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Do you know what Medicaid is Getting From the Stimulus Package? ‐Mostly Medicaid Staff
Wow.
The American Recovery and Reinvestment Act passed on February 17, 2009. Also fondly (and not so
fondly) known as the “Stimulus Package”, the
legislation was signed by Obama almost immediately. All told it was nearly $800,000,000,000 of funding going to a smorgasbord of programs. That’s 11 zeroes. While the math is still fuzzy, it appears that about 90 of those billions are going to Medicaid through an enhanced Federal matching percentage (FMAP), with a total of about $149B going to healthcare (see the chart on the following page for a breakout of the healthcare spending). We repeat – Wow. The funds are going to lots of things besides healthcare, but the healthcare piece is definitely the overall winner. (The labels in the pie chart on this page are selected examples only; see the table at the end of this article for more detail on other spending areas). With a combined $149B going to healthcare, the only larger share goes to
Stimulus Spending by Major Category ($Billion)
tax cuts, and the only thing really
close
somewhat
is
the
ambiguous
“Infrastructure/Science”
Education For Disabled Kids, $12 Disadvantaged Students, $13
Biomed , $10
Energy Efficiency At Us Defense Facilities, $4
Fossil Energy Research, $3 Health+Well Progs, $1
portion. 1 Food Stamps, $19 HIT, $19
The details of the stimulus transformed
through
Tax Cuts, $282
COBRA, $21 State Budget Assistance, $54 Medicaid FMAP Increase, $87
Page 2
Infrastructure / Science, $120
several deals in the House, between the House and the Senate and between the Obama administration through various intermediaries and press campaigns. Health Information Technology Early on it was clear that Medicaid was going to get about $90B, and that Health IT (HIT) was about to be flushed with cash. In the end almost $19B went for HIT, with $17B for incentives for doctors and hospitals to adopt tech like electronic health records (EHRs) and $2B for block grants for the tech itself. Individual docs can get as much as 44‐66k$ bonuses and hospitals could get as much as $11M for moving to EHRs.
2, 3, 4
Hospitals with a higher Medicaid case mix can get
100% federal funding for new systems. The Congressional Budget Office estimates that the HIT investments will bring $12B in annual savings due to improved quality, care coordination and reducing medical errors and duplicated care. The American Medical Association immediately came out in favor of the HIT provisions in stimulus bill because of the focus on HIT interoperability standards. Wall Street Journal writers criticized the package as using HIT to facilitate socialized medicine, who also said the real bennies are the IT industry.5 Impact on the States The states have been floundering for nearly a year and the Medicaid bailout did not come a minute too soon. Opponents may wonder how the healthcare spending spree will stimulate the economy, but it makes sense that such a big chunk is going to Medicaid. Breakdown of Healthcare Funding in Stimulus Package
Until the economy turns around, Americans will continue to get hit from all
sides.
Sources
estimate that the ranks of the uninsured are growing by 14,000 a day. Most of that is
Page 3 Source: Kaiser Commission on Medicaid and the Uninsured
Just the Beginning Keep in mind these are just the stimulus dollars we are talking about. Obama already signed a $33B expansion of CHIP in Feb 09 before the stimulus and has made it more than clear that he wants a wholly separate healthcare reform package funded to the tune of $634B – almost as much as the stimulus package just passed for the whole economy. The White House claims that 50% of the funding for the reform package will come from savings in Medicare and Medicaid. What about the other 50%? It will from tax increases on the wealthy. "The Obama administration has said that the economic stimulus package would take steps toward health care reform, "perhaps softening the blow if Congress fails to comprehensively address the issue this year." the AP/Boston Herald reports. Jenny Backus, a spokesperson for HHS, said that the health care provisions in the stimulus package represent the "beginning of the president's health reform vision." Kaiser Family Foundation Source: Bloomberg News. “President to seek $634B for health care,” by Hans Nichols. February 26, 2009
from Americans continuing to lose their jobs, and new COBRA provisions in the stimulus will pay for them to continue their private health insurance coverage for 9 months (with 65% premium assistance).6 New York is expected to get as much as $11B of the Medicaid stimulus funds. The hospitals there are on the edge of the seat to find out how much they will get, as Governor Patterson has said at least some of the bailout will not go to hospitals. Some wonder if it may get diverted away from Medicaid altogether. The state currently faces a $14B deficit and (although we forget it) there are lots of other needs in the state
New FMAP Formula to Tap Into the $87B in Enhanced Medicaid Match First off – nobody gets a reduction. All states will get a base increase in their FMAP of 6.2%. If your state faces higher unemployment than others, you could get another increase ranging from 5.5‐ 11.5%. If your eligibility standards are more restrictive than they used to be before July 1, 2008 – you get no increase.
besides healthcare.7
There are of course strings attached,
Breakout of All Spending Areas in Stimulus Package Item Tax Cuts Infrastructure/Science Medicaid FMAP Increase State Budget Assistance COBRA HIT Food Stamps Disadvantaged Students Education For Disabled Kids Moderninise Electric Grid Biomed Internet Access In Underserved Areas Clean Water Projects Cleanup Of Former Weapons/Research Sites Wind + Solar Projects Weatherization Assistance Energy Efficiency Of Federal Bldgs Energy Efficiency At Us Defense Facilities Fossil Energy Research Study Effectiveness Of Health+Wellness Progs Health+Wellness Progs Various TOTAL
$ Billion $282 $120 $87 $54 $21 $19 $19 $13 $12 $11 $10 $7 $6 $6 $6 $5 $5 $4 $3 $1 $1 $97 $789
which is why you have seen some governors make what seem like crazy stands in the news media. Some state leaders believe the stimulus conditions will leave their hands tied for certain eligibility criteria once the economy turns around. That’s the long term problem. The immediate problem with some of the stimulus rules is that states can not cut eligibility for Medicaid and get stimulus funding. That’s a pretty hard pill to swallow for any state with the huge budget crises they all face right now (some estimates put the current total state budget deficit at $350B).8
The stimulus package also has a few
Page 4
other indirect healthcare goodies. The moratorium on Bush’s cuts to targeted case management, provider taxes and school‐based services gets an extension through June. A new moratorium is also put on that much‐hated new outpatient rule that finalized in December 2008. Disproportionate share (DSH) funds got a bump of $460M (2.5%), and the prompt payment rule (where 99% of clean claims must be paid in 90 days) now spreads the love to nursing home and hospital reimbursement. Before it was just docs and other providers. Keep in mind all of this was the official word as of the time of this issue (April 2009). With this much money flooding healthcare, who knows exactly which pockets it will end up in. But don’t say we didn’t give you a heads‐up early. Did you know? This is one of those tidbits that always amazes us. Mostly because we forget that millions of Medicaid dollars go to places that are not U.S. states ‐ like Guam, Puerto Rico and in this case, the Commonwealth of the Northern Marianas Island (Yes it really is almost all the way to China and just north of Australia). Anyway, these places get U.S. Congressmen and tax dollars for Medicaid. The stimulus package will up the federal match for CNMI Medicaid to 56% (well below most states). The total amount the feds will pay for CNMI Medicaid also just got raised under the stimulus. The total cost of CNMI Medicaid is about $7M annually, and covers about 12,000 members who are mostly indigenous peoples.1
Source: “Sablan says $5 million in Medicaid funding now available.” Wednesday, 04 March 2009. WASHINGTON, D.C. (Office of the CNMI Congressional Delegate); Map from Allaboutcountries.com
We would love to hear your thoughts on the healthcare piece of the stimulus package. Write to us at info@mostlymedicaid.com or start a discussion in our LinkedIn group on the topic (find us by searching “Medicaid” in the groups at www.linkedin.com )
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Bruce Johnson, Technical Director, Division of Benefits, Eligibility and Managed, Care, CMS
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OHIO
John M. Young, MPH, MA, Acting Director Division of Quality, Evaluation & Health Outcomes, Centers for Medicare & Medicaid Services Brian Osberg, DHS Assistant Commissioner, Health Care, Minnesota Department of Human Services MINNESOTA
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Meet the Next HHS Secretary By Marisa Vigilante After Tom Daschle’s less‐than‐honorable resignation from the nomination for the secretary of Health and Human Services (HHS), Governor Kathleen Sebelius (D‐KS) is poised to become the next head of the U.S. health system. She has been governor of Kansas since 2003 and was elected to a second term in 2006, becoming the first Kansas Democrat to win re‐election in 24 years in an overwhelmingly Republican state. She’s a rising star within the Democratic party, first garnering attention for giving the Democratic response to former President Bush’s 2008 State of the Union address and later landing on the short‐list as a possible vice‐presidential candidate for President Obama. Sebelius embodies Obama’s commitment to bipartisanship, as she is the daughter of a former Democratic governor and congressman and married to the son of a six‐term Republican congressman. Her running mate for the 2006 election, and the current lieutenant governor of Kansas, is former Kansas Republican chairman Mark Parkinson. Some of her biggest accomplishments as governor have been a result of working with the moderate Republicans in Kansas’s Legislature to resolve a school financing crisis and reverse a budget shortfall by implementing broad efficiency measures. However, Sebelius hasn’t had as much success on health care issues, failing to get enough support for her proposal to raise cigarette taxes to supplement health care for the poor, although she did expand SCHIP eligibility during her term. Sebelius grew up in Cincinnati, often helping her father campaign (they are the first father‐ daughter pair of governors) and went to Trinity College in Washington, D.C., where she met her husband, Gary Sebelius, who was a law student at Georgetown. The couple moved to Topeka, in Gary’s home state, where Sebelius earned a master’s in public administration from the University of Kansas. She and her husband have two adult sons, Ned and John. Sebelius served as
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executive director of the Kansas Trial Lawyers Association before winning election to the state’s House of Representatives in 1986. In 1994, she left the legislature to become Kansas’s insurance commissioner, where she remained for eight years until she was elected governor. As insurance commissioner, Sebelius denied the sale of Blue Cross and Blue Shield of Kansas to an Indiana company and prevented higher premiums, a selling point of her gubernatorial campaign. Abortion is shaping up to be one of the hot‐button issues of Sebelius’s upcoming Senate confirmation and possibly during her term as secretary. She is Roman Catholic and opposes abortion, but has vetoed anti‐abortion legislation, including a bill that would have required clinics to report information on why late‐term abortions were performed, and has broadly supported pro‐choice stances. She also has ties to a prominent late‐term abortion provider in Wichita, Kansas, Dr. George Tiller. Several pro‐life groups have already voiced their disapproval of Sebelius’s nomination, and the Archbishop of Kansas told Sebelius that she should not receive communion until she renounces her views, so many expect her strongest dissenters to play up this aspect of her biography during her confirmation hearing. Progressive groups have expressed their support of Sebelius, including Ron Pollack, the executive director of Families USA, and Karen Ignagni, the president of America’s Health Insurance Plans. Labor unions, the American Medical Association, and the National Council of La Raza also commended her nomination. Of course, the biggest fight of Sebelius’s potential term as secretary is health‐care reform, which was a major part of Obama’s campaign platform and a significant part of his recently released budget. Sebelius’s background as insurance commissioner and overseeing Kansas’s Medicaid program as governor will aid her greatly, but pushing the expected intricate, complicated health care changes through Congress is likely to be a huge political challenge. During her terms as governor, Sebelius twice tried to initiate dramatic health care expansions but was thwarted by her Republican legislature. Unlike Daschle, she will not also be leading the White House Office for Health Reform, a position filled by Nancy‐Ann DeParle, a former Medicare and Medicaid administrator during the Clinton administration.
Page 8
“Sebelius embodies Obama’s commitment to bipartisanship, as she is the daughter of a former Democratic governor and congressman and married to the son of a six‐term Republican congressman. Her running mate for the 2006 election, and the current lieutenant governor of Kansas, is former Kansas Republican chairman Mark Parkinson.”
So what does all of this mean for Medicaid? At this point, it’s not entirely clear, although Sebelius certainly has a strong grasp on Medicaid issues after running the program as governor of Kansas. However, part of financing the new health care system involves spending cuts in current government programs, including Medicaid. Nonetheless, Sebelius has shown herself to be a staunch supporter of expanding health care and promoting health care for low‐income populations and is able to stand up to stakeholders like the insurance companies, who may prove to be the most resistant to the move towards universal health care. Overall, she appears to be a strong choice for the next HHS secretary and will most likely be confirmed in the near future.9
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Page 9
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NH: Empl oy e e sa r et a k i ngapa yc uta tMona dnoc k Communi t yHos pi t a l duet ol os sof$400ki nMe di c a i df e e s . Anot he rne a r byhos pi t a l de l a y e dpl a nne dr a i s e sf or6, 5 00 e mpl oy e e s sbe c a us eofl os s e si nMe di c a i df unds . The s ec ut s a r eduet ot hee c onmomya swe l l a sar e c e nt l ypa s s e d NHl a wt ha tpr e v e nt shos pi t a l sf r omc ha r gi nghi ghe rr a t e s i faMe di c a i dpa t i e ntge t sc a r ea tahos pi t a l owne dphy s i c i a n pr a c t i c e . ( AP . Pe t e r b o r o u g hho s p i t al c u t t i ngs al ar i e s . Fe br ua r y2 7 , 2 009)
MA: Be t hI s r a e l De a c one s sMe di c a l Ce nt e rf a c e sa $ 2 0Ms hor t f a l l i n2 009. Ac c or di ngt ohos pi t a l e x e c s , t hes hor t f a l l i sbe c a us eofMe di c a i dc ut sont opof poorc ont r a c tne got i a t i onswi t hBCBS. Thehos pi t a l i sa l s os e e i ngl e s spa t i e nt s . I nt hi sc a s e , t hee c onomy i sgi v i nghos pi t a l sadoubl e wha mmy : Me di c a i di s pa y i ngl e s sANDpa t i e nt sa r ede l a y i ngc a r e( mos t t hi nkde l a y i nge l e c t i v epr oc e dur e s ) . ( AP/ c w5 6ne ws . 3 / 6/ 2 009
CO: Ne whos pi t a l f e e sa r ea l l t her a get he s eda y sa swa y st ofina nc eMe di c a i d c ov e r a ge , wi t h2 3s t a t e sa l r e a dyus i ngt he m. Col or a doi sl ook i ngi nt oi t sown v e r s i ont ha twoul dc r e a t e$1 . 2Bi nf undi nga ndl e v e r a get he mf ort hef e de r a l ma t c h. Al l t ol dt hes t a t et hi nk st hi swoul dc ov e ra na ddi t i ona l 1 00, 000c i t i z e ns . Hos pi t a l swoul da nt eupa boutha l foft hef unds( $ 600M) , wi t ht hef e dsma t c hi ng t hebi d. Thene wf e ei spa r toft heCol or a doHe a l t hc a r eAffor da bi l i t yAc t whi c hpr ohi bi t shos pi t a l sf r ompa s s i ngt hef e eont opa t i e nt s . COhos pi t a l s s pe nd$ 3 7 5 Ma nnua l l yonunc ompe ns a t e dc a r e . ( TheDe nv e rPos t . J e nni f e rBr own. 0 2/ 2 7 / 2 009)
Hospitals in Other States Arkansas: The AR senate passed a hospital assessment fee of up to 1% of hospital annual net revenue. Expected to bring in $40M in fees and then those funds will get Mcaid matching funds. Will apply to 83 hospitals in the state and used to cover uncompensated care in state.10 New York: Hospitals are wondering what they will (or will not get). $11Bb of the $87B Medicaid stimulus $ will go to NY, but Governor Patterson has already said at least some of the NY $ will NOT go to hospitals. NY faces a state deficit of $14B11 Michigan: According to the Michigan Health and Hospital Association, the economic crisis has driven Michigan hospitals into the red and to the "brink of a fiscal crisis." The association has published a report called "Michigan Health Care Safety Net: In Jeopardy." Read the full report here from the Michigan Hospital Association here‐ 12 http://www.mha.org/mha/documents/2009%20MHA%20Safety%20Net%20In%20Jeopardy.pdf North Carolina: A new state mental hospital in North Carolina has gotten of to a rocky start. The NC Medicaid agency is threatening to pull Medicaid funds (Medicare dollars are now vulnerable, too) if an acceptable plan to fix repeated problems is not submitted. A patient attempted suicide in late February, and the hospital was under the gun to pass an inspection in February as well. Another inspection was scheduled to occur March 28th. It is unclear yet what the advocate response to these events will be, but it should be expected that this will be discussed as more evidence in the contentious community vs. institution debate in long term care. Medicare funds are also in jeopardy.13
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Page 11
Mostly Medicaid Spring 2009 Crossword Across 1. Healthcare ____. When the dust of the stimulus settles, this will be the real fight 6. Type of service that the SCHIP reauth includes as a stable component for the first time 7. Hometown of probable HHS secretary 10. Recent casualty in the quest for an HHS secretary 13. The major funding mechanism for the new CHIP reauth package 15. There's a new one for the enhanced FMAP. It's calculation will determine what states get 16. Tax ___. The biggest line item in ARRA. 17. AKA The Stimulus Package (Acronymm) 18. Probable HHS secretary
Down 2. state that the local hospital association has called on the "brink of a fiscal crisis." 3. state with one of the lowest FPL ceilings for CHIP eligibility (185% of FPL) 4. Medicaid _________ Care Congress. The 17th one is coming up in June 2009. 5. _____ and Wellness. Got a few billion when you add in the measurement piece 8. The N in CNMI. A little island group near China that gets $7M a year in Medicaid funds. 9. Hospital ____. Funding mechanism that is popular these days; leverages the FMAP. 11. _________ Package. AKA the American Reinvestment and Recovery Act 12. State that recently upped the FPL ceiling from 200 to 250% for CHIP eligibility 14. The number of millions of more children the SCHIP reauth act can cover if states take advantage of expansion opportunities
Page 12
A new bill gets passed, but some are worried about how much success could depend on tobacco taxes ‐MM Staff The State Children Health Insurance Program (SCHIP) Reauthorization Act of 2009 was signed in February, and will hopefully put an end to the rollercoaster ride that has been on since 2008. SCHIP was initially funded for 10 years, but the clock struck midnight in 2008. Last year was a nail‐biter in Medicaid agencies across the country, with funding on a month‐to‐month basis, with each continuing resolution offering only a short breather before the scramble for funds started up again. The new legislation doesn’t just hit the reset button on the original program. The bill takes CHIP to new homes across America. In addition to re‐authorizing coverage for the 7M kids covered under SCHIP nationwide, the bill offers potential expansion of coverage to 4M more kids if states opt in to the new federal rules.14 The new package also offers a stable dental program under CHIP for the first time, as well as funding for quality measurement.15,16 Early criticism centers on the funding mechanism for much of the reauthorization – increased tobacco taxes. Angry smokers are no surprise, but some analysts are concerned that balancing the future of such a vital program on the back of a vice tax during a recession may not be the brightest idea. States across the country are combing the expansion and tobacco tax opportunities. See below for more state by state info: Page 13
Arizona Arizona was actually ahead of the fund‐ the‐kids‐with‐cigarette‐money game (and it’s not just for healthcare). The tax increase was approved by voters in 2006 (80 cents per pack) and provided $236M in 2008. Even more tobacco dollars will be used to help provide health care and literacy program for kids in Arizona this year. Regional councils get to decide what $ the First Things First program funds.17 Arkansas The Arkansas senate just upped the FPL eligibility for ARKids from 200% to 250% (the bill passed 82 to 14). The new rules will allow 8,000 more kids into the program. Arkansas’ expansion will be financed by an $86M increase in state tobacco tax going into effect March 09.18 California CA CHIP will get 1.5B$ in funding from the reauthorization package in 2009 alone. There are currently 900,000 kids in CA CHIP now, and the rolls are growing by 30,000 kids a month. The federal match for CA went from $800M to $1.5B this year.19 Kentucky KCHIP is considering expanding coverage to 12,000 more kids even n the face of struggling to provide services for the 54,000 kids it already covers. It is estimated that 120,000 kids are eligible, making current enrollment less than 50% of the possible pool of kids even before the expansion.20
Nebraska Nebraska is also looking to expand CHIP coverage after the reauthorization bill. There’s a lot of room for improvement – Nebraska currently caps family income at 185% of FPL, which only 6 states are that low or lower. Iowa covers kids up to 300% FPL. Legislative Bill 126 would raise FPL eligibility for Kids Connection (the Neb CHIP) to 200%. A similar bill was put up by the same sponsor last year but it died. It may be possible this year with Obama's reauthorization bill. 200% of FPL In 2009 is $44,100 for a family of four. An estimated 5,400 more kids could be covered with the change in the eligibility rules. 23,000 kids are currently covered in Kids Connection.21 Utah Even as Utah faces a deficit this year, some legislators are moving to eliminate the five year waiting period for documented immigrant kids to get CHIP coverage. According to estimates, removal of the waiting period would cost about $400,000 to cover as much as 1,300 documented immigrant children. Part of the CHIP bill signed by Obama in February allowed for the removal of restrictions such as these .22
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Job Listings
Hey‐ We know it’s tough out there.
Here’s a few Medicaid‐specific opportunities. VP of Provider Relations (Tampa, Florida) Looking for a dynamic VP of Provider Relations. Location is Tampa, Florida. Candidate needs 10 years experience in all levels of network development and contracting in managed care, preferably with Medicaid experience. Will be responsible for leading the contracting efforts for the state of Florida for this large MCO. Needs to have lead teams of contractors in the past and a college degree is required to be considered. Relocation will be offered for the right candidate. Contact Angela George, CPC, ag@ess.jobs. IV&V Consultants (Mississippi) Role/responsibilities: Consulting Services for Independent Verification and Validation (IV&V) of Electronic Health Records and E‐Prescribing System. Consultant will perform periodic IV&V services on the MMIS system. Qualifications: State Medicaid Management Information Systems (MMIS) experience is mandatory, IV&V experience is a must, Electronic Health Records (EHR) is preferred. Prefer at least 2 years MMIS and 3 or more years IV&V experience. PMP preferred. Consultant must be willing to travel to client facility.
Our Linked in Group is 350 Strong and Growing!
Don’t forget to join the group so you can connect to hundreds of Medicaid professionals in government agencies, health plans, pharmaceutical firms, research groups, consulting firms, hospital associations and many other areas of the Medicaid industry. Discuss jobs, industry trends and breaking news that affects you with the top Medicaid minds out there. Find the group by searching for ‘Medicaid’ in the groups at LinkedIn.com
Contact: jacqueline.perez@eclipsesolutions.com, http://www.linkedin.com/in/jacquelineperez IV&V Consultants (North Carolina) Role/responsibilities: Consulting Services for Independent Verification and Validation (IV&V) for MMIS. Qualifications: State Medicaid Management Information Systems (MMIS) experience is
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mandatory, IV&V experience is a must, Prefer at least 2 years MMIS and 3 or more years IV&V experience. PMP preferred. Contact: jacqueline.perez@eclipsesolutions.com, http://www.linkedin.com/in/jacquelineperez
Crossword Answers
References 1
Post Chronicle. Factbox: Details Of U.S. Stimulus Spending Released. Feb 13, 2009 Congress Reaches Deal On Stimulus That Includes $90B For Medicaid, $19B For Health IT. 13 Feb 2009 3 AP. Highlights of $787 billion stimulus plan detailed. February 18. 2009 4 AP. $790 billion economic stimulus plan offers bigger paychecks, better infrastructure. February 12, 2009 5 Medical News Today. Obama Signs Economic Stimulus Measure Into Law. 19 Feb 2009 6 MarketWatch. Stimulus Plan Gives Personal Health a Booster Shot. Ruth Mantell. February 19, 2009 7 Newsday. NY hospitals wonder how much aid is coming their way. RIDGELY OCHS. February 15, 2009 8 Kaiser Daily Health Policy Report. Congress Approves $787B Economic Stimulus Package; Obama To Sign Bill Into Law Today. Feb 17, 2009. 9 Altman, Alex. “Kansas Governor Kathleen Sebelius.” Time, 9 March 2009: http://www.time.com/time/nation/article/0,8599,1882471,00.html; Baker, Peter. “Kansas Governor Accepts Offer as 28 February 2009: Health Secretary.” New York Times, http://www.nytimes.com/2009/03/01/us/politics/01cabinet.html?_r=1&hp; Fletcher, Michael A. and Ceci Connolly. 2
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“Governor of Kansas Tapped to Lead HHS.” Washington Post, 1 March 2009: A1; “Kansas Governor Kathleen Sebelius.” Office of the Governor of Kansas website: http://www.governor.ks.gov/, accessed 14 March 2009; “Kansas Gov. Sebelius Emerging as Top Choice for HHS Secretary, Advisors Say.” Kaiser Daily Health Policy Report: http://www.kaisernetwork.org/daily_reports/health2008dr.cfm?DR_ID=57056, accessed on 14 March 2009; Superville, Darlene. “Obama Announces Governor Kathleen Sebelius as New Health and Human Services Secretary Nominee.” Associated Press, 2 March 2009, accessed through The Huffington Post: http://www.huffingtonpost.com/2009/03/02/live‐video‐obama‐announce_n_171087.html; Zernike, Kate.”One Hand on Her Job, the Other Across the Aisle.” New York Times, 19 August 2008: http://www.nytimes.com/2008/08/20/us/politics/20sebelius.html. 10 Associated Press ‐ Texarkana Gazette Arkansas House OKs expansion of children’s health insurance. 03/10/2009 11 Newsday. NY hospitals wonder how much aid is coming their way, by RIDGELY OCHS. February 15, 2009 12 The Detroit News Fiscal woes hit hospitals: National economic downturn is putting Michigan health systems on 'brink of fiscal crisis,' report says. Christina Rogers. February 6, 2009 13 DHHS. Central Regional Hospital Submits Plan To Preserve Federal Funding 14 Medical News Today. Medicaid Health Plans Of America Applauds Passage Of SCHIP Legislation. 05 Feb 2009 15 Medical News Today. President Signs Bill Expanding Dental Care Coverage In Health Insurance Program For Low‐ Income Children. 09 Feb 2009 16 Commonwealth Fund. Statement from Commonwealth Fund President Karen Davis on CHIP Bill Signing. February 4, 2009 17 The Arizona Republic . Strategy unveiled on how tobacco tax will help kids:'06 Ariz. initiative will provide $91 mil this year for child health, education. by Chelsea Schneider ‐ Feb. 12, 2009 18 Associated Press ‐ Texarkana Gazette .Arkansas House OKs expansion of children’s health insurance03/10/2009 19 Medical News Today. CMA Praises SCHIP Signing, Calls On State Lawmakers To Cover Kids By Matching Federal Commitment. 09 Feb 2009 20 The Courier‐Journal. Ky. mulls insuring even more children. By Deborah Yetter .February 21, 2009 21 WORLD‐HERALD BUREAU, Nebraska Legislature: LB 136 seeks health coverage for more low‐income kids. BY MARTHA STODDARD. Published Monday February 16, 2009 22 Medical News Today. Two Utah Bills Seek To Lift Restrictions On CHIP, Medicaid Coverage For Documented Immigrant Children. 27 Feb 2009
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