Progress, challenges as Medicaid rolls swell in state [WA]

The Seattle Times ^ | 4/16/2014 | Lisa Stiffler

[steve86]

Washington state has blown past its targets for signing up new Medicaid participants under the Affordable Care Act (ACA).

The program’s ranks have grown roughly 25 percent in the past six months, helping fulfill one of the act’s key goals to provide health care to nearly all Americans.

By the end of March, more than 285,000 adults who are newly eligible to participate in Medicaid had signed up for coverage. That’s twice the number officials had hoped to reach by then, and a target they hadn’t expected to hit for three more years.

[steve86]

Now people earning up to 138 percent of the federal poverty level can get free health and dental care. That covers individuals earning up to nearly $16,000 a year or a family of four making $32,500. Low-income people with higher wages must buy private insurance, though they would receive subsidies to reduce the cost. [...] Last year, medical assistance for Medicaid enrollees cost on average $321 per person, per month.

[steve86]

Apple Health by the numbers

In Washington state, Medicaid is known as Apple Health. Here’s a rundown of the program.

Medicaid budget: $10 billion

Medicaid recipients: 1.5 million

Newly eligible adults under the Affordable Care Act expansion: 285,275

Previously eligible but had not enrolled: 137,930

Ratio of children to adults: Roughly 50-50

Populations served:

• Adults under age 65 earning up to 138 percent of the federal poverty level

• Low-income children and seniors

• Pregnant women

• People with certain disabilities, including blindness

• Foster children

• People in long-term-care and assisted-living facilities

[steve86]

PING!

Note the relatively low capitation payment: $321 per person, per month.

[knarf]

does the “nearly all” mean “almost mostly illegal immigrant” Americans ?

[steve86]

No, adult illegals are very definitely screened out. I'm not sure what happens with kids.

I just dealt with an applicant (born right here in Washington State 60 years ago), who had a heck of a time getting the Healthcare Authority to accept her Social Security number. It was fine but their verification database had a bug in it for a certain range of numbers.

[goldstategop]

The advantage is few out of pocket costs. The bad news is finding a doctor who will take you - unless the state has an expanded Medicaid program.

[steve86]

PING!

Your favorite subject!

[greeneyes]

It sucks, and should be referred to as :

Obama’s Socialist Health Insurance Taxes
O S H I T

Some of the Government’s reimbursement rates are so low that the docs loose money on every patient they treat. That’s why so many don’t take Medicare or Medicaid.

[steve86]

Here in the Tri-Cities we evidently have some medical over-capacity due to the rapid hospital clinic expansions. Hospital-employed practitioners are openly soliciting Medicaid patients. Only among independent practices might a person have difficulty finding a doctor, in addition to a few specialties the hospitals don’t employ.

[goldstategop]

Yup.

The only time they will see patients is in the hospital. Medicaid/Medicare pay more for catastrophic care than for office checkup visits.

“Free” health care doesn’t amount to a hill of beans if the doctor won’t see you. Not because you’re poor but because he won’t be paid enough to give you the proper medical care.

[steve86]

That’s why so many don’t take Medicare or Medicaid.

But you yourself (IIRC) posted that some dentists have gotten rich seeing only pediatric Medicaid patients.

The impression I have is that they can still make money if they design the practice around government patients, but the reporting and coding requirements are onerous.

[goldstategop]

Really? Every patient has a Medicaid card. Usually, the state is billed directly for services rendered and the patient never sees a bill. It is single payer health care for the low income population.

[steve86]

Really? Every patient has a Medicaid card. Usually, the state is billed directly for services rendered and the patient never sees a bill. It is single payer health care for the low income population.

Really what? I don't understand what you're disputing/saying. Who said the patient ever sees the bill?

[greeneyes]

But you yourself (IIRC) posted that some dentists have gotten rich seeing only pediatric Medicaid patients.

******************************************************
I don’t recall ever saying that. Maybe you are thinking of someone else.

I think it is true that pediatric cases have a decent reimbursement rate for FQHC, but IIRC, for the average dentist in private practice, it is not.

And the rules are changing so that Pediatric Dental will no longer be profitable even for the FQHC.

[goldstategop]

Everything is computerized. No one keeps health care records in manila binders anymore. Payment info can now be electronically sent to the state.

That’s what I saw when I went to the hospital for outpatient care.

[zeestephen]

Excellent article.

Thanks for the ping.

The $321 capitation cost does appear low.

I’ve seen the national average reported at $5,500, which would be $460 per month.

Specialist compensation at 20% of normal fee is shocking.

Why would any COMPETENT specialist accept that kind of money, unless he is a candidate for sainthood?

[steve86]

Sorry, it was Grams A

Texas has made a whole bunch of dentists very wealthy by paying for dental work through Medicaid. Children who have parents who are employed and, therefore, not eligible have dental work on “as the budget allows” basis.

25 posted on Thu 17 Apr 2014 11:01:23 AM PDT by Grams A

[steve86]

It IS the electronic records that are so onerous. A FReeper physician said he/she was spending three times as much time entering and correcting data than seeing patients.

In Washington State the claims are sent to the "health management companies". These are contractors to the state such as Community Health Care and Molina that manage the state Medicaid system..

[steve86]

Some procedures are reimbursed at pretty healthy levels. Those are the ones they love to do (like cataract surgery in relation to Medicare patients).

[wiggen]

couple of things. 16k a year? Man i live in NYC and that don’t cover anything.
Second the feds pick up 100% of the cost of these new patients. That goes on until 2020 when it goes to 90%. This is no different from pension issues that plague states. These are truly large numbers of people in a great many states. Its the next financial fiasco. Mind you not saying they shouldn’t be in some program but this is like filling a balloon with water and waiting for it to burst.