Category Archives: Medicaid

Beyond the ‘Private Option’ for Medicaid Expansion

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Screen Shot 2014-10-24 at 9.53.58 AMBy Christine Vestal
Stateline

Less than a year after low-income Arkansans started receiving health coverage under the Affordable Care Act’s controversial Medicaid expansion, the state is declaring its so-called “private option” experiment a success.

Hospitals saw fewer uninsured patients, state coffers were spared millions in health care costs and private insurers reported record-low premium hikes.

Most important, Arkansas’ uninsured rate fell from 23 percent to 12 percent, the sharpest drop in the country.

Arkansas calls its ‘private option’ Medicaid plan a success, and early estimates indicate next year’s insurance rates in the state will be an average of 2 percent lower than this year.

But lawmakers in Arkansas, where Gov. Mike Beebe is a Democrat and the legislature is controlled by Republicans, have already asked the federal government for adjustments to their groundbreaking plan, under which Arkansans used Medicaid dollars to purchase private health insurance on the insurance exchange created under the ACA.

Meanwhile, other states are customizing their own alternative approaches to expanding Medicaid to cover adults with incomes up to 138 percent of the federal poverty level ($16,105 for an individual). Continue reading

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One in four Latinos remain uninsured

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By Teresa Wiltz
Stateline

In the “sala de espera,” or waiting room, at La Clinica del Pueblo, a community health center in Washington, D.C., signs in Spanish encourage patients to “Empower yourself!” and sign up for insurance coverage through the Affordable Care Act.

Adults slump in chairs, scribbling on application forms, texting friends, waiting. In a tiny office a few feet away, William Joachin, the center’s patient access manager, faces down the frustrations of trying to navigate the federal health care program for the thousands of mostly Central American immigrants who flood the clinic each year. He’s not alone.

A year after open enrollment for the ACA began, one in four Latinos living in the U.S. does not have health insurance, according to new census data, more than any other ethnic population in the country—and most states have few backups in place to help those in the coverage gap.

Latino health insurance graphic

 

Latino immigrants are the hardest hit: Foreign-born Hispanics are more than twice as likely to be uninsured than are U.S.-born Hispanics, according to census data compiled by the Pew Research Center. (Pew also funds Stateline.) Continue reading

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Medicaid ADHD treatment under scrutiny

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Amid national concerns that too many children are being medicated for Attention Deficit Hyperactivity Disorder (ADHD), some state Medicaid programs are stepping up oversight of diagnoses and treatments.

By Christine Vestal
Stateline

ATLANTA – Attention Deficit Hyperactivity Disorder, or ADHD, affects one in every seven school-aged children in the U.S., and between 2003 and 2011 the number of children diagnosed with the condition rose by more than 40 percent.

Doctors have considerable leeway in deciding the best course of treatment for a child with the condition, no matter who is paying the bill.

But children covered by Medicaid, the joint federal-state health care program for the poor, are at least 50 percent more likely to be diagnosed with the disorder.

Children covered by Medicaid are at least 50 percent more likely to be diagnosed with the disorder.

Georgia alone spends $28 million to $33 million annually on these treatments out of its $2.5 billion Medicaid budget, according to the Barton Child Law and Policy Center here at Emory University.

That is partly because of the toll poverty takes on kids and a lack of resources in poorer schools. But some states believe there are other factors at work.

Several have begun to investigate whether doctors and mental health providers who bill Medicaid for ADHD are rigorously using evidence-based guidelines when diagnosing and treating it.

ADD by state

In Georgia, state Medicaid officials are working with the Centers for Disease Control and Prevention to improve the accuracy of diagnoses and the efficacy of treatments for the ailment.

Missouri and Vermont have also sought the CDC’s help in analyzing Medicaid claims data to determine how best to improve care for what has become the most commonly diagnosed childhood behavioral disorder. Continue reading

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New report projects a $5.7 billion drop in hospitals’ uncompensated care costs because of the Affordable Care Act

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H for hospitalA report released today by the Department of Health and Human Services projects that hospitals will save $5.7 billion this year in uncompensated care costs because of the Affordable Care Act, with states that have expanded Medicaid seeing about 74 percent of the total savings nationally compared to states that have not expanded Medicaid.

via New report projects a $5.7 billion drop in hospitals’ uncompensated care costs because of the Affordable Care Act.

 

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Health law shows little effect in lowering children’s uninsured rate, study

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The uninsured rate for kids under age 18 hasn’t budged under the health law, according to a new study, even though they’re subject to the law’s requirement to have insurance just as their parents and older siblings are.

Many of those children are likely eligible for coverage under Medicaid or the Children’s Health Insurance Program.

The Urban Institute’s health reform monitoring survey analyzed data on approximately 2,500 children, comparing the uninsured rate in June 2014 with the previous year, before the health insurance marketplaces opened and the individual mandate took effect.

It found that rates remained statistically unchanged at just over 7 percent for both time periods.

Part of the explanation is that even before the health law passed, the uninsured rate for children was already quite low, says Genevieve Kenney, a senior fellow at the Urban Institute and the lead author of the study. Continue reading

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Urgent care centers opening for people with mental illness

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BrainBy Anna Gorman
KHN / 
AUGUST 28TH, 2014

LOS ANGELES, Calif. — Hoping to keep more people with mental illness out of jails and emergency rooms, county health officials opened a mental health urgent care center Wednesday in South Los Angeles.

The goal of The Martin Luther King, Jr. Mental Health Urgent Care Center is to stabilize and treat people in immediate crisis while connecting them to ongoing care.

Run by Exodus Recovery, it will be open 24 hours a day, seven days a week and can serve up to 16 adults and six adolescents.

During their stay of up to one day, patients will undergo a psychiatric evaluation, receive on-the-spot care such as counseling and medication and be referred for longer-term treatment. Continue reading

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Federal officials order Medicaid to cover autism services

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Photo: Willi Heidelbach

When Yuri Maldonado’s 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California’s Medicaid plan for low-income children was going to be tough.

Medi-Cal, as California’s plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage.

But Maldonado’s son was approved for 30 hours a week of applied behavioral analysis (ABA), a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn’t enough.

So she and her husband, neither of whose jobs offered health insurance, bought an individual private policy for their son, with a $900 monthly price tag, to get him more of the comprehensive therapy.

“I don’t know any family that can really afford that,” says Maldonado. “We made some sacrifices.”

That should be changing soon. In July, the Centers for Medicare & Medicaid Services announced that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans, another federal-state program that provide health coverage to lower-income children. Continue reading

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Number of uninsured drops in states enacting Obamacare

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Survey: Insurance Rates Lag In Health Law Holdout States

ACA health reform logoBy Eric Whitney
AUGUST 6TH, 2014
KHN

A Gallup poll released Tuesday says that the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing the law. It echoes previous Gallup surveys, and similar findings by the Urban Institute and RAND Corp.

The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014.

States that follow the laws provisions most closelyas a group saw their uninsured rate drop nearly twice as much as states that declined to do so.

States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so.

“Those states that have not embraced those two major mechanisms have had about half of the decline in uninsured,” said Gallup’s Dan Witters. “So there’s a clear difference in the states that have implemented those mechanisms versus those who haven’t.” Continue reading

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How can I get health coverage for my grandchildren?

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Q. My son has lost his job and my grandchildren, ages 5 and 6, are without health insurance. I am a retired schoolteacher and might be able to afford coverage for them. What are my options?

A. Your grandchildren have a couple of coverage possibilities. Continue reading

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Arkansas weighs plan to make Medicaid enrollees fund savings accounts

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Arkansas_population_map

Map by JimIrwin via Wikipedia/GNU Free Documentation License

By Michelle Andrews
KHN

If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts.

Those that don’t may have to pay more of the cost of their medical services, and in some cases may be refused services.

Supporters say it will help nudge beneficiaries toward becoming more cost-conscious health care consumers.

Patient advocates are skeptical, pointing to studies showing that such financial “skin-in-the-game” requirements discourage low-income people from getting care that they need. Continue reading

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Why are obstetricians among the top billers for group psychotherapy in Illinois?

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Question markBy Charles Ornstein
ProPublica, July 13, 2014

This story was co-published with The Chicago Tribune.

A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions.

Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.

And then there was this: The sessions were often being performed by obstetrician/gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled.

Continue reading

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Does selling your home affect eligibility for assisted living?

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Q. I’m a realtor who’s listing a client’s home. She is on Social Security and is moving into assisted-living housing. Will the proceeds from the sale of her home affect her eligibility for housing, which is based on her income?

A. This is an unusual question because assisted-living facilities typically do not have special eligibility criteria for low-income residents, experts say. Continue reading

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Putting the Home in a nursing home

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Mealtime. Naptime. Bath time. Bedtime. Everything is on a schedule for residents in a traditional nursing home, leaving little flexibility for personal decision making.

But LaVrene Norton is working to change that.

Norton is founder and president of Action Pact, a national consulting firm. It specializes in helping retirement communities and nursing homes train staff and design their facilities to feel and be more like living at home.

Since beginning work on the “household model” in 1984, Norton has helped design hundreds of these communities. Continue reading

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After court’s home health aide ruling, fewer state workers to organize

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U.S. Supreme CourtBy Jake Grovum
Stateline

The U.S. Supreme Court’s recent ruling in a case brought by home health care aides in Illinois casts doubt on labor agreements between such workers and state governments in nine other states.

It also closes off—or at least complicates—one of labor’s clearest paths to reversing a decades-long trend of declining ranks and shrinking clout.

The petitioners in Harris v. Quinn were home health care aides who did not want to join a union, though a majority of their co-workers had voted to join. Continue reading

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Without federal action, states move on long-term care

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Some states are taking steps to ensure that more seniors can get the kind of long-term care they want — without becoming poor to get it.

A younger man holds an elderly man's handBy Michael Ollove
Stateline

Three years after the demise of the long-term care piece of the Affordable Care Act, some states are retooling their Medicaid programs to maximize the number of people who can get care at home and minimize the number who have to become poor to receive help.

They also are trying to save state dollars. Medicaid is a joint state-federal program, and long-term care for the elderly is putting an ever greater burden on state budgets: Total Medicaid spending for long-term services rose from $113 billion in 2007 to nearly $140 billion in 2012. Continue reading

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