#medicaid programs

So much, kittens for the “Justice Agenda”.

Don't get me wrong. It has done some good, but lately, it seems like we can't go a month without hearing about another attack on the disability community, from New York State Governor Andrew Cuomo.

[Illustration of a drag queen in an elaborate wig (pink, orange, and yellows) and outfit (yellow and orange). She is sitting at a table (seen from the chest up) that has a blue tea cup that reads “What’s The Tea?” on it. Next to and slightly underneath the cup is a white napkin with black print that reads “with Anita Mya Rhites . The text around her reads “I am living for this new wig. What I am not living for is Cuomo’s attacks on disabled people!”] And let us not forget, that an attack on the disability community, is also an attack on every single marginalized community. After all, kittens you can be disabled and black, disabled and Muslim, disabled and an immigrant, disabled and queer and so on. 

[image description: Three Black and disabled folx (a non-binary person holding a cane, a woman sitting in a power wheelchair, and a woman sitting in a chair) looking seriously at the camera while a rainbow pride flag drapes on the wall behind them. Photo credit: Disabled And Here] And while I do believe that it is vital that we leave no oppressed group behind, especially in these times, fun fact, kittens: besides being fabulous and fierce, this queen, yours truly Ms. Anita Mya Rhites, is also disabled. And so, yes kittens. That means Andy, is also going, after queens, like me.

[an illustration of a drag queen Ms. Anita, not only revealing her full outfit - which is a very elaborate, colorful and couture dress, but also showing that she uses a stylish black cane to help her mobility, and that she is also disabled. The graphic reads “Ta-daaa!!!” and “Disabled drag queens represent!”] Now, the attacks have been many, but in this issue, kittens we're going to focus on CDPA aka Consumer Directed Personal Assistance program. Horribly boring name, kittens – I know, but besides creating over 100,000 jobs, this medicaid program empowers disabled queens like me to choose and hire who comes into my home and helps me stay the independent queen that I am. (Well... with some help). With traditional services, I don't get a choice, they send whoever is available, regardless if they speak the same language as you (which is kind of helpful when you need to communicate with each other), and regardless if they have experience in assisting someone with your needs. After all kittens, disabled people's needs do vary. But another reason I adore the CDPA is that, I do the hiring, which means I can make sure the people I hire, won't be queer and drag-phobic (nor ableist). The last thing I need kittens, is some homophobic, drag queen hating, ableist, shade throwing ignoramus, giving me crap for being my fabulous self, let alone in my own home. Can you imagine having to then be reliant on a person like that? I've been there, kittens and the thought of going back to traditional services... I don't even want to think about it. So, what's the tea? Why would Mr. Justice Agenda attack a program that is clearly fabulous for New York? Good question, kittens.

[Image Description: Illustration of Ms Anita from the eyes up. She is showing us her snazzy yellow business card, which has her name in a punk styled pink font and the words  in black at the bottom in a more handwritten styled font. “Fierce Drag Queen. Hard Hitting Journalist.” ] I sat down with Ms. Kendra Scalia (Consumer and Policy Analyst and fellow disabled activist) to find out why Cuomo is throwing so much visceral shade at disabled people, and what can be done to stop him. ANITA: Girl, what is going on? Does Cuomo just hate disabled people? Why is he so hell bent on destroying our services? KENDRA: It certainly feels like Cuomo and his administration are purposefully targeting the disability community. ANITA: Ugh, I'm almost afraid to ask, but let's hear it: What is the latest on the attacks on the CDPA? KENDRA: Basically the Department of Health wants to radically change the way they fund and reimburse the FI's or Fiscal Intermediaries. ANITA: FI's, kittens are basically like Go Between Agencies. I do the hiring, but the Go Betweens handle the paperwork, payroll, and in many cases help my peoples make the most of what help is available in our areas - which is needed, because that be can pretty complicated. On top of that, these agencies also create jobs for the community, so really it's a win-win for all.

KENDRA: Exactly. So basically this new policy says that these Go Between Agencies, as you put it, will be paid for their services on a per member per month basis, where the rate they are reimbursed will be determined by how many hours each member is authorized to receive. ANITA: Well, alright, I mean... is that a bad thing?

KENDRA: Well, the problem is that the new reimbursement rates are not sufficient to cover all costs of running the business, which includes rent and health benefits and salaries and so on. As a result, the majority of these Go Between Agencies will be forced to shut down, which will not only destroy jobs for the community...

ANITA: Ugh, as if that's what our state needs right now – less jobs. KENDRA: But would also damage, if not destroy the CDPA program as we know it in New York, making it harder on disabled and senior people to get the proper help they need. ANITA: Ugh, as if the state doesn't make it hard enough as it is.... So, how much does it cost to run a Go Between? KENDRA: Well, I mean of course it varies on location, but here's the weird thing about it: We don't know. Cuomo doesn't know. The Department of Health doesn't know.

[Image Description: White graphic with the words “How is that even a thing?” in a black handwritten font] ANITA: Um... what?! KENDRA: Yeah, there are no real numbers publicly available regarding current costs of running a Go Between Agency. And this is why the community has been calling on the Department of Health, to delay the changes until they, at the very least, have all the information on the actual costs. ANITA: What?! Why... and what?!

KENDRA: Anita, your eye is twitching... ANITA: I just...okay wait, so if they don't even have all the information, then how are they deciding on cuts to the program? KENDRA: Exactly. ANITA: Well wait, so if they get their way, what's gonna happen to the over 70,000 people who rely on the program? Have they even thought about that? KENDRA: Well, if the majority of Go Between agencies are forced to shut down, due to lack of proper funding, people will technically have the right to transfer to another Go Between, but that's only if there is another Go Between in their area, and assuming there's one in their area, that can take on this extra workload, while still running on reduced funding. We may not know the exact costs of running a Go Between, but the math is obvious. Less funding, more workload. Most of the Go Between agencies will be forced to shut down. ANITA: That is going to be a hot... mess. KENDRA: Yes and unfortunately, a lot of people will be booted from the program, and forced onto traditional home care or... into nursing homes. ANITA: Why would Cuomo and the DOH do that? Traditional services is having a hard enough time covering hours as it is? How do they think these same agencies will be able to take on all these extra cases? KENDRA: Oh yeah. There's actually a nationwide home care workforce shortage crisis happening right now. In fact, traditional agencies, in some areas of the state, currently rely on consumer enrollment in CDPA to cover part of their weekly care hours. Because agencies are unable to fully staff and fill shifts, they push the responsibility onto the consumer. These cuts will negatively impact traditional home care agencies, as they will have no other program to support their client’s needs as it becomes more challenging to hire quality caregivers.

ANITA: So, the cuts will shut down the majority of Go Betweens... what happens if Traditional agencies can't cope? What? Is the state just going to just ship the majority of us off into nursing homes and institutions - against our will, I might add? Even if they tried, where will we all go? As it is, there is already a huge waiting list for open beds. KENDRA: There are more than 70,000 people using CDPA today. It is impossible for all of those people to find a nursing home bed because New York State does not have that many nursing home beds open. The math simply doesn’t add up. If people can't get traditional services in their area, some consumers will have to rely on support through family willing to work for free or, for those who are lucky enough, private pay for some level of care. ANITA: Please. We all know, that is not an option for most people. Even if you do have family or friends in the area, people need to work. People need to make money to eat and pay rent. And Private Care? People have CDPAP via Medicaid which is like taking a vow of poverty. Who has money for that? KENDRA: Exactly. I mean unfortunately, if these cuts go through, a lot of disabled and senior New Yorkers will be forced to leave New York, running to any other state with CDPA. ANITA: But a lot us just can't get up and move to another state... KENDRA: I know. It is a bonafide mess. Sadly, a lot of people as a result, will die in their homes without the necessary daily care that keeps them healthy. ANITA: OMG, kittens. What the living hell? Meanwhile, I heard Cuomo and the Department of Health were telling people, that the cuts won't impact the quality of service? Are they just lying to the people or do they just really not understand how this program works? KENDRA: Anyone who knows the facts, knows that these changes are going to impact the disability and senior populations, not to mention the workers. How can it not? Many Go Between agencies have even told Cuomo and the DOH their concerns, but still the Department of Health continues to say that it is “not the intent" of the cuts to impact consumers or the integrity of the CDPA program. But how can they have good intent, when they don't even have all the information needed to make an educated decision? Anita, your eye is twitching again... ANITA: This is so exhausting...and the attacks... they just feel so relentless sometimes... I gotta take off my wig. This is just too damn much. KENDRA: Well, that's why while activism and taking action is important, so is doing self care.

[Image Description: An illustration of Anita who is looking very sad and drained. There are tears coming her left eye and she just looks drained. She has also removed her wig seen in previous illustrations, revealing her bald head.] ANITA: Is there even time for that? Aren't the changes to the program kicking in September? KENDRA: Well, that's if we don't stop it, and we can. That said, yes. There is time for self care. We must make time. We can't neglect our emotional health. Plus, how will we be able to fight if we are so burnt out that we can't even take action? ANITA: True. Well, that said, what are some ways people (inside and beyond our community) can take action? KENDRA: We must mobilize the community to get loud, get proud and get public! We must take this fight to #SaveCDPA to the streets with some old-fashioned protesting, letter writing to your local news outlets, and community conversations to educate your neighbors on CDPA and the devastation these unnecessary cuts will cause to disabled and senior New Yorkers!

[Image Description: White background graphic with text in a black handwritten styled font that reads “How To Take Action!” in larger text with smaller text on the side “Solidarity is fierce!” and “Yaaas Queen!”]

1.) You can sign up to join a Rapid Response Team. When Cuomo is scheduled to be in your area, you will be notified. This helps to easily coordinate a group of individuals to show up at Cuomo’s location to protest the cuts to CDPA.

2.) Join a Facebook group, such as CDPAP Watch Discussion Group. 3,) Join the conversations and share social media messaging by using #SaveCDPA. 4.) Share this interview 5.) Write blog posts about this. 6.) Make videos and post them online. 7.) Call Cuomo @ 518-474-8390 8.) Send him a message on Twitter @NYGovCuomo and via his website I know there is a lot of injustice going on in the world right now, but we can't let them do this to 70,000 people plus the workers! In the end, the people of New York, deserve better. ___

Medicaid Programs Under Affordable Act Reduced Disparities in Cancer Care for Minorities

There were no improvements in uninsured rates for black patients and residents of high-poverty areas in states without Medicaid expansion. In fact, patients in these groups appeared to be losing insurance coverage, although this finding was not statistically significant, according to lead study author Fumiko Chino, M.D., a radiation oncologist at Duke. ‘Medicaid expansion was effective at…

TRENTON, N.J. US wants drug prices in TV ads: ‘Patients deserve to know’

TRENTON, N.J. — The federal government said Monday that it wants to force drugmakers to disclose prices for prescription medicines in their TV commercials.

The drug industry’s main trade group said drug companies are only willing to disclose the prices on their websites, not in commercials, and they’ll start doing that next spring.

Health and Human Services Secretary Alex Azar unveiled a proposal…

CHERRY HILL, N.J. — Even as the Republican health care overhaul remains a work in progress, states are planning for big changes that could swell the ranks of the uninsured and hit them with higher costs.

A key tenet underlying the GOP plan is to give states more authority over how to structure their health care markets. That approach is welcome in states that want fewer mandates from the federal government but is causing alarm in states that embraced former President Barack Obama’s Affordable Care Act.

This is especially true for states that expanded their Medicaid programs and could now see a huge pool of federal health care money evaporate. They will face tough decisions about balancing costs and care.

States’ preparations come even as Republican members of the U.S. Senate promise significant revisions to the health care bill that narrowly passed last week in the House. Some governors already have begun pressing their senators to soften the bill in ways that would lessen the financial blow to the states.

The current GOP plan would undo a mostly federally funded expansion of Medicaid coverage for low-income adults and allow insurance companies to charge far higher premiums on older Americans and some people with pre-existing conditions.

Republican Gov. Bruce Rauner of Illinois, a state that expanded coverage under Obama’s law, said he will push senators to change the legislation so the impacts are not as dire for the state.

“Recent changes did not address fundamental concerns about the bill’s impact on the 650,000 individuals that are part of our Medicaid expansion population,” he said, “nor have those changes eased the concerns of the 350,000 people in the individual market who are dealing with skyrocketing premiums and fewer choices.”

Undoing Obama’s law has been a goal for Republican lawmakers since it was adopted in 2011 and was a top campaign promise of President Donald Trump.

As soon as Trump was elected, state officials were on notice that changes were likely.

Even if it gets major revisions in the Senate, the House bill is serving as a baseline for a task force in New Jersey organized by Joseph Vitale, chairman of the state Senate’s health committee. It starts meeting this month to consider how the state might respond.

“It’s unlikely to get worse from here from where they landed yesterday,” Vitale said Friday, a day after the House vote.

Officials in Connecticut have set up a similar task force, and New York lawmakers say they are prepared to hold a special session later this year to deal with any fallout from the health care changes.

New Jersey, along with 30 other states and the District of Columbia, accepted a core deal from Obama’s health overhaul to expand Medicaid; 550,000 people have gained coverage through it in New Jersey alone. Nationwide, the Medicaid expansion provided coverage to about 11 million people who were newly eligible.

No government estimates have been released showing how much it would cost the states to keep the expansion and pay for it on their own.

In March, a Congressional Budget Office estimate for an earlier version of the bill said it eventually would lead to 24 million Americans losing their health coverage. The same report found that federal Medicaid subsidies to states, which run the programs, would be $880 billion less over 10 years because of the end of the expansion and other changes that would affect allocations even to states that chose not to expand.

In a report this week, Fitch Ratings said states would have to make “material, but not impossible” budget changes to absorb the blow. But it also said implementing those changes by 2020 gives states little time to figure out what to do.

New York officials estimate the GOP bill would lead to 2.7 million residents losing coverage and the state losing up to $6.9 billion in federal Medicaid money. Gov. Andrew Cuomo said such cuts would reduce support for hospitals, nursing homes and 7 million New Yorkers who rely on the program.

“They’re trying to gut Medicaid,” he said Friday. “They’re trying to put our hospitals out of business.”

It’s not just Democratic governors sounding the alarm.

Ohio Gov. John Kasich, a former Republican candidate for president, has been consistently critical of his own party’s attempts to make deep cuts in the Medicaid program. He supported Medicaid expansion in his state and called the House bill “woefully short on the necessary resources to maintain health care for our nation’s most vulnerable citizens.”

Underscoring those concerns, Ohio Sen. Rob Portman, a Republican, said he does not support the House bill in its current form, in part because it does not protect Ohioans who benefited from the Medicaid expansion.

A recent Ohio State University study found that almost everyone covered through Ohio’s Medicaid expansion would have no other viable insurance option if the Affordable Care Act is repealed. That’s roughly 712,000 people.

State Medicaid data also show that Ohio schools would lose about $8 million a year in Medicaid funding for special education services under the House bill.

Katherine Hempstead, who analyzes health policy at the Robert Wood Johnson Foundation, said she does not expect any states to be able to afford keeping the Medicaid expansion in place. But she said some could choose to use federal money for subsidies, in addition to what would be offered anyway, for people who buy insurance on the individual market. In many states, premiums have been rising and insurance choices dwindling.

“States might face a choice of what population they want to reinforce,” she said.

Under the House bill, states would be allowed to reduce coverage requirements for people who buy individual insurance plans while allowing insurers to charge higher premiums to older people and those with pre-existing conditions if they had a lapse in coverage. States taking that step would have to establish government-operated insurance programs for expensive patients called high-risk pools.

Hempstead said she expects that states with more consumer protections won’t go that route.

Minnesota Gov. Mark Dayton, a Democrat, is resolute on that issue: “I would not entertain that notion,” he said.

In some of the states that are likely to relax standards and set up the high-risk pools, the choices that lie ahead are being welcomed. Wisconsin Gov. Scott Walker, a Republican, said he would consider allowing the higher charges for pre-existing conditions.

Texas Gov. Greg Abbott, also a Republican, wasn’t fretting about tough decisions.

“Congress’ efforts to repeal and replace Obamacare is a step toward ending the lawless health care regime that failed to live up to its promises and is spiraling to a hasty death,” Abbott spokesman John Wittman said Friday.

___

Associated Press writers Steve Karnowski in Minneapolis; David Klepper in Albany, New York; John O’Connor in Springfield, Illinois; Todd Richmond in Madison, Wisconsin; Julie Carr Smyth in Columbus, Ohio; and Paul J. Weber in Austin, Texas, contributed to this report.

By GEOFF MULVIHILL – May. 7, 2017 11:16 AM EDT

___

Follow Mulvihill at http://www.twitter.com/geoffmulvihill

Nationwide, physicians who remark upon Medicaid fleur-de-lis Medicare patients must begin establishing "meaningful use" of Electronic Medical Records (EMR) by 2015 octofoil risk having their reimbursements reduced. Meaningful Use is a term that refers to a nailed down speaking of EMR usage requirements that qualified providers must meet in order to receive incentive payments. <\p>

The in earnest of Valid Use is to help ensure that providers using EMRs prosecute the software up-to-the-minute a manner that supports excelling quality and better efficient delivery respecting healthcare. Because physicians may not grip both Preclinical medicine and Medicare incentives, yours truly is important to understand the difference between Medicare and Medicaid Consequential Use before participating. <\p>

Incentive Money<\p>

Under Psychosomatic medicine, the prod amount is 75% of the physician's Clinical medicine stamped charges for the month, up to a maximum re $44,000. Under Medicaid, it is 85% of the physician's Medicaid permitted charges up to $63,750 per year. <\p>

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Requirements to Qualify<\p>

Every Clinical medicine eligible deft must compose a National Provider Identifier (NPI) and be enrolled in the CMS Steward Enrollment, Chain and Ownership System (PECOS) unto participate inward-bound the EHR incentive program. Most physicians more hanker unto have an in motion user account mutual regard the National Plan and Provider Tallying System (NPPES). The Medicaid EHR incentive program is offered and administered deliberately by states and territories.<\p>

Time Sole<\p>

Medicare must complete 90 days of continuous EHR Meaningful Use within the calendar year before reporting in passage to the the crown. Under the Medicine plan, you are not required on itemize Meaningful Use until Sidereal year 2. The Year 1 requirement for Medicaid is grievance committee of "efforts to adopt, implement, or upgrade demonstrated EMR technology."<\p>

Providers Who Are Fittedness for Incentive Payments<\p>

In the two the Welfare state and Medicaid programs, physicians, podiatrists, chiropractors, optometrists and dentists are acceptability for agitational payments. Again, in the Medicaid program, nurse practitioners, certified nurse-midwives, and physicians assistants are extra qualified to participate.<\p>

Penalties for Non-Participation passage the ARRA Program<\p>

In disagreement the Medicaid thrust notice, the Medicare program incorporates penalties. The Social welfare carfare schedule for providers who are not "meaningful EMR users" will occur reduced by 1% in 2015, by 2% in 2016 and by 3% in 2017. <\p>

Implementing Meaningful Use<\p>

If you need more information about the implementation relative to Meaningful Use and how yourselves improves efficiency for allopathic professionals, contact e-MDs, a leader in electronic medical record software provision. e-MDs will help you understand how for worth your new EMR complex or assess and acclinate your current apple-pie order in a way that achieves ARRA-defined Meaningful Use.<\p>

State Medicaid programs, the largest payers of home health services and personal care support, are ill-prepared to pay workers in that sector minimum wage, overtime or traveling expenses, which next month will be required under a new U.S. Labor Department rule. Home healthcare agencies haven’t ever had to pay minimum wage or overtime to companionship…

Did MS Leave You Out? Documentary Explores What Happened When Mississippi Refused To Expand Medicaid

Most Americans are familiar with the Affordable Care Act, also known as “Obamacare,” that was passed by Congress and then signed into law in 2010. In 2012, the Supreme Court made a final decision to uphold the health care law. The intent of the law was to provide access to affordable health coverage to everyone, provided that each state expands their Medicaid programs so that low-income people…