Medicaid: Last Week Tonight with John Oliver (HBO)
LastWeekTonight・26 minutes read
Medicaid, a crucial program for low-income individuals, has seen millions losing coverage due to administrative chaos and procedural reasons. Issues like Medicaid fraud, overbilling by Managed Care Organizations, and illegal service denials highlight the challenges beneficiaries face, emphasizing the need for improvements in the program.
Insights
- The unwinding of Medicaid has led to a significant decrease in enrollment, with procedural issues causing many to lose coverage due to missing paperwork and eligibility checks after a relief bill expired.
- Managed Care Organizations (MCOs) in Medicaid have faced allegations of overbilling and prioritizing profits over patient care, with fixed monthly payments incentivizing cost-cutting that results in denied services for beneficiaries, highlighting the need for improved oversight and accountability in the system.
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Recent questions
What is Medicaid?
Public insurance for low-income individuals in the US.
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Summary
00:00
Medicaid Unwinding Causes Coverage Loss Chaos
- Medicaid is a public insurance program for low-income individuals, covering over 90 million people in the US.
- Due to the Medicaid unwinding, hundreds of thousands of Americans are losing their Medicaid coverage.
- Net enrollment in Medicaid dropped by over 11 million individuals in the last year, including nearly 5 million children.
- States began checking Medicaid eligibility after a relief bill expired, leading to many losing coverage due to procedural reasons.
- The unwinding process has caused administrative chaos, with many losing coverage due to missing paperwork.
- Medicaid was enacted in 1965 alongside Medicare, providing health care to the elderly and low-income individuals.
- Medicaid is a federal-state partnership, with the federal government matching state spending.
- Medicaid can be transformative, providing essential services like home health workers for people with disabilities.
- Accessing Medicaid can be challenging due to administrative errors, complex forms, and renewal requirements.
- Some states have implemented work requirements for Medicaid eligibility, leading to beneficiaries losing coverage and facing significant challenges.
14:25
Medicaid Fraud and Oversight Challenges in 2022
- Medicaid fraud recovery from beneficiaries in 2022 would yield less than $900,000, a fraction of the office's $6.4 million budget.
- Notable Medicaid fraud cases involve providers like the Herens in North Carolina, who scammed the system for at least $17 million by claiming to help deceased patients.
- Arizona saw fake rehab centers fraudulently billing over $2 billion for unnecessary or non-existent services, including a bill for alcohol rehab for a 4-year-old.
- Managed Care Organizations (MCOs) in Medicaid, like Centene, have faced allegations of overbilling in multiple states, settling for millions and raising concerns about prioritizing profits over patient care.
- MCOs receive a fixed monthly amount per person, incentivizing cost-cutting at the expense of necessary care, leading to heartbreaking stories of denied services in various states.
- Iowa's transition to MCOs resulted in a nearly 900% increase in members being illegally denied services, impacting individuals like Louis Fender who lost essential care and medications.
- Medicaid eligibility processes vary by state, with complex rules and frequent checks on income and work status, creating challenges for many applicants.
- Suggestions for improving Medicaid programs include streamlining eligibility processes using existing data, ensuring adequate resources for oversight, and conducting thorough public performance reviews of MCOs.
- Medicaid PSAs should accurately inform people about the complexities of the system, including eligibility criteria and state-specific rules, to help individuals navigate the process effectively.
