Advocates: Disabled take huge hit under GOP health reform

Advocates for the disabled say the House Republican plan to replace the Affordable Care Act seriously threatens some of the most vulnerable Americans.

The website DisabilityScoop reports that advocates say the bill threatens home- and community-based services and other supports that people with developmental disabilities rely upon.

Photo: Joshua Zader/Creative Commons

“The American Health Care Act shows callous and dangerous disregard for the well-being of people with disabilities and their families and erases decades of progress,” said Peter Berns, CEO of The Arc, an organization that service people with intellectual and physical disabilities.

The House passed the bill 217 to 213, allowing President Donald Trump and Republicans to do a victory lap that they had finally succeeded in destroying Obamacare. The measure though was roundly criticized by doctors, hospital and senior groups. It must still pass the U.S. Senate, which gave it a lukewarm response and promised to address its more draconian measures.

While the disabled take a hit, the most wealthiest Americans are big winners with the new legislation as it delivers a big tax cut the would redistribute billions of dollars to the upper tier.

 

How does it hurt the disabled? The many groups who represent them say the bill would institute a per capita cap for Medicaid. This means the federal government would offer a fixed amount of money for each beneficiary.

“These huge cuts and caps will likely put pressure on states to cut home- and community-based waiver services, especially those that are ‘optional,’ like personal care services and therapies,” said Kim Musheno, chair of the Consortium for Citizens with Disabilities, a coalition of disability advocacy groups.

Schools also would be affected by the Medicaid shift because they are currently able to seek reimbursement for a variety of services provided to disabled children to a tune of $4 billion annually. That means money to reimburse schools for speech and occupational therapy, specialized playground equipment, and even wheelchairs is now in jeopardy.

Advocates for the disabled say House Republicans would allow states to no longer consider schools as eligible Medicaid providers.

To read all of the story by DisabilityScoop click here.

 

Study: Red states could lose big in Trump’s repeal of Obamacare

New President Donald Trump has made repealing the Affordable Care Act a top priority.

But a study out of Harvard finds that such a repeal could hurt some of his most ardent supporters in red states. The study focuses on Southern red states who have expanded Medicaid as part of Obamacare. Rolling this portion of the ACA back could have dire consequences for states like Arkansas, Kentucky and Louisiana.

States that have not expanded Medicaid for ideological reasons — such as Florida and Texas — may be less affected, the study from Harvard’s Department of Health Policy and Management. The survey of Texas found that Obamacare had a negative impact, for instance.

“The economics of rolling back Medicaid expansion strongly suggest that doing so would harm patients, hospitals, and state budgets,” stated an article in the New England Journal of Medicine published this week. 

Researchers Benjamin Sommers and Arnold M. Epstein have been doing telephone surveys for four years of low-income adults in Southern states to gauge the effectiveness of Obamacare.

“Our survey provides insight into the current views of many adults living in red states, and the verdict is clear: in states that have embraced coverage expansion despite their political leanings, the ACA’s Medicaid expansion has made a positive difference that is recognizable to the people whose lives have been most directly affected by it,” their article stated.

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Though 19 states declined to expand Medicaid under the ACA, 13 states won by Donald Trump in the 2016 presidential election have opted for expansion since 2014. West Virginia and Kentucky have experienced among the largest proportional increases in Medicaid enrollment in the country.

The researchers said that the question is not whether many Americans — even those in thoroughly red states — have benefited from the ACA, but whether that will be enough to save it.

Study: Red states could lose big in Trump’s repeal of Obamacare

New President Donald Trump has made repealing the Affordable Care Act a top priority.

But a study out of Harvard finds that such a repeal could hurt some of his most ardent supporters in red states. The study focuses on Southern red states who have expanded Medicaid as part of Obamacare. Rolling this portion of the ACA back could have dire consequences for states like Arkansas, Kentucky and Louisiana.

States that have not expanded Medicaid for ideological reasons — such as Florida and Texas — may be less affected, the study from Harvard’s Department of Health Policy and Management. The survey of Texas found that Obamacare had a negative impact, for instance.

“The economics of rolling back Medicaid expansion strongly suggest that doing so would harm patients, hospitals, and state budgets,” stated an article in the New England Journal of Medicine published this week. 

Researchers Benjamin Sommers and Arnold M. Epstein have been doing telephone surveys for four years of low-income adults in Southern states to gauge the effectiveness of Obamacare.

“Our survey provides insight into the current views of many adults living in red states, and the verdict is clear: in states that have embraced coverage expansion despite their political leanings, the ACA’s Medicaid expansion has made a positive difference that is recognizable to the people whose lives have been most directly affected by it,” their article stated.

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Though 19 states declined to expand Medicaid under the ACA, 13 states won by Donald Trump in the 2016 presidential election have opted for expansion since 2014. West Virginia and Kentucky have experienced among the largest proportional increases in Medicaid enrollment in the country.

The researchers said that the question is not whether many Americans — even those in thoroughly red states — have benefited from the ACA, but whether that will be enough to save it.

Audit: Florida Medicaid paid insurance companies for dead people

Florida’s Medicaid Program has come under criticism repeatedly in recent years for its failure to provide for the care of disabled and poor children in the state.

But it appears if you are dead, the state is willing to pay — especially if that money is landing in the pockets of insurance companies.

Florida is shifting all Medicaid recipients into managed care plans. First up: Nursing home and long-term-care recipients.
When Florida shifted all Medicaid recipients into managed care plans, it ended up paying HMOs $26 million for enrollees who had died.

A federal audit released Tuesday reported that over a five-year period the state’s Medicaid program overpaid HMS $26 million in monthly premiums for enrollees who had passed to the great beyond.

Florida Health News reports it appears monthly Medicaid premiums were paid for several thousands of Floridians who had died.

Medicaid is funded by the state and federal government — and the federal government wants its money back.

Officials with the Department of Health and Human Services said the Florida’s Agency for Health Care Administration needs to pay back $15 million in money lost through operational costs.

AHCA says it has already corrected the problem, recouping almost $24 million of the $26 million in overpayments — a 98 percent success rate.

The five-year period covers a time when Florida Medicaid was changing from a traditional fee-based model to a statewide managed care for all Medicaid participants. The state agency paid HMOs about $1.3 billion from July 1, 2009 through Nov. 5, 2014, the report found.

If you want to read more on the audit, click the Florida Health News Story here.

Health care refugees: Couple flees Florida after Medicaid nightmare

A Boynton Beach couple said they left Florida – a state they loved – because they could not get adequate health care for their ailing 5-year-old daughter through Medicaid.
CNN’s series on health care refugees started this week with Kim and Richard Muszynski. The couple in September packed their bags and took their ailing 5-year-old daughter, Abby, to Colorado.
Abby was born with a missing a piece of her brain and is subject to violent seizures.
Like Abby, nearly early half of all children in Florida get their health care through the state-run health insurance Medicaid. Abby ended up on Medicaid when Kim Muszynski left her job – and lost the health insurance that came with it – to care for her daughter full-time.
Abby ended up on Medicaid when Kim Muszynski left her job – and lost the health insurance that came with it — to care for her daughter full-time.
Florida Medicaid refused to pay for lifesaving medicines and initially denied payment for a wheelchair. CNN reported. Sometimes Medicaid took so long to pay some of her health care providers that they refused to treat Abby, CNN reported.
Sometimes Medicaid took so long to pay some of her health care providers that they refused to treat Abby, according to the cable news network.
The Agency for Health Care Administration, which runs Medicaid for Florida, disagreed with the CNN report. “The state has done everything in its power to support this family,” said Mallory McManus,  spokeswoman for the agency.
A federal judge ruled in a civil suit that 2015 that Florida had violated the law by underpaying doctors. The state later reached a settlement.
“Florida’s Medicaid program is currently operating at the highest level of quality in its history,” McManus said.
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State Sen. Joseph Abruzzo
AHCA and CNN also have clashed in the past.
AHCA criticized the cable news network for its story on the pediatric heart surgery program at St. Mary’s Medical Center.
AHCA characterized the June 2015 story as “sensationalized reporting.”
St. Mary’s program closed down shortly after the story ran.
The network is currently being sued for defamation by the surgeon who established the program.
Now CNN is back in South Florida reporting on the Muszynskis.
In February, the family got word she was being kicked off Medicaid by the state of Florida until state Sen. Joseph Abruzzo interceded, CNN reported.
The couple was told by the state Abby was dropped because of a computer glitch but still the family had trouble getting coverage for her. So, they decided it was time to leave Florida.
To read the whole CNN story on the Muszynskis click here.

Local mom fought for kids in Medicaid lawsuit

More than a decade ago, Rita Gorenflo of Palm Beach Gardens signed on as a plaintiff in the class-action lawsuit against the state of Florida on behalf of nearly two million poor and disabled children on Medicaid.

Through a lengthy Miami trial and the appeal of the judge’s scathing findings against the state, Gorenflo lost a son, while she raised six other adopted disabled children to adulthood.

Last week, the state and plaintiffs settled the class-action case with Florida agreeing to increase enrollment efforts that have left children off of Medicaid.

“It is, at least, an admission from the state that issues exist and need to be dealt with,” said Gorenflo, her son Thomas’ care becoming a prime example of the state failing disabled children.

One of the biggest victories in the multifaceted settlement is that the state agreed to increase reimbursement rates for doctors and pediatricians – one of the lowest in the country. The aim is that more doctors will now participate in the Medicaid program, increasing care and cutting travel times for families.

“It’s been 30 years since physicians were able to increase their reimbursement,” Gorenflo said. “You want to know why pediatricians were reluctant to take Medicaid patients? It was way beyond pathetic. Hopefully, it will be better.”

Gorenflo’s son, Thomas, died of his birth defects in 2011 at age 12. He became emblematic of the lawsuit. Despite his lungs being crushed by the curvature of his spine due to progressive scoliosis, the child had to wait 18 months for vital surgery while Gorenflo battled the state.

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Les and Rita Gorenflo of Palm Beach Gardens adopted Thomas, 2, in 2001. Thomas’ care became emblematic of the lawsuit against the state of Florida claiming it failed children on Medicaid. He died in 2011. (Photo by Jennifer Podis)

The registered nurse praised the lead attorney Stuart Singer and his firm Boies, Schiller & Flexner, which handled the case pro-bono. The case was settled after a federal judge ruled for the plaintiffs in December 2014, finding the state was low-balling doctors. Florida, however, appealed the decision.

Singer said there is a belief the state agency that administers Medicaid — the Agency for Health Care Administration — will act in good faith. “There is also the ability to go to court and seek injunctive relief if the agreement is materially breached and that is not remedied,” he told The Post.

Dr. Tommy Shechtman, president of the Florida Chapter of the American Academy of Pediatrics, noted that there is still work to be done as there are approximately 377,000 uninsured children in Florida — more than 28,600 living in Palm Beach County.

“We have the unfortunate distinction of being one of the nation’s top 20 counties for having the highest number children without health insurance,” Schechtman said. “This is alarming. However, I remain encouraged that through FCAAP’s collaboration with the state we can and will strive for significant improvement.”

Tallahassee pediatric cardiologist Louis St. Petery, who was highly involved in the lawsuit, said the effects of the settlement will take some time to implement.

“I don’t see any change in access tomorrow compared to today just because the settlement agreement is in place,” he said. “The settlement agreement meters this out over one year, two years, three years, depending on which category of physicians and dentists you’re talking about.”

Blocked! Feds could usurp Florida’s new abortion law

The federal government and Florida may be on a collision course over a new state law seeking to ban Medicaid funding for services at clinics that offer abortions, such as those run by Planned Parenthood, according to a News Service of Florida story.

The federal government has prohibited such bans on Medicaid funding when such laws have been put into place in other states, said Elizabeth Nash of the Guttmacher Institute, which researches abortion issues and supports abortion rights.

With the Capitol dome in the background, Mary Elizabeth Burke, of Washington, participates in a pro choice rally near the Supreme Court, Wednesday, Jan. 22, 2003. Opponents and supporters of abortion rights rallied at the nation's symbols of freedom Wednesday, energized on both sides by Republican hopes of curbing the procedure 30 years after the Supreme Court legalized it. (AP Photo/Susan Walsh) ORG XMIT: SAW101 ORG XMIT: MER0705021207182794

“You cannot exclude a provider from Medicaid because you don’t like the services they provide,” Nash said.

Florida has already been put on notice by the U.S. Centers for Medicare & Medicaid Services, the News Service reports.

The agency notified Gov. Rick Scott administration, “reminding them of the state’s obligation to ensure Medicaid beneficiaries continue to have access to services provided by any willing provider,” according to a CMS spokeswoman.

While only government-funded abortions can be obtained through extreme circumstances, women can obtain other medical services through Medicaid, the News Service reports. Indiana tried to do the same thing in 2011 and found it could not.

One of the sponsors – Rep. Colleen Burton of Lakeland – said they were aware that the state would have to apply to the federal government for a waiver.

“We knew that,” Burton said. “And we’ve said it in committees — I’ve said it on the floor of the House — that we are aware that this portion of the bill requires a waiver from the federal government.”

WASHINGTON, DC - JUNE 26: Pro-life activists gather outside the U.S. Supreme Court June 26, 2014 in Washington, DC. The court overturned today a Massachusetts law barring protests within 35 feet of abortion clinics. (Photo by Win McNamee/Getty Images)

Scott spokeswoman Jackie Schutz would not confirm that the administration was considering requesting  a waiver.

“The bill doesn’t take effect until July 1, and we’re working with our agencies on it, and looking at our options,” Schutz said.

Read the whole News Services story by clicking here.