Medicaid: Last Week Tonight with John Oliver (HBO)

LastWeekTonight
18 Apr 202428:12

Summary

TLDRThe video script discusses the challenges and issues within the Medicaid system in the United States. It highlights the 'Medicaid unwinding', where hundreds of thousands of Americans are losing their Medicaid coverage due to eligibility rechecks post-pandemic relief measures. The script criticizes the lack of innovation in healthcare administration, the complexity and inefficiency of the enrollment and renewal processes, and the moralizing tone of some state policies, such as work requirements for Medicaid eligibility. It also calls out the role of Managed Care Organizations (MCOs) in denying necessary care to prioritize cost savings. The speaker advocates for more efficient administration, better use of existing databases for eligibility, increased oversight of MCOs, and a push towards a universal healthcare model.

Takeaways

  • 📉 Medicaid, a public insurance program for low-income individuals, has seen a significant drop in enrollment due to the 'Medicaid unwinding', leaving many without coverage.
  • 🚫 The unwinding process has been characterized by people being removed from Medicaid without notice, leading to confusion and a lack of access to necessary healthcare.
  • 📈 Medicaid covers a vast number of Americans, with over 90 million people enrolled at its peak, but the unwinding has reduced this number by over 11 million, including nearly 5 million children.
  • 🔄 The unwinding was partly by design, stemming from a pandemic relief bill that initially prevented states from removing people from Medicaid but expired in March, leading states to reevaluate eligibility.
  • 📝 Administrative issues, such as missing paperwork, have led to the termination of coverage for 69% of those who lost Medicaid, highlighting systemic flaws in the program's administration.
  • 👶 Stories of families with children who have severe health conditions, like leukemia, being abruptly dropped from Medicaid illustrate the human impact of these administrative shortcomings.
  • 💰 Medicaid is a joint federal-state program with significant state discretion, which can result in varying levels of care and accessibility across different states.
  • 🤔 The script questions the moralizing tone of some state policies, such as work requirements for Medicaid eligibility, which may not align with the realities of most enrollees who are already working or unable to work due to disability or education.
  • 🚫 Managed Care Organizations (MCOs), which oversee a large portion of Medicaid enrollees, have been criticized for denying necessary care to cut costs, prioritizing profits over patient health.
  • 💔 Cases like Louis Fender's, who lost critical services after an MCO took over his care, exemplify the negative consequences of prioritizing cost savings over comprehensive healthcare.
  • 📋 The script suggests improvements such as leveraging existing databases for eligibility checks, increasing oversight of MCOs, and ensuring Medicaid agencies have the resources to enforce compliance.

Q & A

  • What is the significance of Medicaid in the US healthcare system?

    -Medicaid is a public insurance program that provides health coverage to people with low incomes. It represents one out of every six dollars spent on healthcare in the US and, as of last year, covered more than 90 million people.

  • What is the 'Medicaid unwinding'?

    -The 'Medicaid unwinding' refers to the process where hundreds of thousands of Americans are being removed from Medicaid coverage, sometimes with no notice. This has led to a rapid decline in the number of people insured by Medicaid.

  • Why was there a surge in Medicaid enrollment during the pandemic?

    -During the pandemic, an early relief bill included a requirement that states could not remove people from Medicaid. This was due to the global public health emergency and the fact that millions were losing jobs and getting sick.

  • How has the end of the public health emergency impacted Medicaid?

    -The end of the public health emergency led to the expiration of the policy preventing states from checking Medicaid eligibility. This resulted in states starting to reevaluate individuals' eligibility for the first time in three years.

  • What are some of the administrative issues that Medicaid beneficiaries face?

    -Administrative issues include navigating poorly designed websites, long wait times, complex forms and notices, and the need to renew coverage every year, which can be burdensome and lead to loss of coverage due to procedural reasons like missing paperwork.

  • What is the role of Managed Care Organizations (MCOs) in Medicaid?

    -MCOs are private companies that states contract with to deliver and pay for healthcare. They oversee care plans for the majority of Medicaid beneficiaries. However, they are paid a fixed rate per person, which incentivizes them to cut costs at the expense of necessary care.

  • Why are some states implementing work requirements for Medicaid eligibility?

    -Some states have implemented work requirements as a condition of Medicaid eligibility in an effort to promote the dignity of work and ensure that only those who are deemed to be contributing to society receive benefits. However, this approach has been controversial and faced legal challenges.

  • What are the consequences of losing Medicaid coverage for individuals?

    -Losing Medicaid coverage can have severe consequences for individuals, particularly those with chronic health conditions or disabilities. It can lead to a lack of access to necessary medications, medical treatments, and preventive care, potentially resulting in more severe health outcomes and increased medical costs.

  • How does the Medicaid system vary from state to state?

    -Medicaid is a partnership between the federal government and the states, which means that while there are some federal requirements, states have significant leeway in how they administer their programs. This leads to variations in eligibility criteria, coverage, and the services offered.

  • What are some of the larger issues with how Medicaid has been administered?

    -Larger issues include the difficulty in accessing Medicaid due to administrative barriers, the variability in state administration leading to unequal access and quality of care, the implementation of work requirements, and the role of MCOs which may prioritize cost-cutting over patient care.

  • What steps could be taken to improve the Medicaid system?

    -Improvements could include leveraging existing databases for eligibility determination, ensuring adequate federal oversight of state Medicaid programs, increasing transparency and public scrutiny of MCOs, and simplifying the application and renewal processes to reduce user errors and improve timely renewals.

Outlines

00:00

😀 Medicaid's Challenges and the Unwinding Process

The first paragraph discusses the lack of innovation in the healthcare industry, particularly concerning Medicaid, a public insurance program for low-income individuals. It highlights the massive scale of Medicaid, covering over 90 million people, or roughly one out of every six dollars spent on healthcare in the US. However, due to the 'Medicaid unwinding', hundreds of thousands are losing their coverage, sometimes without notice. The unwinding began as a policy response to the pandemic, preventing states from removing people from Medicaid, but this policy expired, leading to states reevaluating eligibility and resulting in a significant drop in enrollment.

05:01

😕 Medicaid's Administrative Hurdles and Impact

Paragraph two delves into the history and structure of Medicaid, established in 1965 alongside Medicare. It contrasts Medicare's federal nature with Medicaid's state-federal partnership, allowing states flexibility in program administration. While Medicaid can be life-changing for those with disabilities, the reality is that accessing and maintaining coverage is fraught with difficulties. These include complex application processes, long wait times, and frequent renewal requirements. The paragraph also criticizes the moralistic tone of some state policies, such as work requirements for Medicaid eligibility, which have proven to be more burdensome than beneficial.

10:02

😡 The Human Cost of Medicaid's Work Requirements

The third paragraph focuses on the negative consequences of implementing work requirements for Medicaid eligibility in certain states. Despite most adult Medicaid recipients already being employed, work requirements created unnecessary hardships. The case of Arkansas is highlighted, where thousands lost coverage due to administrative challenges, leading to severe impacts on individuals' health and employment. The paragraph also touches on the broader debate around Medicaid, with critics arguing against perceived abuses of the system, while advocates emphasize the need for healthcare as a basic right.

15:03

🤔 Medicaid Fraud and the Role of Managed Care Organizations

This paragraph discusses the issue of Medicaid fraud, emphasizing that it is often committed by healthcare providers rather than patients. It provides examples of providers defrauding the system, such as a North Carolina case involving millions and an Arizona case with fake rehab centers. The paragraph also criticizes Managed Care Organizations (MCOs), private entities contracted by states to manage Medicaid benefits. It raises concerns about their profit incentives leading to reduced patient care and cites cases where MCOs have been accused of denying necessary services to cut costs.

20:04

😤 The Struggles of Medicaid Recipients with MCOs

The fifth paragraph presents a case study from Iowa, where the transition to MCOs managing Medicaid led to a nearly 900% increase in members being illegally denied services. It tells the story of Louis Fender, a man with cerebral palsy, who lost essential care and medications after an MCO took over his care. The paragraph also includes a doctor's testimony suggesting that it's acceptable for patients to be 'a little dirty' to save costs, which is met with outrage by the patient's family and the narrator.

25:05

😩 The Complexities and Inequalities of Medicaid Eligibility

The final paragraph addresses the complexities and inequalities in Medicaid eligibility across different states. It uses a humorous yet poignant dialogue between various fruits and vegetables to illustrate the varying and often confusing requirements for Medicaid. The paragraph underscores the difficulties faced by individuals in understanding and navigating the system, suggesting that more streamlined and compassionate approaches are needed.

Mindmap

Keywords

💡Medicaid

Medicaid is a public insurance program in the United States that provides health coverage to individuals and families with low incomes. It is a critical component of the healthcare safety net, representing a significant portion of healthcare spending in the country. In the video, Medicaid is central to the discussion, as it is undergoing changes that affect millions of Americans, including potential loss of coverage and administrative challenges.

💡Medicaid Unwinding

The term 'Medicaid Unwinding' refers to the process where states are removing individuals from Medicaid coverage, often due to procedural reasons or changes in eligibility criteria. The video discusses how this has led to a rapid decline in the number of people covered by Medicaid, causing significant distress and healthcare access issues for many, including children and those with chronic health conditions.

💡Administrative Cluster

An 'administrative cluster' in the context of the video refers to the chaotic and inefficient management of Medicaid, particularly in relation to the renewal process and eligibility verification. The term highlights the systemic issues within the Medicaid program that lead to people losing coverage due to paperwork errors or lack of communication, rather than actual ineligibility.

💡Work Requirements

Work requirements are conditions imposed on certain Medicaid beneficiaries, mandating that they engage in work or other activities as a prerequisite for maintaining their health coverage. The video criticizes this policy, illustrating how it can lead to people losing necessary healthcare coverage, even if they are working or face barriers to employment, such as disabilities.

💡Managed Care Organizations (MCOs)

MCOs are private companies that states contract with to deliver and pay for healthcare services for Medicaid beneficiaries. The video discusses how MCOs operate with a profit motive, which can lead to cost-cutting measures that deny necessary care to patients. The role of MCOs is contentious due to the impact on patient care and the potential for overbilling and fraud.

💡Eligibility Determination

Eligibility determination is the process by which states assess whether individuals qualify for Medicaid based on their income, health status, and other factors. The video points out that this process can be overly complex and burdensome, with lengthy forms and frequent renewal requirements contributing to enrollment barriers and loss of coverage.

💡Public Health Emergency

A public health emergency, such as the COVID-19 pandemic, triggers certain provisions that affect Medicaid coverage. During the pandemic, states were initially prohibited from removing people from Medicaid rolls. However, once the federal public health emergency declaration ended, states resumed eligibility checks, leading to the unwinding of Medicaid coverage for many.

💡Overbilling

Overbilling is the practice of charging more for services than what is actually provided or is necessary, which can be a form of fraud. In the context of the video, it refers to allegations against certain MCOs that they have overbilled Medicaid, leading to large settlements and increased scrutiny of their practices.

💡Healthcare Access

Healthcare access refers to the ability of individuals to obtain medical care when needed. The video emphasizes that Medicaid is a crucial pathway for many low-income individuals to access healthcare. Barriers to enrollment, complex bureaucracy, and the unwinding process threaten this access, impacting the health and well-being of millions.

💡Universal Healthcare Model

A universal healthcare model is a system where all residents of a country are provided with healthcare coverage, regardless of their income or employment status. The video suggests this as a potential solution to the problems plaguing Medicaid, advocating for a system that would offer more equitable and streamlined healthcare access.

💡Fraud Unit

A fraud unit is a specialized department or agency tasked with investigating and prosecuting fraudulent activities, such as Medicaid fraud. The video discusses how some states have dedicated units to combat Medicaid fraud, but questions the effectiveness and financial sense of these efforts, particularly when they target individual beneficiaries rather than the larger-scale fraud by providers.

Highlights

Medicaid is a massive public insurance program representing 1 in every 6 dollars spent on healthcare in the US, covering over 90 million people as of last year.

A process called 'Medicaid unwinding' has led to a rapid drop in enrollment, with hundreds of thousands of Americans losing their coverage, sometimes with no notice.

The unwinding began after a pandemic relief bill requiring states not to kick people off Medicaid expired in March 2023, leading states to start re-evaluating eligibility.

69% of those losing coverage had it terminated for procedural reasons like missing paperwork, with the majority not necessarily being ineligible.

Medicaid can be transformative when done well, providing crucial support like home health workers for people with disabilities.

However, Medicaid often doesn't work as intended, with administrative issues and barriers to access preventing eligible people from enrolling and maintaining coverage.

Even before the unwinding, in 2012 only 75% of eligible uninsured people were enrolled in Medicaid due to enrollment hurdles.

Some states have implemented work requirements for Medicaid, which has led to eligible people losing coverage and upending their lives.

There are concerns about fraud in Medicaid, but the costliest fraud is often committed by providers, not patients.

Managed Care Organizations (MCOs), which oversee 72% of Medicaid enrollees, are incentivized to cut costs at the expense of necessary care to increase profits.

There have been numerous cases of MCOs illegally denying care and prioritizing cost savings over patient needs.

The current unwinding and broader Medicaid system need to be run with more care, efficiency and oversight to better serve enrollees.

Potential improvements include using existing data to streamline eligibility determination, providing adequate resources for federal oversight, and holding MCOs accountable.

A universal healthcare model could be a long-term solution to the issues plaguing Medicaid and the broader US healthcare system.

Medicaid eligibility and enrollment processes vary significantly by state, with some states imposing strict requirements and limitations.

The talking peach Medicaid PSA humorously illustrates the confusing and inconsistent nature of Medicaid across different states.

Transcripts

00:04

our main story tonight concerns

00:06

Healthcare the industry that's done

00:07

basically no innovating in the past 50

00:09

years when it comes to big rolls of

00:11

paper you plop your bare ass

00:13

off specifically we're going to be

00:15

talking about Medicaid the public

00:17

insurance program that provides health

00:18

coverage to people with low incomes it

00:20

is massive representing one out of every

00:23

$6 spent on Healthcare in the US and as

00:26

of last year at least it covered more

00:28

than 90 million people the reason I put

00:30

that in the past tense is thanks to

00:32

something called the Medicaid unwinding

00:34

that number has been plummeting and fast

00:37

hundreds of thousands of Americans are

00:39

finding out they may be without all

00:41

important Medicaid coverage it's a

00:43

process they're calling Medicaid

00:45

unwinding they basically said hey sorry

00:47

uh you don't have insurance we took you

00:49

off the books they didn't even tell me

00:50

that it was dropped we have people that

00:53

we have served for 15 to 20 years and

00:57

suddenly they're dropped off Medicaid

00:59

it's true people getting kicked off

01:00

Medicaid and sometimes with no notice in

01:03

the last year net enrollment has dropped

01:04

by over 11 million individuals including

01:07

nearly 5 million children and just for

01:09

once could the government Blindside

01:11

people with something beneficial or even

01:13

just fun like if one day Congress

01:15

announced they'd be adding Shrek to

01:17

Mount Rushmore that would be something

01:19

he beening so naturally you may not have

01:20

even noticed he's in there there he is

01:22

right now and that is better Mount

01:24

Rushmore is better with Shrek on it and

01:28

the thing is all of this was to some

01:30

extent by Design the unwinding has its

01:32

Origins during the pandemic because when

01:34

covid started one early relief bill had

01:36

a requirement the states couldn't kick

01:38

people off Medicaid which was a good

01:40

idea given that there was a giant Global

01:42

Public Health Emergency and millions of

01:44

people were losing work and getting sick

01:46

but at the end of last March that policy

01:49

expired and for the first time in three

01:50

years State started checking people's

01:52

Medicaid Eligibility again some states

01:55

like Georgia even tried putting out PSAs

01:57

like this one to alert people to the

01:59

changes that we

02:02

coming hey did you know there may be

02:04

some big changes coming to your Medicaid

02:06

coverage you're a talking Peach sure am

02:10

but that's not important right now

02:11

what's important is that you visit stay

02:13

covered. ga.gov and update your contact

02:16

information why well the federal Public

02:17

Health Emergency may be ending soon so

02:19

it's important that you verify and

02:21

update your Medicaid account thank you

02:23

Mr py oh no that's my brother I'm George

02:27

it's excellent I mean it's all very good

02:29

but my favorite part there is the

02:30

Shopper saying you're a talking Peach

02:32

and it responding sure am but that's not

02:34

important right now uh disagree talking

02:37

Peach you're a piece of fruit that can

02:39

talk that is maybe the most significant

02:41

event in the history of humanity or

02:43

fruit if that were to happen every

02:45

government would have to rethink their

02:47

farming policies immediately the UN

02:49

would hold an emergency assembly

02:51

regarding the talking Peach issue and

02:53

how could anyone ever be comfortable

02:55

eating fruit again knowing that at any

02:57

moment it could go suddenly ow ow stop

03:00

you're hurting me now unfortunately

03:02

despite magnificent PSAs like that not

03:05

everyone heard about the Medicaid

03:07

unwinding or knew exactly what they had

03:09

to do to keep their health care and what

03:11

that has meant is that a process that

03:13

was theoretically just about removing

03:14

people who no longer qualified has in

03:16

many states turned into an

03:17

administrative cluster because 69%

03:21

of those who lost coverage had it

03:22

terminated for procedural reasons like

03:25

missing paperwork with that number

03:26

climbing as high as 93% in States like

03:29

Nevada and New Mexico that means the

03:31

overwhelming majority weren't

03:33

necessarily ineligible they might have

03:35

been their circumstances might have

03:37

changed but most lost coverage because

03:39

for one reason or another they or their

03:41

parent or Guardian never completed the

03:43

renewal process and for many that wasn't

03:46

their fault but the states take this

03:48

Florida family who received zero notice

03:51

that they had to do anything to maintain

03:52

their Medicaid coverage then suddenly

03:54

found that they lost it at the worst

03:56

possible time the past 24 hours have

03:59

been a nightmare for Liz Adams in that

04:02

time she found out her two kids were

04:04

dropped from Medicaid the news also came

04:06

a day before her 7-year-old son Brian

04:08

was set to have a biopsy procedure he's

04:11

currently in remission for leukemia I'm

04:13

mad I am mad I do not understand how

04:16

they can do this to a child Adams tells

04:18

us she never got a letter a call or any

04:20

other form of communication from DCF no

04:22

one else I can talk to not even the

04:24

doctor's offices can do anything they're

04:26

like we can tell them that it's

04:27

absolutely necessary that he needs

04:29

medical treat treat but we can't make

04:31

them give you your insurance back that

04:34

is terrible because anyone could tell

04:36

you that kid needs medical treatment I

04:38

could tell you that a magic eightball

04:40

could tell you that that octopus that

04:42

used to predict soccer matches could

04:43

tell you if you put out two pieces of

04:45

food each labeled with an option of what

04:47

to do it would ignore them both and

04:48

right in the sand what the is wrong

04:50

with you give the kid Medicaid you

04:52

monsters but the thing is everything

04:55

about the current unwinding is

04:56

emblematic of much larger issues with

04:58

how we've always administered Medicaid

05:00

so given that tonight let's talk about

05:02

Medicaid in general it was first enacted

05:04

in 1965 as part of the same law that

05:06

created Medicare the program providing

05:08

Health Care to the elderly and from the

05:10

start it was set up very differently

05:12

because while Medicare is a purely

05:14

Federal program Open primarily to

05:16

American 65 and older Medicaid is a

05:19

partnership between the federal

05:21

government and the states where the

05:22

federal government contributes at least

05:24

$1 in matching funds for every dollar a

05:26

state spends and while there are some

05:28

federal requirements that states must be

05:30

they get a lot of leeway in deciding how

05:32

to run their programs and when done well

05:35

the service they provide can be

05:36

transformative for instance Medicaid can

05:39

pay for people with disabilities to have

05:40

home health workers come and help with

05:42

mobility and daily living which is huge

05:45

as this activist pointed out a few years

05:47

ago when cuts to Medicaid spending were

05:49

being floated Medicaid paid for my

05:52

shower today made it so I was able to

05:54

eat breakfast help me put on my clothes

05:57

how's it going I breathe because of

06:00

Medicaid my

06:03

ventilator I move through the world

06:05

because of a wheelchair funded by

06:09

Medicade Medicaid touches everything in

06:12

my life and makes everything possible

06:14

exactly when Medicaid works it can be

06:17

amazing unfortunately it often doesn't

06:19

work that way which you can probably

06:21

guess by the fact that we're talking

06:22

about it now if this show was supposed

06:24

to make you feel good it wouldn't be

06:25

hosted by P it' be hosted by Stanley

06:28

Tucci can you imagine

06:30

you'd be watching an impossibly horny 30

06:32

minute deep dive on Negron right now

06:34

that's a better show I wish this were

06:37

that show you wish this were that show

06:39

but guys I'm sorry it just isn't the

06:42

thing is not all states offer care like

06:45

that or make it easy to get but there's

06:47

actually an even bigger problem here

06:49

which is that in general even for those

06:51

who qualify for Medicaid it can be

06:53

incredibly difficult to access and the

06:55

problems begin with basic administrative

06:57

fuckups like what happened to this

06:59

one-year-old in Florida Raven received a

07:02

Medicaid Health insurance card which by

07:04

the way has her correct date of birth on

07:05

it but the state kept rejecting it when

07:07

a doctor tried to run it on ground she's

07:09

not yet born she is not

07:11

born she is 13 months old alive but she

07:15

is not born she is still apparently a

07:17

fetus in my womb so I just pray she

07:19

doesn't get hurt or doesn't get severely

07:22

sick because I'm I'm out of luck they've

07:25

got copies of her birth certificate her

07:28

social security everything to prove she

07:30

was born including being physically

07:33

there wow that Family actually went

07:36

$2,000 into debt paying for routine care

07:39

for their child while the state tried to

07:41

figure out if she existed or not which

07:43

is ridiculous if you want to know if

07:45

someone was born here is a quick trick

07:46

just ask were you born if they say yes

07:50

they were born if they say no they were

07:53

born and if they just stare blankly at

07:55

you they were born I've made this into a

07:57

decision tree but it really doesn't feel

07:59

like that should have been

08:01

necessary for years people trying to

08:04

access Medicaid in their state have had

08:05

to navigate through poorly designed

08:07

websites long wait times and complex

08:09

forms and notices and those burdens have

08:11

had a real effect even before the chaos

08:14

of the unwinding in 20122 about a

08:17

quarter a quarter of uninsured people

08:20

eligible for Medicaid were not enrolled

08:22

in it often due to enrollment barriers

08:25

and the thing about Medicaid is you

08:27

don't just have to go through that

08:28

circus once you have to renew your

08:30

coverage every year which can be

08:31

incredibly honorous at one point

08:33

Tennessee was sending families who

08:35

wanted to renew their Medicaid a

08:36

questionnaire that could be as long as

08:38

47 pages and the state could be pretty

08:41

careless about doing that as one family

08:42

lost coverage after their renewal packet

08:45

was accidentally mailed to a horse

08:47

pasture which is obviously absurd

08:49

because horses aren't eligible for

08:51

Medicaid they get Healthcare through a

08:53

very different program called the glue

08:54

factory we all know this and look glitch

08:59

can occur in any system and they can

09:01

happen more often in government programs

09:03

which do tend to be underfunded

09:04

understaffed and operating on Ancient

09:07

technology and I'm not trying to reain

09:09

down on honest government employees

09:12

who have to process an endless barrage

09:13

of paperwork I have total sympathy of

09:15

how demanding those jobs are in fact

09:17

there's exactly one group of government

09:19

employees that is okay to make fun of

09:21

for something that is not their fault

09:22

and that is Secret Service agents for

09:24

the fact they are constantly being

09:25

bitten by the president's doc I'm sorry

09:28

I hope they're all fine but I'm still

09:30

going to laugh every time I think about

09:32

that but there are times when it feels

09:34

like the obstacles to getting Medicaid

09:36

have been put there deliberately so that

09:38

states can keep those that they see as

09:40

undeserving off the roles because States

09:43

get a lot of discretion in deciding who

09:44

is and isn't eligible for benefits and

09:47

in some they keep the bar to qualify

09:49

troublingly High all while adopting a

09:51

deeply moralizing tone take what

09:54

happened when the Trump Administration

09:55

gave some states permission to implement

09:56

work requirements as a condition of

09:58

Medicaid eligibility some were eager to

10:01

put those in place like this state rep

10:03

in Kentucky why do you think that work

10:06

requirements are going to

10:08

work it's an incentive I think that

10:11

there is dignity in work it's something

10:13

that is about the the the human person

10:16

so often I I say that our our sometimes

10:18

our charity becomes toxic to people in

10:21

our wanting to help them sometimes we

10:25

we've hurt them okay putting aside the

10:27

calling access to basic health care

10:29

charity is immediately infuriating it is

10:32

something that's about the human person

10:34

are you absolutely sure that's a

10:36

sentence because it sounds more like

10:38

something a drunk alien would say while

10:40

trying to describe a David Foster

10:41

Wallace book it's something that's about

10:44

the human person you know the humanoids

10:46

and their person

10:48

feelings but it's worth noting that the

10:50

majority of adults on Medicaid about 63%

10:53

are already working full or part-time

10:56

those who aren't are generally in school

10:58

or might have a disability preventing

11:00

them from working only leaving a very

11:01

small percentage of the population to

11:03

whom the policies could even apply now

11:05

fortunately Kentucky didn't end up

11:07

implementing a work requirement but

11:09

unfortunately Arkansas did and it didn't

11:12

go great for a start simply complying

11:14

with it was a hassle beneficiaries had

11:17

to report their work activities on a

11:19

glitch plagued web portal and just 6

11:21

months in 18,000 arons have been

11:24

stripped off Medicaid and locked out of

11:26

reapplication until the following year

11:28

and for some of those people who again

11:30

were already working losing access to

11:33

healthcare completely upended their

11:34

lives like this man who had a job at a

11:36

chicken plant Adrian McGonagle's Life Is

11:39

Coming Undone he became one of the

11:41

people that the state has booted from

11:43

the Medicaid roles in the last 3 months

11:45

he discovered this only when he went to

11:47

fill prescriptions at this drug store

11:49

and the pharmacist told him sorry your

11:51

coverage has been canceled and that it

11:52

was going to be like $340 for one of the

11:56

medications and like $80 for the other

11:58

one so he left empty-handed this was a

12:01

big deal because mogal has severe COPD a

12:04

chronic lung disease that makes it

12:06

difficult to breathe without his meds he

12:09

landed in the hospital multiple times

12:11

and missed a lot of work his supervisor

12:13

tried to accommodate him but he wasn't

12:15

healthy enough to perform his job so he

12:18

lost it yeah the work requirement for

12:21

Medicaid CA someone who was already on

12:23

Medicaid and working to lose both

12:25

Medicaid and their work which has to be

12:27

the most upsetting thing that's ever

12:28

happened in a chicken processing plant

12:30

apart from all the other things that

12:32

happen in there on purpose and while

12:34

Arkansas ditched that work requirement

12:36

after less than a year Georgia is now

12:38

experimenting with one and it is proving

12:40

just as stupid and just as frustrating

12:42

and that is the thing so much of the

12:44

talk around Medicade seems to Center on

12:46

the fear that someone somewhere might be

12:48

gaming the system you hear that argument

12:51

all the time the people in my district

12:54

that work hard that struggle to pay

12:56

their healthare they're very frustrated

12:58

when they see someone they know uh in

13:00

their small town where everybody knows

13:02

everybody they see someone that's not

13:04

working why should somebody have to go

13:06

to work every day and pay taxes to

13:09

provide something to someone who could

13:12

do the same thing but chooses not to and

13:14

I don't think it's unreasonable to say

13:16

that able-bodied people who are working

13:18

age who are not disabled who are not

13:20

seniors should have to go to work if

13:23

they want someone else to pay for their

13:24

health care look it goes without saying

13:26

that I disagree with Matt Gates on a lot

13:28

of issues his STS on immigration uh his

13:30

STS on gun control his STS on hanging

13:32

around with teenage girls we don't see

13:34

eye to eye on most things but on this I

13:37

particularly disagree because States

13:39

already aggressively monitor Medicaid

13:41

Eligibility and some of their efforts

13:43

can be deranged take Tennesse their

13:46

state Inspector General has a Medicaid

13:47

fraud unit that posts the names and

13:49

photos of people in arrests on a

13:51

government website and social media with

13:53

some even ending up on a most wanted

13:55

list this woman was charged with a

13:57

felony for supposedly receiving

13:59

Tennessee benefits while living in

14:01

Mississippi and wound up having to pay

14:02

$2,000 to bond out of jail and even more

14:05

to hire an attorney all just to show

14:07

that she'd not in fact committed

14:08

Medicaid fraud her driver's license just

14:10

had an outdated Mississippi address so

14:13

her only real crime there was not

14:14

wanting to stand in line at the DMV for

14:17

eight solid hours the head of that

14:20

Tennessee unit even acknowledged it cost

14:21

far more to run the Fraud Unit than the

14:23

office will ever recoup from people on

14:25

Medicaid who are usually lwi income

14:27

because even if the State recovered

14:29

every dollar from charges brought

14:31

against beneficiaries in 2022 the total

14:33

would amount to less than $900,000

14:35

compared to the office's budget of 6.4

14:38

million a year and look I'm not an

14:41

accountant despite having resting budget

14:43

analyst face but even I know that makes

14:46

no Financial sense and look I'm not

14:49

saying Medicaid fraud doesn't exist it

14:51

does but for the most part the costliest

14:54

fraud isn't being committed by patients

14:56

getting care they may not technically be

14:57

eligible for it's providers doing

15:00

like this a husband and wife living a

15:03

fairy tale lifestyle paid for by all of

15:06

us over a 3 to 4E period they were true

15:09

jet Setters in their private $900,000

15:12

plane the herens ran two Health Services

15:15

in North Carolina they build the state's

15:17

Medicaid system at least $17 million

15:20

most if not all of the patients they

15:22

claimed to help were already dead their

15:25

names gleaned from obituaries and

15:27

crosschecked with the

15:29

database that is obviously reprehensible

15:32

but if I could just give one quick note

15:33

to that news station everyone knows what

15:36

dead people are you don't have to show

15:38

b-roll of a cemetery for us to

15:41

understand the concept of death just

15:42

like when you said The Harens ran two

15:44

Health Services you didn't need to show

15:45

stock footage of a doctor writing

15:47

something down on a notepad but

15:49

interestingly you didn't do it all the

15:50

time did you like when you said the

15:52

phrase $7 million you didn't feel the

15:54

need to show this stock footage of cash

15:57

slowly falling out of the air but what

15:59

not how else will your viewers

16:00

understand what money is as if all that

16:03

weren't bad enough that guy liked to

16:05

post his business affirmations online

16:07

including never outlive your usefulness

16:09

doing big things requires one not to be

16:11

stuck on the little things and I'm not

16:13

doing a business that's new I'm doing a

16:15

new way of doing business a quote he

16:18

loved so much he posted it a second time

16:20

a month later but in red text instead of

16:22

yellow and I'll admit it didn't really

16:24

resonate when I read the yellow text

16:26

over dark green background version but

16:28

once I saw the red text over neon green

16:30

one I was like wow that is so

16:33

true that's totally what he was doing

16:37

but that is by no means the only case of

16:39

Medicaid providers defrauding the

16:41

government in Arizona there was a group

16:42

of fake rehab centers that for years

16:45

claimed fraudulent reimbursements for

16:46

patients who were either getting

16:47

Services they didn't need or not getting

16:49

them at all reportedly taking in more

16:51

than2 billion dollar from the state and

16:54

some of their submissions really should

16:56

have raised red flags like a bill for

16:58

alcohol rehabilitation for a 4-year-old

17:02

which is a little difficult to believe

17:03

if toddler alcoholism were a genuine

17:06

problem in this country You' have

17:07

definitely seen a TLC series about that

17:10

you know that is true and you'd probably

17:13

have watched it and while in both of

17:15

those cases the providers were

17:17

eventually caught it took years for that

17:19

to happen again and again the priority

17:22

seems to be making sure no individual

17:24

gets a penny more Healthcare than they

17:27

deserve even as states are weirdly BL

17:30

about much bigger amounts of money

17:32

flowing out the door to large

17:33

organizations and speaking of large

17:35

organizations there is one last massive

17:37

flaw with our Medicaid system and it has

17:39

to do with Managed Care organizations or

17:42

mcos these are private companies States

17:44

contract to deliver and pay for

17:46

healthcare currently 72% of Medicaid

17:49

beneficiaries are enrolled in a care

17:51

plan overseen by an MCO and it is Big

17:55

Business the five biggest mcos are on

17:57

the Fortune 500 including including

17:59

centine which has long been a favorite

18:01

of this guy

18:03

cenen yeah the healthcare plant provider

18:06

for government sponsored programs like

18:08

Medicare Medicaid this one's a long time

18:09

Kramer fa it's been out of favor but

18:11

Michael nidorf tells such a compelling

18:13

story Michael nidorf centine what a

18:16

horse that thing is you have impressed

18:18

me over the years as someone who is

18:20

really out for the consumer to get the

18:22

best health care you have Michael nid on

18:24

all the time no sen I think that Michael

18:27

nid is Amazing by the way he looks great

18:28

for 77 you got to get he's amazing and

18:31

he's just also a fantastic charitable

18:33

man okay you probably already knew that

18:35

cray was wrong about the company but

18:38

before we even get to that I'll point

18:39

out that the guy they just said looked

18:41

great for 77 was actually 79 and more

18:43

importantly died just four months later

18:46

it seems any optimistic prediction that

18:48

Jim kram is involved with is enough to

18:50

kill a business or even a

18:52

person seeing him compliment you on TV

18:55

is the closest thing we have to watching

18:57

the tape from the ring in your

18:59

life now as for centine itself there are

19:03

serious questions about how it's made

19:05

some of its money in 2021 after Ohio

19:07

sued it for over billing Medicaid it

19:09

settled and paid the state $88 million

19:12

in fact it's now settled allegations of

19:14

overbilling in at least 19 States for

19:16

nearly a billion and I would argue that

19:19

if you've had to do that you may not

19:21

deserve to exist as a company anymore

19:23

let alone have Wall Street's thirstiest

19:25

business boy go hubba hubba o over your

19:29

stock price and look Financial damage is

19:32

one thing but the most infuriating thing

19:33

about mcos is that as with so many

19:35

players in our for-profit health care

19:37

System they are incentivized to cut

19:39

costs at the expense of necessary care

19:41

because mcos get paid a set monthly

19:44

amount per person meaning they get a

19:46

fixed rate so their profit is whatever

19:49

they don't spend on patients and you can

19:52

probably see where this is going in

19:54

state after State there have been

19:55

heartbreaking stories of MC's denying

19:58

care and prioritizing cost cost savings

20:00

over patients there have been headlines

20:02

about this in Florida headlines about it

20:04

in Texas and headlines in Iowa and just

20:06

to focus on Iowa it transitioned to

20:08

using MOS to run its Medicaid Program in

20:10

2016 in just its first three years there

20:13

was a nearly 900% increase in members

20:16

being illegally denied services or care

20:19

and some of the cost cutting was

20:21

absolutely enraging like what happened

20:23

with Louis Fender who has cereal py and

20:26

was living with his mother he needs a

20:27

lot of care which prior to the switch

20:29

over was provided by Medicaid but once

20:32

an MCO got involved he lost a lot of

20:34

what he'd been getting starting with his

20:36

medications it was a nightmare it was it

20:39

was literally a nightmare and what am I

20:42

going to do I can't afford all that

20:44

medication also cut were his daily nurse

20:46

visits so for 6 weeks Louis went without

20:49

the inhome bathing and diaper changing

20:51

he had had for years he wasn't getting

20:54

changed like he would normally get

20:56

changed two or three times or more day

20:58

it wasn't just the services it was the

21:01

mental part of his his state of mind not

21:07

understanding why all this was happening

21:10

look that's obviously maddening and it

21:11

doesn't get any better when you hear a

21:13

doctor at a meral the MCO that took over

21:15

in Iowa explaining in a hearing about a

21:17

similar patient just what the corporate

21:19

thinking was about the necessity of

21:21

keeping people clean people have bow

21:24

movements every day where they don't

21:26

completely clean themselves and we don't

21:30

fuss over too much people are allowed to

21:32

be dirty you know I would allow him to

21:34

be a little dirty for a couple

21:36

days look I'll be honest when I first

21:39

heard that I thought that has to be

21:40

taken out of context there is no way a

21:42

doctor a licensed physician would

21:45

testify in a hearing that he thinks it's

21:46

okay if people have on them for

21:48

days so we got the full hearing I'm not

21:50

going to play it for you I'm just going

21:51

to tell you he said it he meant it and

21:54

it made me want to punch a hole in the

21:56

wall and just watch what happens when

21:58

Lou mom were told about what that doctor

22:00

just said what would you say to him if

22:02

you could if he was here I would spit in

22:04

his face to be

22:06

honest yeah right Louie you like to be

22:09

clean I think it's horrible I I don't I

22:13

don't have words for that yeah I'm kind

22:15

of struggling for Words too although I

22:17

will say Lou did kind of nail it there

22:19

by blowing that raspberry and I also

22:21

appreciated that reporter doing a full

22:23

gym from the office look to camera and

22:25

nodding but if I absolutely had to put

22:27

it into words I guess I'd say that

22:30

doctor with a rusty canoe I hope he gets

22:32

tetus of the balls and if he has a

22:34

problem with my language there I'd say

22:36

I'm allowed to be dirty people are

22:37

allowed to be a little dirty sometimes

22:39

apparently that's doctor's

22:41

orders and while legally I have to tell

22:44

you Amer Health eventually restored Lou

22:46

service it is a disgrace it was even a

22:49

fight to begin with look the reality of

22:51

Medicaid is that too often it's hard to

22:54

get easy to lose and not a priority for

22:56

the government or the companies we hire

22:58

to deliver care so what can we do well

23:01

as I've said before I personally think

23:03

the big solution here is to adopt a

23:04

universal healthcare model but in the

23:06

meantime I'd argue both the current

23:08

unwinding and Medicaid programs in

23:10

general need to be run with

23:12

significantly more care and efficiency

23:13

and there are ways to do that for

23:16

instance when it comes to determining

23:17

eligibility maybe rather than sending 47

23:20

page forms to horses states can instead

23:23

rely on information they already have in

23:25

their databases that seems like it would

23:27

make a bit more sense and Michigan is

23:29

actually a good example here it worked

23:31

with a design nonprofit to retool its

23:33

application and renewal processes for

23:35

all public benefits and the result was

23:37

that 95% of renewals were submitted on

23:39

time with a 60% drop in user errors on

23:43

the federal end Congress could ensure

23:45

that uh that the agency that administers

23:47

Medicaid has the resources it needs to

23:49

oversee State compliance and finally

23:51

when it comes to mcos if they are going

23:53

to continue playing a role here there

23:55

clearly has to be way more oversight

23:57

with performance reviews being thorough

23:59

and public especially when it comes to

24:01

things like denials of care and until

24:04

such time as we do all of that the very

24:06

least we can do is make Medicaid PSAs

24:08

that actually prepare people for the

24:11

realities of our current mess of a

24:15

system hey did you know you might be

24:18

eligible for Medicaid you're talking

24:20

Peach sure am but that's not important

24:23

right now what do you mean you can talk

24:26

could all peaches always talk sure we

24:28

could but don't focus on that because I

24:30

want to talk to you about Medicaid is

24:32

anyone else seeing this talking Peach I

24:35

see it too mommy the process of getting

24:37

on Medicaid is different depending on

24:39

where you live okay the good news is

24:42

that pretty much in all states generally

24:44

low-income children pregnant women and

24:46

families and people with disabilities

24:48

are eligible for Medicaid with some

24:51

exceptions are there going to be a bunch

24:52

of loopholes or something oh

24:55

you have no idea well he's right take my

24:59

State Texas oh my God there's more of

25:01

you mama what is that thing well I'm a

25:05

sweet potato now let's say you're a

25:07

single mom with two kids if you're

25:09

making over

25:11

$334 a month you're not eligible for

25:14

Medicade at all it's true and in Georgia

25:17

if you don't have kids you better be

25:19

working otherwise you can't get Medicaid

25:22

hey good for you you're not running a

25:24

charity over there there's dignity in

25:26

work it's something about about the

25:29

human person yes I agree hey y'all I'm

25:32

from Louisiana mom what's up with this

25:35

one's eyes yeah this one's got wrong

25:37

eyes in my state we check your finances

25:40

every 3 months to make sure you haven't

25:42

gotten some overtime or picked up some

25:44

season work or nothing guess what in

25:47

Wyoming if you're an adult without kids

25:49

or disabilities or a pregnancy you can't

25:52

qualify for Medicaid at all no matter

25:55

what your income is there's literally

25:58

Lally no way to qualify for it oh my

26:01

Lord is that true even if you're like

26:04

out of work and like making no money yes

26:08

honestly that's up it is

26:10

up I agree with the coconut that's super

26:13

up mommy I'm scared I know buddy

26:17

come over here stand on this side away

26:19

from the produce that's a cute kid you

26:21

got there thanks don't worry his

26:24

Medicaid coverage won't be cut I smell

26:26

more loopholes unless yes you

26:28

don't fill out the proper paperwork but

26:30

also maybe if you do but there's a

26:32

glitch in the system like I don't know I

26:34

mailing your form to a horse Pastor oh

26:37

it's happened y'all mhm hey how do we

26:40

know your kid was really you know born

26:43

anyway excuse me yeah if that kid wasn't

26:46

born then he doesn't get Medicaid prove

26:49

he was born prove he was born prove he

26:52

was born prove he was born he was born

26:56

Pro he was born was I born prove he was

27:00

born prove he stop prove he was born I

27:04

don't have to prove anything to you your

27:07

vegetables the child is the brute listen

27:11

I know this is all complicated so feel

27:13

free to just give your State Medicaid

27:15

office a call if you have any questions

27:17

be patient though in Florida it takes

27:19

more than an hour to get a live person

27:22

on the phone no way dude

27:30

I don't speak Spanish he said there's an

27:32

80% chance your car would disconnect by

27:35

accident what's the point of even

27:37

calling them because it's a fun thing to

27:39

do I agree with that okay we're leaving

27:43

now thank you Mr pachy oh Mr pachy is my

27:46

brother and you ate him last week what

27:50

and now we're going to eat

27:52

you oh

27:56

[Music]

27:58

oh

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