Medicaid: Last Week Tonight with John Oliver (HBO)

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Medicaid Unwinding and Administrative Challenges

Over 11 million individuals lost Medicaid coverage after the expiration of a pandemic-era policy.
States have faced difficulties in managing the unwinding process, leading to administrative issues and procedural errors.
Approximately 69% of coverage terminations were due to procedural reasons, highlighting administrative complexities.

Medicaid provides crucial support for individuals with disabilities, enabling access to home health services and necessary medical equipment.
Administrative inefficiencies, such as poorly designed websites, long wait times, and complex forms, hinder access to Medicaid.
States have varying approaches to Medicaid administration, resulting in disparities in care quality and accessibility.
The annual renewal process adds to the burden for individuals and families, with some states sending lengthy renewal questionnaires.
Technical glitches and administrative errors further complicate enrollment and renewal processes.

States have discretion in determining Medicaid eligibility, often adopting strict criteria that make it difficult for those in need to qualify.
Some states have implemented work requirements as a condition of eligibility, despite most adults on Medicaid already being employed.
Work requirements have caused beneficiaries to lose healthcare coverage and employment.
States aggressively monitor Medicaid eligibility, sometimes using questionable methods like posting names and photos of accused fraudsters online.
The cost of Medicaid fraud investigations often exceeds recovered funds.

MCOs are private companies that deliver and pay for healthcare for a large portion of Medicaid beneficiaries.
Concerns exist about the quality of care provided by MCOs and their profit-driven motives.
MCOs are incentivized to cut costs, leading to denied care and cost-cutting measures that compromise patient well-being.
In Iowa, after transitioning to an MCO-run Medicaid program, there was a nearly 900% increase in illegally denied services or care.
A doctor at an MCO testified that it was acceptable for people to be dirty for a few days, highlighting the disregard for patient well-being.

Medicaid is often difficult to obtain and easy to lose due to complex eligibility requirements and bureaucratic hurdles.
The author suggests adopting a universal healthcare model as a long-term solution.
Proposed reforms include simplifying eligibility processes, increasing oversight of MCOs, and ensuring adequate resources for Medicaid administration.