By Phil Galewitz
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
President Barack Obama has vowed to redouble his administration’s efforts to persuade all states to expand Medicaid. But if history is any indication, achieving that goal will take some time.
By Christine Vestal
TAMPA, Florida — With its ruling in King v. Burwell last month, the U.S. Supreme Court likely settled the question of whether President Barack Obama’s signature Affordable Care Act will survive.
Whether and when the health law will be fully implemented in all 50 states is a different question.
“With the King decision behind us, the drumbeats for Medicaid expansion are increasing,” said Matt Salo, executive director of the National Association of Medicaid Directors. “There is movement in every state. They’ll get there. Maybe not today and maybe not this year, but they’ll get there soon.”
That’s the hope of health care industry groups and legions of consumer advocates. Major business organizations and local and county governments are also onboard. Following the high court’s decision, President Obama vowed to do all he can to persuade states to opt in before he leaves office in 18 months.
But in the mostly Southern and Midwestern states that have rejected expansion, opposition shows little sign of abating. Continue reading
Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found.
The study by researchers at the Urban Institute examined how office-based primary care practices provided five recommended preventive services over a five-year period.
The services were clinical breast exams, pelvic exams, mammograms, Pap tests and depression screening.
The study used data from the National Ambulatory Medical Care Survey, a federal health database of services provided by physicians in office-based settings.
It looked at 12,444 visits to primary care practitioners by privately insured women and 1,519 visits by women who were covered by Medicaid between 2006 and 2010.
That difference reflects the fact that the share of women who are privately insured is seven times larger than those on Medicaid, the researchers said. Pregnancy-related visits and visits to clinics were excluded from the analysis.
Overall, 26 percent of the visits by women with Medicaid included at least one of the five services, compared with 31 percent of the visits by privately insured women. Continue reading
By Susan Milligan
Iraq war veteran Doug Mercer had been home in McAlester, Oklahoma, for just four days when he was in a motorcycle accident that left him broken and brain-damaged.
His wife Michelle became his caregiver after he left the hospital, but nobody there explained how to transport him safely. A few weeks later, Michelle struggled as she tried to get Doug from the car to his wheelchair, breaking his leg.
“They’re sending you home, and you’re thinking, ‘What?’ Nobody instructs you, and says, ‘This is what’s coming home with you and how to use it,’” she said.
The Mercers’ story was a driving force behind an Oklahoma law that took effect in November that requires hospitals to train a designated family caregiver to tend to the medical needs of a released patient.
As many as 42 million Americans take care of a family member at any given time.
As many as 42 million Americans take care of a family member at any given time. Traditionally, family caregivers provide assistance with bathing, dressing and eating. They shop for groceries and manage finances.
But as the number of elderly Americans with chronic conditions has grown, family caregivers have taken on medical tasks once provided only in hospitals, nursing homes or by home care professionals.
In an AARP survey released in 2012, nearly half of family caregivers said they administered multiple medications, cared for wounds, prepared food for special diets, used monitors or operated specialized medical equipment. Continue reading
By Michael Ollove
Joe Calderon faced uncomfortably high odds of dying after his release from a California prison in 2010.
According to one study, his chances of dying within two weeks — especially from a drug overdose, heart disease, homicide or suicide — were nearly 13 times greater than for a person who had never been incarcerated.
Despite suffering from hypertension during his 17 years and three days of incarceration, Calderon was lucky. He stumbled onto a city of San Francisco program that paid for health services for ex-offenders, and he was directed to Transitions Clinic, which provides comprehensive primary care for former prisoners with chronic illnesses. The clinic saw to all his health needs in the months after his release.
An increasing number of states are striving to connect released prisoners like Calderon to health care programs on the outside. Frequently, that means enrolling them in Medicaid and scheduling appointments for medical services before they are released.
Some state programs — in Massachusetts and Connecticut, for example — provide help to all outgoing prisoners. Programs in some other states are more targeted. Those in Rhode Island and New York, for instance, focus on ex-offenders with HIV or AIDS.
Elsewhere, probation and parole are being used to encourage ex-offenders to adhere to certain treatments. Utah, for example, passed a measure this year that cuts probation time for former prisoners if they get treatment for mental illness or substance abuse.
The goal of these programs isn’t just to address the health needs of a notoriously unhealthy population, but to improve the likelihood they will succeed in society.
“We want to support them as much as possible to make sure they are productive and do not return to prison,” said Dr. Shira Shavit, executive director of Transitions. Continue reading
By Christine Vestal
NEW YORK – At the Interfaith Dental Center in Crown Heights, Brooklyn, people with dental pain can walk into a ground floor office off Bedford Avenue and get treated without an appointment. They might have to wait in a packed waiting room. But if they’re in the door by 5 p.m., a dentist will see them.
The majority of Americans have to travel miles to see a dentist who takes their insurance, particularly if they’re covered by Medicaid.
Federal law requires state Medicaid programs to include dental care for children, and the Affordable Care Act extended that requirement to private insurers. But the federal health law did little for adults: While premium tax credits were made available to help low-income people purchase health insurance, the subsidies cannot be used to purchase dental coverage except as an add-on to health coverage. No new dental benefit requirements were included for adults covered by Medicaid.
“The ACA was a big flop when it comes to adult dental coverage,” said Dr. Jonathan Shenkin, vice president of the American Dental Association (ADA).
Even so, some states have stepped up coverage for at least some adults on Medicaid. Virginia added a dental benefit for pregnant women in March. Colorado introduced limited adult dental coverage for the first time last year. Also last year, California, Illinois, Massachusetts and South Carolina reinstated benefits that had been cut in the years since the recession began in 2007. Indiana began offering expanded adult dental benefits this year. Continue reading
LOCKHART, Texas — The call from the nursing home came just before dawn, jolting Martha Sherwood awake.
During the night, fire ants had swarmed over her 85-year-old mother, injecting their stinging venom into Natalie Sealy’s face, arms, hands and chest.
“She was just lying there being eaten alive,” said daughter Billie Pender, who said she and her sister had repeatedly complained about a broken windowsill in their mother’s room at Parkview Nursing and Rehabilitation Center.
In 11 states, 40 percent or more of nursing homes get Medicare’s lowest two lowest rating.
Their mother had chosen the for-profit facility two years earlier because it was near her adult children. The family didn’t know that Parkview scored poorly on staffing and other quality measures.
This year, Medicare rates it one star out of a possible five stars — the lowest rating possible — on Nursing Home Compare, which was designed by the federal government to help consumers choose a long-term care facility.
The problem for Sealy’s family and residents of many parts of the country is they have few, if any, higher-rated options if they want their loved ones close by.
In 11 states, 40 percent or more of nursing homes get the two lowest ratings, according to an analysis by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
Texas has the highest percentage of one-and two-star homes in the country: 51 percent of its nursing homes are rated “below average,” or “much below average,” on Nursing Home Compare, according to the analysis. Louisiana is close behind at 49 percent, with Oklahoma, Georgia and West Virginia tying for third at 46 percent. Continue reading
By Christine Vestal
The federal government is quietly warning states that failure to expand Medicaid under the Affordable Care Act could imperil billions in federal subsidies for hospitals and doctors who care for the poor.
In an April 14 letter to Florida Medicaid director Justin Senior, Vikki Wachino, acting director of the U.S. Centers for Medicare and Medicaid Services (CMS) wrote: “Uncompensated care pool funding should not pay for costs that would be covered in a Medicaid expansion.”
Federal money to support low-income clinics and hospitals is slated to decline under the Affordable Care Act as more people become insured.
Florida has asked CMS to renew $1.3 billion in federal funding for its 2016 “low-income pool,” even though the state has rejected Medicaid expansion.
CMS maintains that any extension must take into account the more than 800,000 residents whose medical bills would be covered by Medicaid were the state to expand the program.
By Phil Galewitz
When Bruce Hodgins went to the doctor for a checkup in Sioux City, Iowa, he was asked to complete a lengthy survey to gauge his health risks.
In return for filling it out, he saved a $10 monthly premium for his Medicaid coverage.
In Las Cruces, N.M., Isabel Juarez had her eyes tested, her teeth cleaned and recorded how many steps she walked with a pedometer.
In exchange, she received a $100 gift card from Medicaid to help her buy health care products including mouthwash, vitamins, soap and toothpaste.
Taking a cue from workplace wellness programs, Iowa and New Mexico are among more than a dozen states offering incentives to Medicaid beneficiaries to get them to make healthier decisions — and potentially save money for the state-federal health insurance program for the poor.
The stakes are huge because Medicaid enrollees are more likely to engage in unhealthy practices, such as smoking, and are less likely to get preventive care, studies show. Continue reading
By Michael Ollove
Fifteen states are betting they can convince more doctors to accept the growing number of patients covered by Medicaid with a simple incentive: more money.
The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1.
Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, the 15 states are dipping into their own coffers to continue to pay the doctors more.
It seems to be working. Continue reading
By Jenny Gold
A federal law that passed in 2008 was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care.
But until now, the government had only spelled out how the law applied to commercial plans.
That changed Monday, when federal officials released a long-awaited rule proposing how the parity law should also protect low-income Americans insured through the government’s Medicaid managed care and the Children’s Health Insurance Program (CHIP) plans. The proposed regulation is similar to one released in November 2013 for private insurers.
“Whether private insurance, Medicaid, or CHIP, all Americans deserve access to quality mental health services and substance use disorder services,” said Vikki Wachino, acting director at the Center for Medicaid and CHIP Services.
Medicaid and CHIP programs are funded jointly by the federal and state governments.
Even if the state has carved out some benefits under a separate behavioral health plan, patients would be protected under the rule. Medicare patients are generally not affected by the regulation, nor are those in Medicaid fee-for-service plans .
But the rule does affect the majority of the 70 million people on Medicaid who are in managed care plans, and the 8 million children covered by CHIP plans.
Insurers, advocates and the general public will have a chance to comment on the proposed rule. The government will then release a final version.
Photo courtesy of Sanja Gjenero