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Medicaid Monitoring

The Children and Families Committee decided at its June 2011 meeting to spend a portion of the interim reviewing issues related to Medicaid. Committee members decided in September 2011 to incorporate the following topics into their work plan:

  • the use of waivers;
  • managed care options;
  • provider rates;
  • privatization;
  • proposals for block grants and blended rates;
  • the effects of federal health care legislation on Medicaid; and
  • activities in other states.

To date, the committee has undertaken the following activities:

  • September 2011: Received an overview of the Medicaid program and issues related to potential changes to the program under federal health care legislation. A presentation by the National Conference of State Legislatures touched on the types of efforts states have taken to try to control Medicaid costs.
  • November 2011: Reviewed issues related to containing Medicaid costs, including the use of managed care. Representatives of UnitedHealthcare discussed the benefits of the managed care programs they operate, while representatives of mental health providers and hospitals reviewed Montana's past experience with a managed care mental health system. They also highlighted issues that any future managed care plan should take into consideration. The committee also heard about the Health Improvement Program, which is a type of managed care program now used in Montana for Medicaid patients with multiple medical needs.
  • January 2012: Reviewed issues related to error detection in Medicaid billing and to provider rates. Two representatives of Emdeon, a health care data network, discussed ways in which data can be analyzed to prevent incorrect payments. Representatives of the Department of Public Health and Human Services and the Montana Department of Justice discussed the state's current efforts to detect errors and fraud. Representatives of hospitals and of organizations that provide services to children with mental health needs and to people with developmental disabilities talked about how fluctuations in Medicaid reimbursement rates have affected their ability to provide services.
  • March 2012: Received information about matters related to the state's response to the Medicaid expansion under the federal health care law. A DPHHS respresentative discussed the computer system changes the state is making to meet the requirement that the health insurance exchange make determinations about which insurance applicants are eligible for Medicaid or Healthy Montana Kids. A University of Montana Bureau of Business and Economic Research representative discussed the ongoing survey of insured and uninsured Montanans that may provide information about how many more people may be eligible for Medicaid in 2014.
  • May 2012: Approved a bill for introduction in the 2013 Legislature to appropriate $6.5 million in general fund and up to $9.6 million in federal funds to cover the anticipated funding that Medicaid providers lost in fiscal year 2011, when the governor was required by law to make spending reductions. Gov. Schweitzer eliminated a scheduled 2% increase in non-physician provider rates and a 6% increase in physician rates. The bill directs DPHHS to seek federal Medicaid funds to match the state appropriation and appropriates additional general fund money if the federal funds are denied.
  • June 2012: Revised the bill draft for the provider rate payment to appropriate only the $6.5 million in general fund, in fiscal year 2013. The revision was made because of concerns that federal funding could not be authorized quickly enough to match the use of general fund dollars in fiscal year 2013.
  • August 2012: Examined the implications of the Medicaid portion of the U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act. Representatives of governmental consulting firms KPMG, Leavitt Partners, and Deloitte provided information and perspectives about state options in the wake of the decision. The University of Montana Bureau of Business and Ecnonomic Research provided updated information about its survey of insured and uninsured Montanans, providing in-depth information about the study's findings on the potential size of the Medicaid expansion population in Montana and the potential costs the state could incur as the costs of providing care to that group gradually shifts to the states.

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Last Modified:
8/21/2012 2:58:09 PM

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