Friday, August 12, 2011

New Administration policy tells states how to auction off local Medicaid programs to for-profit HMOs without violating regulations

ADAPT, a national grassroots disability advocacy group, announced today its outrage over the Administration's latest attack against the human rights of America's medically vulnerable children, adults and senior citizens.

The policy was outlined in a letter sent to State Medicaid Directors by CMS (the Centers for Medicare & Medicaid Services, the federal regulatory agency for both Medicaid and Medicare) on Friday, August 5.

Reading between the lines, one purpose of the letter is to outline how states can sell off their Medicaid contracts to for-profit HMOs without violating any pesky federal regulations. Specifically, the letter addresses Medicaid issues only as they relate to the infamous "maintenance of effort" (MOE) regulation imposed under the Affordable Care Act.

At one point, the policy instructions are very explicit:

As detailed in our May 20, 2010 State Medicaid Director Letter, there are a variety of mechanisms available to States to rebalance their long-term support systems for persons with disabilities to achieve compliance with the ADA.

One of the points in the May 20 letter was to laud the "service delivery model" of managed care. These are the managed care contracts auctioned off to the growing for-profit HMO industry. The link to CMS' technical manual for running an honest managed care program does not appear to work any longer.

Government revenue for Medicaid and Medicare is already boosting some of these companies 23% higher for the year than the S&P 500. Unitedhealth, for instance, has successfully mislead both the Wall Street Journal and the New York Times into writing that their specular profits are related to performance in their commercial (employer) division.

Over the past three years, Unitedhealth's monthly income from commercial accounts increased by $300,000,000 while their monthly revenue from the government for Medicaid and Medicare increased by $1 billion. Which sector seems more likely to have produced a 313% increase in net earnings?

Last week's Medicaid policy statement is only the latest in a series of events evident of the Obama Administration's extreme pandering to big business HMOs.

Please help us stop this terrible mis-use of public funds.

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About Me

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.