The federal government will not provide 10 years of 100 percent support for a Maine Medicaid expansion, but it will still provide most of the money.
AUGUSTA – The federal government cannot grant Gov. Paul LePage's request for 10 years of full funding for an expansion of Medicaid in Maine, says the agency that administers the program.
The Centers for Medicare and Medicaid Services delivered the message to the LePage administration in a letter on May 24.
The decision wasn't unexpected, but it revived the heated debate among state lawmakers and Le- Page over whether Maine should extend benefits to 60,000 more low-income residents. The federal government has given several states flexibility for their participation in Medicaid expansion under the Affordable Care Act, but no state has secured a deal to fully fund expansion for a decade.
Medicaid, which operates in Maine as MaineCare, is a federal health insurance program that is jointly administered and funded with the states. Its complex eligibility and reimbursement rules enable critics and supporters alike to seize on numbers that make their case.
That's what happened at the State House on Thursday.
http://www.pressherald.com/news/lepage-loses-full-funding-medicaid-request_2013-05-30.html?p=1&tc=pg
Feds to LePage: We can’t offer a better deal on Medicaid expansion
Posted May 30, 2013, at 9:53 a.m.
AUGUSTA, Maine — The federal government has notified the state that it cannot negotiate a better deal on Medicaid expansion under the Affordable Care Act.
Republican Gov. Paul LePage interpreted the latest news, delivered in a May 24 letter, as supporting his position that the federal government is pushing millions of dollars of cost onto Maine taxpayers and failing to give Maine the same provisions other states are receiving through the Medicaid program. Legislative Democrats and others said Thursday morning that the letter affirms the argument they’ve been making for weeks: that Maine would be financially irresponsible not to take the deal that’s already on the table.
The May 24 letter to DHHS Commissioner Mary Mayhew from Cindy Mann, director of the U.S. Centers for Medicare and Medicaid Services, came as the Legislature’s Health and Human Services Committee voted 10-4 on Thursday to send another Medicaid expansion bill to the full Legislature. That vote followed a veto by LePage last week of LD 1546, a bill that linked Medicaid expansion to repayment of the state’s remaining Medicaid debt to hospitals. The committee’s bill is a proposal to have Maine expand Medicaid eligibility separately from repaying the debt to hospitals.
Mann stated in her letter that the federal matching rate in the Affordable Care Act would pay for 100 percent of the state’s Medicaid expansion in calendar years 2014, 2015 and 2016 and decrease to 90 percent by 2020. Mann said that over the 10-year period beginning in 2014, the average matching rate for covering childless adults under the expansion equates to about 94 percent. The federal government currently pays 62.57 percent of coverage costs for about 10,500 adults without children in Maine and likely would increase that funding to 100 percent under the Medicaid expansion, according to the Centers for Medicare and Medicaid Services. Maine also would receive 100 percent funding to cover about 50,000 additional childless adults under Medicaid expansion.
“These rates are set by law, and CMS has no authority to change the matching rates by regulation or waiver,” wrote Mann. “The unprecedented matching rates for newly eligible individuals ensures that Maine can continue to cover low-income adults with significant savings over the 10-year period.”
House Speaker Mark Eves, D-North Berwick, said in a prepared statement Thursday morning that Mann’s letter “is further confirmation that Maine should take the deal.”
“We have a definitive offer,” said Eves. “There is no excuse to delay accepting these federal health care dollars to cover the cost of health care to tens of thousands of Maine people.”
LePage had a decidedly different opinion on what the letter means.
Feds bring good news to LePage, lawmakers
Posted May 30, 2013, at 6:15 p.m.
The state of Maine heard good news Thursday about details pertaining to Medicaid expansion under the federal health reform law. But no one would know it from the LePage administration’s interpretation.
The U.S. Centers for Medicare and Medicaid Services confirmed in a letter to Maine Department of Health and Human Services Commissioner Mary Mayhew that the federal government does not have authority to grant full match rate funding for parents who earn up to 138 percent of the poverty level. It will continue, as it is currently doing, to pay 62 percent of the costs of providing Medicaid to nondisabled parents if Maine participates in Medicaid expansion under the Affordable Care Act.
This is information explained within the ACA and should not be a surprise. A total of 18 states already provide Medicaid to parents earning 100 percent of the poverty line or more. They will not receive enhanced match rates under Medicaid expansion, while the remaining states will see their parent population funded at a full rate for three years when the ACA takes complete effect in 2014.
But LePage said it’s unfair for Maine not to receive more funding since it was an early expander of the program. “Once again, the federal government has failed to come through for Maine. Despite our generosity in expanding welfare over the last decade, we are being offered less than what other states are getting,” he said in a press release.
It’s unfortunate to refer to the continued federal funding level as a type of penalty because it might make people believe the state is giving up something. In reality, nothing would change from the current arrangement. The administration argues that Maine is planning to drop this population from coverage starting Jan. 1, so technically Medicaid expansion would add new parents to Medicaid who would otherwise not be eligible. But they are eligible right now, and DHHS includes transitional funding for them in LePage’s proposed 2014-15 budget.
The letter also made clear the federal government will bear the full cost of expanding Medicaid eligibility to childless adults if the LePage administration confirms certain details about services. The 100 percent funding will continue for three years and then taper down to 90 percent thereafter. Maine expected to get an enhanced rate for this population, but full funding is an excellent development.
The letter also put to rest the issue of whether the federal government would pay all the costs of Maine’s Medicaid expansion for 10 years. This was an unrealistic request by LePage that would have run counter to law. The centers confirmed, “These rates are set by law, and CMS has no authority to change the matching rates by regulation or waiver.”
Still, LePage said he was disappointed that “the feds won’t work with us to provide the additional years of funding I requested.” What is disappointing, really, is the delay this unreasonable request caused. Maine will eventually run out of time to benefit from federal funding for expansion, as the 100 percent support is tied to years 2014, 2015 and 2016. The state should be working toward expansion, not fighting against it.
Residential care for the elderly is moving into the digital age
Posted May 30, 2013, at 11:15 a.m.
HACKENSACK, N.J. — Sensors under the mattresses of elderly residents with dementia track how much they sleep at night. Others in the showers note how often they bathe, while sensors in the walls watch over their movements.
The data are sent to the nurses at the assisted living center where these residents live, a red dot appearing next to the names of residents whose normal routines have changed dramatically. This was how staff was alerted recently about a patient who is usually up and out of her apartment early, but instead had been lying in bed most of the day. It turns out she was developing pneumonia.
“We caught it early enough that we were able to treat her here instead of in the hospital,” said Indra Sooklall, director of resident care at Spring Hills Somerset, a 120-unit assisted living residence in New Jersey that installed “smart sensors” two years ago in a wing for dementia patients.
Technology is changing life inside nursing homes and other residences for seniors. The most cutting-edge among the new systems offer lofty promises of helping providers cope with the coming tsunami of aging baby boomers even as they grapple with funding cutbacks and with the increasing demand to care for sicker and older residents in less-restrictive and less-expensive settings.
Many of the recent technology upgrades inside long-term-care centers mirror the digital advances of the times, with Wii, Skype and YouTube being used to spice up therapy routines and entertainment programs. Wii games are helping get patients in rehabilitation moving again after an injury or surgery, while heath experts believe computer chess, trivia or other skill games can keep brains active and potentially ward off senility.
But the most closely watched technological revolution to hit the long-term-care industry is the growing use of motion sensors and so-called “patient-monitoring systems” to better track changes in a resident’s health and mobility.
“There are a whole host of things that are arriving on the market and being looked at as ways to improve care,” said Paul Langevin, president of the Health Care Association of New Jersey, a trade group that represents the long-term-care industry.
IT Initiatives, a Manalapan, N.J., firm that designs technology and communication systems, is finalizing contracts with seven long-term-care centers in New Jersey to install resident monitoring systems, said John Dalton, the company’s president.
One of them is at Friendship Village, a retirement community in Basking Ridge that is in the middle of a multi-year project to install technology specific to the needs of the different facilities on its campus. The nursing home and assisted living residence at Friendship Village is being outfitted with electronic-medical-records kiosks in hallways where staff will type in data about everything from blood pressure readings to when the patient was last bathed. The community’s independent living units will have telephones with LCD screens that allow residents to call for concierge-type assistance as well as high-tech personal emergency systems that send signals to the staff’s two-way-monitors.
Immigrants help Medicare stay solvent
By Noam N. Levey
Los Angeles Times, May 29, 2013
WASHINGTON — Immigrants in the United States both legally and illegally are helping sustain Medicare, contributing about $14 billion more a year to the federal health program for the elderly than they use in medical services, a new study indicates.
The surplus generated by immigrants contrasts sharply with deficits caused by native-born Americans, as medical care for elderly beneficiaries depletes Medicare’s reserves more quickly than working-age U.S. natives can refill them.
The report — published Wednesday in the journal Health Affairs as Congress debates immigration overhaul legislation — does not calculate the full impact of immigrants in the country illegally on all government healthcare programs.
But the authors estimate that these immigrants are helping to support the Medicare program because many pay taxes, while they are ineligible to receive benefits.
“Our study should raise skepticism about the widespread assumption that immigrants drain public healthcare resources,” said Dr. Leah Zallman, an internist and Harvard Medical School instructor who is lead author of the report.
Most legal immigrants, like U.S. citizens, become eligible for Medicare benefits at 65 if they have worked at least 40 quarters in this country. That means many immigrants who today sustain the program will someday draw benefits. But the authors note that, as long as immigration continues, immigrants should not be drain on the program.
“Policies that reduce immigration would almost certainly weaken Medicare’s financial health, while an increasing flow of immigrants might bolster its sustainability,” the study concludes.
http://www.pnhp.org/print/news/2013/may/immigrants-help-medicare-stay-solvent
Los Angeles Times, May 29, 2013
WASHINGTON — Immigrants in the United States both legally and illegally are helping sustain Medicare, contributing about $14 billion more a year to the federal health program for the elderly than they use in medical services, a new study indicates.
The surplus generated by immigrants contrasts sharply with deficits caused by native-born Americans, as medical care for elderly beneficiaries depletes Medicare’s reserves more quickly than working-age U.S. natives can refill them.
The report — published Wednesday in the journal Health Affairs as Congress debates immigration overhaul legislation — does not calculate the full impact of immigrants in the country illegally on all government healthcare programs.
But the authors estimate that these immigrants are helping to support the Medicare program because many pay taxes, while they are ineligible to receive benefits.
“Our study should raise skepticism about the widespread assumption that immigrants drain public healthcare resources,” said Dr. Leah Zallman, an internist and Harvard Medical School instructor who is lead author of the report.
Most legal immigrants, like U.S. citizens, become eligible for Medicare benefits at 65 if they have worked at least 40 quarters in this country. That means many immigrants who today sustain the program will someday draw benefits. But the authors note that, as long as immigration continues, immigrants should not be drain on the program.
“Policies that reduce immigration would almost certainly weaken Medicare’s financial health, while an increasing flow of immigrants might bolster its sustainability,” the study concludes.
http://www.pnhp.org/print/news/2013/may/immigrants-help-medicare-stay-solvent
Immigrants subsidize Medicare recipients, study says
By Kelly Kennedy
USA Today, May 29, 2013
WASHINGTON — Immigrants contributed about $115 billion more from their paychecks to the Medicare Trust Fund than they took out over a seven-year period in the last decade, according to researchers at Harvard Medical School.
As the Senate debates a new immigration bill and House Republicans work toward a bill that restricts access to government services for unauthorized immigrants who become legal citizens, the researchers concluded in a study released Wednesday that restricting immigration could deplete the fund.
Researchers looked at data from 2002 to 2009.
"The assumption that immigrants are just a drain has been a part of the argument that people should be denied services," said Leah Zallman, lead researcher and an instructor at Harvard Medical School. "Immigration policy has been closely linked to Medicare's finances."
Studies had shown that immigrants use less health care than U.S.-born people, including in government programs, but no one had looked at their contributions to those programs.
In 2009, the researchers found, immigrants contributed $13.9 billion more to the Medicare Trust Fund than they used, while U.S.-born people spent $31 billion more than they contributed. Immigrants, Zallman said, essentially subsidize U.S. health care.
"I was surprised by the degree of subsidy," Zallman said. "We didn't see any changes in the amount of the [immigrant] subsidy each year, but there was a decline in net contribution of U.S.-born citizens."
They found that immigrants ages 18 to 64 on average contributed only about $100 less a year than did U.S.-born people, which is contrary to conventional wisdom that immigrants don't earn enough to contribute. Both U.S.-born citizens and immigrants older than 64 contributed less than they used: $3,333 for the U.S.-born and $2,099 for immigrants.
"We should carefully examine these assumptions that have led to denial of care," Zallman said. She said the study was unable to include undocumented immigrants who paid into the system illegally through fake Social Security numbers.
http://www.pnhp.org/print/news/2013/may/immigrants-subsidize-medicare-recipients-study-says
USA Today, May 29, 2013
WASHINGTON — Immigrants contributed about $115 billion more from their paychecks to the Medicare Trust Fund than they took out over a seven-year period in the last decade, according to researchers at Harvard Medical School.
As the Senate debates a new immigration bill and House Republicans work toward a bill that restricts access to government services for unauthorized immigrants who become legal citizens, the researchers concluded in a study released Wednesday that restricting immigration could deplete the fund.
Researchers looked at data from 2002 to 2009.
"The assumption that immigrants are just a drain has been a part of the argument that people should be denied services," said Leah Zallman, lead researcher and an instructor at Harvard Medical School. "Immigration policy has been closely linked to Medicare's finances."
Studies had shown that immigrants use less health care than U.S.-born people, including in government programs, but no one had looked at their contributions to those programs.
In 2009, the researchers found, immigrants contributed $13.9 billion more to the Medicare Trust Fund than they used, while U.S.-born people spent $31 billion more than they contributed. Immigrants, Zallman said, essentially subsidize U.S. health care.
"I was surprised by the degree of subsidy," Zallman said. "We didn't see any changes in the amount of the [immigrant] subsidy each year, but there was a decline in net contribution of U.S.-born citizens."
They found that immigrants ages 18 to 64 on average contributed only about $100 less a year than did U.S.-born people, which is contrary to conventional wisdom that immigrants don't earn enough to contribute. Both U.S.-born citizens and immigrants older than 64 contributed less than they used: $3,333 for the U.S.-born and $2,099 for immigrants.
"We should carefully examine these assumptions that have led to denial of care," Zallman said. She said the study was unable to include undocumented immigrants who paid into the system illegally through fake Social Security numbers.
http://www.pnhp.org/print/news/2013/may/immigrants-subsidize-medicare-recipients-study-says
Immigrants give more to Medicare than they receive, a study finds
By Sabrina Tavernise
The New York Times, May 29, 2013
Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending.
The study, led by researchers at Harvard Medical School, measured immigrants’ contributions to the part of Medicare that pays for hospital care, a trust fund that accounts for nearly half of the federal program’s revenue. It found that immigrants generated surpluses totaling $115 billion from 2002 to 2009. In comparison, the American-born population incurred a deficit of $28 billion over the same period.
The findings shed light what demographers have long known: Immigrants are crucial in balancing the age structure of American society, providing an infusion of young, working-age adults who support the country’s aging population and help cover the costs of Medicare and Social Security. And with the largest generation in the United States, the baby boomers, now starting to retire, the financial help from immigrants has never been more needed, experts said.
Individual immigrant contributions were roughly the same as those of American citizens, the study found, but immigrants as a group received less than they paid in, largely because they were younger on average than the American-born population and fewer of them were old enough to be eligible for benefits. The median age of Hispanics, whose foreign-born contingent is by far the largest immigrant group, is 27, according to the Brookings Institution. The median age of whites in the United States is 42.
The study, which was published on the Web site of the journal Health Affairs on Wednesday, comes as Congress considers legislation that would eventually give legal status to the country’s 11 million unauthorized immigrants. The legislation has sparked a vigorous debate about whether immigrants ultimately contribute more than they receive from the federal budget. One of the sticking points has been whether immigrants should be eligible for government programs, including health benefits, before they qualify for citizenship, but while they are on the path to getting it.
The New York Times, May 29, 2013
Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending.
The study, led by researchers at Harvard Medical School, measured immigrants’ contributions to the part of Medicare that pays for hospital care, a trust fund that accounts for nearly half of the federal program’s revenue. It found that immigrants generated surpluses totaling $115 billion from 2002 to 2009. In comparison, the American-born population incurred a deficit of $28 billion over the same period.
The findings shed light what demographers have long known: Immigrants are crucial in balancing the age structure of American society, providing an infusion of young, working-age adults who support the country’s aging population and help cover the costs of Medicare and Social Security. And with the largest generation in the United States, the baby boomers, now starting to retire, the financial help from immigrants has never been more needed, experts said.
Individual immigrant contributions were roughly the same as those of American citizens, the study found, but immigrants as a group received less than they paid in, largely because they were younger on average than the American-born population and fewer of them were old enough to be eligible for benefits. The median age of Hispanics, whose foreign-born contingent is by far the largest immigrant group, is 27, according to the Brookings Institution. The median age of whites in the United States is 42.
The study, which was published on the Web site of the journal Health Affairs on Wednesday, comes as Congress considers legislation that would eventually give legal status to the country’s 11 million unauthorized immigrants. The legislation has sparked a vigorous debate about whether immigrants ultimately contribute more than they receive from the federal budget. One of the sticking points has been whether immigrants should be eligible for government programs, including health benefits, before they qualify for citizenship, but while they are on the path to getting it.
| Maine Democrats Draw Line Over Medicaid Expansion | |||||||||||
| 05/30/2013 Reported By: A.J. Higgins | |||||||||||
Democratic leaders in the Maine Legislature are drawing a line over Medicaid expansion, saying they will not vote on repaying money owed to Maine's hospitals until the health care issue is resolved to their satisfaction. The new position comes on the heels of the Legislature's failure to override the governor's veto of a bill linking expanded health care benefits for 70,000 Mainers with the repayment of nearly a half-billion dollars in Medicaid debt to Maine hospitals. A.J. Higgins has more.
Maine Non-Profit Gears up to Join ACA Health Insurance Market
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