Short Takes On News & Events

Feds Demand Medicaid Backlog Fixes By Six States

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

Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health  coverage.

The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee.

“CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people,” said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. He said the agency will monitor states’ progress in solving the problems getting people enrolled in the state-federal insurance program for the poor.

The agency sent letters June 27 requesting the plans, giving states 10 days to respond. It is unclear if any have submitted plans yet. The letters was first reported by InsideHealthPolicy, a trade publication.

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July 10th, 2014, 5:44 AM by Phil Galewitz

Short Takes On News & Events

Report: Adults With Serious Mental Illnesses Face 80% Unemployment

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

Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 – down from 23 percent in 2003.

That’s an unemployment rate of more than 80 percent.

“It isn’t surprising,” says Sita Diehl, director of state policy at NAMI and author of the report.  The problem has less to with the workers themselves, she says, and more with the organizations that provide services for people with serious mental illness.  “We knew that mental health services really took it on the chin during the recession. Employment rates had already been dismal to begin with, and when the supports were eroded, people with mental illness lost support and lost jobs.”

Rates of unemployment for people with mental illnesses varied greatly by state – from 92.6 percent in Maine to 56 percent in Wyoming.

Most adults with mental illness want to work, and six in 10 can succeed with the right supports, according to the report. Yet only 1.7 percent received supported employment services in 2012.

Without proper supports, many end up on expensive public programs including Supplemental Security Income (SSI) and Social Security Disability Income (SSDI). People with mental illnesses make up the largest and fastest growing group for both programs.

There are, however, several evidence-based programs to help individuals with mental illnesses find jobs and maintain them.

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July 10th, 2014, 5:41 AM by Jenny Gold

Short Takes On News & Events

CMS May Soften Paperwork Requirements For Home Health Care

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

Doctors may not have to write a narrative summary for patients needing home health care if a proposed rule by the Centers for Medicare and Medicaid Services is finalized.

For Medicare to pay for a home health visit, which includes physical therapy, speech therapy and skilled nursing care, the patient must be seen by a doctor either 90 days prior to the start of the home health care or 30 days after the start of the services. Currently, Medicare also requires that physicians certify that these patients are under their care and that they have trouble leaving home without the help of a walker or special transportation because of an illness or injury. To do so, doctors have to fill out what’s referred to as a face-to-face document, which states when the doctor saw the patient, and includes a narrative summary stating why the patient is homebound.

Home health agencies have pushed back against these requirements, saying Medicare contractors have denied them payments if physicians’ summaries are too short and not descriptive enough. And physicians have little incentive to do it a second time since the patient has already received care, according to home health sources. Hospital physicians may also not have enough of a full picture of the homebound status of a patient to write detailed summaries, and primary care physicians might not be in the know if a patient becomes homebound after a hospitalization.

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July 9th, 2014, 3:38 PM by Lisa Gillespie

Short Takes On News & Events

Advocates Say California Is Rejecting ‘Free Money’ To Renew Poor People’s Insurance

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

Consumer advocates and some legislators were surprised and frustrated when California health officials recently refused a $6 million donation to help people re-up their Medi-Cal health coverage.

Now two senators have proposed an unusual solution: a bill to force the state to accept the offer from The California Endowment.

Photo by Calsidyrose via Flickr

Sens. Ed Hernandez and Mark Leno, both Democrats, said the money from the health care philanthropy is needed to help people through the process of keeping their health coverage. Moreover, taking the money would make the state eligible for another $6 million in matching funds from the federal government, they say.

“I can’t see leaving money on the table,” Hernandez said Thursday. “It doesn’t cost us a penny.”

The state Department of Finance, however, has said it doesn’t need the money. “We think this is just a duplication of efforts,” Keely Boster, chief deputy director of the department, said in a legislative hearing last month.

The state is already faced with a backlog of new Medi-Cal applicants because of the program’s expansion under the federal health law. Now, advocates say, it is imperiling continued access for existing beneficiaries.

“It’s a head scratcher to me,” said Kristen Golden Testa, health director of The Children’s Partnership, a nonprofit child advocacy organization. “Free money to help keep people covered seems to make a lot of sense to me.”

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July 4th, 2014, 2:10 PM by Anna Gorman

Health Care In The States

Who Shopped The SHOP Exchanges? Very Few Small Businesses

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

Monteith Illingworth and Chris Abbate both have small public relations firms in Manhattan. Both offer their employees health coverage through Oxford Health, a division of insurance giant United Healthcare. Both faced double-digit premium hikes last year. And both considered hitting the eject button to buy coverage from the New York State of Health, the new insurance marketplace set up under the Affordable Care Act.

Illingworth didn’t.

“My instincts told me it was too soon,” said Illingworth, president of Monteith & Company, which has four employees. “I didn’t want to take the risk the first year.”

Abbate signed up.

“I was willing to take a chance,” said Abbate, president of Novitá Communications, with 10 employees.

She is in a distinct minority. New York’s new marketplace covered almost a million people, with about 600,000 people getting Medicaid, 400,000 people getting individual plans and just 10,000 getting employer-based small business plans, through the Small Business Health Options Program, or SHOP.

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July 2nd, 2014, 7:53 AM by Fred Mogul, WNYC

Short Takes On News & Events

Pelvic Exams No Longer Recommended For Well-Woman Visits

The American College of Physicians announced a major change to their screening guidelines Monday evening: Healthy women should no longer receive pelvic exams during their annual well-woman visits.

The recommendation does not apply to women who are pregnant or who have symptoms of pelvic disease.

“It’s an intrusive test, it’s a test women don’t like, and there’s no evidence that we should be doing it,” says Dr. Hanna Bloomfield, associate chief of staff of research at the Minneapolis VA Healthcare System, who conducted the evidence review that led to the new recommendation.

During the exam, the patient lies on the exam table with her feet in stirrups. The doctor examines the woman internally with one hand and applies pressure externally with the other hand, in what is known as a “bimanual exam.” Another part of the exam involves the use of a speculum. The screening is used to find cancer, noncancerous masses and infection in the ovaries, uterus and other pelvic organs.

But the latest evidence review found that in non-pregnant adult women without symptoms, there are no studies showing that cancer is actually detected by pelvic exams alone. And the screenings are more likely to hurt women than help them. The most likely harms include pain, discomfort, anxiety, embarrassment and fear for the woman, says  Bloomfield. But in more serious cases, doctors may also identify false positives that can subject the patient to “a diagnostic cascade” of unnecessary tests and even surgery.

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July 1st, 2014, 9:05 AM by Jenny Gold

Short Takes On News & Events

Poll: Americans Bristle At Penalties In Wellness Programs


Workers believe employer wellness programs should be all gain but no pain, according to a poll released Tuesday.

The poll from the Kaiser Family Foundation found employees approve of corporate wellness programs when they offer perks, but recoil if the plans have punitive incentives such as higher premiums for those who do not take part. (KHN is an editorially independent program of the foundation.)

Wellness programs, which are encouraged under the federal health law, are structured in various ways. In some plans, the worker has to join a particular program, such as an exercise class, while others focus on outcomes, such as the employees’ blood sugar or cholesterol. Evidence is mixed about whether any substantially improve workers’ health or lower costs to employers and insurers.

The poll found 76 percent of workers thought it was appropriate for employers to offer wellness programs that promote healthy behavior. But a majority opposed wellness plans that had financial repercussions for workers: 62 percent did not think employers should charge higher health insurance premiums to workers who did not participate, and 74 percent said management should not charge more to those who did not reach health goals.

The Obama administration is allowing employers to link up to 30 percent of health premiums to wellness programs. Penalties and rewards for participating in a tobacco cessation program can be as high as 50 percent of the insurance plan cost.

The poll found that among workers who get health insurance from their employer, 48 percent said there was a wellness program in their workplace. Six out of 10 people said they participate; women were more likely to take part than men.

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July 1st, 2014, 6:08 AM by Jordan Rau

Health Care In The States

‘A Uniquely New Hampshire Approach’ To Medicaid Expansion


New Hampshire became the 26th state today to embrace the federal health law’s expanded Medicaid program, with as many as 50,000 low-income residents expected to begin signing up.

Coverage for those who enroll this month will take effect Aug. 15. Initially, most New Hampshire enrollees will join one of two Medicaid managed care plans in the state. That’s the way most other states expanded Medicaid earlier this year.

But New Hampshire officials hope that up to 10 percent of those who sign up will eventually enroll in employer plans — using federal money to subsidize that coverage.

In addition, the state plans to seek federal approval to shift most Medicaid enrollees into private insurance plans sold in the online federal marketplace beginning in 2016. Earlier this year, Arkansas and Iowa took this approach, which has become popular among Republicans because it makes use of the private insurance market.

If the federal government approves that plan, the state would shift all enrollees from Medicaid-only managed care plans to marketplace plans in 2016. The only exception would be those who can take advantage of subsidized employer-based coverage. They would remain in their employer plan, if the state deems it is less costly than a Medicaid managed care plan.

New Hampshire and other states have had an employer-subsidy option for years, though few people have used it because most poor people are not offered coverage at work, or the coverage is not as good as Medicaid, according to study by the General Accountability Office.

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July 1st, 2014, 5:00 AM by Phil Galewitz

Health Care In The States

Washington And Other States See New Insurers On Exchanges

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

SEATTLE — Washington State’s health insurance exchange is looking to be an attractive marketplace for new health insurance carriers, according to an early analysis of insurer premium rate filings by McKinsey & Company.

Four new insurers have applied to sell individual policies in the state’s exchange next year, making Washington among the states with the highest number of new exchange entrants of the 12 states where preliminary 2015 rates have been filed, according to McKinsey. If insurance regulators approve the new carriers, Washington will have 12 insurers on the exchange in 2015, up from eight participating this year.

Washington’s not the only state attracting new health insurance business. Michigan also has four new exchange applicants, and five new carriers have applied in Indiana, the state so far with the highest number of new insurance carriers showing interest,  according to the real-time tracking of state insurance department rate filings that McKinsey is doing.

“[There’s] definitely an increase in the competition that will be available in the carrier options to consumers,” said Erica Hutchins Coe, associate principal at McKinsey.

UnitedHealthcare of Washington, Health Alliance Northwest Health Plan, and Columbia United Providers are among the new insurance exchange applicants, according to Washington State’s Office of the Insurance Commissioner.

Hutchins Coe said McKinsey hasn’t drawn conclusions about what brought new carrier interest to the state. But Washington Healthplanfinder officials said the interest shows their exchange is working.

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June 30th, 2014, 5:00 AM by Pauline Bartolone, Capital Public Radio

Health Care In The States

Medicare Penalties For Hospital Infections Will Hit Alaska Hard


The four largest hospitals in Alaska are facing Medicare payment penalties for the quality of their care. Providence, Alaska Regional, Alaska Native Medical Center and Fairbanks Memorial are all in the bottom 25 percent nationally for the number of infections and serious complications patients get in their hospitals, according to data analyzed by Kaiser Health News. The penalties are part of a focus on quality care that’s included in the Affordable Care Act.

Providence estimates it will lose more than $500,000 in federal payments starting in October. Fairbanks Memorial Hospital calculates its lost payments could be as much as $400,000. Both Alaska Regional and Alaska Native Medical Center estimate their penalties will cost them around $200,000. That is 1 percent of their Medicare payments.

Central line infections are one of three measures that Medicare tracked to decide which hospitals will be penalized. Central lines are IV’s inserted in veins that lead right to a patient’s heart, and infections there are serious. In 2012, Providence Alaska Medical Center in Anchorage had 17 of them in their intensive care units.

“There was no one single thing, there’s no smoking gun, ‘we were not doing x,’” said Dr. Dick Mandsager, Providence’s hospital administrator. He says the hospital had already begun to address the infections with emphasis on safety for patients with central lines. In 2013, Providence had six central line infections instead of 17.

“It’s making sure that the whole bundle of care is done every single time, all the time, regardless of how pressured you are, regardless of how many things you’ve got on your mind,” Mandsager said.

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June 27th, 2014, 6:00 AM by Annie Feidt, Alaska Public Radio Network