Expert Witness Medicaid Expansion Affordable Care Act

Expert Witness Medicaid Expansion

As an expert witness in Medicaid Expansion I am regularly requested to provide opinions regarding the value of medical care under the Affordable Care Act.  Expert witness Medicaid expansion must understand eligibility criteria including household income, disability, and Federal Poverty Level (FPL) guidelines.   An Expert Witness in Medicaid Eligibility should be able to articulate what benefits are covered and variations in care at State levels, related to benefits available to the insured.   Expert witness Medicaid expansion roles may include opinions regarding maximum out of pocket costs to a Plaintiff, benefits covered in life care plans in personal injury or medical malpractice, disability benefits, or Children’s Health Insurance Program (CHIP) which provides insurance coverage to uninsured, low-income children above Medicaid income eligibility thresholds. States are permitted to use CHIP funds to create a Separate CHIP program, expand their Medicaid program (Medicaid Expansion), or adopt a Combination approach.

Expert Witness Medicaid Expansion
Medicaid Expansion Map Feb 2015, Source Kaiser Family Foundation

A misunderstood and often overlooked centerpiece of the Patient Protection and Affordable Care Act—often referred to as “Obamacare” or “ACA”—is the expansion of Medicaid eligibility to people with annual incomes below 138 percent of the federal poverty level.

Medicaid, the national health insurance program for low-income people, is administered by States.  As of January 2016, 31 states were expanding their Medicaid programs. Medicaid eligibility for adults in states expanding their programs has rapidly expanded the number of total insureds.  Several factors must be considered including waivers, special programs for women, number of people living in the household and other factors along with Minimum Essential Coverage (“MEC”).   Employers and employees have different considerations depending on which state they reside in, the disease categories and potentially other diagnosis characteristics.

Medicaid plays a critical role in providing health coverage for women (See National Women’s Law Center, Women and Medicaid in Nevada, February 2010). Nationally, nearly 17 million non elderly women were covered through Medicaid.  Medicaid has different names in different states.

Nevada experienced one of the most significant increases in Medicaid insured beneficiaries.  Nevada’s Governor Brian Sandoval announced in December 2012 that the state would expand Medicaid starting in 2014[iii].  Nevada expanded Medicaid in 2014 under the guidelines laid out in the ACA.  As a result, there are 266,000 newly-eligible Nevada residents.  From the fall of 2013 through June 2015, total net enrollment in Nevada’s Medicaid program increased by 69 percent.  This is a much higher percentage increase than most states, and is second only to Kentucky, where Medicaid enrollment has increased by 84 percent[iv].  Nevada’s uninsured rate also fell by 24 percent from 2013 to the first half of 2015, going from 20 percent to 15.2 percent.  The expanded access to Medicaid played a significant role in decreasing the uninsured population.  According to the Reno Gazette Journal, “Many more Nevadans than expected enrolled in Medicaid after Gov. Brian Sandoval opted to expand eligibility, meaning the state will be paying more than projected once the federal government scales back its support. State officials said as of July 20, 2015 that 181,051 people are now receiving benefits as a direct result of the Republican governor’s decision, which extends Medicaid eligibility to all non-disabled adults with incomes at or below 138 percent of the federal poverty level — currently $16,243 for an individual.”  The Federal Poverty Level is based on annual household income, which means that if an individual loses or gain income during the year their cost assistance eligibility can change.

[i] Source: http://gov.nv.gov/News-and-Media/Press/2012/Governor-Sandoval-Statement-on-Medicaid-Expansion/

[ii] Source: https://www.healthinsurance.org/nevada-medicaid/

[iii] Source: Kaiser Family Foundation, Women’s Health Insurance Coverage (Oct. 2009), http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/

[iv] Kaiser Family Foundation, Health Insurance Coverage of Women Ages 18-64, by State, 2007-2008 (Oct. 2009), http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/

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Expert Witness

Michael F. Arrigo

Michael Arrigo brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health IT, and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations who provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and medical billing, fraud damages, as well as electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, medical malpractice, insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software SA (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls IT audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and is published in Healthcare IT News.

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