Clip files / Local news from the states

This column features selected short items about state health care policy.

Congestive heart failure added to Florida Medicaid program

Tallahassee, FL—Florida’s Agency for Health Care Administration has extended its preventive care program for state Medicaid beneficiaries to cover disease management services for patients with congestive heart failure.

Under a three-year contract, the administration signed with health management services company LifeMasters Supported SelfCare, and will offer such services as vital sign and symptom monitors, health education, lifestyle modification coaching, and regular patient interaction with registered nurses.

AHA News Now

Regulation proposed to close Medicaid loophole

Washington, DC—Secretary of Health and Human Services Donna Shalala announced on Oct. 5 a proposed rule that would close a loophole in Medicaid that costs taxpayers billions of dollars by revising Medicaid’s "upper payment limit" rules.

Current upper payment limit regulations allow states to pay facilities in aggregate as much as Medicare would pay for the same services. According to the Department of Health and Human Services, some states use this flexibility to pay excessive rates to a few county or municipal facilities and then require those facilities to return some or all of the money after the state has claimed federal Medicaid matching funds based on those payments.

—American Health Lawyers Association

Declining welfare caseloads, sicker Medicaid beneficiaries

Washington, DC—As healthier beneficiaries leave the Medicaid program and less healthy adults continue to receive coverage, Medicaid may be left with a sicker group of individuals remaining in the program, according to a new report by the Urban Institute’s Assessing the New Federalism project.

A sicker Medicaid caseload may require states to increase their per-enrollee expenditures, including the capitation rates paid to managed care organizations, to maintain the same level of access and quality of care Medicaid beneficiaries currently receive.

—Center for Health Care Strategies Inc.