Another Day in the Third Year After the End of the American Century

I’m sure Stephen Miller’s and Kirstjen Nielsen’s parents are so proud…

Open thread!

Schrodinger’s Coverage

Here is a koan for Balloon Juice:

If you do not know you are insured, are you insured?

Maine is in the process of expanding Medicaid.  The new Governor-Elect, Janet Mills (D), has promised to expand Medicaid on her first day in office.  She wants to make the coverage retroactive to July 2, 2018.

A Maine judge has ordered the current Maine governor to expand Medicaid with claims payment retroactive to July 2, 2018.

In most states, Medicaid has an individualized retroactive eligibility processes.  Someone who is uninsured will interact with the medical system.  The medical service provider will ask several standardized questions to determine if the uninsured patient is highly likely to be eligible for Medicaid.  If they determine that the patient is likely to be eligible, they can file a claim and an eligibility determination.  If the beneficiary is deemed eligible, some state Medicaid programs will pay both the index claim that initiated the eligibility determination process and claims in the three previous months if the benefeciary would have been eligible for Medicaid if they had applied.

The trigger event is a claim which means the trigger is an encounter with the healthcare system.  Most people who are eligible for Medicaid but not enrolled don’t interact with the healthcare system in any given month because most people don’t interact with the healthcare system in any given month.

Retrospective eligibility is a safety net for both the patient who will not be faced with crippling medical bills and healthcare providers who will get reasonably timely payment that is most likely more than the net present value of the minimal cash stream that uninsured and Medicaid eligible patients can and will pay.

Retrospective eligibility is highly likely to occur for either pregnancy or major medical events that require hospitalization.  More common and lower cost events like a primary care physician visit are less likely to generate a claim and retrospective eligibility determination because that appointment will either not be made by the beneficiary or the appointment will be denied by the provider once they are sure that they won’t get paid.

Maine is going to be doing something very different.  It will be declaring that all claims on or after July 2 will be eligible for retroactive payments if the beneficiary would have been Medicaid eligible (either for legacy or expansion).

Now this is where I have a question.

Will we see changes in provider and beneficiary behavior in anticipation of a Medicaid Expansion?  Did they increase the number of determination assessments that they submitted that would fail for legacy Medicaid but pass for Medicaid Expansion in July, August and September?  Are providers pre-emptively opening up appointment blocks for people who are uninsured but Medicaid Expansion eligible?  Are people who are Medicaid Expansion eligible making appointments in anticipation of retroactive eligibility?

How do people behave when they are covered if they are not sure that they are covered?


I don’t know but I think that this is one hell of a question.



Good news in Maine

The Maine Medicaid Expansion will be moving forward. Here is the relevant part of the court order:

IV. Conclusion
The Court Orders the Commissioner to submit a state plan amendment to the United
States Department of Health and Human Services, Centers for Medicare and Medicaid Services
ensuring MaineCare eligibility for people under 65 years of age who qualify for medical
assistance pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) by June 11, 2018.

A State Plan Amendment is the most straightforward way for a state to expand Medicaid. It tells HHS/CMS that a state is modifying the standard Medicaid provisions that the state accepts and it will want the appropriate matching money. There will be some lag between an SPA and the first enrollment but people should be getting on Expanded Medicaid sometime this year.

Good job Maine!

Yes Virginia, there is a Voter-claus

And with that, it looks like the Virginia House of Delegates is now a 50-50 split as the Democrats will have picked up a net of 16 seats during the November election.

So let’s hear it for all the door knockers, phone bankers and post card writers.

Open thread

Monday Evening Open Thread: Comic Interlude

I suspect Dr. Stein has always fantasized being Lillian Hellman (as played by Jane Fonda) in front of an unsympathetic HUAC committee, and now she’s got her big chance.

The top congressional committee investigating Russian interference in the 2016 presidential election has set its sights on the Green Party and its nominee, Jill Stein, according to a former campaign employee.

Dennis Trainor Jr., who worked for the Stein campaign from January to August of 2015, says Stein contacted him on Friday saying the Senate Intelligence Committee had requested that the campaign comply with a document search.

Trainor, who served as the campaign’s communications director and acting manager during that time, told BuzzFeed News that he was informed of the committee’s request because during his time on the campaign, his personal cell phone was “a primary point of contact” for those looking to reach Stein or the campaign. That included producers from RT News, the Russian state-funded media company, who booked Stein for several appearances, Trainor said…

Trainor, who has done on-and-off work for Stein since formally leaving the campaign in 2015, said he is inclined to cooperate with the committee’s request but wants to first seek legal counsel. He said he believes Stein plans to comply as well and post the documents on her own website “in an effort to show complete transparency and kind of wage her own war against […] what I imagine she thinks is an overblown investigation into collusion.”

Stein did not immediately respond to a request for comment. A spokesperson for North Carolina Sen. Richard Burr, the committee’s chairman, declined to comment.

Stein has not previously been a major focus during the Russia investigations on Capitol Hill, but her name has surfaced occasionally. The Senate Judiciary mentioned her in a letter to Donald Trump Jr. in July, requesting copies of “all communications to, from, or copied” to the president’s son that related to Stein and a long list of other, more prominent figures in the investigations…

The Senate Intelligence Committee has to ask, because Stein spent her 2016 campaign putting the “idiot” in the time-tested Soviet term “useful idiot”. I very sincerely misdoubt she has anything useful to offer, on this or any other topic, but I expect her interview to be second only in {face-palm} worthy moments to that of Carter Page.