Latest Kaiser Health News Stories
Managed-care plans, which reap billions in taxpayer dollars to coordinate care for low-income Americans on Medicaid, outsource crucial treatment decisions to subcontractors that aren’t directly accountable to the government. In California, health officials say one firm improperly withheld or delayed care for hundreds of people.
The money was paid on behalf of more than 400,000 people who may have been ineligible for the public program, a state audit found. One had been dead for four years before payments stopped.
How a California health plan’s CEO and her husband, an executive consultant, got rich off the taxpayer-funded program for the poor. Critics see a conflict of interest, the plan doesn’t, and the state has no rules either way.
State regulators and insurers are looking into SynerMed, which medical groups depend upon to handle their finances and business operations. The groups, serving 1 million patients, fear a messy fallout.
Complaints are rising against for-profit insurance companies that manage Medicaid for about 600,000 Iowans. The privatization of Medicaid is a national trend affecting more than half of the 74 million Americans who get their health care through the state-federal program.
Advocates say California’s Medicaid program is violating its own rules by overturning decisions that would allow seriously ill patients to stay out of managed care and keep their doctors.
LogistiCare often shows up late, if at all, and compromises patient safety, according to a public interest firm’s lawsuit. The company says the allegations are inaccurate.
The California Nurses Association, representing some 100,000 registered nurses, is regarded statewide and nationally as a progressive political powerhouse. “Politicians are afraid” of the activists they turn out, said one critic.
The HMO blew two deadlines to supply information required by the state to monitor Medi-Cal managed care plans. Kaiser says it is “taking steps” to resolve the problem.
Medi-Cal’s controversial program to go after your assets when you die will be significantly curtailed, but some enrollees could be hit by new claims.
Private insurers that administer Medicaid for the poor also face limits on profits and requirements to provide sufficient doctors.
As officials seek to take control of costs in the health coverage for low-income residents, they are relying on hospitals, not private insurance companies, to run the program.
The proposed compromise would avert $1 billion in budget cuts but still must be approved by a two-thirds majority in the legislature.
Federal policy requires that California broaden taxes on insurers to fund Medicaid, but state insurers and many Republican legislators are opposed.
About 47 percent opt out of California’s “dual eligibles” program serving Medicare and Medicaid patients, in part because they fear losing their doctors, a survey finds. But once enrolled in the pilot program, most stay.
With legislation that passed last month, North Carolina is trying to build a hybrid managed care, accountable care model – with doctors, hospitals and insurance companies all sharing some risk. Advocates worry it could eclipse gains made by Medicaid in the state in the past.