating to get millions of dollars more in state funding.
So where’s the savings? So far, no state has actually done a comprehensive review of whether private companies actually save Medicaid dollars, said Kelly Whitener, an associate professor with Georgetown University who studies managed care.
“You’d really need to be able to see, are you saving money overall or not, and if you are spending less money, are you suppressing services that are needed? Or are you really finding efficiencies and only delivering care that families really need?” said Whitener.
For the moment, those questions don’t have definitive answers.
Meanwhile, Iowa has to balance its books. Republican Gov. Kim Reynolds had to tap more than $260 million of the state’s reserve fund this year, and officials expect next year’s budget will be even tougher to negotiate. Medicaid funding is likely to continue to be a large part of the discussion.
This story is part of a reporting partnership with NPR, Iowa Public Radio and Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
Siegel, a former financial consultant, was in a hit-and-run bicycle crash four years ago that left him with a severe brain injury. He uses a wheelchair and can barely speak.
“I would probably put Neal at about 98 percent cognitive (awareness) of what’s going on around him, but unfortunately (he’s) not able to articulate it,” said Siegel’s girlfriend, Beth Wargo. “So it’s being trapped inside your own body.”
After the accident, Siegel qualified for Medicaid. He lived in a rehabilitation center for a while, and the lawsuit, filed in U.S. District Court in June, says he was the victim of abuse and neglect while living there.
Eventually he moved home with Wargo, where he’s totally reliant on caregivers to assist him with all activities of daily life.
Then last year, Wargo said, they got a letter in the mail from AmeriHealth Caritas, the company that manages his care. Siegel’s budget for home help had been slashed by 50 percent, Wargo said. Siegel’s face lit up as Wargo talked about the lawsuit, and he managed to say, “Oh yeah,” when she mentioned how happy they were that they could be part of it.
Cyndy Miller is the legal director with Disability Rights Iowa, the advocacy group that spearheaded the lawsuit.
“The system is too stressed right now with the way it’s being managed, and it’s not healthy for individuals with chronic or serious disabilities,” said Miller.
According to the lawsuit, the company claimed that spending on Siegel’s case was cut because it had exceeded a limit set in state policy. A spokesman for AmeriHealth Caritas said the company could not comment on ongoing litigation. The state has asked for the lawsuit to be dropped.
In addition to the suit, complaints about Medicaid from hospitals, doctors and patients have spiked in Iowa.
Iowa’s Department of Human Services Director Jerry Foxhoven defended moving the entire Medicaid population to managed care. He said more taxpayer dollars will be saved under private management.
But he said his agency is willing to make changes, especially for people like Neal with serious disabilities.
“Everything’s always on the table. We’re always looking at everything to say, ‘How do we best serve the people we’re trying to serve and be the best stewards of taxpayer dollars?'” Foxhoven said.
For their part, the three companies with contracts in Iowa said in statements that the first 18 months of Medicaid managed care have been successful. But they also have said to state officials that reimbursement rates were based on deeply flawed cost estimatesprovided to them before the project began.
They are now negotiating to get millions of dollars more in state funding.
So where’s the savings? So far, no state has actually done a comprehensive review of whether private companies actually save Medicaid dollars, said Kelly Whitener, an associate professor with Georgetown University who studies managed care.
“You’d really need to be able to see, are you saving money overall or not, and if you are spending less money, are you suppressing services that are needed? Or are you really finding efficiencies and only delivering care that families really need?” said Whitener.
For the moment, those questions don’t have definitive answers.
Meanwhile, Iowa has to balance its books. Republican Gov. Kim Reynolds had to tap more than $260 million of the state’s reserve fund this year, and officials expect next year’s budget will be even tougher to negotiate. Medicaid funding is likely to continue to be a large part of the discussion.
This story is part of a reporting partnership with NPR, Iowa Public Radio and Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
Wednesday, August 30, 2017
Michigan compromise budget for mental health: stalls complete takeover by medicaid health plans & funds pilot programs
The final budget compromise has at least stalled the complete privatization of the mental health system. The compromise preserves the current ten Prepaid In Patient Health Plans (PIHPs), regional administrative agency that distribute Medicaid funding for Mental Health services. There will also be as many as four pilot programs to test whether privatization, i.e. handing over control of Medicaid funding for mental health services to Michigan’s Medicaid Health Plans, can lower costs and expand services.
These are excerpts from an article in Crain’s Detroit Business, “Budget deal advances plan to test Medicaid mental health integration” by Jay Greene, 6/20/17.
“The budget deal allocates $2.8 million the first year to the fiscal 2017 budget to plan the pilots, and $3.1 million for fiscal 2018, which starts Oct. 1, to fund the pilots themselves. The $5.9 million funding includes $2 million in general state tax funds.
“The implementation of the pilots will be overseen by the state Department of Health and Human Services, which must hire by Aug. 1 an experienced project facilitator. The manager must establish performance metrics and pilot plans.”
…
“Over the past 18 months, Michigan's 11 Medicaid health plans have lobbied legislators and the public to try a semi-privatized approach. They contend they can run an efficient $11.6 billion integrated delivery system, save the state several hundred million dollars of administrative money and plow back the savings into expanded services. There are an estimated 350,000 people in the state's Medicaid program with mental illness, developmental and intellectual disabilities, and substance abuse problems.
“But mental health advocates, providers and families object to Medicaid HMOs taking over the system — even to test an integrated approach with which more than two dozen states are experimenting. They believe health plans have insufficient experience at overseeing complex populations and argue that private profit motivations of the health plans will trump public service.”
…
“[State Senator Mike] Shirkey, chair of the Senate health policy committee, has told Crain's the Medicaid HMOs will not be able to keep any savings. They must reinvest any savings into expanded services.
“Bob Sheehan, CEO of the Michigan Association of Community Mental Health Boards, said he is concerned that the budget language allows Medicaid health plans to contract outside of the several dozen established community mental health agencies and provider networks.
“‘Making the local community mental health (agency) only one of many providers in the pilot communities will immediately drain dollars from the community's mental health safety net ... leaving it unable to fulfill its statutory safety net role,’ Sheehan said Tuesday night in an email to Crain’s.”
Implementation of the pilot programs will include the following:
- That any changes made to a Medicaid waiver or Medicaid state plan to implement the pilot project must only be in effect for the duration of the pilot project.
- That the project is consistent with the stated core values as identified in the final report of the Section 298 workgroup in Public Act 268 of 2016.
- That updates are provided to the medical care advisory council, behavioral health advisory council and developmental disabilities council.
Friday, June 9, 2017
Will Michigan legislators listen to constituents on mental health funding proposals?
Michigan Public Radio aired an interview on 6/7/2017 with Gail Marsh, the mother of an adult daughter with Down Syndrome, and Bob White, the father of two adult sons on the autism spectrum. Both parents have been involved in “Section 298” workgroups and affinity groups for more than a year. These groups were formed after the Governor’s budget proposed to shift mental health Medicaid funding from public Community Mental Health (CMH) agencies to private health plans that currently administer Medicaid medical health plans. They were a response to the strong opposition that met the Governor's proposal.
People with developmental disabilities are one of the populations served by the mental health system in local Community Mental Health (CMH) agencies.
From the Michigan Radio website, "Parents 'afraid to die' because of fear mental health care system won’t take care of their children" by Stateside staff and Josh Hakala, 6/7/17:
“Tomorrow, state lawmakers are expected to release their final budget for fiscal year 2017-18 for the Department of Health and Human Services.
“That budget will reveal if Republicans have chosen to shift control of mental health funding – which amounts to nearly $2.5 billion in annual Medicaid payments – away from public mental health organizations, and transfer it to private insurers.
...
"Listen to the full interview … to hear more about their children and how they rely on mental health services as well as Marsh's examples of how privatizing ‘doesn't work’ and why White describes it as a form of ‘outsourcing.’"
Here is part of the interview with Gail Marsh on how the legislature has so far ignored much of the public input from the “Section 298 Initiative”. Start listening at about 12 minutes and 30 seconds into the interview. [Note that in this discussion, “integration” of care is about integrating funding for medical and behavioral health services under one administrative roof - the private Medicaid health plans.] The stakeholder workgroups and affinity groups overwhelmingly supported maintaining a public system to provide behavioral health services which include the social services and supports necessary to maintain people served in community settings.
Gail Marsh recently testified at a Michigan House appropriations subcommittee where she heard references to a State Senator’s comment that, “We’ve been dancing around the concept of integration for too long and the legislature needs to force things to happen.”
Here is her response in the interview:
“…I told them, the reason we’ve been dancing around total integration for so long is because it’s not what people want …The job they’ve been hired to do …is not to force unwanted things on their constituents, but to listen to the people who elected them. So, both the House and the Senate…have dismissed the recommendations of the workgroup and the stakeholder affinity groups, which were to maintain a public behavioral healthcare system.”
From the Michigan Radio website, "Parents 'afraid to die' because of fear mental health care system won’t take care of their children" by Stateside staff and Josh Hakala, 6/7/17:
“Tomorrow, state lawmakers are expected to release their final budget for fiscal year 2017-18 for the Department of Health and Human Services.
“That budget will reveal if Republicans have chosen to shift control of mental health funding – which amounts to nearly $2.5 billion in annual Medicaid payments – away from public mental health organizations, and transfer it to private insurers.
...
"Listen to the full interview … to hear more about their children and how they rely on mental health services as well as Marsh's examples of how privatizing ‘doesn't work’ and why White describes it as a form of ‘outsourcing.’"
Here is part of the interview with Gail Marsh on how the legislature has so far ignored much of the public input from the “Section 298 Initiative”. Start listening at about 12 minutes and 30 seconds into the interview. [Note that in this discussion, “integration” of care is about integrating funding for medical and behavioral health services under one administrative roof - the private Medicaid health plans.] The stakeholder workgroups and affinity groups overwhelmingly supported maintaining a public system to provide behavioral health services which include the social services and supports necessary to maintain people served in community settings.
Gail Marsh recently testified at a Michigan House appropriations subcommittee where she heard references to a State Senator’s comment that, “We’ve been dancing around the concept of integration for too long and the legislature needs to force things to happen.”
Here is her response in the interview:
“…I told them, the reason we’ve been dancing around total integration for so long is because it’s not what people want …The job they’ve been hired to do …is not to force unwanted things on their constituents, but to listen to the people who elected them. So, both the House and the Senate…have dismissed the recommendations of the workgroup and the stakeholder affinity groups, which were to maintain a public behavioral healthcare system.”
- Listen to the whole interview here.
- Link to background information on “Section 298 Initiative”
- Minding Michigan, is Stateside’s ongoing series about mental health issues is Michigan.
- So far, I have not seen news on whether the budget proposals for MI Health and Human Services have been acted on.
Thursday, May 25, 2017
Michigan: Budget negotiations and radical changes to DD service delivery
May 25. 2017
Where to start? The Michigan legislature is considering a radical change in how services for people with developmental disabilities, mental illness, and substance abuse disorders will be delivered and who will be in control of the Medicaid dollars that pay for those services. The intent of proposed legislation is the eventual privatization of mental health services by “integrating” mental health and medical Medicaid services under the control of Michigan’s private Medicaid Health Plans.
This intent of the Governor was spelled out clearly more than a year ago by the governor’s proposed budget for Fiscal Year 2017:
“…the FY17 executive budget recommendation includes section 298 of the Michigan Department of Health and Human Services Budget - a proposed change without any initial research or analysis that would transfer management responsibilities of all Medicaid behavioral health dollars ($3 billion) from the current publicly managed PIHP system to the privately managed Medicaid health plans by the end of FY17. This change would significantly harm an already underfunded system of care for Michigan's most vulnerable citizens.”
The plan that was proposed in 2016 was met with almost universal opposition from people receiving services through the Community Mental Health system, advocates, providers, and CMH agencies throughout the state. This was enough to halt the plan in its tracks, form various committees and workgroups to study the problem and submit reports to the legislature for consideration of this year’s budget negotiations.
The plans set forth by the Governor and the legislature for future fiscal years have changed in the details, but not in their intent. Privatization is the goal and the way to reach this goal has been laid out in proposed legislation. Many, many words, letters, emails, and phone calls have been exchanged trying to make sense of these proposals and assure that the people affected by them are heard and that their views are taken into consideration. Whether that will be the case remains to be seen.
The budget negotiations and the news about them from Lansing are overwhelming and confusing. Part of the problem for me and for many families of people living with severe disabilities is that real life keeps intervening. In my case, it mostly has to do with my older son’s struggle with seizures. I have decided to start with the present and work backwards to find ways to explain what is going on with the state and how it is affecting people at the local level.
In an article in the Ann Arbor News, “Lawmakers say mental health cuts put Michigan counties in a bad spot” by Ryan Stanton, 5/23/17, local legislators discuss the harmful effects of past actions by the state legislature and current proposals that make it increasingly difficult for local agencies to meet the needs of people with DD, mental illness, and other vulnerable populations:
"...Cuts at the state level in recent years already have created a crisis for community mental health service providers across Michigan, putting counties in a bad spot, [legislators] argued Monday night, May 22, during a legislative forum hosted by Washtenaw County's Office of Community and Economic Development.
"GOP lawmakers in Lansing are now considering further changes to how mental health services are provided in Michigan, and Democrats fear it could essentially lead to privatization of community mental health by 2020.
"GOP lawmakers in Lansing are now considering further changes to how mental health services are provided in Michigan, and Democrats fear it could essentially lead to privatization of community mental health by 2020.
"Rep. Adam Zemke, D-Ann Arbor, said a lack of state general fund support for mental health is having devastating consequences, and counties are asking local taxpayers to dig deeper into their pockets to fund vital services.”
In past years, while Medicaid was the main source of funding for mental health services, dollars from the state’s General Fund could be used to pick up the slack for people who were not eligible for Medicaid but were nonetheless in need of services for medical care, job support, psychiatric care, and programs to prevent homelessness and incarceration. Recently, available General Fund resources have been shrinking drastically:
“Washtenaw County Community Mental Health's state general fund allocation has dropped from $6.5 million in 2014 to $2.7 million as of 2017.
In past years, while Medicaid was the main source of funding for mental health services, dollars from the state’s General Fund could be used to pick up the slack for people who were not eligible for Medicaid but were nonetheless in need of services for medical care, job support, psychiatric care, and programs to prevent homelessness and incarceration. Recently, available General Fund resources have been shrinking drastically:
“Washtenaw County Community Mental Health's state general fund allocation has dropped from $6.5 million in 2014 to $2.7 million as of 2017.
“As a result, county officials say, critical treatment and services for highly vulnerable citizens have been reduced or eliminated, and WCCMH is currently wait-listing people who are uninsured or underinsured.”
State Senator Rebekah Warren, D-Ann Arbor, voted against the Senate budget plan that calls for privatization of community mental health programs by 2020:
"'We were being sort of sold a promise that they will be able to deliver more care for more people with less money and I'm not exactly sure how they think they can do that, but that's kind of the promise.'"
Washtenaw and other Michigan counties are considering ballot measures for increasing local property taxes to pay for the lack of state general fund dollars and potential decreases in federal Medicaid funding for crucial services. This seems to be a stopgap measure to fund services, but is not a longterm solution. Legislators continue to seek tax cuts even as the demand for services for vulnerable populations increases along with the public’s demand for infrastructure improvements that have been neglected for years.
State Senator Rebekah Warren, D-Ann Arbor, voted against the Senate budget plan that calls for privatization of community mental health programs by 2020:
"'We were being sort of sold a promise that they will be able to deliver more care for more people with less money and I'm not exactly sure how they think they can do that, but that's kind of the promise.'"
Washtenaw and other Michigan counties are considering ballot measures for increasing local property taxes to pay for the lack of state general fund dollars and potential decreases in federal Medicaid funding for crucial services. This seems to be a stopgap measure to fund services, but is not a longterm solution. Legislators continue to seek tax cuts even as the demand for services for vulnerable populations increases along with the public’s demand for infrastructure improvements that have been neglected for years.
Friday, March 18, 2016
Iowa to switch to Medicaid managed care; 25,000 people receiving Home and Community-Based Services affected
According to KCRG.com, the problems that Kansas has encountered include “a lack of meaningful oversight, confusing reimbursement requirements from the three managed care organizations, or MCOs, who are contracted with the state, and cuts to care.” In Iowa and Kansas, two of the managed care organizations (MCOs) are the same - “Both companies are facing accusations in Kansas of systematically denying claims to turn a profit.”
For people who receive Home and Community-Based Services (HCBS) (13,000 in Kansas and 25,000 in Iowa), the threat of service cuts is a significant problem. According to Sharon Spratt, CEO of Cottonwood, Inc., a provider of long-term community-based care in Lawrence, Kansas, round-the-clock services are not cheap and it has been a constant battle to maintain them:
“We understood there could be some efficiencies on the medical side,” Spratt said. “But the right service at the right time doesn’t cure our folks. Our folks have lifelong disabilities.”
Spratt said Cottonwood often deals with the same problem of denied or unpaid claims, but most levels of care have remained the same. But following our Feb. 19 interview, Cottonwood received its first notice of an MCO denying all residential care for one of its clients. Cottonwood plans to appeal the decision.
Despite the warnings from Kansas, Iowa is poised to take the plunge into privatization and managed care. Whether Iowa has any better chance of success, remains to be seen.
More dysfunction from Kansas: A couple with a 21-year-old daughter with intellectual and developmental disabilities, autism, and a seizure disorder has been waiting since 2008 for state-funded services. 3,450 people are on the waiting list. On a lighter note (?), a woman whose daughter needed a new wheelchair and receives state services, says the state covered the wheelchair, but not the wheels.
Tuesday, March 15, 2016
Michigan reverses course on privatization of the mental health system
When the Michigan budget for Fiscal Year 2017 was released earlier this year, it included the now infamous Section 298 that would have turned Medicaid funding over to Medicaid Health Plans that would have in turn contracted with local community mental health agencies to provide services to people with developmental disabilities, mental illness, and other disabilities. Currently, mental health services are funded separately as a “carve-out” to assure that these vulnerable populations are taken care of appropriately. The Michigan Department of Health and Human Services contracts with regional administrative community mental health agencies (PIHPs) that distribute funds to local CMH agencies to provide services. PIHPs would have been eliminated and Medicaid Health Plans, many of them for-profit, would have taken over, reducing the amount in the total budget available for services. The difference in overhead with the current PIHP System is striking: for Medicaid Health Plans, overhead costs for administering these plans is 15 - 17 % of the total funding. The Michigan PIHP system costs for overhead are only 6%.
By March 3, 2016, there was enough of an uproar over the proposed budget that the Michigan House Subcommittee on Judiciary and the Department of Community Health changed course, at least for now.
This is an email from Alan Bolter, Associate Director of the Michigan Association of Community Mental Health Boards (MACMHB), on 3/4/16:
...Today, Rep. VerHeulen issued the following statement regarding Section 298 of the Executive Budget request for the Department of Health and Human Services (MDHHS) Budget:
"After spending several weeks reviewing the proposed language in Section 298, I want to ensure stakeholders, patients, and Michiganders that the language will not be included in the House MDHHS budget.
“I appreciate the work of the Department of Health and Human Services in exploring new and innovative ideas to enhance the care of beneficiaries in the state of Michigan. Mental health is one of the most critical aspects of our health care system, and it is important that we carefully review proposed changes.
“The language in Section 298 will be removed in the House MDHHS budget. I am always open to proposed changes that prioritize more efficient and effective mental health care. I appreciate the workgroup process that has been initiated by Lieutenant Governor Calley and MDHHS, and look forward to analyzing the results of that workgroup process.
“The House Appropriations MDHHS Subcommittee will continue to work to craft a budget that ensures a high level of responsible care for Michiganders. Health care will remain a pressing issue, and the subcommittee looks forward to tackling the other challenges we face with Michigan's health care and social safety net systems."
#####
Alan Bolter, Associate Director
MACMHB
426 S. Walnut St.
Lansing, MI 48933
(517) 374-6848
************************
This is far from over, but at least there is a considered effort underway to analyze and study proposed changes to the way services to people with DD and other disabilities are funded and delivered before those changes are enacted into law.
Here is more information on Section 298 and proposals that would have made drastic changes in Michigan's mental health system.
Subscribe to:
Posts (Atom)