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The CBO estimates that total Medicaid enrollment will grow from 72 million in to 93 million by While the federal and many state governments are watching their nickels, many Medicaid managed care plans are watching theirs pile up.

For example, Molina Healthcare announced buoyant financial results for in mid-February. The company has insurance programs outside Medicaid but was founded as a Medicaid company, and Medicaid remains its core business. It added , new members in , primarily due to the Medicaid expansion. Centene Corporation, another major commercial Medicaid managed care provider, did even better. When it announced results in February, Michael F. Membership grew by 1.

Even many nonprofit managed care companies are doing very well. Actually, nonprofit is a bit of a misnomer. These plans earn revenues that exceed expenses, but they call them margins; they are distributed to affiliated health care facilities and often, in generous amounts, to the executives of the nonprofits in the form of salaries. Salaries for top executives at some safety net hospitals, which have relatively high percentages of Medicaid patients, are just as high.

If not in a managed care environment, the costs would be higher. Already dealing with a population that is sicker than those of Medicare and employer health plans, Medicaid is now welcoming more relatively unhealthy Americans, some of whom have had little-to-no health care in the past and are beset by comorbidities.

Medicaid expansions were implemented by Pennsylvania on January 1, , and Indiana on February 1, Medicaid expansions have been controversial, especially in Republican states where governors and legislatures fear the federal contribution will diminish or even disappear in the future because of deficit and debt concerns in Congress.

Republican governors may also harbor political motives some may not want to appear to be furthering the PPACA, the root of the Medicaid expansion. New enrollees in both Democratic and Republican states were mostly added via so-called Section waivers. The penalty for not paying into a health savings account, which has never before been approved by HHS, reflects an important GOP health care tenet: People who receive Medicaid benefits should take personal responsibility for their care.

However, some Republican governors who were able to wheedle favorable waivers from the Obama administration have found themselves with egg on their faces when state legislatures voted against expansion.

The Section waivers allow the states and the federal government to exert some downward cost pressure on this entitlement program. But Medicaid, Medicare, and Social Security are gobbling up ever-larger shares of the federal budget. While the Obama administration and members of Congress have tossed around reform ideas for Medicare and Social Security, they have been unusually quiet about Medicaid.

One House subcommittee did hold hearings on Medicaid fraud, which is substantial and has inflated federal costs. But the federal government is not looking at managed care providers, nor are the states, to any great extent.

The CMS does not require states to audit managed care payments. State officials interviewed by the GAO said they need more CMS support, such as additional guidance and the option of obtaining audit assistance from Medicaid integrity contractors, to oversee Medicaid managed care program integrity.

Medicaid reform may move up a bit on the congressional priority list now that Republicans control the Senate. Similar to the reforms proposed in the s, federal per-capita caps would be placed on the four major beneficiary groups: elderly people age 65 years and older , blind and disabled people, children, and other adults.

Neither office answered emails asking whether the legislators would introduce Medicaid reform legislation in So the burden is apparently on the states to make Medicaid work as is. The HHS granting of Section waivers may help staunch some of the financial bleeding. But those waivers are really just so many fingers in the dike. Stephen Barlas. Author information Copyright and License information Disclaimer. Barlas, a freelance writer based in Washington, D.

Open in a separate window. Rising Medicaid Costs Squeeze U. Specialty Drugs Fuel Costs Almost every state is struggling, as Arkansas did with Kalydeco, with escalating prices for specialty drugs. Far Beyond Its Origins The Medicaid program has changed drastically since it was established in The Stress of Medicaid Growth The quickening shift to managed care reflects an imperative on both the state and federal levels to reduce the expansion of Medicaid costs.

Medicaid Expansion Under the PPACA Already dealing with a population that is sicker than those of Medicare and employer health plans, Medicaid is now welcoming more relatively unhealthy Americans, some of whom have had little-to-no health care in the past and are beset by comorbidities. Changes to Medicaid Going Forward The Section waivers allow the states and the federal government to exert some downward cost pressure on this entitlement program.

Woodcock CH, National Governors Association Long-term services and supports: challenges and opportunities for states in difficult budget times. Accessed March 2, Sep, Accessed March 3, Government Accountability Office Medicaid program integrity: Increased oversight needed to ensure integrity of growing managed care expenditures. The new contract originally was set to start this July, but Community Health has said it will be Jan.

Four companies — Amerigroup, Peach State, WellCare and CareSource — were picked in September as winners of the contract to serve lower-income adults and children in Georgia. Reese said he hopes to reduce the waiting list for services in the Community Care Services Program, which helps seniors and individuals with disabilities remain in their own homes, as an alternative to a nursing home.

Reese also said the Rural Hospital Stabilization Committee is moving toward adding as many as four more sites for pilot programs to boost health care in rural Georgia. The committee, created by Gov.

It plans to use telemedicine-equipped ambulances to facilitate remote diagnoses of patients in rural areas. Skip to content More Georgia facilities run by a financially troubled nursing home operator are under federal and state regulatory scrutiny, a state health care agency said Thursday. Clyde Reese. A sign in Abbeville.

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