Medicaid

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.

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.

When the state legislature passed a measure last year to include hospice care in Medicaid benefits starting Jan. 1, it in effect created a new benefit for AIDS patients. Typically, patients with acquired immune deficiency syndrome are too young for hospice benefits provided under Medicare, are unemployed and do not have private health insurance. But most do qualify for Medicaid, which is available to people who cannot afford medical care. Prior to Jan. 1, Medicaid did not cover hospice care, which is provided for people who are terminally ill. Hospice program administrators say they are hurrying to incorporate the new state provisions into the package of services they already provide for AIDS patients.

In a bid to build pressure on Gov. Corbett to expand Medicaid next year, Democratic members of the Pennsylvania Senate Appropriations Committee met Thursday in Philadelphia with city health officials, hospital experts, and advocates for the poor. The session in City Hall came less than two weeks before Corbett is to present his budget proposal for fiscal 2014. Were he to opt for Medicaid expansion under the Affordable Care Act, provisions for the rollout starting in October would have to be built into that budget, officials said.

TOP DEMOCRATS in the state Senate came to Philly on Tuesday to increase pressure on Gov. Corbett to "opt in" to an expansion of Medicaid offered under the Affordable Care Act, or "ObamaCare. " Following a report that said the state could save hundreds of millions by opting in, Democratic Leader Jay Costa, of Pittsburgh, and Philly's Vincent Hughes, the top Democrat on the Appropriations Committee, spoke at City Hall about the benefits they believe would result from an expansion of Medicaid, the state-federal program that provides health care to low-income Americans.

EVEN ON our better days, we have a hard time figuring out how Gov. Corbett's brain works - although not for lack of trying. We get that one of his big ideas is that bigger government is bad, and that free markets are better. That probably explains his resistance to allowing more federal dollars to flow into the state under an expansion of the Medicaid program. But Corbett is the governor of an entire state, not just a single party, so when economic benefits outweigh ideological beliefs, it's his job to make the decision that will help as many residents as possible.

TRENTON - New Jersey is gearing up for a huge expansion of its Medicaid health-care plan for the poor and, despite uncertainty over federal eligibility requirements, new enrollees are expected to begin receiving services by the Jan. 1 deadline, Human Services Commissioner Jennifer Velez said Tuesday. Velez, who testified before the Assembly Budget Committee on her department's proposed $15 billion budget for the fiscal year that begins July 1, said she expected about 300,000 new Medicaid enrollees to be added to the 1.3 million who receive care under the program.

A BOMBING in Boston on Patriots' Day. We don't know who did it yet, but does it really matter? The whole world seems to be about hate. I hate you because you don't look like me, or maybe you're a different color, or I don't like your sexual choices. Maybe I don't believe what you believe . Yes, it is a shame because religion does have a lot to do with the hate. I don't think that was what God intended. I just watched the series named "Bible. " It was the greatest series I have ever seen.

What first-term governor would welcome a legacy of letting thousands of low-income adults and children slip through widening holes in his state's health-care safety net? Gov. Corbett may be coming around to the realization that his track record in this area isn't likely to win many points with Pennsylvania voters around reelection time next year. Because of Corbett's austere spending policies, 41,000 working-poor adults lost access to adultBasic, the low-cost state health plan, almost as soon as he took the oath of office in early 2011.

  AmeriHealth Mercy Family of Cos. of Philadelphia received final approval Friday to take over the operations of the financially troubled DC Chartered Health Plan Inc., which managed Medicaid benefits for about 100,000 Washington residents. The deal calls for AmeriHealth Mercy, which is majority owned by Independence Blue Cross, to pay $5 million for certain assets of DC Chartered and to provide $30 million in capital to AmeriHealth District of Columbia, a new AmeriHealth subsidiary.

  HARRISBURG - Gov. Corbett, under pressure to accept a federal expansion of Medicaid, said Wednesday he was looking at ways to use that money to fund private coverage for hundreds of thousands of uninsured Pennsylvanians. Corbett has resisted opting into the Medicaid expansion envisioned under President Obama's health-care overhaul, saying he is concerned it would be too costly for the state down the road. He did not commit to changing his mind on Wednesday. After a late Tuesday meeting with Health and Human Services Secretary Kathleen Sebelius, however, he said he may consider pursuing a private plan similar to what Arkansas, Ohio, and a handful of other states are exploring.

HARRISBURG - Gov. Corbett, under pressure to accept a federal expansion of Medicaid, said Wednesday that he is looking at ways to use those same dollars to fund private coverage for hundreds of thousands of uninsured Pennsylvanians. Corbett has resisted opting into the Medicaid expansion envisioned under President Obama's healthcare overhaul, saying he is concerned it would be too costly for the state down the road. He did not commit to changing his mind on Wednesday. After a late Tuesday meeting with Health and Human Services Secretary Kathleen Sebelius, however, he said he may consider pursuing a private plan similar to what Arkansas, Ohio and a handful of other states are exploring.

For years, the Philadelphia region has been among the best places for a child to get sick. Pennsylvania's Children's Health Insurance Program, dating to 1992, was a model for what Congress expanded to all the states five years later. New Jersey set one of the easiest income thresholds for SCHIP and has aggressively enrolled children into Medicaid as well. New Jersey still has a top reputation, with more than 25,000 children added to the public insurance rolls since July 1, 2011.