The Emperor Has No Clothes: Medicaid Waiver Managing only Citizens 18 and over When Bulk of Medicaid Recipients are 18 and Under
The Medicaid Waiver being hoisted upon providers and clients (some call them 'consumers') alike is only associated with ADULT Medicaid Services and/ or I cannot discern how many 'Health Choice' Medicaid youth consumers are folded into the population numbers from the DMA information below.
What a sleight of hand! It looks like all these Medicaid consumers are about to be serviced by these LME-MCO's, wolfing down the money for administrative purposes, when, in fact, Health Choice consumers are OUTSIDE of this management.
See below the chart from a NC DMA website indicating consumers within the 4 age categories (you can click on the link and get a better view but I cut and pasted it also).
Here is how NC DMA describes Health Choice, which is part of NC Medicaid:
http://www.ncdhhs.gov/dma/healthchoice/
North Carolina Health Choice (NCHC) for Children is a free or reduced price comprehensive health care program for children. The goal of the NCHC Program is to reduce the number of uninsured children in the State to ensure that the population served will be healthy and ready to learn and work. If your family makes too much money to qualify for Medicaid but too little to afford rising health insurance premiums, your child(ren) may qualify for NCHC.
If a youth has 'Health Choice', this is not being monitored by the LME-MCO's as associated w/ this Medicaid waiver.
Notice below how that the bulk of the population across the LME's is in the population aged 0-17+ (meaning anyone less than 18 years of age).
Thus, all this Medicaid Waiver money flooding into the administration coffers of the LME-MCO's----all those new hires w/ fat salaries of 50 grand/ year plus benefits-----is mostly going towards administration.
Gee, what does this remind me of?
I know! I know!
The matter of the Medicare Advantage Plans (Humana; United Health, etc) having administration overhead of 15+% with Medicare having administration overhead of 5% or less.
********************************************
From: http://www.ncdhhs.gov/mhddsas/providers/1915bcWaiver/finalrfa11-1915bcwaiver4-1-11.pdf
page 15:
Table 2. Medicaid Eligible Individuals September 2010 for RFA Waiver Application
Minimum Requirement #1 Source: DMA’s management information system, DRIVE Client-Population table, report date Jan. 12, 2011 LME cod e LME Name
age=0-2 age=3-17 age= 18-64 age= 65-200 Grand Total
101 SMOKY_MTN 11,060 36,002 34,018 13,069 94,149 83,089
102 WESTERN_HIGHLANDS 10,691 33,437 31,396 10,556 86,080 75,389
108 PATHWAYS 9,053 29,529 29,070 7,890 75,542 66,489
109 CATAWBA 5,783 17,800 14,106 4,436 42,125 36,342
110 MECKLENBURG 21,674 61,024 44,748 9,572 137,018 115,344
112 PIEDMONT 16,040 48,574 37,453 10,531 112,598 96,558
201 CROSSROADS 5,700 18,129 14,679 5,038 43,546 37,846
202 CENTERPOINT 12,327 37,401 29,731 8,568 88,027 75,700
204 GUILFORD 10,788 32,063 25,821 6,871 75,543 64,755
205 ALAMANCE_CASWELL 4,308 12,452 9,863 3,315 29,938 25,630
206 OPC 3,716 10,716 8,677 2,979 26,088 22,372
207 DURHAM 6,905 17,852 14,496 2,948 42,201 35,296
208 FIVE_COUNTY 6,008 20,425 21,500 6,906 54,839 48,831
303 SANDHILLS 13,964 43,983 35,369 10,795 104,111 90,147
304 SOUTHEASTERN_RE G 9,054 30,277 29,933 8,702 77,966 68,912
305 CUMBERLAND 7,681 24,344 23,035 3,893 58,953 51,272
307 JOHNSTON 4,142 12,670 10,008 2,841 29,661 25,519
308 WAKE 14,924 40,437 27,235 6,726 89,322 74,398
401 SOUTHEASTERN 6,654 20,689 19,908 4,815 52,066 45,412
402 ONSLOW_CARTERET 3,769 11,108 10,734 2,533 28,144 24,375
405 BEACO N 7,346 23,388 20,983 6,797 58,514 51,168
407 ECBH 13,182 42,287 41,025 13,631 110,125 96,943
413 EASTPOINT E 8,933 27,914 23,081 7,700 67,628 58,695
Total 213,702 652,501 556,869 161,112 1,584,184 1,370,482
What a sleight of hand! It looks like all these Medicaid consumers are about to be serviced by these LME-MCO's, wolfing down the money for administrative purposes, when, in fact, Health Choice consumers are OUTSIDE of this management.
See below the chart from a NC DMA website indicating consumers within the 4 age categories (you can click on the link and get a better view but I cut and pasted it also).
Here is how NC DMA describes Health Choice, which is part of NC Medicaid:
http://www.ncdhhs.gov/dma/healthchoice/
North Carolina Health Choice (NCHC) for Children is a free or reduced price comprehensive health care program for children. The goal of the NCHC Program is to reduce the number of uninsured children in the State to ensure that the population served will be healthy and ready to learn and work. If your family makes too much money to qualify for Medicaid but too little to afford rising health insurance premiums, your child(ren) may qualify for NCHC.
If a youth has 'Health Choice', this is not being monitored by the LME-MCO's as associated w/ this Medicaid waiver.
Notice below how that the bulk of the population across the LME's is in the population aged 0-17+ (meaning anyone less than 18 years of age).
Thus, all this Medicaid Waiver money flooding into the administration coffers of the LME-MCO's----all those new hires w/ fat salaries of 50 grand/ year plus benefits-----is mostly going towards administration.
Gee, what does this remind me of?
I know! I know!
The matter of the Medicare Advantage Plans (Humana; United Health, etc) having administration overhead of 15+% with Medicare having administration overhead of 5% or less.
********************************************
From: http://www.ncdhhs.gov/mhddsas/providers/1915bcWaiver/finalrfa11-1915bcwaiver4-1-11.pdf
page 15:
Table 2. Medicaid Eligible Individuals September 2010 for RFA Waiver Application
Minimum Requirement #1 Source: DMA’s management information system, DRIVE Client-Population table, report date Jan. 12, 2011 LME cod e LME Name
age=0-2 age=3-17 age= 18-64 age= 65-200 Grand Total
101 SMOKY_MTN 11,060 36,002 34,018 13,069 94,149 83,089
102 WESTERN_HIGHLANDS 10,691 33,437 31,396 10,556 86,080 75,389
108 PATHWAYS 9,053 29,529 29,070 7,890 75,542 66,489
109 CATAWBA 5,783 17,800 14,106 4,436 42,125 36,342
110 MECKLENBURG 21,674 61,024 44,748 9,572 137,018 115,344
112 PIEDMONT 16,040 48,574 37,453 10,531 112,598 96,558
201 CROSSROADS 5,700 18,129 14,679 5,038 43,546 37,846
202 CENTERPOINT 12,327 37,401 29,731 8,568 88,027 75,700
204 GUILFORD 10,788 32,063 25,821 6,871 75,543 64,755
205 ALAMANCE_CASWELL 4,308 12,452 9,863 3,315 29,938 25,630
206 OPC 3,716 10,716 8,677 2,979 26,088 22,372
207 DURHAM 6,905 17,852 14,496 2,948 42,201 35,296
208 FIVE_COUNTY 6,008 20,425 21,500 6,906 54,839 48,831
303 SANDHILLS 13,964 43,983 35,369 10,795 104,111 90,147
304 SOUTHEASTERN_RE G 9,054 30,277 29,933 8,702 77,966 68,912
305 CUMBERLAND 7,681 24,344 23,035 3,893 58,953 51,272
307 JOHNSTON 4,142 12,670 10,008 2,841 29,661 25,519
308 WAKE 14,924 40,437 27,235 6,726 89,322 74,398
401 SOUTHEASTERN 6,654 20,689 19,908 4,815 52,066 45,412
402 ONSLOW_CARTERET 3,769 11,108 10,734 2,533 28,144 24,375
405 BEACO N 7,346 23,388 20,983 6,797 58,514 51,168
407 ECBH 13,182 42,287 41,025 13,631 110,125 96,943
413 EASTPOINT E 8,933 27,914 23,081 7,700 67,628 58,695
Total 213,702 652,501 556,869 161,112 1,584,184 1,370,482
posted by Marsha V. Hammond, PhD at 12:01 PM
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