Contents tagged with medicaid

  • How the CCO model would address our nation’s health care crisis

    Tags: Jim Rickards, Moda Health, Oregon, medicaid, Coordinated Care Model, CCO

    By Jim Rickards, MD, MBA

    Back in 2011, the state of Oregon was facing a massive budget deficit, primarily driven by rising Medicaid costs. Medicaid is government-supported health insurance for economically disadvantaged individuals earning up to 138 percent of the federal poverty level. About 25 percent of Oregon’s population, nearly 1 million individuals, are currently enrolled in Medicaid. This is a similar percentage to what is seen nationally. Not only did the deficit substantially impact the state’s overall budget for health care funding, but the potential impact on the lives of many Oregonians also weighed heavy on the medical community.

    Typically, when states try to manage deficits related to Medicaid, they employ a combination of three strategies. For one, they will decrease reimbursement rates to hospitals and providers. This does not work very well because, ultimately, clinics will need to limit the number of Medicaid members they see since they are not financially viable, in turn creating access issues for patients. Second, the number and types of covered services can be restricted by the state. In Oregon, we had already employed the Prioritized List of Health Services for more than 20 years, which served as an evidence-based approach to prioritizing and limiting the availability of health care services. Limiting what was already on the list would not have been possible without denying many essential services. Finally, a state can decrease the number of individuals enrolled in Medicaid. This was not an option either, as Oregon was going to be an expansion state under the Affordable Care Act and would see its Medicaid population grow from 600,000 to a little over 1 million members within just a short time.

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  • HHSC seeks physicians for new state advisory committees

    Tags: advisory committee, medicaid, HHSC, DSHS

    Last year the Legislature made its regular adjustments to the list of advisory committees that report to the Texas Health and Human Services Commission and the Department of State Health Services. These committees play important roles in bringing fresh perspectives to the agencies and family doctors who have served on them in the past have had the chance to influence state programs to benefit patients.

    The full list of advisory committees with available seats can be found on the HHSC website, but two committees are of particular interest to the Academy. The new Value-Based Payment and Quality Improvement Committee is a combination of the previous Medicaid/CHIP Quality-Based Payment Advisory Committee and the Texas Institute for Healthcare Quality. Its purpose is to provide a forum to promote public-private, multi-stakeholder collaboration in support of quality improvement and value-based payment initiatives for Medicaid and other health services.

    The Statewide Medicaid Managed Care Advisory Committee will advise HHSC on the operation of Medicaid managed care, including program design and benefits, concerns about the system from consumers and providers, efficiency and quality of services, contract requirements, network adequacy, trends in claims processing, and other issues. The agency is looking for primary care physicians and has a specific directive to include rural providers.

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  • Texas Family Physician - Vol. 67 No. 1, Winter 2016

    Tags: falcon, rio grande city, rio grande valley, rural medicine, rural physician, rural, annual session and primary care summit, annual session, medicaid, medicare, payment reform, alternative payment model, medicare access and CHIP reauthorization act, sgr, centers for medicare and medicaid services, physician of the year, perspective, president's letter

    Go to the TFP archive

    View the virtual issue

    President’s letter

    Perspective

    CONTENTS

    Texas Family Physician of the Year 2015-16: Antonio Falcon, MDBorn and bred in Rio Grande City, … more

  • Blue Button makes finding Medicaid patient records simple

    Tags: medicaid

    Medicaid providers can now find their patients’ medical histories on YourTexasBenefitsCard.com. Medicaid Eligibility and Health Information Services added the Blue Button to the site in September.

    Once a provider or office staff receives a client’s consent, they can log in to the site and click on the Blue Button to see and download the client’s health information. The information can then be saved as a Portable Document Format document, a Clinical Document Architecture data file, or a simple text file. Once saved, it can be imported into the provider's health management tool.

    The YourTexasBenefitsCard Blue Button is assembled from client data found in the current database and claims data stored in the Medicaid Claims Administrator System. It generates easily accessible patient records on the website for providers to download, import, or print.

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  • Texas Family Physician - Vol. 66 No. 3, Summer 2015

    Tags: texas family physician, members, president's letter, perspective, medicare, health care reform, reform, reiner, practice management, medicaid, end-of-life, sgr, legislature, briggs, johnson, kelly, molina, icd-10

    Go to the TFP archive

    View the virtual issue

    President’s letter

    Perspective

    CONTENTS

    Inside the coverage gapTexas is the only state left with at least 20 percent of its population … more

  • Court upholds subsidies in ACA

    Tags: texas association of community health centers, affordable care act, health care reform, medicaid, supreme court

    Health care organizations and millions of people across the country can breathe a sigh of relief. The Supreme Court has upheld the subsidies established by the Affordable Care Act that help about 6.4 million Americans purchase health insurance on the federal exchange. Had the court struck down those subsidies, more than one million Texans might have lost their coverage.

    President Obama addressed the nation from the White House shortly after the ruling was announced, saying there could be no doubt that the ACA is working and that the law is here to stay.

    “Today is a victory for hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law,” the president said.

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  • Report from TACHC, TAFP says Supreme Court ruling could worsen growing consequences to Texas’ refusal to expand Medicaid coverage

    Tags: texas association of community health centers, affordable care act, health care reform, medicaid

    More than 1 million Texans might lose their health insurance if the Supreme Court rules against the Obama administration this month in King v. Burwell. Such a ruling would deny premium subsidies to Texans and residents of 35 other states that refused to establish state exchanges under the Affordable Care Act.

    Texas’ decision not to expand Medicaid coverage under the Affordable Care Act already leaves more than a million low-income, uninsured Texans without access to Medicaid or to federal subsidies to help them purchase insurance. A new report, “How will Texas’ Affordable Care Act Implementation Decisions Affect the Population? A Closer Look,” written by health care law and policy experts at George Washington University and commissioned by the Texas Association of Community Health Centers and TAFP examines the effects of that decision and the compounded damage to the state’s economy and health care infrastructure that would accompany a Supreme Court ruling in favor of the plaintiff.

    “The combined effects of not expanding Medicaid and the potential impact of King v. Burwell will hit Texas’ health care system hard,” according to the report. “County‐level estimates show that prior to implementation of the ACA, 38 counties experienced hospital annual uncompensated care levels of $50 million or greater, and four counties showed losses greater than $200 million. Texas’ failure to adopt the Medicaid expansion, coupled with the loss of premium subsidies as a result of a decision against the government in King would reverse the progress that has been made in reducing the number of uninsured Texans. Furthermore, hospitals could find that the demand for charity care actually rises, as thousands of previously‐insured people with serious health conditions turn to their hospitals for help.”

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