Category Archives: Medicaid

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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Jigsaw puzzle with one piece to add

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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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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Washington among top-ranked states for long-term care

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A younger man's hand holding the hand of an elderly manThe state with the highest marks long-term services and support for the elderly, disabled and their caregivers was Minnesota, followed by Washington, Oregon, Colorado and Alaska.

The lowest ranked states were: Indiana, Tennessee, Mississippi and Alabama, and, coming in last, Kentucky, according to a new report.

The report “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers,” evaluates 26 indicators in five key dimensions that make up the Long-Term Services and Supports (LTSS) system in each state. It was produced by  AARP, The Commonwealth Fund and The SCAN Foundation.

Major Findings

Minnesota, Washington, Oregon, Colorado, Alaska, Hawaii, Vermont, and Wisconsin, in this order, ranked the highest across all five dimensions of the scorecard..

These eight states clearly established a level of performance at a higher tier than other states—even other states in the top quartile. But even these top states have ample room to improve.

The cost of long sterm continues to outpace affordability for middle-income families, and private long-term care insurance is not filling the gap. Continue reading

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Insurers push back against growing cost of cancer treatments

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 This KHN story also ran in .

Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.

Patients say, “‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 — and I was in the same room with the same doctor same nurse and the same length of time’,” said Dr. Donald Fischer, chief medical officer for Highmark, the largest health plan in Pennsylvania. Continue reading

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Medicaid sign ups surged by more than 1 million in April

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ACA health reform logoBy Phil Galewitz
KHN/June 4, 2014

Medicaid enrollment surged by more than 1 million people in April, bringing the total growth in the state-federal health insurance program for the poor since September to about 6 million, the Obama administration said Wednesday.

The increase is significant because it shows Medicaid enrollment continued to grow even after the new state and federal online insurance exchanges closed their open enrollment period for private insurance at the end of March. Continue reading

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