Reporter's Notebook

Deadline Today For 300,000 To Prove They Should Get Subsidies

KHN’s Julie Rovner was on WBUR’s Here and Now Tuesday morning to talk about the 300,000 people who stand to lose their health law subsidies if they don’t prove by today that they are eligible to get them.

Listen to audio of the interview below:

September 30th, 2014, 3:05 PM by KHN Editors

Short Takes On News & Events

California To Launch Medicaid-Funded Teledentistry

California Governor Jerry Brown has signed into law a bill that would require Medi-Cal, the state’s insurance program for the poor, to pay for dental services delivered by teams of hygienists and dentists connected through the Internet.

California is among the first states to launch such teledentistry services, which are intended to increase the options for patients in remote and underserved areas. Other states, like Oregon, Colorado, Hawaii and West Virginia, are interested in creating their own teledentistry programs but are farther behind, advocates for the projects said.

The bill, signed by the governor over the weekend, also expands the types of procedures hygienists and certain assistants can perform without onsite supervision by a dentist — deciding what X-rays to take, for instance, or installing temporary fillings that help prevent decay. The hygienists and other workers will consult with a dentist remotely, sharing records online but will refer a person directly to a dentist if more sophisticated  procedures are needed.

The legislation will take effect on Jan. 1.

Expanding teledentistry statewide will increase Medi-Cal costs minimally in the short-term — by upward of $500,000 a year, according to a State Assembly’s Appropriations Committee fiscal analysis. If teledentistry takes off, the costs could be higher.

Already, the Medi-Cal budget for dental services is slated to grow from $682 million to roughly $940 million by June 2015, thanks to legislation signed in June 2013 that brought back certain dental benefits for adults.

Dr. James Stephens, a Palo Alto dentist and president of the California Dental Association, said that teledentistry could save money down the line, however.

“That’s the real key. It’s a way of getting people who are outside the system into the system,” he said. “Preventive care costs so much less.”

The newly signed law is the culmination of years of work and research by hygienists, dentists and patient advocacy organizations across the state. About five years ago, Dr. Paul Glassman, a dentist at the University of the Pacific in San Francisco, started the pilot Virtual Dental Home Demonstration Project to show that teledentistry could provide a means to improve access at low costs.

“We’re very very excited. It’s a great ending to a long, long adventure here,” Glassman said. “The next challenge is to be able to spread this system.”

According to Glassman, as many as 50 percent of consumers eligible for dental services through Medi-Cal don’t get care. The idea is to deploy hygienists and dental assistants to schools, nursing homes and other community organizations where underserved populations gather. Glassman and other advocates say that will ease transportation, financial, language and cultural barriers that typically keep people from accessing treatment.

Telemedicine in general has been gaining traction, thanks in part to an increasing number of small Internet-enabled medical devices and consumer health trackers as well as growing interest among venture capitalists.  The federal Affordable Care Act has emphasized the use of digital technologies to improve care and cut costs. Recently, a bill was introduced in the U.S. House of Representatives that would allow accountable care organizations to get reimbursed for and use telemedicine more widely.

“Technology has really allowed things that weren’t possible before,” said Shelly Gehshan, the director of the children’s dental policy team at the Pew Charitable Trust. “But it’s not like flipping a switch.”

Before the promise of teledentistry can be borne out, the state still has to figure out the billing mechanism and payment structure for telemedicine-enabled services. Glassman acknowledged this could be a topic of debate: Providers will want to bill at the same rates as for in-person consultations, while Medi-Cal might opt for lower rates to control costs.

Professional organizations still need to build programs to train hygienists and dental assistants on taking X-rays by themselves, applying temporary fillings, and working as part of a teledentistry team. The bill spells out the type of training that will be necessary.

September 29th, 2014, 4:01 PM by Daniela Hernandez

Health Care In The States

Calif. Governor Vetoes Bill To Protect Assets From Medi-Cal

This story is part of a partnership that includes Capital Public Radio, NPR and Kaiser Health News. It can be republished for free. (details)

With the stroke of a pen, Gov. Jerry Brown rejected an effort to protect the estates of Medicaid beneficiaries in California, the San Jose Mercury News reported Friday. The bill, which the Democratic governor vetoed on Thursday, would have shielded the assets of people who receive Medicaid, known as Medi-Cal in California, from being recouped by the state after their deaths.

In a three-paragraph letter to the state senate, Brown advised legislators to consider the issue during the budget process. Brown wrote: “Allowing more estate protection for the next generation may be a worthy policy goal. The cost of this change, however, needs to be considered alongside other worthwhile policy changes in the budget process next year.”

The issue is important to people like Anne-Louise Vernon, who recently signed up for Medi-Cal under the Affordable Care Act’s expansion of the program. Vernon told Pauline Bartolone of Capitol Public Radio that she fears using her new coverage.  “I feel so unsettled about this whole estate recovery thing that I’m afraid to go to the doctor,” she said.

The law has been on California’s books for two decades, but with the expansion of Medi-Cal it now has the potential to affect many more people.

More from Pauline Bartolone’s story for Kaiser Health News and Capitol Public Radio:

Elizabeth Landsberg of the Western Center on Law and Poverty said it turns what was intended to be a safety net program into a long-term loan program and undermines the security that families might pass on to the next generation.

“So in most cases it’s modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes,” said Landsberg.

Landsberg said the law is unfair under the Affordable Care Act, because other people buying insurance and getting premium subsidies through Covered California aren’t subject to the same rules.

“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publicly-subsidized health coverage have no worries,” said Landsberg.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

September 26th, 2014, 2:29 PM by Diane Webber and Pauline Bartolone

Short Takes On News & Events

After Glitch, CVS Gives 11,000 Birth Control Refunds

CVS Health will pay refunds to about 11,000 women whom it accidentally charged co-payments for generic prescription birth control – a violation of the federal health law – due to a price coding glitch affecting Maryland, Virginia and the District of Columbia.

The company found that the charges resulted from an error that affected people covered by a single plan, CVS spokeswoman Carolyn Castel said in an email.

That plan was offered through CareFirst BlueCross BlueShield, which operates in Maryland, Virginia and Washington, D.C., according to California Democratic Rep. Jackie Speier’s office.

Speier was contacted by CVS in response to concerns she had raised earlier this month, when a congressional staffer purchased generic prescription birth control and was charged a $20 copay.

The coding error was in effect for less than two months, according to the letter, which noted that the problem should be fixed by Sept. 26. The 11,000 affected customers are expected to receive refunds by the start of October.

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September 26th, 2014, 8:19 AM by Shefali Luthra

Short Takes On News & Events

California Program Trains Young Men To Change Their Lives By Saving Others

On Thursday’s PBS NewsHour, KHN’s Sarah Varney reported on an innovative program in Oakland, Calif., that trains at risk youths to be emergency medical technicians. Watch the video below and read more on the NewsHour website.

September 26th, 2014, 8:10 AM by KHN Editors

Short Takes On News & Events

For Gay Men, Gaps In HIV Knowledge And Treatment Persist

This KHN story can be republished for free. (details)

Saturday is National Gay Men’s HIV/AIDS Awareness Day, but the news about knowledge and treatment of HIV in the gay community is dispiriting.

(Photo by Mario Tama/Getty Images)

Just 30 percent of gay and bisexual men say they were tested for HIV within the last year as recommended; another 30 percent say they have never been tested.

And even when they are tested, only half of those who have been diagnosed with HIV are receiving care and treatment for their infection.

Those statistics come from two reports released Thursday, the first a survey of gay and bisexual men from the Kaiser Family Foundation and the second, an analysis of men diagnosed with HIV in 2010 from the Centers for Disease Control and Prevention. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

“It’s unacceptable that treatment, one of our most powerful tools for protecting people’s health and preventing new HIV infections, is reaching only a fraction of gay men who need it,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention in a statement. “A top prevention priority at CDC is making sure every gay man with HIV knows his status and receives ongoing medical care – otherwise, we will never tackle the HIV epidemic in the country.”

At least part of the problem may be a lack of education about the disease.

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September 25th, 2014, 1:02 PM by Jenny Gold

Short Takes On News & Events

Consumer Group Sues 2 More Calif. Plans Over Narrow Networks

This KHN story can be republished for free. (details)

Insurers Cigna and Blue Shield of California misled consumers about the size of their networks of doctors and hospitals, leaving enrollees frustrated and owing large bills, according to two lawsuits filed this week in Los Angeles.

“As a result, many patients were left without coverage in the course of treatment,” said Laura Antonini, staff attorney for Consumer Watchdog, a Santa Monica-based advocacy group that filed the case.

Both cases allege that the insurers offered inadequate networks of doctors and hospitals  and that the companies advertised lists of participating providers that were incorrect.  Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status.

Cigna and Blue Shield officials said they had not seen the complaints and declined to comment.

In July, Consumer Watchdog filed a lawsuit against insurance giant Anthem Blue Cross of California with similar allegations. No court date has been set.

The cases are part of growing consumer pushback against so-called “narrow network” health plans, which are increasingly common, especially in the state and federal insurance marketplaces created by the Affordable Care Act.  Insurers say such plans are necessary to hold down premium prices. Consumer Watchdog is also putting a measure on the November ballot that would give the state insurance commissioner greater authority to veto rate increases.

The new lawsuits relate to Blue Shield plans sold through the state-run Covered California website, and Cigna plans sold outside of that marketplace.

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September 25th, 2014, 1:00 PM by Julie Appleby

Short Takes On News & Events

Report: Difficulties Likely To Persist In Enrolling Asian-Americans, Pacific Islanders

Language and cultural issues, along with immigration concerns, could still pose major barriers to enrolling Asian-Americans, Native Hawaiians and Pacific Islanders in health insurance plans this fall, according to a report released Wednesday by Action for Health Justice, an advocacy coalition that aims to educate these populations about the health law.

The report argues that efforts to enroll people from those ethnic groups were undermined last year by ineffective translations of health law guides; limited language options on the federal online marketplace,; insufficient training for enrollment assisters and complications in processing applicants’ immigration information. If those issues are not addressed by this year’s open enrollment – which begins Nov. 15 – they will likely continue to be a roadblock to expanding coverage, according to the report.

“Even with some of the advocacy efforts, both on the national level and also in the state-based marketplaces, I think some of the challenges will remain the same,” said Priscilla Huang, senior director of impact at the Asian and Pacific Islander American Health Forum, one of the AHJ’s member associations.

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September 24th, 2014, 8:01 AM by Shefali Luthra

Short Takes On News & Events

How To Fix Medicare? Ask The Public

This KHN story can be republished for free. (details)

Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered.

Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program.

Seventy-seven percent of participants in her “MedCHAT” group sessions said Medicare should cover at least one year of care in a nursing home, in supportive housing or at a person’s home. Eight-five percent wanted “modest coverage” of dental, vision and hearing services. To help Medicare last another half-century — it turns 50 next year — 85 percent were willing to reduce program spending on current and future beneficiaries.

Over the past year, Ginsburg’s group, the nonprofit, non-partisan Center for Healthcare Decisions, conducted 82 three-hour “MedCHAT” sessions in California with 810 participants to discover what changes they would make to the federal entitlement program. Small groups of eight to 15 people gathered in community centers and churches to use the “MedCHAT” tool on computers with guidance from facilitators. The groups included seniors, young adults, health care professionals and community and senior service leaders, and the interactive simulation tool explored Medicare options among 12 categories of coverage. If participants wanted to add benefits, they had to eliminate others or impose new restrictions on current coverage.

While participants did not eliminate benefits, they accepted stricter criteria or new limitations on current coverage. For example, 82 percent supported the use of defined networks of providers, but allowed the use of a provider outside the set network if approved by a primary care provider. Eighty-eight percent supported “value-based coverage” but also agreed with patients picking up at least half of the tab if research showed the benefits of a treatment “was small, unlikely or more expensive than an equivalent treatment.” Forty-eight percent backed using both penalties and rewards to encourage compliance with medical advice.

So how will Ginsburg’s findings fare in Washington where entitlement reform is the “third rail” of politics — touch it and your career dies?

Health care experts offered their thoughts at a Sept. 19 forum sponsored by the American Enterprise Institute and the Engelberg Center for Health Care Reform at the Brookings Institution where Ginsburg presented her findings.

Don’t confuse what took place in California with what will happen in Congress, said John Rother, a longtime Washington health care policy expert who is now president and chief executive officer of the National Coalition on Health Care. While many changes could be made to Medicare to make it more efficient, “we’ve got to figure this out in a way that minimizes political difficulty,” he said.

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September 23rd, 2014, 5:00 AM by Mary Agnes Carey

Short Takes On News & Events

San Francisco Politician: ‘I Take A Pill Called Truvada’

This story is part of a partnership that includes KQED, NPR and Kaiser Health News. It can be republished for free. (details)

In an effort to combat stigma that has arisen around a treatment that prevents HIV, a San Francisco elected official announced publicly Wednesday that he is taking the medicine. City Supervisor Scott Wiener said that he is taking Truvada, an FDA-approved drug that dramatically reduces the risk of HIV infection. He appears to be first public official to make such an announcement.

Wiener wrote about his experience in The Huffington Post:

Each morning, I take a pill called Truvada to protect me from becoming infected with HIV. This strategy, also known as pre-exposure prophylaxis, or PrEP, reduces the risk of HIV infection by up to 99 percent if the pill is taken once a day. This makes PrEP one of the most effective HIV-prevention measures in existence. …

As an elected official, disclosing this personal health decision was a hard but necessary choice. After all these years, we still see enormous stigma, shame, and judgment around HIV, and around sexuality in general. That is precisely why I decided to be public about my choice: to contribute to a larger dialogue about our community’s health.

“My hope is that by disclosing my PrEP use publicly that I can help move the conversation forward and get more people thinking about PrEP as a possibility, and encouraging people to consult with their medical provider,” Wiener said in an interview at his office in San Francisco’s City Hall.

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September 18th, 2014, 9:18 AM by Lisa Aliferis, KQED