RSS Articles and Information
  • How to Fight and Prevent Sugar Cravings February 27, 2015
    The average American consumes about 16 teaspoons more sugar per day than what is recommended. Sugar causes the brain to release serotonin, creating a natural high, and the endorphins leave us wanting more. Kicking a sugar addiction can be tough, …
  • Hospital Closures Bring “New Day” in Healthcare February 25, 2015
    Hospitals are operating with fewer beds or closing, as patients seek more affordable medical care at clinics and outpatient surgery centers. A low occupancy rate makes for a high-priced facility, which is not competitive. These closures are due to the …
  • Do Your Part to Protect Your Heart – February Special February 23, 2015
    February is Heart month. Protect the health of your heart, preventing heart disease and stroke, with a simple blood test. Below are the February specials from DirectLabs. Lipid Profile – $19 (Regular Price $29, $98 Retail) Test includes: Cholesterol, Total …
  • The Various Dimensions of Mammogram Screening February 20, 2015
    by Adrienne Snavely Every year, over 200,000 women in the U.S. are diagnosed with breast cancer and about 40,000 will die from it. When breast cancer is detected early, it is easier to treat. Forty million mammograms are performed each …
  • Crashing the Free Market Party February 16, 2015
    by G. Keith Smith MD Riding in to rescue the victims of Obamacare and other government healthcare schemes are guess who? The legislators? The regulators? Don’t make me laugh. It is the growing group of healthcare free marketeers. The celebration …
  • Dark Chocolate is Good For You and Your Valentine February 13, 2015
    Dark chocolate is loaded with nutrients, one of the best sources of antioxidants, and can improve health and lower risk of heart disease. Dark chocolate is very nutritious. It contains a fair amount of soluble fiber and is full of …
  • The Fraser Institute: Education Spending in Canada February 12, 2015
    Despite a steady decline in student enrolment, spending on public schools in Canada has skyrocketed.Teachers’ unions and activists repeatedly claim that education spending is being cut and school budgets are in peril. That’s simply not true and ignores the reality …
  • Eye-Tracking Test Detects Early Alzheimer’s Disease February 11, 2015
    One in nine Americans over 65 has Alzheimer’s disease. There is no way to revive dead cells, but if detected early enough, the disease progression can be slowed with treatment. Spinal fluid analysis and PET scans can detect the approaching …
  • OMTEC 2014 – Emerging Trends in Orthopaedic Device Packaging February 11, 2015
    Laura Bix, Associate Professor, School of Packaging, Michigan State University discusses current and emerging trends in orthopaedic device packaging at OMTEC 2014.
  • Fee for Service Healthcare Just Makes Sense February 9, 2015
    Contrary to what the HHS has stated, the fee-for-service payment model has nothing to do with abuse or wasteful spending. This model has been the standard method of payment for a wide range of goods and services from the beginning …
  • A Healthy Heart at Any Age February 6, 2015
    Any age is a good age to take care of your heart. Smart choices now can pay off for the rest of your life. There are some simple steps to keep your heart healthy during each decade of life. All …
  • FRASER INSTITUTE 40th Anniversary 2014 February 5, 2015
    The Fraser Institute is an internationally-recognized research and education organization, ranked first among Canadian think tanks and in the top 20 globally. Our mission is to improve the quality of life for Canadians, their families and future generations by studying, …
  • Cut Your Costs by Just Not Paying February 4, 2015
    If patients all got healthy, medical costs would plummet. And if doctors weren’t paid for caring for patients who don’t get healthy, costs would also plummet. This seems to be the reasoning behind the Obama Administration’s ambitious plans for payment …
  • Measles – What You Need to Know February 2, 2015
    by Adrienne Snavely Over the last month, the Centers for Disease Control and Prevention reported 67 cases of measles traced to Disneyland, and the number continues to rise. This was a souvenir people didn’t plan for. For a disease that …
  • Free Markets are Destroyed by Congress, Not Created January 30, 2015
    By Jane M. Orient, M.D. When people clamor for Congress to pass a “free-market health plan,” they are forgetting two things: Congress only does laws, which restrict freedom. We need fewer laws, not more. And the free market is by …
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 3 January 26, 2015
    MediBid is the free market answer to rising healthcare costs. Employer-sponsored plans, as well as self-insured individuals, make up most of MediBid’s customers. On MediBid, a patient makes a procedure request which gets sent out to physicians and facilities around …
  • Medical Debt Still a Problem for Those With Health Insurance January 23, 2015
    by Adrienne Snavely Medical debt can affect anyone of any age in any state in any income bracket. Medical debts account for more than half of debt collections on credit reports. One in three Americans struggle to pay medical bills, …
  • Q&A with Direct Pay Physicians January 22, 2015
    Direct pay physicians answer colleagues’ questions about third-party-free medical practice. From January 9, 2015, New Orleans AAPS workshop.
  • Ralph Weber Talks MediCrats with FreedomWorks – Part 2 January 21, 2015
    The pitfalls of Obamacare are that it makes healthcare affordable to the employee, yet unaffordable to dependents. Some plans cover children, but not spouses. This means less options for families. The independent physicians are being bought out by hospitals and …
  • Cash and out-of-network: good for medicine as free agency is for sports January 21, 2015
    Andrew Schlafly, J.D., General Counsel, AAPS, opens the 21st Thrive, Not Just Survive workshop held Jan. 9, 2015 in New Orleans, LA.

Some States are Limiting Hospital Coverage for Those Medicaid Patients Whose Lives Depend on it

Obamacare won’t allow insurance companies from denying people with pre-existing conditions coverage, but certain states are having to limit Medicaid coverage for those with critical illnesses requiring excessive hopsitalization due to its unafordablity. These expenses are going to fall on hosptitals and privately insured patients, as well as restricting health care access to those whose lives depend on it. Other states have taken steps to cut costs by eliminating things like vision coverage, adult day care, and dental exams/prodedures.

By Phil Galewitz

KHN Staff Writer

Oct 24, 2011

This story was produced in collaboration with USA Today

In the latest sign of how desperate they are to control rising Medicaid costs, a small but growing number of states are sharply limiting hospital coverage — to as few as 10 days a year.

Advocates for the poor and hospital executives say the moves will restrict patients’ access to care, force hospitals to absorb more costs and lead to higher charges for privately insured patients.

 States defend the actions as a way to balance budgets hammered by the economic downturn and the end of billions of dollars in federal stimulus funding this summer – funds that had helped prop up Medicaid, the state-federal health insurance program for the poor.

Arizona, which last year received national attention for stopping coverage of certain transplants for several months, plans to limit adult Medicaid recipients to 25 days of hospital coverage a year, starting as soon as the end of October.

Hawaii is going even further. In April 2012, it plans to cut Medicaid coverage to 10 days a year — the fewest of any state, experts say.

Both efforts are pending federal approval, which state officials consider likely because several other states already restrict hospital coverage, among them Alabama (16 days), Arkansas (24 days), Florida (45 days), and Mississippi (30 days). Last year, Massachusetts started a 20-day per stay limit.

Private health insurers generally don’t limit hospital coverage, according to America’s Health Insurance Plans, a trade group.

In Alabama, which has had a 16-day limit for more than decade, hospitals have billed patients for days not covered by Medicaid, said Larry Gardella, director of advocacy at Legal Services Alabama. Because poor patients often are unable to pay, the hospitals typically must pick up the cost, he said.

Another problem: Patients may also delay seeking elective services if they’ve already reached the coverage limit, Gardella said.

Rosemary Blackmon, executive vice president of the Alabama Hospital Association, said “for the most part hospitals do what they can” to provide care to Medicaid patients despite the limits.

In Arizona, hospitals won’t discharge or refuse to admit patients who medically need to be there, said Peter Wertheim, spokesman for the Arizona Hospital and Healthcare Association. “Hospitals will get stuck with the bill,” he said.

While the coverage limits affect only a small percentage of Medicaid patients, they are often are some of the sickest in the program. About 4,000 of Arizona’s 1.3 million Medicaid recipients were in hospitals for more than 25 days from July 2009 to July 2010.

Hospital coverage limits are just one of the strategies states are using to control rising Medicaid costs. Driven by higher enrollment and rising medical costs, total spending on Medicaid was projected to increase by an average of 11 percent in fiscal 2011, according to the National Association of State Budget Officers.

For the 2012 fiscal year that began in July, the association estimated state Medicaid spending would rise 19 percent, largely because of the end of the federal stimulus dollars.

To deal with the higher costs, states are requiring more Medicaid recipients to enroll in managed-care plans run by private insurers, cutting reimbursement rates to hospitals and doctors, and reducing benefits.

The federal health law requires states to maintain Medicaid eligibility and enrollment standards through 2013. But states are still free to cut optional benefits, which include drugs, vision care and visits to certain providers such as chiropractors and podiatrists.

Within those restrictions, many states have enacted benefit cuts in fiscal 2012, digging deeply into their Medicaid programs for savings. This month, Nebraska began limiting the number of adult diapers it pays for to 180 a month. In July, Colorado stopped covering circumcisions and Tennessee ended coverage of adult acne medicine.

Other steps:

  • California plans to eliminate adult day care coverage and limit Medicaid patients to seven doctor visits per year beginning in November.

 

 

  • Connecticut in July cut the number of dental exams covered for adults on Medicaid from twice a year to once a year.

 

 Matt Salo, executive director of the National Association of Medicaid Directors, said the hospital coverage limits reflect how states are “desperately looking for any and all levers to reduce Medicaid costs,” without violating the law.

The federal Centers for Medicare and Medicaid Services refused to comment on the hospital limits proposed by Arizona and Hawaii, saying they are under review.

CMS is working with states to “provide them with flexibility to run their Medicaid programs and reduce their costs,” Medicaid director Cindy Mann said in a statement. At the same time, “we must also ensure the Medicaid program continues to meet the health care needs of the children, people with disabilities and the elderly whom it serves.”

Brian Turney, CEO of Kingman Regional Medical Center in northwestern Arizona, estimates the hospital coverage limit will cost his 235-bed rural hospital more than $1 million a year. “We can’t kick out patients if they need care from a medical standpoint,” he said. “We are going to just get stuck eating the cost as uncompensated care.”

Turney said hospitals will try to shift costs to private health plans.

The limit will also hamper hospitals’ ability to transfer patients to rehabilitation hospitals because those types of hospitals will be covered by the coverage limit.

Turney said hospitals are especially upset by the limit because it comes as hospitals already are being hit by a 5 percent Medicaid reimbursement cut and the state is taking steps to reduce by the number of people eligible for the program.

Advocates for the poor also are crying foul.

“We do not think people who need medical care should be denied hospitalizations,” said Ellen Katz, director of the Morris Institute for Justice, an advocacy group for the poor based in Phoenix. She said the state is wrong to impose the coverage limit because it penalizes the sickest patients.

The inpatient limit excludes burn units, transplants and inpatient psychiatric care, Arizona Medicaid spokeswoman Monica Higuera Coury said.

Arizona estimates the coverage limit will save a total of $94 million in Medicaid spending in fiscal 2012, including $30.7 million in state funds. Coury said the limit and other cuts to the program are needed to help the state balance its budget.

“The 25-day limit is a cost savings measure and is part of a larger effort to address the $800 million shortfall created by the end of the federal stimulus program,” she said.

 



At MediBid, we restore market forces to medical care. Doctors get to set their own rates based on their training, experience, and outcomes, and patients get to shop for medical care across state lines and international borders. Many times with MediBid, you will find procedures that are more effective than procedures allowed, or covered by health plans. Transparency and competition are the only way to achieve reasonable costs. Many of our employer clients offering group health insurance through MediBid save $5,000 per employee per year. Those are substantial savings. Patients are saving an average of 48% vs. insurance discounted rates, or 80% vs. retail. Contact us for more information.
Share

Comments

This entry was posted in Business and Medicine, Cost of Health Care, Health Care News, Health Law and Legislation, Hospital Bills, News and tagged , , . Bookmark the permalink.
More Affordable Insurance AlternativeCategories
Bulk Email Sender