Medicaid

In rejecting PSA screening for prostate cancer, an influential federal panel has chipped a cornerstone of preventive medicine, declaring that it's not always best to catch cancer as early as possible. "At best, PSA screening may help only 1 man in 1,000 avoid death from prostate cancer," the U.S. Preventive Services Task Force said Monday. "Most prostate cancers found by PSA screening are slow growing, not life threatening, and will not cause a man any harm during his lifetime.

Three jobs, three layoffs and three mouths to feed. Losing my job made me realize the importance of health insurance and how devastating it is to lose it. I thank God that Medicaid was there to protect my family from utter devastation. I hope Congress does not destroy that protection for other working families who may need it. When, after 17 years on the job, Enclosure Corp. of Bristol closed down in 1990, I felt the world closing in on me. My wife already had been sick and I had just been diagnosed with diabetes.

SINCE LAST summer, when Gov. Corbett's administration started a massive effort to review whether Medicaid recipients were still eligible for their benefits, thousands of Philadelphia children have vanished from the rolls. Here's a look at the change in child Medicaid enrollments in Philadelphia County from August 2011 through January 2012. August 2011: 273,484. September 2011: 270,648. October 2011: 264,341. November 2011: 261,850. December 2011: 247,968.

The state budget crisis is about to hit home for hospitals, doctors and pharmacists. A spokeswoman for the state Department of Public Welfare yesterday said the agency was short nearly $29 million, because of lagging tax revenues, and, as a result, would be able to pay hospitals, doctors and pharmacies only part of what they are owed in the next Medicaid payment cycle. The department is scheduled to mail checks Friday to health-care providers for services they performed in recent weeks for Medicaid recipients.

ACOUPLE OF questions for Ed Rendell. (You remember him, don't you? He's the guy you see in Philadelphia during football season.): Ed, do you have any idea how hard it is for middle-class Pennsylvania residents to obtain Medicaid to cover a hospital bill? The leaders of our great state just decided, starting July 1, that U.S. citizens must prove they are such by providing an original birth certificate or passport. That seems fair, right? Don't answer just yet. An illegal alien can get Medicaid to cover a hospital bill with a notarized letter, a letter from the doctor and a copy of the bill.

RE YOUR editorial "Watchdog Bites Guv": I couldn't agree more that an in-your-face, my-way-or-the-highway approach to auditing isn't helpful or productive. But your reference to the auditor general finding $3.3 million in improper Medicaid health insurance benefits in this multibillion-dollar program is akin to the discovery that a dog recently bit a man. While any degree of error in a public program is regrettable, it is a minuscule part of the total spending. Moreover, the auditors failed to take into account the complexities of the program and the fact that many of the alleged errors are inadvertent bookkeeping errors that have nothing to do with the integrity of the program and may not even have caused any mistaken payment for health care.

WASHINGTON - President Obama's health-care law would let several million middle-class people get nearly free insurance meant for the poor, a twist that government number crunchers say they discovered only after the complex bill was signed. The change would affect early retirees: A married couple could have an annual income of $64,000 and still get Medicaid, said officials who make long-range cost estimates for the Health and Human Services Department. After initially downplaying any concern, the Obama administration said late Tuesday that it would look for a fix. Up to three million more people could qualify for Medicaid in 2014 as a result of the anomaly.

Commonwealth Court yesterday upheld a ruling by the state Department of Public Welfare denying additional medical-assistance reimbursement to Hahnemann University and Frankford Hospitals in Philadelphia. Senior Judge Jacob Kalish said a new reimbursement system put into place by the department was proper, even though the reimbursements might be "inadequate" or less than actual costs. Jennifer Stiller, a lawyer representing the two hospitals, said the decision would cost Hahnemann and Frankford "in excess of a million dollars.

THEY DIDN'T peddle worthless stock derivatives that crashed the stock market, killing more than eight million jobs. They didn't wage two unnecessary, budget-busting wars. And they surely won't benefit from trillions in tax cuts for the wealthiest Americans. So why should the children of America's poorest families bear the brunt of the newfound, and phony, passion to cut the budget deficit - especially when the "banksters" who got us into this mess are pocketing record profits?

A psychiatrist who operated eight inner-city mental health clinics for more than a decade was placed on three years' probation yesterday with three months under house arrest for an admitted $122,000 Medicaid fraud. "I am very sorry for what I have done," Dr. Howard H. Wurtzel, 60, of Lower Merion, told U.S. District Judge Herbert J. Hutton. The lenient sentence came as a relief for the defendant, his family and friends who had praised Wurtzel for being a compassionate, dedicated physician who has helped thousands of patients over the past 34 years.

New Jersey is being asked to pay back $61 million in federal Medicaid reimbursements because the state has not documented whether some services claimed for disabled people were provided, U.S. government auditors said. The overbilling happened from 2005 to 2007 in a program that provides home care for mentally and physically disabled people, auditors at the Health and Human Services Department's Office of Inspector General said in a report today. The state billed the federal government $1.4 billion for the program during the period.

AS HIS critics see it, Gov. Corbett has declared war on Pennsylvania's poor. At a Senate Appropriations Committee hearing in February to discuss the administration's proposed $629 million in cuts for the state's public-welfare agency next year, state Sen. Vincent Hughes, D-Philadelphia, said the proposed cuts were "downright cruel," adding that "this administration is putting its foot on the neck of poor folks. " The proposed cuts come on top of $600 million in cuts to public-welfare spending in the current budget.

KHELI Muhammad was trying to schedule a routine pediatrician's appointment last summer when she discovered that her 2-year-old son, who has a congenital heart disorder, had been kicked off the Medicaid rolls. The 30-year-old mother of two boys was stunned. "It is written in stone that he's covered," Muhammad said of Samad, who qualifies for Medicaid based on his serious medical condition, not the family's income level. "He's pacemaker-dependent . . . [H]is heart will not beat without a pacemaker.

SINCE LAST summer, when Gov. Corbett's administration started a massive effort to review whether Medicaid recipients were still eligible for their benefits, thousands of Philadelphia children have vanished from the rolls. Here's a look at the change in child Medicaid enrollments in Philadelphia County from August 2011 through January 2012. August 2011: 273,484. September 2011: 270,648. October 2011: 264,341. November 2011: 261,850. December 2011: 247,968.

The Pennsylvania Department of Public Welfare's stepped-up efforts over the summer to target waste, fraud, and abuse quickly bore fruit in the fall. Adult Medicaid enrollment alone was down 109,000 through November. Cause and effect seemed clear. Advocates for the poor and disabled were outraged. Now, DPW has suddenly changed its reporting method. Revised calculations show a decline of just 6,000 participants for the same period. And when December is added in, enrollment is up by 23,000 since August - a time when officials agree that tens of thousands of people lost benefits after overdue reviews found they were ineligible.

More children lost Medicaid coverage in Pennsylvania in December than in the previous three months combined, according to new Department of Public Welfare numbers that show a total of 88,000 cut since August. Advocates for the poor and disabled say orders to quickly process a backlog of eligibility reviews, which has mushroomed to more than 700,000 cases, have pushed an already overwhelmed workforce over the edge. Many cuts that legal-services and social workers challenged turned out to involve paperwork that they say DPW lost - sometimes repeatedly, even when clients had receipts - or that had never been sent in the first place.

Since the day she was born, 19 months ago, Anabelle Linzey of Ridley Township has been on a category of state Medical Assistance that covers severely disabled children. Profound brain malformations limit her functions to those of a newborn, and she requires round-the-clock care. During one of his daughter's frequent hospital visits, Brian Linzey was told that Anabelle no longer had health insurance. Terrified - "One day without coverage would be like life or death," he said - he repeatedly called the state welfare office in Delaware County, but no one answered.

Since August, the Corbett administration has cut off more than 150,000 people - including 43,000 children - from medical assistance in a drive to save costs. That purge far exceeds what any other state has tried, health policy experts say, and officials may be walking a fine line between rooting out waste and erecting barriers to care for the poor and disabled. When most states were experiencing flat or rising Medicaid enrollment from the economic downturn, stepped-up eligibility reviews in Pennsylvania began producing a decline over the summer.

State Department of Public Welfare officials have been doing a bang-up job lately. But that's only if their marching orders have been changed from helping the neediest Pennsylvanians to letting thousands drop through gaping holes in the social safety net. With a mandate from Gov. Corbett and budget-conscious lawmakers to help squeeze $470 million in savings from the state's $10.6 billion in welfare spending, it's probably no surprise that...