Medicaid

President Donald Trump promised on the campaign trail to "expand access to drug treatment, strengthen prevention options and address the scourge of drug addiction after hearing about many Americans' struggle with opiate abuse," CNN's Dan Merica reports. But the Republican health care plan Trump backs would end the requirement that states that have expanded Medicaid cover addiction-treatment services and mental health treatment.

Dr. Andrew Kolodny, the director of the Opioid Policy Research Collaborative at Brandeis University, told CNN the proposed change is a "step in the wrong direction at a time when America's most urgent public health crisis is an addictive disorder."

Ohio can't deny Medicaid benefits to a senior citizen by defining family to exclude his spouse, the U.S. Court of Appeals for the Sixth Circuit has ruled.

Courthouse News' Lorraine Bailey reports that Medicare beneficiaries Leslie Wheaton, George Hart and Joe Turner did not also qualify for Medicaid benefits under a Ohio Department of Medicaid rule. That rule says that a spouse doesn't count as a member of a beneficiary's family.

Judge Raymond Kethledge opined, '"The term 'planet' might be ambiguous as applied to Pluto, but is clear as applied to Jupiter. And though there might be some ambiguity in 2015 as to whether Ukraine's borders encompass the Crimean Peninsula, there is no doubt that Kiev lies within them. So too here: whatever ambiguity the 'persons living under one roof' or 'basic unit of society' definitions might have at the margins, there is no doubt that, under either definition, a person's family includes her resident spouse."'

People with disabilities are fighting Wisconsin Governor Scott Walker's proposed changes to long-term managed care in the state's budget, The Marshfield News-Herald's Liz Welter reports. They are concerned that changes to managed care would trade a community-centered system with a state-wide approach run by out-of-state insurance companies. They also are concerned that the autonomy the current system gives them to direct how some of their care is carried out would be eliminated.

The U.S. Supreme Court, 5-4, ruled in the past week that healthcare providers can't force states to raise Medicaid rates to keep up with rising medical costs, the Associated Press' Sam Hananel reports. The mostly more conservative justices in the majority said that private medical providers have no private right to enforce Medicaid funding laws because Congress did not create such a right.

The case involved five centers in Idaho that provide care to developmentally disabled children and adults, which claim that Idaho ignoring rising costs by keeping reimbursement rates low.

Maine Governor Paul LePage spent close to $53,000 on private lawyers to try to remove low-income young adults from the state's Medicaid program, even though Attorney General Janet Mills rejected pursing the case and told the governor he couldn't win, the Associated Press reports.  The U.S. Court of Appeals for the First Circuit ruled that the Affordable Care Act requires the state of Maine to keep providing Medicaid coverage to 19- and 20-year-olds from low-income families. The Patient Protection and Affordable Care Act requires states accepting federal Medicaid funds to freeze their Medicaid eligibility standards for children until 2019.

The New York Times' Robert Pear reports that, even as the rolls of people getting healthcare coverage through Medicaid are swelling, Medicaid reimbursements for primary care will be cut by 43 percent, on average. Why? Some healthcare providers will not take Medicaid patients at the lower rates. Moreover, the extension of higher Medicaid payments faces long odds in the Republican-controlled Congress. 

Separately, there is a case pending in the U.S. Supreme Court in which the Obama administration has taken the position that healthcare providers have no right to enforce a requirement that Medicaid rates must be sufficient to "'enlist enough providers' so that beneficiaries have at least as much access to care as the general population in their geographic area," Pear further reports.

Courthouse News' Jack Bouboushian reports that the First Circuit ruled that the Affordable Care Act requires the state of Maine to keep providing Medicaid coverage to 19- and 20-year-olds from low-income families: "the federal Department of Health and Human Services would not approve the change, because the Patient Protection and Affordable Care Act requires states accepting federal Medicaid funds to 'freeze' their Medicaid eligibility standards for children until 2019." The First Circuit ruled the requirement "does not step on state sovereignty ... as setting conditions of eligibility for participation in Medicaid is not a core state function, such as, for example, regulating state elections," Bouboushian further reports.

During law school I did research about various efforts to put patients in charge of their own care, whether their issue is addiction, a disability or mental health. So I was very interested to read a piece that Newsworks' Laura Benshoff published about a pilot program in a Philadelphia suburb to put Medicaid patients with mental health issues in charge of decisions about their care: "It gives patients the option to redirect that money towards a 'freedom fund,' saving for something that improves quality of life. In addition, participants make decisions about care with a certified peer specialist as a recovery coach."

However, putting people in charge of their health care did not reduce costs. The first two years of the program showed that costs went up from $6,800 to $7,500 because "participants who had gotten used managing their symptoms tended to opt for more, off-plan services through the program – such as gym memberships – rather than cut back," Benshoff reports.

Self-directed care has become a big trend for people with mental illness, disabilities and other issues. The idea is that consumers know what will help them live healthier lives better than "experts," and many Medicaid programs have built in flexible funds to allow consumers to spend their money as they set fit (subject to some conditions). Consumers often are directing their care to hiring home-care workers.

So the latest development for self-directed care is that home-care workers are going to have to be paid minimum wage and overtime if they work more than 40 hours a week. The U.S. Department of Labor won't be enforcing the rule for the first six months after it goes into effect January 1, 2015, the Kansas Health Institute's news service reports.

Increasing wages for home-care workers won't be without cost. Kansas Gov. Sam Brownback "had expressed concern that the rule boosting the pay of personal care attendants hired by elderly and disabled Kansans to help them stay in their own homes would add $33 million to $40 million to the overall Medicaid budget in Kansas, including $15 million from state funds not in the current budget," KHI reports.