Improving Medicaid

Improving Medicaid

A recent audit of Louisiana’s old Medicaid eligibility system has drawn attention from the Trump administration. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma found it “deeply troubling” to learn that some people who enrolled in Medicaid coverage earned too much money to qualify for the program. The AP’s Melinda Deslatte reports that CMS will take a closer look at Louisiana, but notes that the state has already overhauled the way it verifies eligibility:

The U.S. Centers for Medicare and Medicaid Services said it will include Louisiana in a future review of how “high risk states” determine eligibility for government-financed Medicaid benefits, in response to work done by Louisiana Legislative Auditor Daryl Purpera. But the federal agency, known as CMS, also noted a computer system change launched by Gov. John Bel Edwards’ administration after Purpera’s audit. The Louisiana Department of Health now does quarterly eligibility checks, rather than previously performed annual checks, and uses more wage data for comparison. “As we understand, recent upgrades to Louisiana’s eligibility systems will help to address some of the issues identified,” CMS Administrator Seema Verma wrote in a March 8 letter to U.S. Sen. Ron Johnson, a Wisconsin Republican and chairman of a Senate oversight committee.

The audit that sparked all this was reviewed by Jeanie Donovan (then of Louisiana Budget Project) who broke down the numbers:

The “random sample” study conducted by the auditor was not a random sample of all Medicaid expansion enrollees or even of all 195,306 single-person households in Medicaid expansion. Rather, it was a random sample of the 19,226 single-person households that the auditor pre-identified as having average quarterly income above the Medicaid eligibility income limit. The auditor then found that 82 of those 100 pre-identified individuals were ineligible for Medicaid at some point during their enrollment in the program. The audit then applied that rate to the entire pre-identified population and estimated that 15,958 individuals were enrolled in Medicaid but earned above the income limit. When compared to the entire single-person household Medicaid population of 195,306 individuals, the actual statistic is that 8.2 percent of single-person households enrolled in Medicaid expansion at some point had income above the Medicaid eligibility limit, far different from the 82 percent reported in the audit summary.

Reality check: It’s certainly important to ensure that Medicaid coverage only extends to those who qualify. But more important is making sure that low-income people have access to health coverage, including preventive care. As the Affordable Care Act celebrates its nine-year anniversary this week, The Center on Budget and Policy Priorities notes that 20 million people have gained health insurance through the landmark law, including 500,000 Lousianans through Medicaid expansion.


The Trump tax cut did not “pay for itself”
Supporters of President Donald Trump’s massive tax cut law often claimed, without evidence, that it would end up paying for itself through increased economic growth. The argument went something like this:

Revenues would rise from the combination of higher wages and hours worked, greater investment returns, and larger corporate profits. Under this scenario, that “dynamic” effect would more than offset the entire “static” revenue loss of the tax cut.

Not surprisingly, the opposite has happened. As Brookings’ William G. Gale and Aaron Krupkin report in a new blog, the tax cut meant less revenue to the federal government – one reason that budget deficits are back to the trillion-dollar range.

The most appropriate test of the revenue impact of (the Tax Cut and Jobs Act) is to compare (a) actual revenues in FY2018 with (b) predicted revenues in FY2018 assuming Congress had not passed the legislation. In fact, the actual amount of revenue collected in FY2018 was significantly lower than the Congressional Budget Office (CBO)’s projection of FY2018 revenue from January 2017 – before the tax cuts were signed. The shortfall is $275 billion, or 7.6 percent of revenues that were expected before the tax cuts took place. Given that the economy grew, unless one can find some other change that caused a large revenue loss, the data imply that TCJA reduced revenues – substantially.


Time to revisit the Voting Rights Act
The Voting Rights Act of 1965 gave the federal government the ability to approve or deny changes to voting requirements in states and localities with a history of discriminatory practices, which included Louisiana. This protection was seen as vital in encouraging minority participation. But as Charlise Randall outlines in, a recent court case overturned the Voting Rights Act preclearance formula that allowed for the oversight:

In 2013, the Supreme Court ruled that section 4B of the Voting Rights Act was unconstitutional in the landmark Shelby County Alabama v. Holder case. This section, in culmination with section 5, gave oversight to the Department of Justice where locales with a history of voting discrimination were required to garner approval before changing election practices. Changes that would have a proven disparate impact on certain communities would be denied. In a 5–4 decision, Justices John Roberts, Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito explained their decision by stating that times have changed and that the clause was no longer necessary. This disregarded the “bail out” provision of the Act that said counties who could demonstrate that their discriminatory practices have been abandoned could be removed from oversight and that those who remain on the list had not done so to this day. By 2014, 14 additional states passed voter restriction statutes, including a myriad of voter ID laws.

Efforts are underway to restore federal oversight, Benjamin Barber of Facing South writes:

At the time it was struck down by the Supreme Court, the Voting Rights Act’s preclearance formula covered jurisdictions that had voter registration or turnout rates below 50 percent in 1964 and had employed discriminatory devices to discourage voting, like literacy tests. Jurisdictions were also allowed to “bail out” of preclearance if they could prove no voting discrimination for 10 years. That formula covered nine states as a whole (…) (U.S. Rep. Terry) Sewell’s H.R.4 sets out a new formula that the U.S. Department of Justice would use to determine which states need federal preclearance of election changes: those with 15 or more voting rights violations during the past 25 years, and those with 10 or more violations if at least one was committed by the state itself. Under that formula, 11 states would be subject to preclearance, most of them still in the South: Alabama, California, Florida, Georgia, Louisiana, Mississippi, New York, North Carolina, South Carolina, Texas, and Virginia.


The poor continue to pay for the government shutdown
The administrative chaos created by the recent federal government shutdown continues, with the state’s low-income residents bearing significant costs. The Supplemental Nutrition Assistance for Program (SNAP) issued benefits early in March to address the gap created by the shutdown. This month, as The Advocate reports, the Louisiana Department of Children and Family Services, which administers the program, will finally make its last adjustment to SNAP issuance, to get the program back on track after its January disruption. This administrative complication adds one more headache to families already juggling the demands of poverty.

The department said the modified schedule for April will ensure that SNAP recipients don’t go more than 40 days between issuances while transitioning families back to the normal schedule for May. March benefits were issued to current SNAP recipients on March 1 and 2 because of the government shutdown. Nearly 1 in 5 people in Louisiana receives food stamps — more than 850,000 people each year, many of them families with children. SNAP benefits are distributed based on several calculations but the biggest factors are household income and family size. In Louisiana, a single person whose net income is $1,012 or less each month would qualify for up to $192 in food stamps each month. A family of four with a net monthly income of up to $2,092 could get up to $642 a month.


Number of the Day
$275 billion –Shortfall in federal revenues in federal fiscal year 2018 directly attributable to the 2017 tax cut law (Source: Brookings)