Category Archives: Medicaid

A states obligated to provide expensive hepatitis C drugs?


By Michael Ollove

A handful of federal lawsuits against states that have denied highly effective but costly hepatitis C drugs to Medicaid patients and prisoners could cost states hundreds of millions of dollars.

The drugs boast cure rates of 95 percent or better, compared to 40 percent for previous treatments. But they cost between $83,000 and $95,000 for a single course of treatment.

The class actions, all filed in the last eight months in federal courts in Indiana, Massachusetts, Minnesota and Pennsylvania, present a series of extremes: a deadly epidemic, a treatment that can stop the disease in its tracks, and an enormous price tag.

At least 3.5 million Americans have hepatitis C, a virus spread through blood-to-blood contact that is usually contracted through the sharing of needles or other equipment to inject drugs.

Left untreated, hepatitis C slowly destroys the liver. Medicaid beneficiaries, a low-income population, have a slightly higher rate of hepatitis C infection than the privately insured, and the rate among prisoners is 30 times higher than in the general population.

The U.S. Food and Drug Administration approved the first of the new drugs, Sovaldi, in 2013. Since then, the FDA has also approved two other drugs, Viekira Pak and Harvoni.

But because the drugs are so expensive, state Medicaid programs and prisons have been restricting them to people in the advanced stages of the disease. Continue reading


After Texas stopped funding Planned Parenthood, low-income women had more babies – LA Times


200px-Flag-map_of_TexasThe state of Texas’ sustained campaign against Planned Parenthood and other family planning clinics affiliated with abortion providers appears to have led to an increase in births among low-income women who lost access to affordable and effective birth control, a new study says.

The analysis, published Wednesday in the New England Journal of Medicine, documents a significant increase in births among women who had previously received birth control at clinics that no longer get state funding.

Source: After Texas stopped funding Planned Parenthood, low-income women had more babies – LA Times


Slipping between Medicaid and marketplace coverage can leave consumers confused


Shopping CartBy Michelle Andrews

For people whose income changes shift them above or below the Medicaid threshold during the year, navigating their health insurance coverage can be confusing.

Ditto for lower income people who live in states that may expand Medicaid this year.

Under the health law, states can expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level (about $16,000 for an individual). Thirty states and the District of Columbia have done so.

This week I answered three questions from readers about how Medicaid interacts with plans on the health insurance marketplaces.

Q. In my state, if my income drops below 138 percent of the federal poverty level, I have to drop my marketplace plan and sign up for Medicaid. But if my income increases and I become eligible for a marketplace plan again, what happens to any payments I’ve made toward the deductible and out-of-pocket maximum for that plan? Do they reset to zero so I have to start all over again? Continue reading


Regardless of state’s approach, Medicaid expansion helps poor obtain health care – study


From the Commonwealth Fund

Low-income adults in Kentucky and Arkansas, which both expanded Medicaid eligibility under the Affordable Care Act, were more likely to be insured and to report fewer problems paying medical bills or skipping prescriptions because of cost than adults in Texas, which did not expand coverage, according to a Commonwealth Fund-supported study released in Health Affairs today.

Despite the fact that the expansion states used different methods to offer coverage to more people (traditional Medicaid in Kentucky versus private insurance in Arkansas), adults in both states saw greater increases in coverage rates and ability to afford needed health care compared to adults in the non-expansion state.

The study, conducted by Benjamin Sommers, Robert Blendon, and E. John Orav at Harvard University, compared the health care experiences of low-income adults in Kentucky, Arkansas, and Texas in late 2013 and again 12 months later.

Arkansas expanded Medicaid by using federal funds to purchase private health insurance for enrollees through the ACA’s marketplaces, while Kentucky expanded eligibility through its traditional Medicaid program. Texas did not expand its Medicaid program.

The survey of more than 5,600 low-income adults found that:

  • Uninsured rates dropped more in the expansion states.
    • The uninsured rate in Kentucky and Arkansas dropped 14 percentage points more than it did in Texas between 2013, prior to full implementation of the ACA’s health insurance provisions, and 2014, after the expansion’s first full year.
    • The uninsured rate for low-income adults was about 40 percent in all three states in 2013 but had dropped to 19 percent in Arkansas, 12 percent in Kentucky, and 27 percent in Texas in 2014.
  • Fewer people reported problems with medical bills or skipping prescriptions because of cost in the expansion states.
    • In Kentucky and Arkansas the share of people who said they were struggling to pay medical bills fell by nearly 9 percentage points more than in Texas over 2013–2014.
    • Adults reporting not filling a prescription because of the cost fell by nearly 10 percentage points more in Kentucky and Arkansas than in Texas.
    • Low-income adults in Kentucky experienced an even larger reduction in problems paying medical bills than those in Arkansas, which the authors suggest indicates the greater financial protection provided by Medicaid compared to private coverage, even with subsidies.

Continue reading


Feds fund effort to tie medical services to social needs


Young woman holds an older woman's handBy Julie Rovner

The federal government has announced a $157 million project to help hospitals and doctors link Medicare and Medicaid patients to needed social services that sometimes have a bigger impact on their health than medical interventions.

Public health experts have known for decades that even with medical care easily available, patients are often limited in their ability to get better or maintain good health if they lack stable housing, access to healthy food, or the ability to get to and from medical appointments.

The goal of the project is to find better ways to identify patients’ non-medical needs and connect them to available services in their communities.

The goal of the “Accountable Health Communities” project is to find better ways to identify patients’ non-medical needs and connect them to available services in their communities.

The social services to be linked include those related to housing, food, personal safety, inability to pay utility bills and transportation. The project will fund up to 44 separate experiments over five years.

Applications are being accepted by the Centers for Medicare & Medicaid Services and announcement of the winning proposals is expected later this year. Continue reading


Report: Home care workers need better job protections


A younger man's hand holding the hand of an elderly manBy Anna Gorman

A lack of oversight in the rapidly growing home care workforce could undermine new wage and labor gains for many of the nation’s 2 million workers, according to a report released Monday.

Private agencies employ the vast majority of home care workers, who provide services that are largely paid for by Medicare, Medicaid and other federal and state programs. But the companies are poorly regulated, which could hamper the enforcement of new labor standards, said the National Employment Law Project (NELP), a labor advocacy group.

Home care workers this year gained federal minimum wage and overtime protections after a lengthy battle in the federal courts. The U.S. Department of Labor is expected to begin full enforcement in 2016.

To ensure that workers can take advantage of the new benefits, stronger oversight of the industry is needed, said Sarah Leberstein, one of the report’s authors. Continue reading


Baby boomers set another trend: More golden years in poorer health


240px-Peace_sign.svgBy Lisa Gillespie

After the last of the baby boomers become fully eligible for Medicare, the federal health program can expect significantly higher costs in 2030 both because of the high number of beneficiaries and because many are expected to be significantly less healthy than previous generations.

The typical Medicare beneficiary who is 65 or older in 2030 will more likely be obese, disabled and suffering from chronic conditions.

such as heart disease and high blood pressure than those in 2010The typical Medicare beneficiary who is 65 or older then will more likely be obese, disabled and suffering from chronic conditions such as heart disease and high blood pressure than those in 2010, according to a report by the University for Southern California’s Schaeffer Center of Health Policy and Economics. Continue reading


Medicaid denies nearly half of requests for hepatitis C drug

Hepatitis C virus

Hepatitis C virus

By Michelle Andrews

People with hepatitis C who sought prescriptions for highly effective but pricey new drugs were significantly more likely to get turned down if they had Medicaid coverage than if they were insured by Medicare or private commercial policies, a recent study found.

Researchers at the University of Pennsylvania Perelman School of Medicine analyzed the hepatitis C prescriptions from 2,342 patients in Maryland, Delaware, Pennsylvania and New Jersey that were submitted between November 2014 and April 2015 to a large specialty pharmacy that serves the region.

The drugs included Sovaldi, Harvoni and Viekira Pak, and others that are part of the treatment regimen. A 12-week course of treatment for one patient can reach more than $90,000. Continue reading


Enrollment Guide: Tips on how to shop for a marketplace lan


Shopping CartBy Mary Agnes Carey

Open enrollment for the health law’s 2016 marketplace plans begins Sunday, and federal officials caution consumers to check out premium prices because in many places they may be higher. But officials are planning to offer new features to make the process faster and smoother for consumers.

They can already do some window-shopping for plans on the federal marketplace,  A new feature that may help some customers is an online, out-of-pocket expense calculator on the website to help estimate how much they will pay in deductibles and co-payments in addition to the monthly premiums.

Answers to these and other questions:

  • I enrolled on last year. Do I have to do it again?
  • I want to buy health insurance but can’t afford it. What should I do?
  • What if I make too much money to qualify for Medicaid but still can’t afford to buy coverage?
  • What if I have health problems?
  • I get health coverage at work and want to keep my current plan. Can I do that?
  • I didn’t get health insurance in 2015. What is going to happen to me now?
  • I own a business. Will I have to buy health insurance for my workers?

Continue reading


Newly insured treasure Medicaid, but growing pains felt


By Sara Varney

SAN DIEGO — The Affordable Care Act unleashed a building boom of community health centers across the country. At a cost of $11 billion, more than 950 health centers have opened and thousands have expanded or modernized.

In San Diego, new clinics have popped up on school campuses and busy street corners. Cramped storefront clinics have been replaced with gleaming, three-story medical centers with family medicine, radiology and physical therapy on site. They are outfitted to care for new immigrants in dozens of languages from Spanish to Somali.

The community health centers are the country’s largest primary care system for low-income patients, now working to absorb a tsunami of new Medicaid enrollees.

At age 58, after several worrisome decades without health insurance, Lori Simpson is finally getting treatment for her dangerously high blood pressure, a serious thyroid disorder and, after years of double vision that had made it difficult for her to work and care for her grandchildren, surgery for her eyes.

“I have nine medications that I get every month, and mine comes to a little over two hundred dollars,” Simpson said. Prescription medications for her husband, a diabetic, cost $400 a month. “We don’t pay anything, it’s all covered. It’s just amazing.”

Simpson goes to the Family Health Centers of San Diego, which saw an increase of 24,000 patients, almost overnight, after the Medicaid expansion began in January 2014. Dr. Chris Gordon, the center’s assistant medical director, said it was a rush primary care clinics have been waiting for ever since President Barack Obama signed the health law in 2010.

“We’ve anticipated this for years and have been planning for it,” Gordon said. “We have capacity to take on patients. These are patients that haven’t had access before because they just didn’t have the financial means to get in. And now all of a sudden, they actually get to come in, get to spend time with somebody and get to feel like they’re heard.” Continue reading


From pills to pins: Oregon is changing how it deals with back pain

kfv-oregon-pain-3-570 (1)

Doris Keene (right) at Portland’s Quest Center for Integrative Health. (Photo by Kristian Foden-Vencil/Oregon Public Broadcasting)

By Kristian Foden-Vencil
Oregon Public Broadcasting

When Portland resident Doris Keene raised her four children, she walked everywhere and stayed active. But when she turned 59, she says, everything fell apart.

“My leg started bothering me. First it was my knees.” She ignored the pain, and thinks now it was it the sciatic nerve acting up, all along. “I just tried to deal with it,” Keene says.

But eventually, she went to a doctor who prescribed Vicodin and muscle relaxants. In 2012, about one in four Oregonians received an opioid prescription – more than 900,000 people. The state currently leads the nation in nonmedical use of opioids. And about a third of the hospitalizations related to drug abuse in Oregon are because of opioids.

Keene says the drugs helped her, but only to a degree. Continue reading


Happy 50th birthday, Medicare. Your patients are getting healthier


Photo: Courtesy of Ed g2s under Creative Commons license

The past 15 years have seen a marked drop in deaths and hospitalizations among Medicare patients — people 65 and older. Teasing out why is tricky, but it seems a good trend for the 50-year-old program.


Five challenges facing Medicaid at 50


By Phil Galewitz


President Lyndon B. Johnson signed the bill creating Medicare and Medicaid at the library of former President Harry Truman, who was in attendance, on July 30, 1965. (Photo courtesy of Truman Library)

A “sleeper” provision when Congress created Medicare in 1965 to cover health care for seniors, Medicaid now provides coverage to nearly 1 in 4 Americans, at an annual cost of more than $500 billion.

Today, it is the workhorse of the U.S. health system, covering nearly half of all births, one-third of children and two-thirds of people in nursing homes.

Enrollment has soared to more than 70 million people since 2014 when the Affordable Care Act began providing billions to states that chose to expand eligibility to low-income adults under age 65. Previously, the program mainly covered children, pregnant women and the disabled.

Unlike Medicare, which is mostly funded by the federal government (with beneficiaries paying some costs), Medicaid is a state-federal hybrid. States share in the cost, and within broad federal parameters, have flexibility to set benefits and eligibility rules.

Though it provides a vital safety net, Medicaid faces five big challenges to providing good care and control costs into the future: Continue reading