51ÊÓƵ

It's unclear how Iowa will give all Medicaid recipients an independent way to voice complaints about service under private management that goes into effect soon, lawmakers said Wednesday following a presentation on some proposed oversight of the system. Lawmakers in the Senate Human Resources Committee expressed concern that an independent system for all Medicaid recipients to file more serious challenges to insurance claims or treatment won't be in effect in time for the privatization switch on March 1. (Rodriguez, 1/27)

Gayle Taylor-Ford’s husband has been waiting two months for the treatment his doctor thinks is most likely to help with his multiple sclerosis, a wait she attributes to their insurer’s step therapy protocol. Through step therapy, doctors and patients must document that lower-cost drugs didn’t work before a more expensive prescription can be tried. Taylor-Ford and others spoke Wednesday at a Senate Public Health and Welfare Committee hearing on Senate Bill 341, which would allow step therapy in the state’s privatized Medicaid program known as KanCare. (Hart, 1/27)

As a mother, Anya Staton says her primary instinct is to feed her children. So when her oldest son developed an eating disorder she knew he needed help -- help she didn't know how to give. And care the family's insurance company, through Florida's Medicaid program, denied the boy needed. (Watts, 1/27)

Sen. Anna MacKinnon, R-Eagle River, announced today that a new Medicaid reform subcommittee will focus on the issue over the next month. The subcommittee will look at separate bill proposed by Gov. Bill Walker’s administration and Sen. Pete Kelly, R-Fairbanks, to change how healthcare is delivered to low-income Alaskans. Both bills encourage the use of case management. In the state’s version, a contractor assigns a primary care provider to each patient. The provider would help coordinate the healthcare that the patient receives, with an eye toward preventing problems that cause unnecessary hospital stays and emergency room visits. (Kitchenman, 1/27)

Governor Charlie Baker’s proposed state budget keeps spending growth in the state’s Medicaid program, a lifeline for low-income residents who need medical care, to 5 percent a year. That increase would be modest compared to the double-digit jumps in recent years. But the program, known as MassHealth, would still account for $15.4 billion — the single biggest chunk of the state budget — to provide insurance to more than one-fourth of the state’s residents. (Dayal McCluskey, 1/28)

The Office of State Comptroller increased its recovery of Medicaid fraud funds by 12 percent in 2015, to a total of $87.26 million. The comptroller’s Medicaid fraud division uses a number of techniques to ferret out abuses, including audits, data mining, investigations that result from tips, and recoveries from overpayments. (1/27)