June 27, 2011

Middle Class Could Qualify For Medicaid Under Loophole In Health Reform Law
As many as 3 million middle-income U.S. residents could qualify for Medicaid in 2014 because of new Medicaid eligibility standards contained in the federal health reform law, according to Medicare Chief Actuary Richard Foster. Under the law, most Social Security benefits will no longer be counted as income for determining Medicaid eligibility. As a result, retirees under age 65 who receive Social Security benefits could be eligible if the rest of their income is less than 133 percent of the federal poverty level. President Obama’s administration initially defended the provision. However, U.S. Department of Health and Human Services Assistant Secretary for Public Affairs Richard Sorian said the agency is working to address the issue.

State Issues Bulletin On Proposed Medical Home Initiative
A commercial payer medical home initiative previously reported by MHA is being coordinated with the MO HealthNet Primary Care Health Home Initiative. MO HealthNet issued a recent bulletin describing its proposed program. Details, including payment protocol, still are being negotiated with the Centers for Medicaid and Medicare. The Missouri Foundation for Health and the Health Care Foundation of Greater Kansas City will sponsor Medicaid Learning Collaboratives. Applications for the MO HealthNet Primary Care Health Home Initiative are due July 11.

Foundation Offers Medical Home Collaborative
The Missouri Foundation for Health is supporting a medical home initiative in which major commercial health insurers in Missouri will pay primary care practices that agree to become a certified medical home under the National Committee for Quality Assurance. The expected payments will be per member per month, plus shared savings from expected reduced hospitalizations and emergency room usage. Insurers participating include Anthem/Blue Cross and Blue Shield and Coventry Group Health Plan. CIGNA has declined, and United Healthcare is still considering participation. Additional information about the initiative is available online.

State Legislative Committee To Study Health Insurance Exchanges
A new Missouri Senate interim committee will assess the implications of creating a health insurance exchange. The federal health reform law intends for each state to establish a health insurance exchange to implement the public and private coverage expansions scheduled to take effect Jan. 1, 2014. If a state declines or fails to do so, the Centers for Medicare & Medicaid Services will establish and operate an exchange in that state. In the 2011 legislative session, the Missouri House of Representatives unanimously passed legislation to authorize a state health insurance exchange. However, several senators threatened to filibuster the measure, and it was set aside in the session’s final days.

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