obamacare

Brown prof on why so many RI elderly are in nursing homes

December 9th, 2014 at 5:58 pm by under Nesi's Notes, On the Main Site

My WPRI.com piece Monday on 12 things to know about Medicaid in Rhode Island has – happily! – gotten a lot more clicks and feedback than I expected. Thanks to all who read it.

The most interesting feedback I received was from Kali Thomas, an assistant professor of health services, policy and practice at Brown University, who thinks there are ways Rhode Island can reduce its far-above-average Medicaid spending on elderly residents:

I wanted to point out some interesting information about those highest spenders you referenced (particularly those in nursing homes).

One disappointing statistic is that we are ranked 43rd out of the 50 states with almost one-fifth of our population of nursing home residents identified as having low-care needs. These “low-care” residents are those who do not necessarily require the level of care provided in nursing homes. Specifically, they do not require assistance with any of the four late-loss activities of daily living – eating, bathing, toileting, or transferring – and they are not classified as needing extensive rehabilitation or identified as “clinically complex.” This suggests that were we able to provide them with supportive services in the community, they may be able to be cared for and sustained in a less restrictive and more appropriate setting. Focusing on efforts to reduce the numbers of low-care residents in our state is a great opportunity to reduce the excessive spending in our Medicaid program.

Previous work I have conducted with colleagues at Brown’s School of Public Health suggests that increased spending on home- and community-based programs, like home-delivered meals, is related to a lower proportion of low-care residents. Further analyses have suggested that increasing capacity in the home-delivered meals program can potentially result in savings to states’ Medicaid programs. However, despite legislative testimony I gave this past year highlighting the beneficial effects we could recognize by reinstating previous funding levels for our state’s Meals on Wheels program, the cuts that were made to the program have sadly remained in place.

I would like to draw attention to A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers, produced by AARP, SCAN Foundation and the Commonwealth Fund. It lists specific domains related to long-term care where we could use improvement and how we compare to other states. For example, Rhode Island ranks second to last in our efforts to re-balance Medicaid long-term care spending. As a state, only 16% of our Medicaid long-term care spending goes toward services provided in people’s home and in the community. Investing in relatively more affordable supportive services that enable people to remain in the community rather than being placed in costly nursing homes is one way we can lower overall costs. I believe that our state’s residents and policymakers need to have a better awareness of why we are among the highest spenders on long-term care and what we can do about it.

There is so much we can learn from other states and with our size, we are ideally positioned to enact changes to improve our system of long-term services and supports. Thank you for spreading awareness about our state’s Medicaid spending “problem.” Now, let’s focus on solutions!

Another interesting point was made by Secretary of Health and Human Services Steven Costantino, who pointed me to this July study by Pew looking at state Medicaid costs nationwide.

The Pew study shows Medicaid spending growth in Rhode Island averaged just 2% from 2000 to 2012, the third-lowest growth rate in the country and only half the national average of 4.1%. That’s far below the 7% growth rate for Medicaid spending projected last month by the House Fiscal Office.

The study also shows Medicaid spending per enrollee rose 13% in Rhode Island between 2000 and 2010, more than twice the national average of 13%. Also interesting: 33% of Rhode Island’s Medicaid enrollees were elderly and disabled, tied for fifth-highest share in the country.

Finally, if you want to dig in further on all these issues, you’ll want to read this 2007 “Future of Medicaid” report conducted by the Carcieri administration. It’s a very good overviews of the issues Medicaid was facing in Rhode Island pre-recession and pre-Obamacare, and has some terrific charts. For example, here’s another look at how Medicaid costs breakdown across elderly beneficiaries during the state’s 2005-06 fiscal year:

Medicaid elderly population RI costs 2007 report

One of the many challenges noted in the report: “Medicaid beneficiaries in mandatory coverage groups tend to be high-need, high-cost service utilizers. As is explained elsewhere in this report, by contrast, beneficiaries in the optional coverage groups are primarily children and families – e.g., RIte Care enrollees – who have less complex service needs and are less costly to cover.” It goes on to say:

Of critical importance is that recent efforts by the state to improve services to the adult populations “carved out” many of the high cost beneficiaries and focused instead on managing the care of users at the middle and lower ends of the cost distribution curve. This includes the soon to be implemented health plans for both elders and adults with disabilities. Yet, as these distribution curves reveal, care management is necessary for all beneficiaries and, in particular, for those who are high cost users, to ensure that the right services are being provided in the most appropriate setting.

And here’s another chart from that report, this one showing how fast RIte Care and RIte Share, the managed-care insurance program for lower-income children and adults, expanded during the Almond administration:

Medicaid RIte Care 1995 2006 enrollment

Ted Nesi ( tnesi@wpri.com ) covers politics and the economy for WPRI.com and writes the Nesi’s Notes blog. Follow him on Twitter: @tednesi


12 things to know about Medicaid in Rhode Island

December 8th, 2014 at 4:40 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – When Gov.-elect Gina Raimondo tapped Lt. Gov. Elizabeth Roberts as her secretary of health and human services on Sunday, the state’s incoming leader gave Roberts a clear mission: “We have to commit ourselves to being the national leader in controlling Medicaid costs.”

Why is Medicaid such a big deal, and why is Raimondo focusing on it? Here are 12 facts to help you understand the $2.7-billion-a-year program, its costs and its importance.

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Feds drop demand for $4.6M to fund HealthSource RI

May 27th, 2014 at 3:41 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – The head of Rhode Island’s HealthSource RI Obamacare marketplace said Tuesday the federal government is dropping its request that state lawmakers come up with $4.6 million to fund its operations, less than a week after the demand gave new ammunition to critics who want to shut down the marketplace.

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• Related: RI delegation weighs in on scrapping HealthSource RI (May 27)


RI delegation weighs in on scrapping HealthSource RI

May 27th, 2014 at 2:28 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island’s congressional delegation is taking a cautious approach to the state’s debate over whether to jettison HealthSource RI for the federal Obamacare marketplace, saying it’s a matter for state lawmakers to decide.

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• Related: Feds drop demand for $4.6M to fund HealthSource RI (May 27)


RI must find unexpected $4.6M to fund Obamacare

May 22nd, 2014 at 3:05 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – The head of Rhode Island’s HealthSource RI Obamacare marketplace revealed Thursday state lawmakers need to come up with $4.6 million to fund its operations in the next state budget, while urging them not to scrap the local system for the federal HealthCare.gov one.

HealthSource RI’s Christine Ferguson estimated that if Rhode Island scraps HealthSource RI and switches to HealthCare.gov, the federal government would fund it by charging a roughly 1.9% fee – for a total of about $17.3 million in 2016 – on all Rhode Island small businesses and individuals whose insurers sell coverage on HealthCare.gov, regardless of whether they themselves use it.

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91% pay first premiums for private HealthSource RI plans

May 2nd, 2014 at 4:22 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – The vast majority of individuals who signed up for private insurance plans through Rhode Island’s new Obamacare marketplace finished the process by paying their first premiums, the agency’s leader confirmed Friday.

HealthSource RI’s Christine Ferguson also confirmed that the agency is “in very serious discussions” with executives at UnitedHealth Group Inc. to have United start selling plans for individuals on the Rhode Island marketplace this fall.

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RI taxpayers face $52M tab as Medicaid enrollment soars

April 29th, 2014 at 2:43 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – It will cost Rhode Island taxpayers tens of millions of dollars more than originally projected to provide low-income residents with health insurance as enrollment soars amid the launch of President Obama’s health overhaul.

The extra Medicaid spending poses a significant challenge to newly elected House Speaker Nicholas Mattiello, D-Cranston, who is in the process of crafting a state budget for the upcoming fiscal year that starts July 1. He took over in March after the resignation of Gordon Fox.

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• Related: Cost of soaring Medicaid enrollment in RI is still a mystery (April 15)


Cost of soaring Medicaid enrollment in RI is still a mystery

April 15th, 2014 at 1:28 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Obamacare will likely cost Rhode Island more money than state leaders expected. But nobody knows exactly how much yet.

Figures obtained from the Chafee administration by WPRI.com show 34% of the 64,590 Rhode Islanders who signed up for Medicaid from October through March using the state’s new Obamacare marketplace, HealthSource RI, were eligible before the new law expanded the rules for who could sign up.

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Chart: Blue Cross has 98% RI market share under Obamacare

April 7th, 2014 at 10:24 am by under Nesi's Notes, On the Main Site

Here’s something Obamacare has hardly changed: the way one insurer dominates Rhode Island.

Blue Cross & Blue Shield of Rhode Island’s share of the individual health insurance market dipped from 100% in 2013 to 98% in 2014, as the launch of HealthSource RI more than doubled total enrollment of those who purchase plans directly for themselves rather than get them through an employer or the government, according to preliminary figures released last week by Blue Cross and HealthSource RI.

Take a look:

RI individual health insurance 2014

Blue Cross was the only insurer selling plans to individuals last year, but finally got a little bit of competition in 2014 when Neighborhood – which was created in 1993 to take advantage of local Medicaid changes – began offering commercial plans to individuals who make up to 250% of the federal poverty level.

(more…)


Obamacare swells RI individual insurance rolls to nearly 40,000

April 2nd, 2014 at 5:52 pm by under Nesi's Notes, On the Main Site

Rhode Island’s individual health insurance market has gotten considerably larger due to Obamacare.

Nearly 40,000 Rhode Islanders signed up for individual policies during the 2014 open enrollment period that ended Monday night, up from roughly 17,000 who did so in 2013, according to preliminary figures from the state’s new HealthSource RI marketplace and Blue Cross & Blue Shield of Rhode Island.

That total breaks down as 27,968 individuals who used HealthSource RI to sign up for plans from Blue Cross or Neighborhood Health Plan of Rhode Island, along with 11,271 who bypassed HealthSource and bought Obamacare-compliant policies directly from Blue Cross, the two organizations told WPRI.com.

Those 11,271 direct-purchasers are important to Blue Cross because they will be combined with those who bought through HealthSource RI to make up the insurer’s 2014 risk pool for individual insurance. The size and shape of the risk pool is crucial to determining how much premiums will cost.

Gary Claxton, an expert at the Kaiser Family Foundation, told The New York Times that “these lives count every bit as much as the ones that came in through the exchange” for insurers because of the risk pool issue.

(more…)


Medicaid enrollment from HealthSource RI hits 56,531

April 1st, 2014 at 3:05 pm by under Nesi's Notes

From my updated story on the new Obamacare enrollment numbers:

Separately, the R.I. Executive Office of Health and Human Services told WPRI.com 56,531 individuals used HealthSource RI to sign up for Medicaid, the government health insurance program for low-income individuals, from Oct. 1 to March 22. That’s far more than what state officials had forecast, which was for 28,000 Medicaid sign-ups by Sept. 30 and 51,000 by March 2015.

At this point, then, more than 84,000 Rhode Islanders have signed up for health insurance through the new Obamacare marketplace since it opened Oct. 1 when private and Medicaid enrollment are combined. Blue Cross was not immediately able to say how many others have signed up for coverage directly through its website, bypassing HealthSource RI.

• Related: Chart: 6.5% in RI sign up under Obamacare, most for Medicaid (March 18)


Nearly 28,000 in RI signed up for HealthSource RI plans

April 1st, 2014 at 12:26 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Nearly 28,000 Rhode Islanders signed up for private health insurance plans through the state’s new Obamacare marketplace before Monday night’s deadline to enroll, according to a preliminary count.

HealthSource RI spokeswoman Dara Chadwick said 27,968 individuals signed up for private plans through the new marketplace between Oct. 1 and the 11:59 p.m. deadline for 2014 enrollment, 1,840 of whom signed up Monday. The number is expected to rise as others finish getting processed.

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Over 26,000 sign up for private Obamacare plans in RI

March 31st, 2014 at 2:00 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – The number of Rhode Islanders signing up for private health insurance plans through the state’s new Obamacare marketplace has surged ahead of Monday night’s deadline to enroll, WPRI.com has learned.

A total of 26,128 individuals had signed up for private plans through the HealthSource RI marketplace as of Sunday night since the start of enrollment Oct. 1, up from 19,690 as of March 8, HealthSource RI spokeswoman Dara Chadwick told WPRI.com.

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Chart: 6.5% in RI sign up under Obamacare, most for Medicaid

March 18th, 2014 at 6:00 pm by under Nesi's Notes, On the Main Site

Since Oct. 1, more than 68,000 Rhode Islanders – roughly 6.5% of the state’s population – have signed up for health insurance through HealthSource RI, the state’s new Obamacare marketplace. But two-thirds of them have enrolled in a program that was actually created by Lyndon Johnson, not Barack Obama.

Medicaid, the government health program for low-income Americans, has gotten the majority of sign-ups on HealthSource RI: 48,602 of the 68,292 Rhode Islanders who used the new marketplace to enroll through March 8 were added to the state’s Medicaid rolls. (Even that may understate the Medicaid share, since 3,345 of the 19,690 who signed up for private insurance plans hadn’t paid their first premiums yet.)

In fact, while December was HealthSource RI’s biggest month for private insurance enrollment so far, the most recent reporting period from Feb. 12 to March 8 was actually the biggest one yet for Medicaid. The deadline to sign up for private plans for 2014 is March 31, but there is no deadline to sign up for Medicaid.

Medicaid enrollment has already far surprised Rhode Island officials’ expectations, which was for 28,000 residents to sign up by Sept. 30. Here’s a chart that shows the pace of individual enrollment on HealthSource RI since the marketplace began accepting applications on Oct. 1:

HealthSource_RI_enrollment_Oct_1_March_8


Watch Newsmakers: Gov. Lincoln Chafee in his final year

January 19th, 2014 at 5:00 am by under Nesi's Notes


Blue Cross, older enrollees dominate HealthSource RI; 30 hired

January 13th, 2014 at 5:48 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island’s new Obamacare insurance marketplace, HealthSource RI, said Monday nearly 10,000 people have enrolled in private plans and paid their first premiums, with the vast majority choosing a federally subsidized plan from Blue Cross & Blue Shield of Rhode Island.

Christine Ferguson, HealthSource RI’s executive director, called the enrollment numbers “a good, solid beginning” but acknowledged the wait times for people to reach its call center are still “too high.” The agency is bringing on roughly 30 additional employees to handle the volume, she said.

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New Medicaid sign-ups under Obamacare pass 20,000 in RI

January 8th, 2014 at 3:12 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – More than 20,000 Rhode Islanders have used the state’s new HealthSource RI Obamacare marketplace to sign up for Medicaid, the government insurance program for low-income Americans, WPRI.com has confirmed.

The number of Medicaid enrollments through HealthSource RI totaled 19,941 as of Wednesday, with an additional 1,500 sign-ups pending, David Burnett, chief of government and public affairs at the R.I. Executive Office of Health & Human Services, revealed Wednesday in response to a request from WPRI.com.

The number of Medicaid sign-ups on HealthSource RI roughly quadrupled in December, jumping from 5,280 to 19,941, amid a drumbeat of publicity about deadlines to get coverage under President Obama’s new health law.

(more…)


HealthSource RI quietly extends deadline again amid long waits

January 7th, 2014 at 4:52 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island’s new Obamacare insurance marketplace, HealthSource RI, has quietly extended the deadline for newly enrolled individuals to pay their first premiums amid reports of multihour wait times at its contact center.

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• Related: HealthSource RI enrollment quadrupled to 11,305 in December (Jan. 7)


RI lawmakers may get déjà vu once 2014 session starts today

January 7th, 2014 at 5:00 am by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island’s 113 state lawmakers may get a sharp sense of déjà vu Tuesday when they return to Smith Hill for the first time since July.

The House and Senate will convene at the State House at 4 p.m., when House Speaker Gordon Fox and Senate President M. Teresa Paiva Weed will gavel their 2014 sessions to order. But most of the big issues on their radars so far are hardy perennials from prior sessions: pensions, tolls, 38 Studios, taxes and a persistently weak economy.

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HealthSource RI enrollment quadrupled to 11,305 in December

January 6th, 2014 at 7:22 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island’s new Obamacare insurance marketplace, HealthSource RI, enrolled 11,305 individuals in private health insurance plans from Oct. 1 to Dec. 31, though not all of them have paid their first premiums, according to preliminary figures released Monday.

That’s more than four times the 2,649 who had enrolled as of Nov. 30 and more than double the 5,469 who’d enrolled as of Dec. 14. It’s double the Obama administration’s internal forecast for enrollment, and about one-third the level a consulting firm expects the state to reach by March 31.

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HealthSource RI enrollment triples in Dec.; deadline is tonight

December 31st, 2013 at 3:35 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – HealthSource RI enrolled 9,803 individuals in private health insurance plans from Oct. 1 to Dec. 28, according to preliminary figures the agency released Monday. That’s more than triple the 2,649 who had enrolled as of the end of November and an increase of 4,334 since Dec. 14.

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‘Exceptionally high’ demand hits HealthSource RI pre-Dec. 31

December 30th, 2013 at 5:57 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island’s new Obamacare insurance marketplace, HealthSource RI, says it’s struggling to manage high demand ahead of Tuesday’s deadline for individuals to sign up if they want to have health coverage on New Year’s Day.

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HealthSource RI enrollment doubled over first 2 weeks of Dec.

December 23rd, 2013 at 7:53 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island’s new Obamacare insurance marketplace, HealthSource RI, says the pace of enrollment has been picking up as a deadline nears for individuals to sign up if they want to have health coverage on New Year’s Day.

HealthSource RI enrolled 2,820 individuals in private health insurance plans over the first two weeks of December, according to figures the agency released Monday. That was more than twice as many people as HealthSource RI signed up during the entire months of October and November combined.

Read the rest of this story »

• Watch: HealthSource RI’s Christine Ferguson (Dec. 5) | BCBSRI’s Peter Andruszkiewicz (Dec. 12)


HealthSource RI extends deadline again, this time to Dec. 31

December 17th, 2013 at 4:24 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Individuals will be able to sign up for health insurance coverage until Dec. 31 and still have it take effect on New Year’s Day, HealthSource RI spokeswoman Dara Chadwick told WPRI.com on Sunday. They will also have until Jan. 6 to pay their first premiums.

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• Related: Blue Cross CEO: HealthSource RI enrollment ‘disappointing’ (Dec. 12)


Watch Executive Suite: Blue Cross CEO Peter Andruszkiewicz

December 16th, 2013 at 5:00 am by under Nesi's Notes


Blue Cross CEO: HealthSource RI enrollment ‘disappointing’

December 12th, 2013 at 7:46 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Enrollment in private health insurance plans through the state’s new HealthSource RI marketplace hasn’t met early expectations as federal-level havoc caused confusion, Blue Cross & Blue Shield of Rhode Island CEO Peter Andruszkiewicz said Thursday.

“We definitely have fewer people than we anticipated at this point,” Andruszkiewicz said during a taping of myRITV’s Executive Suite. “There’s no question about it … and that’s disappointing.”

Read the rest of this story »

• Watch: Executive Suite with Blue Cross RI CEO Peter Andruszkiewicz (Dec. 12)


Private plan sign-ups through HealthSource RI reach 2,669

December 11th, 2013 at 4:41 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – HealthSource RI, Rhode Island’s new Obamacare marketplace, enrolled 2,669 individuals in private health insurance plans during its first two months of operation, the Obama administration announced Wednesday.

Read the rest of this story »

• Watch: Executive Suite with Health Source RI’s Christine Ferguson (Dec. 5)


Watch Executive Suite: HealthSource RI’s Christine Ferguson

December 9th, 2013 at 5:00 am by under Nesi's Notes


Federal Obamacare glitches ‘devastating’ for HealthSource RI

December 5th, 2013 at 9:06 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – The Obama administration’s botched launch of the health law’s online marketplaces has created problems for Rhode Island even though the state’s own locally built system has been working well, HealthSource RI executive director Christine Ferguson acknowledged Thursday.

“For us what happened at the federal level has been somewhat devastating,” Ferguson said during a taping of Executive Suite. “If you think about marketing – anytime you have to do marketing or sales, if you’ve got some huge thing that’s affecting your ability to get your message out, it seriously dampens your ability to do it.”

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• Watch: Executive Suite with HealthSource RI’s Christine Ferguson (Dec. 5)


HealthSource RI’s sign-up period extended through Dec. 23

November 24th, 2013 at 6:09 pm by under Nesi's Notes

By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Islanders will be able to sign up for health insurance coverage until Dec. 23 and still have it take effect on New Year’s Day, HealthSource RI spokeswoman Dara Chadwick told WPRI.com on Sunday. HealthSource RI is the state’s Obamacare marketplace.

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