Mary Mayhew seeks managed care extension but eyes future changes

Florida health care officials on Monday formally asked the federal government to extend for two more years a “waiver” to allow the state to keep intact its Medicaid program that relies on steering patients into privately run managed-care plans. The request, published Monday, doesn’t contemplate making any major immediate revisions to Medicaid, the safety-net health […]

California Nursing Home Residents Told To Find New Homes

Some of California’s most vulnerable nursing home residents, many of whom have nowhere else to go, are receiving letters from their health care plans saying they are no longer eligible for long-term care. In one notable example, three dozen nursing home residents in San Luis Obispo County were informed on the same day that their […]

Invoking ‘Pain & Profit’, Sen. Bob Casey requests — and gets — federal probe of ‘dangerous’ denials by Medicaid companies.

Last year, an investigation by The Dallas Morning News exposed how the giant companies Texas pays to provide health insurance to extremely poor and disabled people were systematically skimping on care to boost profits. Days after “Pain & Profit” began publishing, Texas lawmakers launched official inquiries, millions of dollars were freed up to increase state oversight and about two dozen bills […]

Key Issues in Long-Term Services and Supports Quality

2017 marks the 30th anniversary of the passage of the Nursing Home Reform Act as part of the Omnibus Budget Reconciliation Act of 1987, the federal legislation that substantially strengthened federal standards, inspections and enforcement of nursing home quality. The Act also merged Medicare and Medicaid standards, required comprehensive assessments of residents, set minimal requirements for […]

Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit

Marcela Villa isn’t a big name in health care — but she played a crucial role in the lives of thousands of Medicaid patients in California. Her official title: denial nurse. Each week, dozens of requests for treatment landed on her desk after preliminary rejections. Her job, with the assistance of a part-time medical director, […]