I Blame NoVA

http://www.washingtonpost.com/blogs/federal-eye/wp/2014/09/15/how-states-have-gamed-medicaid-for-hundreds-of-millions/?wpisrc=nl_fed&wpmm=1

 

You healthcare lobbyists should have written a law without loopholes to begin with.

 

I am curious as to what is the net effect of revenue matching laws.  It seems to me that revenue match for a particular program that bypasses the state’s general coffers might achieve the supposed result of more program funding, but considering how it is normally done, I think it is simply a transfer of deficit raised federal dollars to state general revenues.

 

We have so many revenue matching programs.  I assume that Highway funding is the largest one, followed by Medicaid.  Or perhaps vice versa.  I believe that in TX all fed revenues into both are used however the Lege desires.

 

Should a federal/state joint venture like highway construction even have a feature like “revenue matching”?  What purpose does it actually serve?  Assume with me that interstate highways are basically federal responsibilities.  Nevertheless, the R.O.W. impacts are all local, and state and local input are critical to managing the minimum damage to a community.  So cooperation is a legitimate goal, but does revenue matching have anything to do with that?  Is it possible states or localities were blackmailed into supporting the interstate system financially, or else the feds would have drawn the roadway to kill commerce in a town?

 

The article calls the gaming of Medicaid by the states “waste”.  But it seems to me the structure was established as a “game”.  If you see revenue matching as other than an invitation to increase the federal deficit in order to permit states to have the pleasure of spending money they did not have the pain of raising, explain it to me.

 

 

 

9 Responses

  1. What responses would I get at PL? Is it worth the experiment to try this there, NoVA?

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    • I wonder about another logistical aspect. The first post road in the country is US 1 from Boston to NYC. In that stretch, it is called the Boston Post Road. If the Village of Mamaroneck fills a pothole in the BPR does it bill the USA for a % of the cost?

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  2. “I think it is simply a transfer of deficit raised federal dollars to state general revenues.”

    But that’s the whole point of the “free money” arguments for Medicaid expansion. It’s a feature, not a bug.

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  3. For highways, the feds pay for new construction and states pick up maintenance. This is part of why roads in many states (I’m looking at you, Pennsylvania) are in deplorable shape even as new highways are built.

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    • Thanks, YJ. Can the states “goose” more fed highway money by appropriating more state money, in any way analogous to the Medicaid article linked in the post?

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    • For highways, the feds pay for new construction and states pick up maintenance.

      Don’t tolls go to the states for the purposes of maintenance?

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  4. Ha. i saw the headline and thought “what did I do!”

    I wouldn’t bother with PL on this one — it’s way in the weeds. At issue is the various provider taxes, etc. These are known as IGT — intergovernmental transfers.

    Federal law requires that a least 40% of the state’s contribution come from the state. the rest gets really complicated, really quickly. see:

    http://www.piperreport.com/blog/2012/04/25/medicaid-upper-payment-limits-understanding-federal-limits-medicaid-fee-for-service-reimbursement-hospitals-nursing-homes/

    The Bush adminstration tied to crackdown on this in 2004-2005 when i was at CMS. at least some of the more creative IGTs. some are legal. others are not.

    see also: https://www.hmprg.org/assets/root/PDFs/2011/04/Illinois-Medicaid-financing-4-25-11.-Bonnyman.pdf
    states are very upfront about this. because they don’t have the $$ otherwise. that’s why I harp consistenctly on the 90% match in a few years for Medicaid expansion. 10% from the state. 10% of what and where are they going to get it. i vote from the schools.

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  5. i don’t know. the rules might change by then. we’ll grandfather your responses in.

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