Category Archives: Medicaid

States target asthma care as number of patients grow

Washington is one of the few states that has made the Asthma and Allergy Foundation of America honor roll of states that have adopted comprehensive public policies supporting people with asthma, food allergies, anaphylaxis risk and related allergic diseases in schools.

Illustration of the lungs in blueBy Michael Ollove
Stateline Staff Writer

April 16, 2014 

In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge.

St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live.

But the state has also pioneered advances in addressing asthma treatment and costs. Two years ago, the Missouri legislature became the first to allow schools to stock quick-relief asthma medications for emergencies.  Continue reading

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Tried to sign up but couldn’t finish by the deadline?

Washington Healthplanfinder outlines steps you need to take to qualify for special enrollment

From Washington Healthplanfinder:

Coverage is hereWith the deadline to enroll in a Qualified Health Plan through wahealthplanfinder.org now passed, Washington Healthplanfinder is reaching out to residents who couldn’t complete their application by March 31 with important guidance to qualify for a special enrollment.

Washingtonians who were prevented from submitting their application by the deadline should complete these steps as soon as possible to qualify for coverage that begins May 1, 2014. Continue reading

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3 million gained coverage through Medicaid from October to February

ACA health reform logoBy Phil Galewitz
KHN

The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services.

States that expanded Medicaid eligibility under the health law saw an average 8 percent increase in enrollment, with enrollment leaping almost 35 percent in Oregon and almost 34 percent in West Virginia.  Continue reading

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You can still sign up for Medicaid if you qualify

Apple Health LogoBy Britt Olson
Public Health – Seattle & King County

If you or your family qualifies for Apple Health — Washington state’s Medicaid program — there is no deadline to register for insurance.

A major component of the new Affordable Care Act in Washington state is expanded Medicaid coverage, or Apple Health. This allows thousands more people statewide to qualify for free health insurance.

Although the open enrollment period has officially ended to buy into the insurance exchange, individuals and families who are eligible for Apple Health may continue to enroll throughout the year; in other words, there is no deadline.

Who qualifies? It depends on family size and household income

  • Individuals who earn less than $15,857 annually qualify
  • A family of four with a combined income below $32,500 will qualify
  • The more children or dependents in your family, the higher your household income level can be.

To find out if you qualify, go to Washington Healthplanfinder. Enter your monthly household income, the social security number and date of birth for each member of your family seeking health insurance and any relevant immigration information.

You should receive notification of your coverage options within the hour.

While the federal deadlines do not apply to those who qualify for Apple Health, why wait? The sooner you apply, the sooner your insurance kicks in and you can better manage your and your family’s health.

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‘Private Option’ for Medicaid would cut benefits

Center for Medicare & Medicaid ServicesBy Christine Vestal
Stateline Staff Writer

When Arkansas won federal approval to use Medicaid expansion dollars to help low-income people purchase private health insurance, officials on both sides of the aisle applauded the compromise.

For supporters of the Affordable Care Act, it meant coverage for the millions of uninsured Americans who live in states that have resisted Medicaid expansion under the ACA.

For governors and lawmakers opposed to the law, it was a politically feasible way to accept billions in federal dollars and improve the overall health of their residents without embracing “Obamacare.”

Now, as more states craft their own versions of what is known as the “private option” – and Arkansas seeks revisions to its original plan – advocates are increasingly concerned that the private market approach to Medicaid expansion could erode the effectiveness of the Medicaid program.  Continue reading

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There’s a life-saving hepatitis C drug. But you may not be able to afford it.

Sovaldi logoBy Julie Appleby
KHN Staff Writer

MAR 03, 2014

This KHN story was produced in collaboration with 

There’s a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C.  But it costs $84,000 – or $1,000 a pill.

And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug —and who pays for it.

Called Sovaldi, the drug is made by California-based Gilead Sciences Inc. and is the latest in handful of new treatments for hepatitis C, a chronic infection that afflicts at least 3 million Americans and is a leading cause of liver failure. It was approved by the U.S. Food & Drug Administration in December. Continue reading

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Will new hepatitis C drugs bust state budgets?

OlysioBy Michael Ollove
Stateline Staff Writer

Two new medications to treat the deadly epidemic of hepatitis C promise millions of Americans a better chance of a cure, shorter periods of treatment and fewer side effects than older drugs. They also threaten to bust state budgets and raise private insurance rates. Continue reading

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Health law helps states move elderly and disabled from nursing homes to home care

01_17_Chart_Health_Funding_thumbnailBy Christine Vestal
Stateline Staff Writer

In New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes.

To remedy this imbalance, New Hampshire is taking advantage of Affordable Care Act funding for a program aimed at removing existing barriers to providing long-term care in people’s homes and communities.

Known as the Balancing Incentive Payments Program, it is one of several ACA provisions designed to keep as many people as possible out of costly institutions. Continue reading

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As incomes go up and down, patients may bounce between exchanges and Medicaid

Refresh ThumbBy Jenni Bergal

This KHN story was produced in collaboration with wapo

While government officials have spent months scrambling to fix the federal health law’s botched rollout, another issue is looming that could create new headaches for states, health plans – and patients.

In 2014, millions of people are expected to shift between the health exchanges and Medicaid, as their income fluctuates over the year. That could be costly for states and insurance companies, and patients could wind up having gaps in coverage or having to switch health plans or doctors.

The process — called “churning” – is common in Medicaid, the state-federal program for the poor and disabled. Typically, people lose Medicaid eligibility after their income spikes temporarily, such as when they get a seasonal job or pick up extra hours at certain times of the year. They re-enroll when their income drops.

Until now, people who churn out of Medicaid because of an income bump often wound up uninsured because they can’t afford private insurance. Starting this month under the Affordable Care Act, many will become eligible for insurance and subsidies through the exchanges.

Experts warn that churning will continue to be a problem, as patients bounce between Medicaid and the exchanges.

But experts warn that churning will continue to be a problem, as patients bounce between Medicaid and the exchanges. Patients in an exchange plan may end up in a Medicaid managed care plan run by another company, with different doctors – or vice versa.

“This is a critical issue for the states and the providers. They are worried about patients experiencing gaps in coverage,” said Jenna Stento, a senior manager who tracks the federal health law at Avalere Health, a consulting firm. “It could be a very significant population that is moving back and forth.”

Matthew Buettgens, a senior research analyst at the Urban Institute who studies churning, estimates nine million people will shift between Medicaid and the exchanges over the course of a year.

Nearly 30 million Americans on Medicaid are in private managed care plans, which are designed to help reduce costs by providing administrative control over health-care services and are becoming the coverage of choice for state Medicaid operations.

Millions more will become eligible for Medicaid this year under the federal health law. Many will be put in managed care. States pay managed care plans a fixed amount per member each month to set up networks of doctors and hospitals to provide services.

Buettgens said most states are only now beginning to think about ways to deal with the upcoming dilemma.

“It took a backseat to Medicaid expansion decisions and launching the marketplaces. Now it’s starting to get more practical attention,” he said. “The churning issue is going to become much more visible this year.”

Jeff Myers, president of Medicaid Health Plans of America, a trade group representing about 120 members, called the problem “serious” both for patients’ continuity of care and for the plans’ stability. Companies not only face administrative cost burdens, but they won’t be able to predict what their financial risk will be, he said.

“The challenge is how the states want to address the churning issue,” Myers added. “As far as we know, we haven’t gotten any guidance about how they intend to do that yet. They haven’t really given us any guidelines. We are on the front line.”

Matt Salo, executive director of the National Association of Medicaid Directors, said states are anxious to seek solutions.

“You want people to have consistent insurance coverage, whether you’re dealing with someone who’s got mental health and substance abuse issues or a variety of undertreated chronic conditions,” Salo said. “If you get them into Medicaid at one point and get them stable and on a plan of care, you don’t want a transition into a different plan to set them back, and then have those people rebound back into Medicaid.”

Washington has created a program to help health care companies in the exchange also become Medicaid plans if they provide an identical network for patients.

Some states have tried to tackle the problem.

Nevada will require Medicaid managed care companies to offer a comparable plan on the exchanges starting this year.

Washington has created a program to help health care companies in the exchange also become Medicaid plans if they provide an identical network for patients.

In Delaware, companies in the exchange must continue to cover approved medical treatment and medications for new members coming from Medicaid during a transition period.

In Congress, a bill sponsored by Democratic Rep. Gene Green and Republican Rep. Joe Barton, both of Texas, would require states to guarantee 12 months of continuous eligibility to people on Medicaid, to help reduce churning. About two dozen states already require that for children on Medicaid and in the Children’s Health Insurance Program.

While the bill is enthusiastically supported by groups including the Children’s Hospital Association, many states are skeptical because they believe it will be costly.

All sides agree, however, that churning affects quality and interrupts care for Medicaid patients.

An April 2013 study by George Washington University researchers noted that interruptions in Medicaid coverage can result in sick people being unable to afford to visit the doctor or pay for prescription drugs. They wind up delaying or avoiding treatment, such as vaccinations and blood pressure screenings.

While churning isn’t unique to Medicaid, in workplace insurance, health benefits generally remain unchanged over the course of a year. Employees stay enrolled until the next open enrollment or they change jobs.

With Medicaid, people generally must reapply for or renew coverage every six or 12 months, depending on the state. They also must report changes in income or family composition, such as a marriage or divorce, which could affect eligibility. They could be dumped from the rolls any given month.

Some experts suggest that the best strategy to avoid churning between Medicaid and the exchanges will be for health plans to sign up for both markets.

But that’s easier said than done.

Margaret Murray, CEO of the Association for Community Affiliated Plans, a trade group of nonprofit Medicaid health plans, said that 16 of its 60 members have joined the exchanges. The process isn’t easy, she noted, because of the differences between Medicaid contract requirements and state insurance department rules for commercial health plans.

“It’s definitely a challenge for our members,” Murray said. “They don’t collect premiums, they don’t market, they don’t set rates.” Commercial plans do all three.

A recent analysis by Murray’s group found that while 41 percent of health-care plans that have signed up for the exchanges also operate Medicaid plans, the rest don’t.

Even if a health-care company runs both a Medicaid plan and an exchange plan in a state, that doesn’t mean that patients will be able to stay in the same network.

“There’s no guarantee that your plan in one market is also participating in another market,” said Sara Rosenbaum, a health policy professor at George Washington University. “The potential is great that you not only will have to switch plans, but you’ll have to switch providers if they don’t share networks.”

Experts say that whatever changes states make, they won’t be able to eliminate churning. But they can create programs that make the changeover smooth and reach out through consumer assistance and education.

In Oregon, where an advisory committee is spending six months reviewing options and data from other states before coming up with a plan, health officials are optimistic.

“The bottom line is we want to make sure people and their families are getting the care they need and that it’s a smooth transition,” said Jeanene Smith, chief medical officer for the Oregon Health Authority.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Coverage is here

Important steps you need to take to complete enrollment by Dec. 23 deadline

The Washington Healthplanfinder has issued some important tips to help consumers to successfully complete their complete enrollment by the December 23 deadline.

From Washington Healthplanfinder:

Important Steps for Consumers to Complete Enrollment by Dec. 23 Deadline

Washington Healthplanfinder 

Enrollment in Private Health Plans Increases by More than 50 Percent

Enrollment in Private Health Plans Increases by More than 50 Percent

With new health coverage benefits taking effect in the New Year, Washington Healthplanfinder is reminding residents to complete applications by Dec. 23 for their health coverage to start on Jan. 1.

Since Dec. 13, more than 143,000 individuals visited the online marketplace and 37,000 applications for health coverage were submitted through wahealthplanfinder.org.

In the last week, enrollment in private health plans has increased by more than 50 percent with 17,000 new enrollees. Since Oct. 1, more than 50,000 individuals have selected and purchased a private health plan.

“Our staff is processing a surge in applications,” said Richard Onizuka, CEO for Washington Healthplanfinder. “In addition to distributing final reminders to our customers, Customer Support Center staff will work through the weekend to call individuals who are stuck in the process and manually verify paper documents. IT staff continue to resolve data issues and run nightly batches of applications through the system.”

The Exchange recently announced that residents who have made an effort to receive health coverage through Washington Healthplanfinder before the Dec. 23 deadline, but who were unable to complete their applications, will have additional time to enroll in coverage that begins Jan. 1.

Applications submitted by 11:59 p.m. on Monday, Dec. 23 will have their insurance benefits retroactively configured to the start of the year.

“We want to remind residents the deadline for submitting applications has not been extended,” said Onizuka. “While we are allowing more time to process applications through Jan. 15, residents must have started an application in our system by Dec. 23 and follow important step-by-step guidance to receive their coverage on Jan. 1.”

Affected customers should be on high alert to receive notifications from Washington Healthplanfinder. Customers will receive notifications outlining important steps to bypass or fix errors affecting their application.

Key steps include:

  • One. Customers will be required to select a health plan and submit their payment through Washington Healthplanfinder. At that time, customer accounts will show that coverage is effective Feb. 1, 2014.
  • Two. Customers must notify Healthplanfinder they are interested in coverage for Jan. 12014. They will receive a detailed communication instructing them how to confirm their interest via phone or email for coverage effective Jan. 1.

Customers may not make changes to their account after notifying Healthplanfinder of their desired Jan. 1 effective date until their applications are modified to support Jan. 1 coverage.

The Exchange continues to work with health insurance carriers to communicate the process for customers who receive coverage retroactively to Jan. 1 but who need to access health services immediately in the New Year.

Some customers may not receive plan ID cards or they may be subject to out-of-pocket costs until they receive an enrollment confirmation, which may take up to three weeks.

“We realize that retroactive coverage is not a perfect solution for our customers,” said Onizuka. “However, it will allow them to receive desired health plan benefits if they need important services immediately after Jan. 1.”

  • For a new list of Frequently Asked Questions on the Dec. 23 deadline, please click here.
  • For helpful hints for customers seeking coverage beginning Jan. 1, 2014, please click here.

Medicaid Note:

Washington Apple Health (Medicaid) does not have an open enrollment period.  Individuals and families will be able to apply and complete their renewals via www.wahealthplanfinder.org throughout the year.

Questions about Healthplanfinder should be directed to the toll-free Customer Support Center at 1-855-WAFINDER; Apple Health questions can be directed to the toll-free hot line at 1-800-562-3022 or emailed to AskMedicaid@hca.wa.gov.

For more information about Washington Healthplanfinder, visit wahealthplanfinder.org.  

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Thousands enroll in Medicaid as result of health law’s ‘woodwork’ effect

Center for Medicare & Medicaid ServicesBy Phil Galewitz

Supporters and opponents of the federal health law still can’t decide whether to call it the “woodwork” or “welcome mat” effect — the millions of people currently eligible for Medicaid who are not enrolled and who are expected to sign up as a result of the Affordable Care Act.

The Obama administration’s first enrollment report released Wednesday shows the phenomenon is real. It is happening even in Republican-led states that have fought the health law and refused to take advantage of a provision that would expand their Medicaid programs.

In the first month of open enrollment, about 91,000 people in those non-expanding states who would have qualified for Medicaid before but had not signed up, came to the federal online marketplace and were deemed eligible  for the program,  according to a Kaiser Health News analysis of the data.

In Florida, nearly 13,000 people have visited healthcare.gov and been determined eligible for Medicaid – more than in any of the states not expanding the program.

In Texas, the figure is about 11,600. Texas and Florida have been among the most hostile states to the health law. Nearly 11,000 people in Wisconsin have also been deemed eligible for Medicaid. Wisconsin is planning to reduce Medicaid eligibility next year.

“This is good news,” said Deborah Bachrach, a partner with consulting firm Manatt, Phelps & Phillips and a former Medicaid director in New York. “It shows despite the opposition from Texas Gov. Rick Perry and the Florida legislature and other states that people want coverage and they are coming in and applying despite the problems with healthcare.gov.”

Half the states next year are expanding Medicaid under the law to cover everyone under 138 percent of the federal poverty level, which is about $15,800 for an individual.

Those who are eligible for Medicaid or the Children’s Health Insurance Program still must enroll through the state Medicaid program. About 9 million people are expected to sign up for Medicaid as a result of the health law in the first year–including many who are eligible today for the program, according to the Congressional Budget Office.

In all, nearly 400,000 people nationally have been deemed eligible for Medicaid after going through either the federal online marketplace or their state exchange, according to the government’s announcement Wednesday. No information was released to indicate how many of the people applying in expansion states were previously eligible.

However, figures released on Wednesday by Washington state — which has its own online exchange — show  nearly 70,000 people enrolled in Medicaid of which 30,000 were previously eligible.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Prevention programs can help those left without insurance

Blue doctorBy Michelle Andrews

The health law gave a huge boost to insurance coverage for preventive care, requiring nearly all health plans to provide cancer screenings, check-ups and, more controversially, contraceptives, to patients free of charge.

But that doesn’t help the 30 million people who are expected to remain uninsured under the law and who will continue to rely on a patchwork of federal and state prevention programs whose funding is anything but certain.

One of the largest groups affected is low-income people who live in states that decide not to adopt the health law’s expansion of Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013).

The Supreme Court ruled last year that states aren’t required to expand that coverage, and half of the states have so far opted not to do so. Adults with incomes below the federal poverty level ($11,490 in 2013) aren’t eligible for subsidies on the state health insurance exchanges and many are likely to remain uninsured.

Other groups that need access to preventive services but may fall through the cracks include people who are exempt from the requirement to have insurance under the health law next year because coverage on the exchanges would cost more than 8 percent of their income, or those whose income is below the tax filing threshold ($10,000 for an individual or $20,000 for a married couple filing jointly), among others.

Immigrants who are in the country illegally and are prohibited from buying coverage on the exchanges will have no guaranteed access to preventive services either. In addition, low-income legal immigrants who must be in the country for five years before they can qualify for Medicaid may not be able to afford coverage, although they are eligible for premium subsidies to purchase it on the state marketplaces.

The lack of preventive coverage also hits women particularly hard. Women’s reproductive health care needs are greater than those of men, requiring regular doctor visits for exams and contraceptives.

Women’s health advocates say many women who want to ensure that their visits to health care clinics for birth control and other reproductive health services remain confidential frequently choose not to use insurance, even if they have it.

“The Affordable Care Act is wonderful in expanding coverage to millions of women, but it’s very difficult to obtain confidential services if you’re a dependent on anyone else’s policy,” says Kinsey Hasstedt, a public policy associate at the Guttmacher Institute, a research and policy organization that focuses on reproductive health.

There are programs available that help uninsured and low-income people get the preventive care they need, but advocates worry that funding, which is always precarious, will be further cut because of the misperception that starting next year everyone will have insurance that covers preventive care.

The health law requires that health plans provide preventive services recommended by the U.S. Preventive Services Task Force without any out-of-pocket cost to patients. The only exception is for grandfathered plans.

The federal Centers for Disease Control and Prevention runs two cancer screening programs for uninsured and underinsured people with incomes up to 250 percent of the federal poverty level ($28,725 in 2013).

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides screening in all states and the District, and women who are diagnosed with cancer or precancerous conditions can receive treatment through the Medicaid program.

The Colorectal Cancer Control Program is smaller, operating in half the states, and doesn’t provide access to treatment following diagnosis.

A 2012 analysis published by researchers at George Washington University and the Lewin Group  estimated that if every state expanded Medicaid under the ACA, 1.7 million low-income uninsured women would still be eligible for breast cancer screening in 2014 and 4.5 million women would be eligible for cervical cancer screening.

An additional 1.6 million men and women would be eligible for the colorectal cancer screening program, says  Leighton Ku, a professor of health policy who co-authored the study. Since every state isn’t required to expand Medicaid coverage under the law, the actual screening eligibility figures would be somewhat higher, says Ku.

Patient advocates are working to ensure the screening programs aren’t cut back and that Medicaid will continue to provide treatment.

“We don’t want to take steps backwards,” says Citseko Staples Miller, senior specialist for state and local campaigns at the American Cancer Society’s Cancer Action Network. “Maybe a woman gets a free screening, and then she’s told she has cancer but she’s no longer eligible for any other screening or treatment.”

Advocates have similar concerns about access to family planning services for low-income and uninsured women. Title X, a federal grant program for family planning and related health care, provides free or low-cost services to women and men through more than 4,000 health centers nationwide.

In addition, 26 states have expanded eligibility for family planning services under the Medicaid program, often to 200 percent of the federal poverty level. These Medicaid “waivers,” as they’re called, are going to be particularly important in the 15 states that have so far chosen not to expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level, says Hasstedt.

“Women [who] can get enrolled in their state’s family planning expansion can get exams, lab tests and the full range of contraceptives,” she says.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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How healthcare reform will affect people with HIV and AIDS

ACA health reform logoBy Christine Vestal
Stateline Staff Writer

The Affordable Care Act will broaden health care coverage for many of the 1.1 million Americans infected with HIV, especially those who live in the 25 states and the District of Columbia that have opted to expand Medicaid.

In those states, the larger Medicaid programs will cover about 60 percent of the mostly uninsured patients currently receiving help from federal-state HIV programs.

Medicaid will cover all of their health needs, not just their AIDS/HIV treatments.

Nationwide, another 30 percent of the people receiving HIV services now will qualify for tax subsidies to help them purchase insurance on exchanges, according to data from the National Alliance of State & Territorial AIDS Directors.

As a result, state officials who run so-called Ryan White programs that provide health care and other services for HIV-infected residents are preparing for a major shift in the type of benefits they offer and possibly the level of future investment.

What are the biggest ACA benefits for people with HIV?

In addition to expanding Medicaid, the ACA prevents insurance companies — whether they are on the exchanges or not — from dropping or denying coverage or charging higher rates for people with pre-existing conditions such as HIV/AIDS.

Currently, at least 30 percent of HIV infected people are uninsured. That compares to 15 percent in the general population, according to a study from the Kaiser Family Foundation. Until the ACA was enacted, private insurers often dropped people diagnosed with HIV, and it was difficult for people with the virus to purchase health insurance at an affordable price.

When the federal health law was signed in 2010, high-risk insurance backed by states and the federal government became available for people with pre-existing conditions, including HIV. Starting Jan. 1, 2014, all insurance carriers will be required to offer coverage to people with conditions such as HIV/AIDS, making high-risk insurance no longer necessary.

Top 10 States and Territories by Concentration of HIV Diagnoses
Diagnoses Per 100,000 People

  1. D.C. — 178
  2. Virgin Islands — 40
  3. Louisiana — 37
  4. Maryland — 36
  5. Florida — 33
  6. Georgia — 31
  7. New York — 30
  8. Puerto Rico — 29
  9. Mississippi — 25
  10. Texas — 25

Source: U.S. Centers for Disease Control and Prevention

How do HIV/AIDS programs work now?

Under a 1990 law named after Ryan White, a California teenager who died of AIDS, the federal government gives block grants to states to provide a variety of services for people with HIV/AIDS. In 2012, federal funding totaled $900 million. States are not required to contribute, but many do. Total state funding in 2012 was $275 million.

The bulk of the money has traditionally gone to a program called the AIDS Drug Assistance Program, under which states purchase antiretroviral drugs for people with HIV who can’t afford them.

Over the last decade, however, states have used more of the money to purchase health coverage for uninsured HIV clients, instead of directly purchasing drugs.

This practice has saved money and resulted in better health outcomes, including fewer hospitalizations and longer lives.

The AIDS Drug Assistance Program is not intended to provide comprehensive health care in the way Medicaid or private insurance do.

Will the ACA cause major changes to HIV/AIDS programs?

The answer is not yet known. In calculating the budget implications of expanding Medicaid, many states assumed a reduction in state funding for a variety of adult health care programs, including Ryan White. Some even questioned whether the program would be necessary after 2014.

But those calculations were only theoretical.

When Massachusetts expanded its Medicaid program in 2000 to include low-income HIV-infected adults, it maintained its investment in existing HIV treatment programs.

It did the same when it implemented its health care reforms in 2006, resulting in nearly universal health care coverage. Instead of cutting back, Massachusetts was able to offer assistance to more people, precipitously reducing the spread of AIDS.

However, in the 23 years since the Ryan White program began, states have adopted widely varying approaches to the structure and funding of HIV programs.  A similar patchwork is expected in the future.

Is the federal government expected to maintain AIDS funding?

Yes. In 2011, the results of a randomized clinical trial showed that treatment of HIV/AIDS with a cocktail of antiretroviral drugs reduced the risk of sexually transmitting HIV by 96 percent.

In response to this landmark study, state and federal officials decided to redouble their efforts with the goal of stamping out the deadly disease altogether.

Historically, federal funding has kept pace with inflation, but not with the spread of the disease, advocates say. Congress’ most recent authorization of the Ryan White law expired Sept. 30, although the law will stay in force indefinitely.

The Obama administration, advocates and state officials have agreed to wait to see how much the ACA benefits people with HIV before making any major changes to the federal Ryan White law.

In 2012, total federal funding to combat AIDS totaled $28 billion, including Medicaid, Medicare, Social Security income for the disabled, medical research and the Ryan White program.

What about Medicaid expansion under the ACA?

Medicaid expansion is the top priority for AIDS advocates, said Ronald Johnson, vice president of policy for advocates AIDS United.  If more states decided to expand Medicaid, it would have a major impact on the overall health of people with HIV.

About half of all Americans with HIV live in the South, where GOP governors and lawmakers have almost uniformly opposed the expansion. Louisiana, Florida, Georgia, Mississippi and Texas are among the top 10 states and territories with the highest concentration of HIV diagnoses.

None of those states has agreed to expand Medicaid as part of the ACA.

In states that are expanding Medicaid, Johnson said his organization and others are urging states to provide an adequate transition period for Ryan White clients who become newly eligible for Medicaid. Advocates also want states to more closely integrate new Medicaid benefits with Ryan White services than they have in the past.

When are states expected to recalibrate Ryan White programs?

It remains to be seen. A lot will depend on how many states ultimately decide to expand Medicaid and how many HIV infected people enroll in the program.

Similarly, shifts in the program will hinge on how many HIV-infected people ultimately sign up for private insurance on the exchanges and whether they will be able to pay the relatively high deductibles and co-payments the policies will require of all customers.

Another unknown is exactly how well public and private insurance will cover the complex health care needs of those with HIV. For example, many insurers currently do not provide adequate coverage of the transportation, case management and dentistry needs of HIV-infected people, said Amy Killelea of the National Alliance of State & Territorial AIDS Directors.

It is not clear whether coverage gaps will improve as states interpret the ACA’s essential benefits requirements, she said. “The case is being made that Ryan White and other AIDS programs cannot be offset,” Killelea said. For now, states are trying to figure out where exchange coverage and Medicaid stops and where Ryan White should start.
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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Oregon experiment puts therapists on primary care teams

dave-tyson-and-jennifer-engel

Tyler Engel with his parents, Dave and Jennifer. His doctor and therapist worked with the family to help Tyler recover from a concussion. (Photo by Kristian Foden-Vencil/OPB)

By Kristian Foden-Vencil, Oregon Public Broadcasting

The state of Oregon is trying some experiments to bring different kinds of medical professionals under the same roof.

Medicaid patients can see different kind of doctors in one visit, and the hope is it will provide better patient care, eventually at less cost to the state.

This can make sense in a primary care setting, where doctors often have to deal with stomach aches and migraines that end up stemming from mental, rather than physical, problems.

Before, primary care doctors typically would refer those patients to a psychologist. But very few patients actually go see the psychologist, says Robin Henderson, a psychologist with the St. Charles Health System in Bend, Ore.

They don’t want the stigma of seeing a psychologist, Henderson says, so they procrastinate and get sicker.

In an effort to solve the problem, St. Charles has been running a pilot project that puts psychologists in doctors’ offices.

“You’re sitting on the table, in comes your psychologist to sit next to you. It changes the stigma dynamic,” Henderson says.

Take the case of 17-year-old Tyson Engel.

Back in the spring of 2011, he was snowboarding on Mt. Batchelor when he fell so hard he cracked his helmet. His mom Jennifer Engel says she soon began to notice dramatic changes.

“Tyson talked about headaches for a while. He was always on the run, not eating very much, not sleeping very much,” she says.

Over a period of several months, she took him to the ER five times and tried several doctors around town. But the symptoms weren’t improving.

Eventually she ended up at the Mosaic Medical Clinic, where they saw Dr. Kristi Nix, a pediatrician, and Sandra Marshall, a clinical psychologist.

Nix treated Tyson for his physical brain injuries, while Marshall helped him with everyday coping skills to deal with symptoms like sensory overload and impulse control. For instance, Tyson’s mom remembers taking him to an appointment one day when he suddenly ran across a busy street to see a shiny new bike.

Marshall says it wasn’t just Tyson who needed help — his parents needed it too.

“Sometimes there would be too much talk,” says Marshall. “They would talk and talk and talk and he would get frustrated, and too fast. And it was ‘Okay, you guys have to stop talking too much.’ ”

Tyson says Marshall gave him coping strategies explained clearly enough that he could use them, as opposed to trying to recall some long in-depth family conversation.

So now if he sees a bike, he says, “I think to myself: ‘Is now the right time, is now the wrong time? How badly do I want to see the bike? Is it that important, is it not important?’ And just by asking myself questions, I’d get better at the certain situations I was into.”

Henderson says Tyson’s issues are complex. More common examples at Mosaic involve children getting upset tummies or headaches because they’re being bullied or because their parents are getting divorced.

For them, a more typical treatment would be brief interventional strategies designed to help parents and children deal with things that Henderson says “aren’t necessarily treatable with an antibiotic.”

For her part, Nix says having a psychologist in the clinic has lifted a burden off her shoulders.

“It’s not satisfying as a physician to say, ‘I don’t know what’s wrong with you. Get out of my office.’ Right. That’s not OK and it’s not good healthcare,” she says.

But asking a psychologist drop in to talk to a patient for 20 minutes, instead of setting up a schedule of weekly visits, is a big change in how psychologists are used to working.

Henderson says St. Charles has had problems hiring psychologists to place at local medical practices like Mosaic, where they would work with Medicaid clients.

“It’s not worked for some of them,” she says.”Initially we had a couple of folks who just couldn’t manage the model. It takes a different type of personality, and we find the folks coming right out of school, fresh, who’ve been trained in health psychology models. You have to have that type of personality who wants to engage in team-based care.”

As far as saving money, Henderson says therapists hired by St. Charles have cared for 400 Medicaid patients over about two years.

The annual cost of care dropped from an average of about $7,650 per patient per year to about $6,800 per patent per year. ”That included a minor increase in their pharmacy costs,” she explains. “But even with that increase, the total medical spend was going down.”

St. Charles is doing a much longer study to see if the savings are real. But several other health systems around the state as well as in Colorado and Massachusetts are also trying this approach.

This piece is part of a collaboration that includes NPROregon Public Broadcasting and Kaiser Health News.By Kristian Foden-Vencil, Oregon Public Broadcasting
OCT 22, 2013
The state of Oregon is trying some experiments to bring different kinds of medical professionals under the same roof. Medicaid patients can see different kind of doctors in one visit, and the hope is it will provide better patient care, eventually at less cost to the state.

This can make sense in a primary care setting, where doctors often have to deal with stomach aches and migraines that end up stemming from mental, rather than physical, problems.

Before, primary care doctors typically would refer those patients to a psychologist. But very few patients actually go see the psychologist, says Robin Henderson, a psychologist with the St. Charles Health System in Bend, Ore. They don’t want the stigma of seeing a psychologist, Henderson says, so they procrastinate and get sicker.

In an effort to solve the problem, St. Charles has been running a pilot project that puts psychologists in doctors’ offices.

“You’re sitting on the table, in comes your psychologist to sit next to you. It changes the stigma dynamic,” Henderson says.

Take the case of 17-year-old Tyson Engel.

Back in the spring of 2011, he was snowboarding on Mt. Batchelor when he fell so hard he cracked his helmet. His mom Jennifer Engel says she soon began to notice dramatic changes.

“Tyson talked about headaches for a while. He was always on the run, not eating very much, not sleeping very much,” she says.

Tyler Engel with his parents, Dave and Jennifer. His doctor and therapist worked with the family to help Tyler recover from a concussion. (Photo by Kristian Foden-Vencil/OPB)
Over a period of several months, she took him to the ER five times and tried several doctors around town. But the symptoms weren’t improving.

Eventually she ended up at the Mosaic Medical Clinic, where they saw Dr. Kristi Nix, a pediatrician, and Sandra Marshall, a clinical psychologist.

Nix treated Tyson for his physical brain injuries, while Marshall helped him with everyday coping skills to deal with symptoms like sensory overload and impulse control. For instance, Tyson’s mom remembers taking him to an appointment one day when he suddenly ran across a busy street to see a shiny new bike.

Marshall says it wasn’t just Tyson who needed help — his parents needed it too.

“Sometimes there would be too much talk,” says Marshall. “They would talk and talk and talk and he would get frustrated, and too fast. And it was ‘Okay, you guys have to stop talking too much.’ ”

Tyson says Marshall gave him coping strategies explained clearly enough that he could use them, as opposed to trying to recall some long in-depth family conversation.

So now if he sees a bike, he says, “I think to myself: ‘Is now the right time, is now the wrong time? How badly do I want to see the bike? Is it that important, is it not important?’ And just by asking myself questions, I’d get better at the certain situations I was into.”

Henderson says Tyson’s issues are complex. More common examples at Mosaic involve children getting upset tummies or headaches because they’re being bullied or because their parents are getting divorced.

For them, a more typical treatment would be brief interventional strategies designed to help parents and children deal with things that Henderson says “aren’t necessarily treatable with an antibiotic.”

For her part, Nix says having a psychologist in the clinic has lifted a burden off her shoulders.

“It’s not satisfying as a physician to say, ‘I don’t know what’s wrong with you. Get out of my office.’ Right. That’s not OK and it’s not good healthcare,” she says.

But asking a psychologist drop in to talk to a patient for 20 minutes, instead of setting up a schedule of weekly visits, is a big change in how psychologists are used to working.

Henderson says St. Charles has had problems hiring psychologists to place at local medical practices like Mosaic, where they would work with Medicaid clients.

“It’s not worked for some of them,” she says.”Initially we had a couple of folks who just couldn’t manage the model. It takes a different type of personality, and we find the folks coming right out of school, fresh, who’ve been trained in health psychology models. You have to have that type of personality who wants to engage in team-based care.”

As far as saving money, Henderson says therapists hired by St. Charles have cared for 400 Medicaid patients over about two years.

The annual cost of care dropped from an average of about $7,650 per patient per year to about $6,800 per patent per year. “That included a minor increase in their pharmacy costs,” she explains. “But even with that increase, the total medical spend was going down.”

St. Charles is doing a much longer study to see if the savings are real. But several other health systems around the state as well as in Colorado and Massachusetts are also trying this approach.

This piece is part of a collaboration that includes NPR, Oregon Public Broadcasting and Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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