State legislators attending the fourth annual CSG Medicaid Policy Academy June 17-19, in Washington, D.C., learned how critical Medicaid funding can be to services for vulnerable persons. Dr. Jeffery Brenner, a 2013 winner of a MacArthur Foundation genius award, challenged the group to rationalize the health care system. He described how his project in Camden, N.J. has reduced costs and improved care for patients suffering from a complex set of chronic diseases. Health care workers visit patients in their residences and seek to evaluate not just medical needs but social and emotional needs as well. 

Long-term care and supports were the focus of the 2015 CSG Medicaid Policy Academy, held in Washington, D.C., June 17-19, 2015. The 30 registered CSG members came from 19 states. Home states are marked in purple in the map below. Over the four years CSG has convened the Medicaid Policy Academy, legislators from 42 states have participated. 

The program concluded with a plenary session featuring Dr. Jeffrey Brenner, medical director of the Urban Health Institute at the Cooper University Healthcare as well as the founder and executive director of Camden (N.J.)  Coalition of Healthcare Providers. In 2013, Dr. Brenner was named a MacArthur Fellow for his work on addressing the health care needs of the chronically ill in impoverished neighborhoods. 

Forty-eight rural hospitals have closed their doors since 2010, according to data recorded by the North Carolina Rural Health Research Program at the University of North Carolina, Chapel Hill. The typical rural hospital has 25 to 50 beds. It is more dependent on Medicare and Medicaid, which generally pay less than other insurers, and it has lower patient volume than urban hospitals. “The implication of lower volume is that the hospital is spreading fixed costs over less people and there is less certainty about the numbers of services that will be provided on any given day,” said Mark Holmes, director of the North Carolina Rural Health Research Program. “This uncertainty makes it hard to staff the hospital and hard to plan.”

As states across the country continue to transform health care, achieving the balance between cost containment and high quality care remains a primary focus. CSG is pleased to present a FREE eCademy webcast featuring national health care expert Dr. Jeffrey Brenner, who explores strategies to improve the quality of health care delivery while minimizing costs. Brenner is the medical director of the Urban Health Institute at the Cooper University Healthcare as well as the founder and executive director of Camden (N.J.) Coalition of Healthcare Providers. He was named a MacArthur Fellow in 2013 for his work on addressing the health care needs of the chronically ill in impoverished communities in the U.S. This presentation was broadcast as part of CSG’s 2015 Medicaid Policy Academy in Washington, D.C.

Data regarding federal and state Medicaid expenditures from 2004 to 2014 show the significant impact the Great Recession had on the federal-state partnership program. Enrollment and expenditures increased during the 10-year period; however, the increased program costs were borne disproportionately by the federal government.

Florida’s Gov. Scott took the Obama administration to federal court on April 28, claiming that they are attempting to force the state to expand Medicaid by threatening to withdraw other federal health funds.

Increasing health care expenditures are a source of great worry to public officials. Perhaps new data that show that public programs – Medicare and Medicaid – seem to hold down per capita spending growth more than private insurance will provide some reassurance to officials as they consider expanding public programs in their states.

The Cleveland Clinic, one of the nation’s largest hospitals, reported a 40 percent drop in charity care and credited the good news to Ohio’s Medicaid expansion, according to Kaiser Health News. Free care costs fell from $171 million in 2013 to $101 million in 2014.

In Armstrong v. Exceptional Child Center the Supreme Court held 5-4 that Medicaid providers cannot rely on the Supremacy Clause or equity to sue states to enforce a Medicaid reimbursement statute. 

The Court’s rejection of a private cause of action under the Supremacy Clause has implications well beyond this case.  Had the Supreme Court ruled otherwise, the Supremacy Clause would have provided a cause of action for every federal statute that arguably conflicts with state law.  

I learned a few things last week when I was visiting with Indiana Rep. Ed Clere, one of the new co-chairs of CSG’s Health Public Policy Committee.

  • That week, the state announced the 100,000th person enrolled in the Medicaid expansion waiver, called HIP 2.0 in Indiana, after the program opened less than a month before. Indiana had three Medicaid managed care organizations already engaged in the state and the state Medicaid office and the
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