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Another Republican Governor switches to support Medicaid expansion

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bcobbdeacs

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I see that Florida governor Rick Scott has decided that since it is fully covered that it would be unduly cruel to not expand his state's Medicaid program so that 900,000 low income Floridians can receive medical and dental care for at least the next 3 years. Joins a list of other states governed by Repubs to switch and support this expansion.
 
I believe McCrory is currently considering whether to expand it. Last I heard, it was a lean to no.
 
He has already said no, I am on the executive committee at Cone Health and the hospitals are getting killed over this failure in NC due to the Medicare reductions that are to pay for this expansion which would allow the hospitals to have more paying customers to offset this give back. It is thought that many of the smaller community hospitals may go under.
 
Scott's may be leaving office. he sees the opportunity to steal a few billion like he did before becoming a politician.
 
bcobbdeacs said:
He has already said no, I am on the executive committee at Cone Health and the hospitals are getting killed over this failure in NC due to the Medicare reductions that are to pay for this expansion which would allow the hospitals to have more paying customers to offset this give back. It is thought that many of the smaller community hospitals may go under.
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Interesting. Aside from ideology, do you know of the reason Mc decided this?
 
Legislature is up in arms saying the program is mismanaged and have published their data in another thread, spoke with one of the administrators today and he said their complaints were not related to the programs, he also said that DMA's expense ratio was 2%, meaning 98% of the money provided to DMA was paid out in claims and that they were under budget this year.Probably a political decision with pressure from the legislature who actually make the decisions.
 
bcobbdeacs said:
Legislature is up in arms saying the program is mismanaged and have published their data in another thread, spoke with one of the administrators today and he said their complaints were not related to the programs, he also said that DMA's expense ratio was 2%, meaning 98% of the money provided to DMA was paid out in claims and that they were under budget this year.Probably a political decision with pressure from the legislature who actually make the decisions.
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Thanks. Doesn't make much sense to me. But, as we say around here often, elections have consequences.
 
would not surprise me to see several little rural hospitals go under because of this. My dad is on the board of the little hospital in my podunk hometown, they're barely surviving as is. If they lose any material amount of the federal aid they get now it will almost certainly be curtains. People up there will probably have to drive into Virginia for care, which I'm sure the Raleigh GOP will love - nothing better than offloading your poors onto a neighboring state.
 
Deacon923, that will certainly occur, remember the 700 billion taken from medicare was principally taken from hospitals because the medicaid expansion was supposed to provide more paying customers to make up for the shortfall, further, the medicare carve back is part of the payment for the Medicaid expansion.
 
bcobbdeacs said:
Legislature is up in arms saying the program is mismanaged and have published their data in another thread, spoke with one of the administrators today and he said their complaints were not related to the programs, he also said that DMA's expense ratio was 2%, meaning 98% of the money provided to DMA was paid out in claims and that they were under budget this year.Probably a political decision with pressure from the legislature who actually make the decisions.
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Just out of curiosity, I wonder what that expense ratio would be if it factored in the cost of use by DMA of other state agencies. For example, DMA uses the State Attorney General's office as its police force, but obvioulsy DMA isn't paying any of those lawyer salaries, staff salaries, or overhead. Simlarly, they also use services provided by the Department of Revenue, but none of the expenses of those services would show up in DMA's budget.
 
Would still be less than a private insurer because there is not a profit angle, further, the expenses you site would probably be less than a private insurer because the lawyers on the AG staff are paid a salary whether they work on DMA problems or not and don't bill hourly like the insurance legal advisors do.
 
Maybe, maybe not. A private insurer may pay $300/hour to a good lawyer to have the right answer answer in 2 hours, whereas it may take the NC Central hack in the AG's office 3 days to come up with the wrong answer. Compound that over the course of the year and all you get is more staff being hired or pulled from other areas to cover the workload and a bunch of wrong answers.
 
That would be a strange assumption, I worked with the AG's office on a case a few years ago and the AG assigned lawyer was a UNC law grad and was not full of wrong answers. Also, we have evidence of a state program being run by a private insurer, the Health Choice program was run by Blue Cross for a number of years until the State pulled the contract to cut the costs. I was informed that the state reduced outlays on the health Choice program without reducing the amount of services to the participants.
 
I don't know, every lawyer I've dealt with in the AG's office who has been assigned DMA cases has been a loser. Don't get me wrong, they do have some very talented people in the AG's office, just not the ones handling DMA's crap. I'm obviously jaded based on personal experience, but I don't think I've ever seen anything associated with DMA that has been reasonably correct or efficient.
 
I can give you one current example of efficiency from DMA, claims filed direct from my office to DMA by Thursday at 5;00PM are paid on the next checkwrite, most times the next Tuesday, most private insurers take the full 45 days that they are allowed or claim they never received the claim thereby giving themselves another 45 days to hold the money that belongs to my office. People in other states are amazed that in NC the turnaround is that rapid.
 
The flip side of what you perceive as efficient is that nobody at DMA is actually reviewing those payments, the computer is just spitting them out. I've had multiple cases with them over the past couple of years where they have processed payments like that from the same provider for YEARS, to the tune of multiple millions of dollars, only to then later come back and say they were coded wrong and demanding the full amount of the money back. What kind of half-assed system is that? If there is an alleged problem with the coding, why not fix it at the beginning, instead of trying to recoup it years after the fact and for 100% recovery against a Medicaid provider that may have a 7-10% profit margin? Where do they think the other 90-93% went, the guy's pocket? It went for staff and rent and supplies and equipment, all to do the services that were actually performed and billed and paid for. But because they are on a 100% reimbursement program with the feds, once they report a potential problem to the feds they are committed to throwing taxpayer dollars to see it through, no matter how ridiculous the claim. The whole process is a lesson in governmental ineptitude and wasted taxpayer funds of the highest degree.
 
That is a rare occurance, and you are right it is not reviewed by a human which would involve more employees and more state funds, and for what it is worth they do track overutilization on their computer but it is not agile enough, therefore the new computer that the state was trying to purchase, which is, once up to speed, to improve fraud and utilization problem surveillance. Finally, in my field you cannot upcode to cheat unless you are obviously cheating and if you are audited it will be obvious if they have made an error or the provider has cheated. perhaps that is a difference in my field of practice and yours.
 
One addendum, private insurers do not hand check claims under a certain threshold dollar amount for the same reason the state does not, they would require hundreds of unnecessary employees with all the benefits and salaries. They have actuarily decided that there is not sufficient fraud to warrant the increased cost of employment to them.
 
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