Category Archives: Medicaid

New Medicaid rule could hinder shift away from nursing homes

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A younger man holds an elderly man's handBy Christine Vestal
Stateline

For more than 30 years, states have been finding new ways to care for aged and disabled Medicaid beneficiaries without confining them to nursing homes.

In fact, the number of people living in skilled nursing facilities has declined significantly over the last decade, despite a marked increase in the ranks of the elderly in the U.S.

Starting this year, a new federal rule will require states to ensure that long-term care alternatives to nursing homes—such as assisted living facilities, continuing care retirement communities, group homes and adult day care—work with residents and their families to develop individual care plans specifying the services and setting each resident wants.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one and to give residents choices about their care.

While nearly everyone supports the concept, states, providers and even some consumer advocates are complaining that the rule could make it difficult for health care providers to fulfill increasing demand for long-term care outside of nursing homes.

Under the rule, for example, elderly people with dementia who enter assisted living facilities should not be subjected to constraints, such as locked exits, unless they are at risk for wandering.

But if they share living space with other residents with dementia who do need to be prevented from wandering, it will be difficult to allow them to leave the building whenever they want without jeopardizing the safety of others.

“The goal was completely laudable,” said Martha Roherty, director of the National Association of States United for Aging and Disabilities, which works to help elders and people with disabilities live in their communities for as long as possible.

“Unfortunately, what’s happened is that it is limiting individuals’ choice of what and where to receive (long-term care) services rather than broadening it, especially as it relates to seniors,” she said. Continue reading

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Perry-Appointed Board Backs Health Coverage Expansion | The Texas Tribune

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200px-Flag-map_of_TexasThe 15-member Texas Institute of Health Care Quality and Efficiency recommended that the state’s health commissioner be authorized to negotiate a Texas-specific agreement with the federal government to expand health coverage to the poor, “using available federal funds.”

“We’re trying to look at actions whereby more Texans can be covered,” said board chairman Steve Berkowitz, the president and founder 0f SMB Health Consulting. “We’re trying to take the politics out of it.”

via Perry-Appointed Board Backs Health Coverage Expansion | The Texas Tribune.

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Millions of Medicaid Kids missing regular checkups

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Illustration: Doctor listens to a young boy's chest with a stethoscopeBy Phil Galewitz
KHN

Millions of low-income children are failing to get the free preventive exams and screenings guaranteed by Medicaid and the Obama administration is not doing enough to fix the problem, according to a federal watchdog report.

The report, released Thursday by the Department of Health and Human Services’ Office of Inspector General (OIG), says the administration has boosted rates of participation but needs to do more to ensure that children get the regular wellness exams, dental checkups and vision and hearing tests.

The report notes that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but still far below the department’s 80 percent goal. Continue reading

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Home health workers struggle for better pay and health insurance

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Home health care workers Jasmine Almodovar (far right) and Artheta Peters (center) take part in a Cleveland rally for higher pay on Sept. 4. (Photo by Sarah Jane Tribble, WPCN/Ideastream)

Home health care workers Jasmine Almodovar (far right) and Artheta Peters (center) take part in a Cleveland rally for higher pay on Sept. 4. (Photo: Sarah Jane Tribble.)

By Sarah Jane Tribble, WCPN

Holly Dawson believes her job is a calling.

She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay.

Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear.

George Grellinger, a former client of hers, has dementia. He recently fell down the back steps of his home. Dawson remains friends and regularly stops in to check on him. To remain living at home, Grellinger had to switch to an aide who is covered by his veterans’ benefits.

A lot of us are barely home because if we don’t go to work, we don’t get time off. We don’t get paid vacations. And some of us haven’t had raises in years.”

When Dawson worked for him, Grellinger paid an agency $37 for two hours of her time each day. Dawson received $13 an hour, higher than the national average for home health aides. She had to pay her own taxes and health care benefits. Dawson says she can’t remember the last time she could afford health insurance.

Dawson says she has been a home health aide for 31 years. She has never done it for the money, rather to help people like Grellinger, she says.

But the conditions of home health work are leading many aides to seek better pay and benefits.

On an early September morning, home health workers held a rally in Cleveland. Jasmine Almodovar, 35, chants with the crowd: “We want change and we don’t mean pennies!”

She says she earns $9.50 an hour, which is actually just above average for a home health worker in Ohio.

“We work really long hours, really hard work,” she says. “A lot of us are barely home because if we don’t go to work, we don’t get time off. We don’t get paid vacations. And some of us haven’t had raises in years.”

Almodovar says her last raise was four years ago. She makes about $21,000 a year so she makes too much to qualify for Medicaid, but paying for a plan on Ohio’s federal exchange doesn’t fit in her monthly budget. Continue reading

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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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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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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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