Idaho Medicaid Case Makes it to U.S. Supreme Court & Why it Matters

Supreme Court

Last week the United States Supreme Court began hearing arguments in an Idaho case that could set a new precedent. The case centers on Idaho’s reimbursement rates for Medicaid providers. The case began in 2009 when 5 Idaho facilities sued the state in an effort to get an increase in the rates providers receive for treating Medicaid enrollees. The state lost the 2009 case and in 2011 a U.S. District Court ordered Idaho to increase reimbursement rates. Now the state has appealed the case all the way to the U.S. Supreme Court. The court’s ruling on this case could potentially affect Medicaid throughout all 50 states.

At the heart of the case is whether or not providers and other parties (such as patient advocacy groups) should be able to petition the courts in order to get states to increase reimbursement rates. Idaho officials have taken the position that reimbursement rates for Medicaid should only be set by states and federal government agencies. On the other hand, providers and others feel that they have no other option but to turn to the courts for assistance. With states “freezing” reimbursement rates for year or decades, Medicaid enrollees now face decreased access to care, and providers are faced with the decision as to whether or not they can afford to treat Medicaid patients.

Many are optimistic that the 5 agencies stand a chance to win this case due to compelling evidence that supports their argument. If Idaho losses this cases it will set a precedent and potentially open the doors for similar lawsuits in the future. The issue of “frozen” reimbursement is not a problem that is unique to only Idaho. There are other states like Florida and Pennsylvania that also have serious issues as well. Florida ranks as one of the lowest-paying states as it relates to reimbursing Medicaid providers. As a result of the low reimbursement, on December 31, 2014 a federal judge found that Florida violated federal Medicaid laws, because the state failed to ensure that Medicaid patients received care that they are guaranteed and entitled to as a Medicaid enrollee. In Pennsylvania, Medicaid reimbursement rates have been “frozen” at 1991 rate levels. As a result, it is estimated that Medicaid providers are only reimbursed for approximately 30% of the actual cost of each treatment for their Medicaid patient population.

Those who feel that a reimbursement rate increase is necessary, also believe the increase will help change the current way that many people have their healthcare needs met. It is believed that there will be an increase in patients who establish a “medical home” or primary care physician that they can see for routine types of visits. Which in turn will decrease the number of non-emergent visits to local emergency rooms, which are some of the most costly visits.

For now, we wait to see what the Supreme Court decides.


New Lab Keeps Md. On Cutting Edge Of Health & Technology

John Hopkins always seems to stay on the forefront of medicine & research. It is great!

CBS Baltimore

BALTIMORE (WJZ) — Infectious diseases, pathogens and bioterrorism agents are all inside a new building downtown.

Jessica Kartalija explains it’s great news for researchers at Johns Hopkins.

It’s the newest addition to the Baltimore Science and Technology Park at Johns Hopkins. Inside, it’s a state-of-the-art lab that will keep Maryland on the cutting edge of public health and technology.

“That’s what Baltimore is, a place that is known for world class health facilities and world class research facilities,” said Mayor Stephanie Rawlings-Blake.

The state lab tracks epidemics of dangerous pathogens, infectious diseases and bioterrorism agents.

“This is another wonderful project that’s going to make our city more livable and make our city better,” said Congressman Elijah Cummings.

[worldnow id=10410600 width=320 height=240 type=video]

The new 17,000 square foot building will be equipped to handle potentially deadly pathogens.

“This would be 200 people coming every day to do the most important work…

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Nursing Tip of the Day! – Fundamentals

Texas Nursing Schools

Category: Fundamentals
Heart murmurs result from audible vibrations caused by increased turbulence and are defined by their timing within the cardiac cycle. Not all murmurs indicate valvular or structural heart disease.

from Nurse Nacole | Nurse Meets YouTube

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This nurse is exactly the type of nurss we want to have as part of the 1st Choice Team any day. The author illustrates how often times there are so many aspects of caring for patients that go unseen and unrecognnized everyday. We would all be blessed if we had the opportunity to be cared for by a nurse who cared for us the way this nurse seems to care for the patients she is responsible for daily.

Our Front Door


As I sit and reflect on my life, I find myself humbled. Humbled by the business that takes place all around me, the real fight for life and struggle against death, the palpable emotions of situations I often find myself in, and the incredible strength of those whom I work alongside. It’s the stuff movies are made of and it is truly amazing to watch.

Working in an Emergency Department creates such an interesting outlook on life. One that knows and understands all to well the fragility of every single breath and the vital importance of embracing all aspects of living, even the scary ones. We are the truest definition of realism. Would I like to wrap my kids in bubble wrap and never let them out? Yes. Do I? No. Instead they can be found jumping on the bed, because let’s face it, it’s awesome. Riding their bikes outside…

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Starving for Assistance Pt. 1

EBT CardOld school food stamps

The past few months have been pretty rough for the North Carolina Department of Health and Human Services. DHHS Secretary Dr. Alonda Wos has faced questioning multiple times regarding the ongoing issues that have plagued the department she oversees. Two major issues that have come to everyone’s attention lately are 1.) NC FAST, the system that processes requests for food stamps and other assistance programs and 2.) NCTracks the Medicaid payment system, which processes payments to healthcare providers who treat Medicaid patients. The food stamps have become a great concern for many around the state, especially because the United Stated Department of Agriculture has set a February 10th deadline for the state to make some significant progress towards resolving the backlogged food stamp and other nutrition assistance program initial & recertification applications. If the state fails to make enough progress to address the backlogged applications the USDA could potentially withhold approximately $88 million in funding; which essentially covers administrative costs associated with running the food stamp program annually. As DHHS Officials began to review the pending cases they, did report there were numerous cases of duplicate applications, especially for those who had been waiting longer periods of time.

Secretary Wos faced questioning by the NC Legislature regarding the continued delays with the food assistance program, After hearing the new numbers and finding out the true status of things at DHHS, some of the leadership felt they had been mislead about the state of affairs at the department and the food assistance program.  The Secretary was not unable to provide concrete answers that seemed to satisfy anyone, nor did it appear that she was able to boost the morale about the ability to resolve the ongoing issues. Secretary Wos was questioned about everything from personnel decisions to whether or not the new system was actually going to work for the state or not.

Legally applications should be processed within 30 days. However based on the USDA letter to NC DHHS date January 23, 2014; NC had approximately 19, 974 untimely applications, and another 11,482 recertification applications. Secretary Wos has stated that changes in Medicaid eligibility have effected the department, as well as the implementation of the Affordable Care Act. So to address the backlog of pending applications the State sent about 200 employees to various counties around the state to assist them with things like processing applications, technical, and policy support. Some counties like Cumberland County allowed certain employees to work from home when some county social agencies were shutdown due to inclement weather. Enabling employees to work from home allowed them to continue to chip away at the pending applications. Cumberland County had the second highest number of overdue food stamp applications. The state sent four staff members to help process applications, and two others to assist with policy or technical support. Other counties like Wake County; have their staff working overtime, which includes late evenings and some Saturdays. Wake County had the highest number of overdue food stamp applications for the entire state. However it appears that the county has made major progress with processing the applications. They too received assistance from several staff members of the state that were sent to help out with the backlog.

In the Triad & Northwestern NC Counties local agencies have been very hard at work to resolve pending applications, like other agencies all over the state. The most significant area of improvement for Triad & Northwestern NC Counties is resolving applications that were 120 days overdue- combined the local agencies reduced the number of applications from 204 to nine in the normal processing cycle and also reduced the number from 126 applications to nine in the expedited processing cycle. It is clear that the counties are stepping up and doing everything that the possibly can to help resolve the pending applications. When asked individually each county seems confident that they are capable of meeting the USDA deadline.

As of Monday February 3rd there were approximately 7,000 applications that were still pending. It’s not so much that the applications can’t be processed by the 10th. It’s more about can DHHS prevent this from happening again? Should the state be considering other options for a computer system to manage things like the food stamp program? Will there even be funding for a food stamp program after Monday?

In an update reported today by WFAE 90.7 in Charlotte, it is reported that unfortunately NC just barely missed the USDA February 10th deadline to clear the entire backlog of food stamp applications by approximately 25. However, the state has until the absolute and final deadline the USDA has imposed to completely resolve the backlog which is March 31, 2014. Secretary Wos stated that counties will continue to maintain the same work schedules that they have been working until the state has satisfied the demands of the USDA. Some county employees have been working long work schedules requiring their day to begin at 5 a.m. and ending at 9 p.m. and almost all counties have their staff working overtime to resolve the backlogged applications.

Much gratitude and respect to those who are working diligently around the state to process the backlogged food stamp and nutrition assistance applications.  Hopefully our Secretary of DHHS will find a more concrete solution to resolve the issues with the system that the state has decided it will use to process applications for assistance programs such as food stamps and nutrition assistantce. So that nothing like this happens to the residents of NC again in the future.

Temp Chicks


What is a Temp Chick?!

Welcome to our new blog, Temp Chicks! We are a couple of ladies in North Carolina who manage & operate a temporary staffing agency for medical professional & allied healthcare professionals. Between the two of us we have over 50 years of combined experience in the healthcare industry. At our staffing agency we cater exclusively to licensed & certified medical processionals. Our staff are placed in various types of medical facilities & medical settings throughout the state. Due to the fact that we only cater specifically to those in the medical arena, it allows us to focus more on getting to know our staff and our clients- which helps ensure better client & staff satisfaction at the end of the day.

Having worked in the healthcare industry for so many years, we both saw the growing shortage of nurses in our state and others. We also recognized & agreed that agencies don’t function well when they are not properly staffed. These two factors were our motivation for starting 1st Choice. We saw the real value that staffing agencies can bring to the healthcare industry. Regardless of whether it is just a short-term assignment to fill in for someone who is out for several weeks for things like a temporary disability or maternity leave; or whether an agency needs to find qualified staff and they just don’t have the time to do the recruiting themselves- 1st Choice can help with all types of staffing solutions.

Temp Chicks blog will discuss various medical topics and things that are going on in the medical industry in our state & around the world. We also plan to discuss some medical awareness observances throughout each month.

Have a great weekend!

Temp Chicks