Massachusetts Health Care Reform

CMS announced on July 28 that it had granted a third extension on a Medicaid waiver that allows Massachusetts to use $385 million in federal funds to implement the Commonwealth's universal health care law. The extension runs through August 11. Governor Patrick is seeking legislative approval this week of additional funding to cover the cost of faster than expected enrollments in the new program, which has expanded coverage to 340,000 Massachusetts residents since enactment in April 2006. The Massachusetts House voted 135-21 on July 29 to approve $89 million from insurance companies and providers but rejected $33 million sought by the Governor from other employers. The Massachusetts Senate is expected to vote by the end of the week.

Rhode Island Waiver Proposal

Rhode Island released a new Medicaid waiver proposal for legislative review on July 29. The proposal would expand consumer-directed services to improve consumer satisfaction and to reduce costs. Rhode Island would also increase Medicaid reimbursement rates for services that are alternatives to institutional care, increase the number of individuals eligible to receive such services, and impose new controls and cost-sharing on hospital emergency room and other high cost services. Rhode Island plans to submit the proposal to CMS on August 8.
 
Rhode Island estimates that it can achieve a 12% reduction in nursing home utilization through its proposal. Coincidentally, the U.S. Senate Committee on Aging held hearings on July 23 taking testimony on the extent to which consumer-directed services and improved access to community-based alternatives can reduce admissions of the frail elderly to nursing facilities.

Tom Entrikin

Tom Entrikin is a PCG manager and former Medicaid policy specialist with the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS).

Senators Forced to Shelve Resolution Blocking Implementation of Restrictive SCHIP Directive Due to Parliamentarian Ruling

Senate efforts to advance a resolution blocking implementation of CMS's controversial Aug. 17, 2007 directive to States concerning eligibility for SCHIP were stymied this past week by a parliamentarian ruling that the deadline for such actions under the Congressional Review Act had passed. Senators John D. Rockefeller IV (D-WV) and Max Baucus (D-MT) authored the joint resolution, which was sponsored by 45 senators.  Senators Rockefeller and Baucus vowed to continue their efforts to block the directive.

Sam Fish

DHHS Awards $49 Million to 30 States for High-Risk Insurance Pools

30 States will share over $49 million in grants form DHHS to help defray costs of providing health insurance to residents whose health status prevent them form obtaining conventional coverage elsewhere. To be eligible, a State must have a "qualified" high-risk pool, typically state-created nonprofit associations that offer health coverage to individuals with serious medical conditions, and follow certain rules such as capping premiums at no higher than 200% of the standard charge in the State. The 30 States are: Alabama, Alaska, Arkansas, Colorado, Connecticut, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin, and Wyoming. 

Sam Fish

Sam Fish is a legal consultant at PCG and formerly served as Chief Regional Counsel, New England Region, for the U.S. Department of Health and Human Services.