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States Continue to Cut Medicaid - Hospital Stays Reduced Due to Cost

Note: None of this should be taken as legal or tax advice.

Citing rising costs, Arizona and Hawaii are next in line for federal approval to limit hospital stays for Medicaid members.

The USA Today recently reported that Arizona plans to limit Medicaid member stays to 25 days per year starting as early as October 2011, while Hawaii plans to limit stays to 10 days per year beginning April 2012.

Opponents argue that the moves will: 
  1. Restrict access to health care.
  2. Result in higher costs to health care providers (hospitals).
  3. Result in higher costs for patients with private insurance.
States argue that the moves are an absolute necessity due to the economic downturn and the end of federal stimulus dollars.

What affect do you think this move will have?


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Small Businesses Continue to Drop Health Coverage

Note: None of this should be taken as legal or tax advice.

The percentage of small businesses in the United States offering health benefits dropped from 47% in 2000 to 42% in 2009.

A recent graphic provided by Bloomberg Businessweek (below) outlined how states like Arizona, Colorado, Florida, Illinois, Indiana, Michigan, Nebraska, North Carolina, and Wisconsin all saw the percentage of small businesses that offer health coverage drop by 9% or greater.  Michigan saw the greatest decline with a 14% decrease. 

Where does your state fall?

Small Business Health Benefits 


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PCIP High Risk Pool Eases Enrollment Requirements and Reduces Premiums by up to 40%

Note: None of this should be taken as legal or tax advice.

Premium rates for the Pre-Existing Condition Insurance Plan (PCIP) have been reduced by up to 40%, and restrictions on enrollment have been removed.     

The changes, announced by the Department of Health and Human Services (HHS), are effective July 1, 2011 and involve the following:

  • Reduction of premiums by up to 40% for 18 of the 23 states with federally-run PCIP programs
  • Removal of enrollment restrictions for all 23 states with federally-run PCIP programs 

The premium reductions will align costs with plans available on the individual market in each state.  The states that will see the most significant decrease in premium prices will be Alabama, Arizona, Delaware, Florida, Kentucky, and Virginia.

Enrollment in the federally-run high-risk pools will no longer be limited to applicants who have been denied private insurance coverage.  Now, applicants must only show a letter from a doctor stating that they have had a medical condition in the past year.

Will lowering premiums provide the incentive needed for new applicants to apply for PCIP?  How many new applicants will be eligible due to the removal of restrictions?


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Arizona Restores Medicaid Transplant Coverage

Note: None of this should be taken as legal or tax advice.


Late last year, the state of Arizona and its governor, Jan Brewer, were heavily criticized for a decision to drop Medicaid coverage for some organ transplants.  The decision was made in an attempt to lessen the $1 billion gap in the state's health care budget.

On April 7th, 2011, Governor Brewer reinstated the transplant services that were previously eliminated, allowing for the reinstatement of approximately 100 individuals that had lost their eligibility in October 2010.  The reinstatements are retroactive to April 1, 2011.       

While this is a welcomed move for some Arizona citizens, it did not come without sacrifice.  

In order to cut into its $1 billion health care gap, Arizona is planning a reduction of state funding of Medicaid by $510 million. 

What are your thoughts on the cuts and subsequent reinstatement?  Was the Medicaid transplant cut necessary or was it a temporary fix that bought the time needed to find more appropriate areas for budget reductions?  


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State-by-State Guide to PCIP (Federal Health Insurance Risk Pool)

Note: None of this should be taken as legal or tax advice.

In July, 2010, the health reform bill created the Pre-Existing Condition Exclusion Plan (PCIP) to provide health insurance coverage to uninsurable citizens. Currently, 24 states (including District of Columbia) administer their own PCIP program. The federal government and HHS run the program on behalf of the remaining states.

Eligibility for PCIP is based on the following criteria:
  • Legal citizen of the United States
  • Uninsured for 6-months prior to application
  • Denied an individual health insurance plan due to a pre-existing condition

A state-by-state summary is provided below for your convenience. Please add questions and suggestions via the comment section.


State Federal or State Run? State Program Name (if applicable) Additional PCIP Notes*
Alabama Federal N/A
Alaska State ACHIA-FED $1500 deductible plan, rates from $468/mo (25 yr old) to $1310/mo (55 yr old)
Arizona Federal N/A
Arkansas State CHIP
California State California PCIP
$1500 deductible plan, rates from $180/mo (25 yr old) to $564/mo (55 yr old)
Colorado State GettingUSCovered $2500 deductible plan, rates from $184/mo (25 yr old) to $486/mo (55 yr old)
Connecticut State CT PCIP Plan $1250 deductible plan, rates from $285/mo (25 yr old) to $628/mo (55 yr old)  
Delaware Federal N/A
District of Columbia Federal N/A  
Florida Federal N/A
Georgia Federal N/A
Hawaii Federal N/A  
Idaho Federal N/A
Illinois State IPXP $2000 deductible plan, rates from $135/mo (25 yr old) to $368/mo (55 yr old)  
Indiana Federal N/A
Iowa State HIPIOWA-FED $1000 deductible plan, rates from $261/mo (25 yr old) to $435/mo (55 yr old)  
Kansas State PCIP-KS $2500 deductible plan, rates available via phone at 1-877-505-0511
Kentucky Federal N/A
Louisiana Federal N/A
Maine State DirigoChoice Choice of three deductible amounts from $1250 - $2500
Maryland State MHIP $1500 deductible plan, rates from $141/mo (under 30) to $354/mo (65 and over)  
Massachusetts Federal N/A
Michigan State HIP Michigan $1000 deductible plan, rates from $241/mo (25 yr old) to $563/mo (55 yr old)  
Minnesota Federal N/A
Mississippi Federal N/A
Missouri State MHIP Choice of three deductible amounts from $1000 - $5000 with plan rates from $271/mo (25 yr old) to $570/mo (55 yr old)
Montana State MAC Plan $2500 deductible plan, rates from $219/mo (25 yr old) to $516/mo (55 yr old)  
Nebraska Federal N/A
Nevada Federal N/A
New Hampshire State NHHP-FED $1000, $2000, and $2500 deductible plan options, rates from $159/mo (25 yr old) to $520/mo (55 yr old)  
New Jersey State NJ Protect Several plan options with plan rates from $252/mo (25 yr old) to $440/mo (55 yr old)
New Mexico State NMMIP $500, $1000, and $2000 deductible plan options, rates from $168/mo (25 yr old) to $409/mo (55 yr old) 
New York State NY Bridge Plan Zero deductible plan with standardized premium rates ranging from $362/mo to $421/mo, depending on geographic location
North Carolina State Inclusive Health Choice of four deductible amounts from $1000 - $4500 with plan rates from $109/mo (25 yr old) to $276/mo (55 yr old)
North Dakota Federal N/A
Ohio State Ohio Risk Pool Choice of $1500 or $2500 deductible amounts with plan rates from $130/mo (25 yr old) to $358/mo (55 yr old), depending on geographic location
Oklahoma State OHRP $2000 deductible plan, rates from $137/mo (25 yr old) to $395/mo (55 yr old)  
Oregon State Oregon Medical Insurance Pool Choice of four deductible amounts from $500 - $1500 with plan rates from $266/mo (25 yr old) to $557/mo (55 yr old)
Pennsylvania State PA Fair Care $1000 deductible plan, with average rate of $283/mo 
Rhode Island State PCIPRI $1000 deductible plan, with plan rates from $231/mo (25 yr old) to $520/mo (55 yr old)
South Carolina Federal N/A
South Dakota State SD Federal Risk Pool $2000 deductible plan, with plan rates from $231/mo (25 yr old) to $535/mo (55 yr old)
Tennessee Federal N/A
Texas Federal N/A
Utah State Federal HIPUtah Choice of four deductible amounts from $500 - $5000 with plan rates from $137/mo (25 yr old) to $271/mo (55 yr old)
Vermont Federal N/A
Virginia Federal N/A  
Washington State PCIP-WA Choice of $500 or $2500 deductible amounts with plan rates from $221/mo (25 yr old) to $606/mo (55 yr old)
West Virginia Federal N/A
Wisconsin State HIRSP-Federal Choice of four deductible amounts from $500 - $3500 with plan rates from $113/mo (25 yr old) to $340/mo (55 yr old)
Wyoming Federal N/A
  
SRC:  Pre-Existing Condition Insurance Plan Website
*Monthly premium rates are estimates, please obtain unique individual quote based on your needs 


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Clarifying Health is a blog about health insurance, health benefits, and everything else related to how Americans pay for medical expenses.

If you have any tips or suggestions for this blog, send an email to blog@ZaneBenefits.com and let us know. We always appreciate feedback

We also run a company called Zane Benefits where we're doing everything we can to help America out of the current healthcare mess.

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