Weekly Dose of Health News December 2 – 6, 2013
In this week’s summary you’ll find an update on New York’s Medicaid expansion, Q&A from Kaiser Health news on the new federal mental health parity rules and the Affordable Health Care Act and a link to the NYS Department of Health’s recent webinar on the status of the MRT Waiver Amendment.
New York’s Medicaid expansion will result in 300,000 additional enrollees to the program, a 7.3% increase. New York’s covered population will increase from 5.3 to 5.6 million by the end of 2014, according to the New York Post. State officials estimate that an additional one million people are eligible for Medicaid, so total enrollment could easily exceed six million. New York will save $2.3 billion per year through enhanced federal reimbursement for Medicaid expansion populations under the Affordable Care Act (ACA). Starting in 2014, the federal government will reimburse 75% of the costs of coverage for the new Medicaid enrollees, as opposed to the usual 50% federal match. Reimbursement for childless adults will eventually be at 90%. The ACA coverage expands eligibility for single adults from 100% to 130% of the federal poverty level.
Kaiser Health News has this Q & A on new federal mental health parity rules and how the new rules mesh with the Affordable Care Act. Highlights include: health plans do not have to cover mental health benefits, but if they do, they must provide coverage for inpatient, outpatient and emergency room care as well as prescription drug coverage; when determining medical necessity, plans must apply the same processes that are used for medical services; the new rules also make clear that the Affordable Care Act trumps previous parity rules regarding annual or lifetime dollar limits, i.e., there can be no limits on essential benefits including mental health; the new rules do not apply to Medicaid expansion populations and do apply to fully insured and self-funded large group plans, individual and small group plans available on or off the health exchanges. Lastly, federal parity rules do not pre-empt more stringent state rules and laws.
Kaiser Health News, in conjunction with the Washington Post writes that the Department of Justice estimates that former inmates will comprise 35% of people who newly qualify for Medicaid in states that are expanding eligibility to 138% of the federal poverty level. Currently, prisoners are not eligible for Medicaid coverage while incarcerated and states must use their own funds to cover the cost of prison health care. The Affordable Care Act doesn’t change this but it will result in eligible prisoners gaining health coverage upon re-entering society. New York has ‘suspension Medicaid’ for individuals who entered prison in the Medicaid program. Coverage is suspended during incarceration and is then available upon release. New York has also instituted some Medicaid re-entry pilots, designed to boost post-incarceration health status and prevent recidivism.
The Department of Health held a webinar this week, which provided a Medicaid Waiver update. As a result of much back and forth with the Centers of Medicare and Medicaid Services (CMS), New York will submit a revised application next week. CMS has told New York that it will not approve funding for capital, rental subsidies, regional planning, evaluation of waiver projects and health information technology. However, it seems that the waiver will contain $7.85 billion for safety net hospital providers.