�鶹Ů��

It used to be that whatever else happened with the General Fund, legislators would give the Alabama Medicaid Agency the funding it requested. But legislators are discussing the possibility of passing a budget without the full amount of Medicaid’s requested funding, a move that could doom regional care organizations (RCOs) which the Legislature approved in 2013 in the hopes of slowing the growth in health care costs. That has Medicaid and health care groups concerned about major consequences for Alabama’s health care system, which depends on the program, and the loss of hundreds of millions of dollars from the federal government to implement RCOs. (Lyman, 3/18)

At a time when most states are paying private insurers to provide health care for their Medicaid recipients, Connecticut says it has saved money and improved care by going the opposite way. In 2012, Connecticut fired the companies that were running Husky, as its Medicaid system is known, and returned to a more traditional “fee-for-service” arrangement where the state reimburses doctors and hospitals directly. (Beck, 3/18)

The Democratic members of New Mexico’s congressional delegation have introduced legislation containing safeguards for Medicaid consumers and providers when fraud is alleged. The bill was prompted by the 2013 shakeup in New Mexico’s behavioral health system, which the Democrats in a news release called “reckless” and “a manufactured crisis.” Republican Gov. Susana Martinez’s administration abruptly halted Medicaid funding to 15 providers in June 2013, alleging they overbilled and may have committed fraud. Arizona companies were brought in to replace them, and many of the New Mexico nonprofits were driven out of the behavioral health business. (Baker, 3/20)

The 2013 audit alleged providers mishandled $36 million in Medicaid funding. An investigation by the state attorney general found some regulatory violations but no pattern of fraud. Investigations into two of the nonprofits are ongoing. State officials have vowed to recoup what they classify as millions of dollars in misspent funds. They have pointed to accusations that one of the companies lent public money to its CEO to buy a private plane. Some nonprofits have fired back with lawsuits, saying the state failed to give them a chance to answer concerns about the use of Medicaid money. (Montoya Bryan, 3/18)