Tag: Medicaid Reform

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A new report commissioned by the TX legislature supports funding for improving air quality inside asthmatic Medicaid members’ homes.

 
 

Clipped from: https://www.reformaustin.org/healthcare/non-medical-home-remediation-study-could-be-game-changer-for-texas-medicaid-patients/

 
 

Evidence from a recent national study of Medicaid benefits shows that newly implemented programs utilizing preventative products and services to address respiratory and other health issues resulted in improved outcomes for Medicaid enrollees. The result of using these non-medical programs was that patients had fewer emergency room visits, took fewer sick days, and ultimately saved on the cost of their medical care.  

A report prepared by researchers at Episcopal Health Foundation and the Center for Health Care Strategies illustrates how such programs could benefit Medicaid recipients in Texas. 

The report is part of 2022 legislative recommendations from the Texas Value-Based Payment and Quality Improvement Advisory Committee, which urges state lawmakers to expand preventative Medicaid programs that cover non-medical drivers of health. They provide a forum to promote public-private, multi-stakeholder collaboration in support of quality improvement and value-based payment initiatives for Medicaid.

The research that led to the report focused on indoor environmental conditions in which people live and work that influence their health and wellness in non-medical programs covered by Medicaid. 

They focused on these three areas:

1. Air quality issues that trigger asthma attacks in homes and offices
   
2. How the lack of access to affordable healthy food contributes to overall health issues
   
3. And the maintaining of housing quality to aid in positive health outcomes
   

An example cited in the report describes how an asthma remediation program identified mold in a 12-year-old girl’s home as a primary trigger of her asthma attacks. So, the program paid to remove and replace moldy carpeting. 

The results were profound — she suffered fewer asthma attacks, and no absences from school — and a better ability to keep her asthma under control. 

According to the Mayo Clinic, many patients suffer from allergic asthma, which not only includes reactions to typical triggers like pollen, dust mites, and pet dander but also mold and mildew, which the non-medical remediation and other air filtration machines greatly reduce.

“This is a game changer that could improve the health and wellness of Texans most in need in an entirely new way,” Barnes said. “We have to change the way we think about health and how we pay for it. The report shows how things could change for the better in Texas,” said Dr. Ann Barnes, a physician, and CEO of Episcopal Health Foundation. 

“As a philanthropy, we’ve funded asthma remediation projects and food as medicine programs that have shown great health improvements, but they were limited to patients of a single clinic or area. This report describes a great opportunity for Medicaid in Texas to cover these non-medical programs on a much larger scale across the state with sustainable funding,” Barnes added.

“Medical care makes up about 20% of what determines a person’s health, yet right now we spend almost all health dollars – including Medicaid – treating conditions medically and not preventing disease outside the exam room,” she continued.

The Centers for Disease Control reviews of similar nationwide asthma remediation showed that for every $1 invested, projects returned anywhere from $5 to $14 in overall savings. 

The report also found that the Center for Medicaid and CHIP Services has approved similar non-medical programs in other states, and it provides new guidance that will outline how states like Texas can use “in lieu of services” authority to pay for programs that cover non-medical approaches to health instead of only covering traditional medical care.  

According to AsthmaMD.com, 11 Americans die from asthma every day in the U.S., resulting in more than 4,000 deaths due to asthma each year, many of which are avoidable with proper treatment and care. 

And the non-medical care advocated by the study could greatly impact this number if adopted more broadly.

In addition, asthma is indicated as a contributing factor for nearly 7,000 other medical emergency deaths each year. 

And the cost of treating asthma is a staggering $18 billion per year, while direct costs account for nearly $10 billion, with hospitalizations being the single largest portion, and indirect costs are $8 billion in lost earnings due to illness or death.

For adults, asthma is the fourth leading cause of work absenteeism resulting in nearly 15 million missed or lost or non-productive work days each year. 

And, and chronic disease is the top reason for school absences among children ages 5 to 17, which costs the nation’s students an annual loss of more than 14 million school days per year, roughly eight days per year. It results in more hospitalizations than any other childhood disease. 

And these figures do not include the impact on the parents of children with asthma, who also suffer lost work days when their children are forced to stay home due to attacks and other respiratory symptoms. 

Other successful non-medical programs cited in the report include medically-tailored meals for those with diabetes and other chronic illnesses, fresh produce prescriptions for low-income families, and health-supporting grocery projects for seniors and pregnant women. 

These programs show health improvements such as fewer hospital visits and sick days, and also reduced Medicaid spending on medical care by an average of $220 a month per person. 

The report found similar evidence of health and financial benefits in housing-related programs that assist people in getting apartments after leaving mental health facilities. Programs that provide financial assistance for making homes accessible for disabilities, helping people learn how to maintain their housing, and negotiations with landlords also greatly benefit recipients.

Along with showing the benefits of these non-medical programs, the report outlines specific ways that Medicaid, Texas Health and Human Services, and Medicaid-managed care organizations could implement the interventions.  

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Most of the states that will need to cough up more for vaxxes are non-expansion states.

 
 

Clipped from: https://healthpayerintelligence.com/news/19-states-must-change-medicaid-vaccine-coverage-policies-to-comply-with-ira

Both fee-for-service programs and Medicaid managed care plans will have to review their Medicaid vaccine coverage policies.

 
 

Source: Getty Images

 
 

By Kelsey Waddill

December 06, 2022 – Almost two-fifths of US states—particularly those that have avoided Medicaid expansion—will need to change their Medicaid vaccine coverage policies in order to align with the Inflation Reduction Act, an Avalere white paper found.

The Inflation Reduction Act passed through Congress and received the presidential signature on August 16, 2022.

The law requires states to cover all recommended vaccines for adult Medicaid enrollees with zero cost-sharing by the beginning of October 2023. Coverage will be similar to commercial market requirements.

Avalere examined the difference between vaccine coverage pre-implementation of the Inflation Reduction Act and post-implementation. The white paper received funding but no editorial input from Pfizer.

The researchers used publicly available data to observe changes for five recommended vaccines: influenza, tetanus/diptheria/acellular pertussis (Tdap), human papillomavirus (HPV), pneumococcal polysaccharide vaccine (PPSV23), and pneumococcal conjugate vaccine (PCV13). Avalere conducted this research from April through December 2021.

There were 11 fee-for-service programs and 6 Medicaid managed care plans that did not cover at least one of the recommended vaccines. The researchers noted that states that did not adopt Medicaid expansion were more likely not to cover one or more of the recommended vaccines.

States were most likely not to cover vaccines that involved risk-based or shared clinical decision-making. Across the states that had coverage gaps, eight fee-for-service and Medicaid managed care plans did not cover the HPV vaccine. Six plans—five fee-for-service programs and one Medicaid managed care plan—did not cover the PCV13 vaccine. Every plan covered the influenza vaccine.

Additionally, five fee-for-service programs and one Medicaid managed care plan covered a vaccine but required cost-sharing, which could range from $0.65 to $4.00.

These findings are critical for the 19 states that need to adjust their Medicaid coverage policies or review Medicaid managed care plans’ coverage to align with the Inflation Reduction Act.

“Although IRA requirements will not take effect until October 1, 2023, states that do not already cover all ACIP-recommended vaccines without cost sharing for their full adult Medicaid populations will need to act quickly and modify coverage policies in the coming months to meet the IRA timeline,” Avalere researchers noted.

Avalere anticipated that CMS would offer guidance to help Medicaid programs and stakeholders understand their obligations.

The researchers warned that the law could be pursued in a way that increases care disparities. The Inflation Reduction Act did not fix low provider reimbursement rates for vaccinations that disincentivize this form of preventive care, and the law may not reimburse pharmacists and set up billing barriers.

“These barriers may also extend to safety net providers which disproportionally serve vulnerable individuals and families, like Federally Qualified Health Centers. These barriers could lead to increased health disparities for patients. Some Medicaid-related vaccine topics are likely to be addressed in forthcoming implementation guidance; interested stakeholders should consider whether and how to engage CMS to shape that guidance,” Avalere recommended.

During the coronavirus pandemic, health equity in coronavirus vaccine distribution was a critical issue, but the challenges proved to have a presence beyond the coronavirus vaccine as well.

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The state is moving forward with its work requirements program, despite Biden’s best efforts to stop it.

 
 

Clipped from: https://www.medpagetoday.com/publichealthpolicy/medicaid/101982

— Demonstration program expected to add 50,000 recipients to the state’s Medicaid rolls

 
 

Georgia’s new Medicaid demonstration program that requires recipients to be working, going to school, or volunteering is expected to start up next year, but critics say it will be expensive to administer and will result in far fewer people added to the Medicaid rolls compared with a regular Medicaid expansion.

“The systems being set up for work requirements are very costly to implement for states,” said Laura Harker, a senior policy analyst at the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C. She noted that a 2019 Government Accountability Office report found that the cost of administering work requirements could cost a state millions to hundreds of millions of dollars; it requires adding more staff people to keep up with who is and who is not reporting their hours, among other costs.

Wider Eligibility Criteria

Georgia’s demonstration program, known as Pathways to Coverage, would widen the state’s Medicaid eligibility criteria to include individuals with annual incomes up to 100% of the Federal Poverty Level, or $13,590 for a single person. Currently, adults in Georgia are only eligible for Medicaid if their incomes are less than 35% of the poverty level, or $4,757, although eligibility criteria for children are more generous.

To stay eligible for the program, beneficiaries must continue to spend at least 80 hours per month working, volunteering, or going to school, according to the state’s application with the Centers for Medicare & Medicaid Services (CMS). “If a member does not meet the hours and activities threshold, they will be suspended from Medicaid and no longer able to receive the Medicaid benefit,” the application noted. “The member has 3 months to meet the hours and activities threshold for Georgia Pathways for the suspension to be lifted. If the member does not meet the requirement, after 3 months of suspension, then the member will be disenrolled from Medicaid,” although they can be reinstated later if they achieve the 80 hours.

State officials estimate that the demonstration program, which will last for 5 years, will add 50,000 people to Georgia’s Medicaid rolls. This is in contrast to the approximately 448,000 people that could be added if Georgia agreed to a more traditional Medicaid expansion as outlined in the Affordable Care Act (ACA), Harker said.

In addition, the Pathways program is eligible for reimbursement at the standard federal Medicaid matching rate for Georgia of 67%, whereas under an ACA expansion, the federal government would reimburse at a 90% rate. As a result, under the Pathways program, “it’s much more expensive to cover a lot fewer people,” she said.

Debate Over Work Requirements

Why did the state go for a work requirements demonstration program instead? “The foundation of the Georgia Pathways to Coverage program is incentivizing and promoting employment and employment-related activities,” according to the application. “Research shows the various positive effects of employment on an individual. Employed individuals are both physically and mentally healthier than those who are unemployed. Work improves various measures of general health and wellbeing, such as self-esteem, self-rated health, and self-satisfaction. Employed individuals are also more financially stable.”

Chris Denson, director of policy and research at the Georgia Public Policy Foundation, a right-leaning think tank in Atlanta, pointed out in an email that the 50,000 people potentially being added to the Medicaid rolls “would not be the same 50,000 recipients at any given time. Whereas traditional Medicaid discourages recipients from earning more money to avoid losing eligibility and thus their coverage, the [demonstration project] proposal is designed to create a more seamless transition from Medicaid eligibility for many workers.” For instance, if the enrollee has a job with a health insurance benefit, the Pathways program would pay the premium for the employer plan if it was financially advantageous for Pathways.

In addition, “in the event their income rises above the eligibility threshold, they could keep their coverage and not have to move from one plan to another,” he said.

But critics of the program say other motives are involved. “The motivation behind work requirements comes from a misguided ‘poor law’ mindset that sees Medicaid as something that people don’t ‘deserve’ unless they fit one of the categorical eligibility groups like disability or pregnancy,” Katherine Hempstead, PhD, senior policy advisor at the Robert Wood Johnson Foundation, said in an email. “According to this line of thinking, those who are merely poor should work for their benefits. Repeatedly courts have found that this framework is inappropriate and inconsistent with the purpose of the Medicaid program, which is to provide access to healthcare services.”

“The purpose of a work requirement is not to promote work so much as it is to deter enrollment,” she added. “The vast majority of those eligible for Medicaid under the expansion are already working or face significant barriers to work such as health problems or family caregiving responsibilities. Studies of Medicaid expansion in other states have shown that expansion supports work by allowing people to manage health issues that can sometimes present a barrier to work. It stands to reason that healthy people are better able to work and be productive.”

Rocky History

CMS approved the Pathways program in October 2020 during the Trump administration. Since then, however, it has been the subject of several administrative and federal court actions, beginning in February 2021 when CMS notified Georgia officials that the agency was considering withdrawing its approval of the Pathways program because the COVID-19 pandemic made it difficult for some potential beneficiaries to fulfill the work requirement. Georgia officials responded that the pandemic “provides no basis to excise the [work requirements] from the Georgia Pathways program.”

In December 2021, the Biden administration rescinded CMS’s approval of Pathways. The state of Georgia sued the Biden administration in federal court, and in August, Judge Lisa Godbey Wood of the U.S. District Court for the Southern District of Georgia ruled in favor of the state, saying that the Biden administration’s rescission of the program “was arbitrary and capricious on numerous, independent grounds.”

The government decided not to appeal the decision, possibly because it was worried about what would happen next, Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, told Kaiser Health News. “The decision not to appeal may have been based on fear that the result would get confirmed on appeal, since most of the appellate judges in the [federal] 11th Circuit are Republican-appointed,” he said. That confirmation could set a stronger precedent for similar programs.

Arkansas was the first state to implement a Medicaid work requirement, but that program — later halted by a federal judge — resulted in about 18,000 beneficiaries losing their Medicaid coverage, often because they couldn’t comply with the reporting requirements. In addition, “many faced negative consequences such as medical debt,” said Hempstead. “It did not improve employment.”

Denson, on the other hand, noted that the Georgia program differs from the Arkansas program because it “imposed this [work] requirement on potential recipients rather than existing Medicaid beneficiaries … Because Georgia is expanding healthcare coverage for previously uncovered applicants, there is no reduction in the legally mandated Medicaid coverage for current enrollees.”

• Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow
  

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: While this op-ed is guaranteed to make most of you furious, there are some decent points about the new CMS reg on Medicaid eligibility if you can see past the bombastic tone.

 
 

Clipped from: https://amac.us/biden-turning-medicaid-into-welfare-for-all/

AMAC Exclusive – By Sam Adolphsen

 
 

The nation’s largest welfare program, Medicaid, is a total mess. We are fast approaching 100 million people on the program, mostly because of expansions to able-bodied adults. States spend one of every three state budget dollars on the program – and more than one of every five of those dollars is spent in error. On top of that, states have been banned from removing ineligible people since early 2020 because of the so-called public health emergency that President Joe Biden keeps extending.

If Medicaid were a person, they would be drowning.

Now, the Biden administration’s Centers for Medicare & Medicaid Services (CMS) is proposing a new regulation that would make things much worse. The rule would make significant changes to state welfare eligibility processes, adding millions to welfare and adding $100 billion in new costs to taxpayers.

This latest proposed Medicaid rule would be like helping that poor drowning person by throwing them a cement block.

If President Biden is looking to finish off the program and send it to the bottom, he nailed it.

Of course, the administration isn’t really hiding its plan. The stated goal of the rule is to “maximize enrollment.” They talk about “retention rates” as if it’s a for-profit business, and how they need to “remove barriers to enrollment,” as if that’s a problem, with nearly a third of the country already on the program.

Biden’s 300-plus-page regulation has so many terrible welfare eligibility policies that it’s difficult to pick just a few on which to focus. But there are some that stand out as especially damaging to the integrity of the country’s safety net.

First, the new rule would prohibit all states from checking eligibility more than once a year. Under President Obama, CMS had already banned states from more frequent checks for certain populations. This proposed rule would expand that bad policy by making the previous minimum level of eligibility checks (once a year) the new maximum for everyone in the program. Some states check more often than once a year right now, and they should, because there are at least 16 million ineligible people on the program.

Second, the rule would ban states from requiring face-to-face interviews for any eligibility groups. This change comes despite the constant news about the significant problems with identity theft across all welfare benefits and COVID-19 unemployment programs. It is common sense that if states are going to hand out a costly welfare benefit, they should require one simple office visit before awarding that benefit. President Biden wants to ban that common-sense check.

Third, the rule creates an entirely new eligibility process for states, requiring them to keep cases open for months even after they determine someone is ineligible. This new “reconsideration period” would also force states to handhold someone to apply for alternative coverage before they can remove them from Medicaid. This also contradicts the entire stated justification for the rule, that it will “reduce the administrative burden” on states.

As if that weren’t bad enough, the rule would also require states to ignore returned mail if the new address is an in-state address. CMS outrageously claims that a change of address “does not indicate a change in circumstances.” Any reasonable person knows that isn’t true. A change in mailing address likely signals a meaningful shift in life circumstances that could affect eligibility.

Another crazy requirement in the Biden administration’s welfare proposal is that states will be required to accept as gospel certain government data sets. While this may seem smart at first glance, the policy only applies when the data indicates that the person is eligible for Medicaid. What happens if the data shows they are ineligible? Then the state must undertake a series of administrative-intensive follow-ups to ensure the person is ineligible. CMS only wants “administrative efficiency” when it will add someone to welfare, never when it would keep someone ineligible from being added.

One final bit of Medicaid madness is that the proposed rule would prohibit states from requiring ID verification as part of the process of reviewing an immigrant’s citizenship status when they apply for Medicaid. This is not surprising coming from Open Borders Biden, but it is alarming. There are many more problems with the proposal, including that it is probably illegal.

The bottom line is that one of the country’s chief safety net programs, Medicaid, has already been stretched and shredded by expansions to able-bodied adults and abysmal program integrity. Now Biden has doubled down, throwing program integrity completely out the window to push the country toward welfare for all. States need to step up and oppose this latest attack on Medicaid.

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MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: More details on what is really going on with pregnancy related death: There are a total of 700 in the US each year, 13% of them happen during childbirth- 65% occur in the year after childbirth and most of them have to do with substance abuse/ suicide.

 
 

 
 

Clipped from: https://theconversation.com/more-than-4-in-5-pregnancy-related-deaths-are-preventable-in-the-us-and-mental-health-is-the-leading-cause-193909

Rachel Diamond, Adler University

Author

 
 

Rachel Diamond

Clinical Training DIrector and Assistant Professor of Couple and Family Therapy, Adler University

Disclosure statement

Rachel Diamond does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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According to the CDC’s latest numbers, 65% of pregancy-related deaths occur in the first year following childbirth. Petri Oeschger/Moment via Getty Images

Preventable failures in U.S. maternal health care result in far too many pregnancy-related deaths. Each year, approximately 700 parents die from pregnancy and childbirth complications. As such, the U.S. maternal mortality rate is more than double that of most other developed countries.

The Department of Health and Human Services declared maternal deaths a public health crisis in December 2020. Such calls to action by the U.S. Surgeon General are reserved for only the most serious of public health crises.

In October 2022, the Centers for Disease Control and Prevention released new data gathered between 2017 and 2019 that further paints an alarming picture of maternal health in the U.S. The report concluded that a staggering 84% of pregnancy-related deaths are preventable.

However, these numbers don’t even reflect how widespread this problem could be. At present, only 39 states have dedicated committees in place to review maternal deaths and determine whether they were preventable; of those, 36 states were included in the latest CDC data.

I am a therapist and scholar specializing in mental health during the perinatal period, the time during pregnancy and postpartum. Research has long demonstrated significant mental health risks associated with pregnancy, childbirth and the year following childbirth. The CDC’s report now makes it clear that mental health conditions are an important factor in many of these preventable deaths.

A closer look at the numbers

The staggering number of preventable maternal deaths – 84% – from the CDC’s most recent report represents a 27% increase from the agency’s previous report, from 2008 to 2017. Of these pregnancy-related deaths, 22% occur during pregnancy, 13% during childbirth and 65% during the year following childbirth.

This raises the obvious question: Why are so many preventable pregnancy-related deaths occurring in the U.S., and why is the number rising?

For a pregnancy-related death to be categorized as preventable, a maternal mortality review committee must conclude there was some chance the death could have been avoided by at least one reasonable change related to the patient, community, provider, facility or systems of care.

The most commonly identified factors in these preventable deaths have been those directly related to the patient or their support networks, followed next by providers and systems of care. While patient factors may be most frequently identified, they are often dependent on providers and systems of care.

Take, for instance, the example of a new mother dying by suicide from a mental health condition, such as depression. Patient factors could include her lack of awareness about the warning signs of clinical depression, which she may have mistaken for difficulties with the transition to parenthood and perceived personal failures as a new parent.

As is often the case, these factors would have directly related to the inaction of health care providers, such as a failure to screen for mental health concerns, delays in diagnosis and ineffective treatment. This type of breakdown – which is common – would have been made worse by poor coordination of care between providers across the health care system.

This example illustrates the complexities of the failures and preventable outcomes in the maternal health care system.

The U.S. has a far higher rate of pregnancy-related deaths than other developed nations.

The role of mental health

In the CDC’s latest report, mental health conditions are the overall most frequent cause of pregnancy-related death. Approximately 23% of deaths are attributed to suicide, substance use disorder or are otherwise associated with a mental health condition. The next two leading causes are hemorrhage and cardiac conditions, which combined contribute to only slightly more deaths than mental health conditions, at about 14 and 13%, respectively.

Research has long shown that 1 in 5 women suffer from mental health conditions during pregnancy and the postpartum period, and that this is also a time of increased risk for suicide. Yet, mental illness – namely, depression – is the most underdiagnosed obstetric complication in America. Despite some promising reductions in U.S. suicide rates in the general population over the last decade, maternal suicide has tripled during this same time period.

As it relates to maternal substance use, this issue is also worsening. In recent years, almost all deaths from drug overdose during pregnancy and the postpartum period involved opioids. A review from 2007 to 2016 found that pregnancy-related deaths involving opioids more than doubled.

Many of these issues stem from the fact that up to 80% of women with maternal mental health concerns are undiagnosed or untreated.

Barriers to care

In 2021, the first national data set of its kind showed that less than 20% of prenatal and postpartum patients were screened for depression. Only half of those who screened positive received follow-up care.

Research has long demonstrated widespread barriers and gaps in maternal mental health care. Many health care providers do not screen for mental health concerns because they do not know where to refer a patient or how to treat the condition. In addition, only about 40% of new mothers even attend their postpartum visit to have the opportunity for detection. Non-attendance is more common among higher-risk populations of postpartum women, such as those who are socially and economically vulnerable and whose births are covered by Medicaid.

Medicaid covers around 4 in 10 births. Through Medicaid benefits, pregnant women are covered for care related to pregnancy, birth and associated complications, but only up to 60 days postpartum. Not until 2021 did the American Rescue Plan Act begin extending Medicaid coverage up to one year postpartum.

But as of November 2022, only 27 states have adopted the Medicaid extension. In the other states, new mothers lose postpartum coverage after just 60 days. This matters a great deal because low-income mothers are at a greater risk for postpartum depression, with reported rates as high as 40% to 60%.

In addition, the recent CDC report showed that 30% of preventable pregnancy-related deaths happened between 43 and 365 days postpartum – which is also the time frame suicide most commonly occurs. Continued Medicaid expansion would reduce the number of uninsured new parents and rates of maternal mortality.

Another challenging barrier to addressing maternal mental health is the criminalization of substance use during pregnancy. If seeking care exposes a pregnant person to the possibility of criminal or civil pentalties – including incarceration, involvement with child protective services and the prospect of separation from their baby – it will naturally dissuade them from seeking treatment.

At this time, 24 states consider substance use during pregnancy to be child abuse, and 25 states require health care professionals to report suspected prenatal drug use. Likewise, there are also tremendous barriers in the postpartum period for mothers seeking substance use treatment, due in part to the lack of family-centered options.

With all these barriers, many pregnant and new mothers may make the difficult decision to not engage in treatment during a critical window for intervention.

Looking ahead

While the information described above already paints a dire picture, the CDC data was collected prior to two major events: the COVID-19 pandemic and the fall of Roe v. Wade, which overturned nearly 50 years of abortion rights. Both of these events have exacerbated existing cracks in the health care system and, subsequently, worsened the maternal health in the U.S.

In my view, without radical changes to maternal health care in the U.S., starting with how mental health is treated throughout pregnancy and postpartum, it’s likely parents will continue to die from causes that could otherwise be prevented.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Prior auth requirements in LA are causing extreme delays, especially for MH services.

 
 

Clipped from: https://www.fiercehealthcare.com/providers/mental-health-providers-decry-mind-numbing-prior-authorization-burdens-senate-debates

 
 

Several mental health providers told a key Senate panel that prior authorization requests are getting in the way of patient care, as the chamber debates a key reform package. 

A subcommittee of the Senate Committee on Health, Education, Labor and Pensions (HELP) held a hearing Wednesday on youth mental health. Some of the providers complained of long wait times and high administrative costs for prior authorization, a cost management tool employed by insurers that requires approval before physicians can administer certain services or prescribe drugs.

“It is mind-numbing,” said Ashley Weiss, director of medical student education in psychiatry for Tulane University and one of the panel’s witnesses. “It will take weeks sometimes getting prior authorization for community-based mental health services.”

A particular concern is getting responses for Medicaid mental health claims. Weiss said that in Louisiana there are five companies that provide managed care for Medicaid and each has a different prior authorization system. 

“The amount of administrative support you need to get these done is astronomical,” she said. 

There does need to be some authorization system in place and a process for helping youths understand the medications that they are prescribed, but the wait for approval of such requests is burdensome, said Sharon Hoover, professor of psychiatry and co-director of the National Center for School Mental Health with the University of Maryland.

“The wait times for getting into mental healthcare … for families can be really impossible to navigate,” she said.

The House did unanimously pass the Improving Seniors Timely Access to Care Act earlier this year, which would require all Medicare Advantage plans to install electronic prior authorization systems to speed up the gap between requests and approvals. It would also set up a system to get faster approvals for items and services that routinely get the green light. 

While the legislation passed the House back in September without any opposition, it remains unclear if the Senate will clear it before the end of the year. 

Sen. Roger Marshall, R-Kan., endorsed the legislation during the panel hearing, calling prior authorization “the number one physician administrative concern in America.”

Marshall, an obstetrician, said that his nurses sometimes deal with multiple fax requests from insurers as opposed to e-mails. While the legislation only focuses on Medicare, Marshall pledged to “go after [the Children’s Health Insurance Program] and Medicaid” in future packages.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: 47% to be exact.

 
 

 
 

Clipped from: https://www.upmc.com/media/news/102722-medicaid-health-policy

 
 

 
 

PITTSBURGH – Despite strong evidence for the importance of outpatient care after inpatient residential treatment for opioid use disorder, nearly half of Medicaid beneficiaries are not receiving follow-up care or medication-assisted treatment within a month of discharge, according to a new analysis led by University of Pittsburgh School of Public Health scientists.

Discharge from residential treatment is a sensitive time when people with opioid use disorder are at higher risk to relapse. Outpatient treatment with counseling, medication or both can reduce this risk. The findings, published this week in Drug and Alcohol Dependence, are the first to study patient and episode-level factors related to the likelihood of receiving post-discharge follow-up among recipients of Medicaid, which is the largest payer of opioid use disorder-related inpatient stays and emergency department visits. 

 
 

“Over the past few years, Medicaid programs have really expanded the scope of substance use disorder treatments they will cover, including residential treatment,” said lead author Evan Cole, Ph.D., research associate professor in the Department of Health Policy and Management at Pitt Public Health. “But outpatient follow-up is key to predicting long-term recovery, and there is very little research – particularly in the past decade when the opioid epidemic has gripped the U.S. – into whether that critical follow-up care is actually happening.”

An estimated 10 million Americans have misused opioids in the past year, and more than 100,000 people died of drug overdoses in the U.S. last year, the majority after taking opioids, according to the U.S. Centers for Disease Control and Prevention. Residential treatment for substance use disorder – commonly known as “rehab” – includes 24-hour living support with on-site clinical services, which can include counseling and addiction treatment. Most residential treatment stays are less than 30 days. 

Medicaid provides health insurance for low-income or disabled people, and, with more than 88 million enrollees, it is the largest health insurer in the U.S. It covers 38% of people with opioid use disorder. 

Cole and his colleagues looked at data from more than 90,000 residential treatment stays in 2018 and 2019 for Medicaid beneficiaries across 10 states – Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia and West Virginia – using the Medicaid Outcomes Distributed Research Network. 

Previous research has shown that after leaving residential treatment, timely follow-up for outpatient addiction treatment, which can include medications such as buprenorphine, methadone or naltrexone, reduces relapse and lowers risk of death.  

Cole’s team found that 47% of the time, Medicaid beneficiaries discharged from residential treatment did not receive follow-up care or a medication for opioid use disorder within 30 days. Medicaid enrollees who were male, lived in rural areas or were members of racial and ethnic minority groups were the least likely to receive follow-up care. 

“This was not what we’d hoped to see,” said Cole, who is also research director of the Medicaid Research Center at Pitt. “I’m sure Medicaid programs want people to be engaged in outpatient care to continue their treatment and successfully manage opioid use disorder after residential treatment.”

On a positive note, patients who had been prescribed medications to treat opioid use disorder before they’d been admitted to residential treatment were 24% more likely to get follow-up care and medication after discharge than their counterparts who hadn’t had such a prescription before entering residential treatment. 

Cole hypothesized that previous engagement in addiction treatment made it easier for patients to navigate to treatment after discharge. He said future research could test this by exploring whether patients were seeing the same outpatient provider before and after residential treatment, and, if so, more effort could be made to connect patients to outpatient providers before they enter residential treatment. 

Since Medicaid enrollment soared by 25% during the COVID-19 pandemic, it will be interesting to see if that impacted connection with care after residential treatment, Cole said. He also noted that some states, including Pennsylvania, have become more committed to “warm handoffs,” creating protocols intended to facilitate a seamless transition to addiction treatment after an emergency. 

“While our study wasn’t designed to see the impact of warm hand-off protocols, it certainly indicates that exploring whether or not these programs are working could be worthwhile for future research,” Cole said. 

Additional authors of this study are Lindsay Allen, Ph.D., of Northwestern University; Anna Austin, Ph.D., and Paul Lanier, Ph.D., both of the University of North Carolina, Chapel Hill; Andrew Barnes, Ph.D., and Peter Cunningham, Ph.D., of Virginia Commonwealth University; Chung-Chou H. Chang, Ph.D., Joo Yeon Kim, M.S., Lu Tang, Ph.D., and Julie Donohue, Ph.D., all of Pitt; Sarah Clark, M.P.H., and Kara Zivin, Ph.D., both of the University of Michigan; Dushka Crane, Ph.D., and Rachel Mauk, Ph.D., both of The Ohio State University; Carrie E. Fry, Ph.D., of Vanderbilt University; Adam J. Gordon, M.D., M.P.H., of the University of Utah; Lindsey Hammerslag, Ph.D., and Jeff Talbert, Ph.D., both of the University of Kentucky; David Idala, M.A., and Shamis Mohamoud, M.A., both of the Hilltop Institute in Baltimore; Susan Kennedy, M.P.P., M.S.W., and Sunita Krishnan, M.P.H., of Academy Health in Washington, D.C.; Shyama Mahakalanda, Ph.D., of West Virginia University; and Mary Joan McDuffie, M.A., of the University of Delaware.

This research was funded by National Institute on Drug Abuse grant R01DA048029.

 
 

Left photo:

 
 

PHOTO DETAILS: (click images for high-res versions) 


CREDIT: University of Pittsburgh


CAPTION: Evan Cole, Ph.D.

 
 

Bottom photo:  


PHOTO DETAILS: (click images for high-res versions) 


CREDIT:  Cole, et al. Drug and Alcohol Dependence (2022)


CAPTION: Visual Study Abstract

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A lotta cash was spent on all those Medicaid expansion ads. Where did it come from?

 
 

 
 

SIOUX FALLS, S.D. (KELO) — The group wanting to pass Medicaid expansion in South Dakota reported raising more than $2 million since May 2022, campaign finance reports from the secretary of state’s office show. 

South Dakotans Decide Healthcare reported a total income of $250,000 ahead of the June 7 primary on May 23. That number increased to $2.3 million in the latest filing reported on Monday. 

Yes and no on Medicaid, recreational pot, poll says

In direct contributions from entities, South Dakotans Decide Healthcare received $500,000 payments from South Dakota’s three major hospitals – Avera, Sanford and Monument. 

SDAHO Enterprises, the wholly-owned subsidiary of South Dakota Association of Healthcare Organizations, contributed two payments of $500,000 and $100,000. 

South Dakotans Decide Healthcare reported spending $1.6 million on advertising and spending $2.1 million for an ending balance of $524,672. 

Constitutional Amendment D, which is one of two statewide ballot questions, would amend the South Dakota Constitution to expand Medicaid eligibility to help provide medical coverage for low-income people in designated categories.

The Legislative Research Council’s Fiscal Note for Amendment D says Medicaid expansion would cover 42,500 new individuals for a cost of $1.5 billion in the first five years, where the state would pay $166 million and earn a general fund savings of $162 million. 

Proponents – Rapid City Mayor Steve Allender and retired businessman Jim Woster – say passing Amendment D will return more federal tax money to the state and allow South Dakota to use more federal funds on resident’s health.  

“Amendment D will strengthen rural hospitals and clinics and make it easier for people in rural South Dakota to get health care,” Allender and Woster wrote in the proponent section in the Secretary of State’s official ballot question pamphlet. 

Opponents – Americans for Prosperity State Director Keith Moore – said Medicaid expansion in South Dakota will impact the state’s budget in the future. 

“Expanding Medicaid shreds our Constitution and expands services to able-bodied adults under ObamaCare,” Moore wrote in the opponent section in the Secretary of State’s official ballot question pamphlet. 

The “No on Amendment D” group created by state lawmakers John Wiik (R-Big Stone City) and Ryan Maher (R-Isabel) reported $3,646 in donated goods but no money raised. 

Dakotans for Health reports $93K 

Up until the final day listed by state law to withdraw an initiated measure, it appeared Medicaid expansion would be voted on with both Constitutional Amendment D, sponsored by South Dakotans Decide Healthcare, and Initiated Measure 28, sponsored by Dakotans for Health. 

That changed when Dakotans for Health contacted the secretary of state’s office to withdraw the measure from the November 2022 general election ballot. 

Dakotans for Health reported more than $72,000 in May 2022 and that increased to $93,120 in Monday’s filing. The group has changed its focus from Medicaid expansion to the issue of abortion. 

Dakotans for Health wants to put abortion on 2024 ballot

Dakotans for Health, chaired and co-founded by Rick Weiland, will be gathering signatures for a 2024 ballot measure on aborition. The group wants to create a Constitutional Amendment to establish a right to an abortion in South Dakota. 

Abortion is currently illegal in South Dakota under state law after the Supreme Court overturned Roe v. Wade with its ruling on the Dobbs v. Jackson case in June 2022.  

The group called Life Defense Fund, sponsored by state lawmaker Jon Hansen (R-Dell Rapids), has organized to oppose any measures to legalize abortion in South Dakota. The group officially filed paperwork to form in August 2022 and reports raising $17,529.

Clipped from: https://www.keloland.com/keloland-com-original/medicaid-expansion-groups-raises-2-3-million-for-amendment-d-race/