OBJECTIVE

To examine trends in uninsured rates between 2012 and 2016 among low-income adults aged <65 years and to determine whether the Patient Protection and Affordable Care Act (ACA), which expanded Medicaid, impacted insurance coverage in the Diabetes Belt, a region across 15 southern and eastern states in which residents have high rates of diabetes.

RESEARCH DESIGN AND METHODS

Data for 3,129 U.S. counties, obtained from the Small Area Health Insurance Estimates and Area Health Resources Files, were used to analyze trends in uninsured rates among populations with a household income ≤138% of the federal poverty level. Multivariable analysis adjusted for the percentage of county populations aged 50–64 years, the percentage of women, Distressed Communities Index value, and rurality.

RESULTS

In 2012, 39% of the population in the Diabetes Belt and 34% in non-Belt counties were uninsured (P < 0.001). In 2016 in states where Medicaid was expanded, uninsured rates declined rapidly to 13% in Diabetes Belt counties and to 15% in non-Belt counties. Adjusting for county demographic and economic factors, Medicaid expansion helped reduce uninsured rates by 12.3% in Diabetes Belt counties and by 4.9% in non-Belt counties. In 2016, uninsured rates were 15% higher for both Diabetes Belt and non-Belt counties in the nonexpansion states than in the expansion states.

CONCLUSIONS

ACA-driven Medicaid expansion was more significantly associated with reduced uninsured rates in Diabetes Belt than in non-Belt counties. Initial disparities in uninsured rates between Diabetes Belt and non-Belt counties have not existed since 2014 among expansion states. Future studies should examine whether and how Medicaid expansion may have contributed to an increase in the use of health services in order to prevent and treat diabetes in the Diabetes Belt.

New Jersey used an incorrect method to calculate Medicaid reimbursements for services provided to students with disabilities, according to a federal audit, but the state disputes that claim.

Numerous studies report disparate use of dental services among poor children. National estimates vary based on the data source, and little is known about how age, race, and health plan affect use of dental services among Medicaid-enrolled children.

Based on of Medicaid claims, dental services improved since 2002 but varied substantially by state, age, and type of insurance. Children entering school had the highest prevalence of care as did children in primary care case management and health maintenance organizations. (Read the full article)

Child maltreatment is a serious and prevalent public health problem in the United States. Responsible for substantial morbidity and mortality, maltreatment affects children's physical and mental health.

Although many health impacts of child maltreatment have been documented, no claims-based study has quantified the impact of maltreatment on health service utilization and costs. This study presents systematic claims-based estimates of maltreatment impacts on utilization and costs for the Medicaid population. (Read the full article)

Cross-sectional estimates suggest that one-third of children are enrolled in Medicaid or other public insurance programs. The percentage of children enrolled in Medicaid at any point during childhood, and which children use Medicaid as a longer-term insurance source, is unknown.

Over a 5-year period, 41% of children were enrolled in Medicaid at some point. Of those children, 51.5% were enrolled during all 5 years. Children with sociodemographic risk factors are more often enrolled for longer periods of childhood. (Read the full article)

Use of behavioral health (BH) screens in pediatrics have increased identification of children with BH issues. Screening rates increased in Massachusetts after it was mandated, as did the volume of some mental health services.

This is the first study of children after Massachusetts mandated behavioral screening began. Almost 40% of children who screened positive were newly identified. Being male, having a BH history, and being in foster care predicted a positive screen. (Read the full article)

Previous analyses have documented that the prevalence of children with chronic conditions is growing and is responsible for increased growth in hospital charges; however, such utilization trends have not been documented in Medicaid and the Children’s Health Insurance Program.

From 2007 through 2010 in Illinois, children with chronic conditions became Medicaid and Children’s Health Insurance Program recipients at a higher rate than healthy children. In contrast to studies of hospital data, this analysis found per-member spending decreases in most chronic condition groups. (Read the full article)

Clinical decisions must be medically necessary to be approved by insurers. There is a federally mandated medical necessity standard for children in Medicaid, but not in private plans. American Academy of Pediatrics policy calls on pediatricians to help define pediatric medical necessity.

This study reviewed pediatric medical necessity definitions in Medicaid state statutes, regulations, and provider manuals. The federal standard was not replicated on all levels, and provider manuals were least likely to have it. Pediatricians should engage in defining pediatric standards. (Read the full article)

Behavioral health (BH) screening is known to increase identification of children with BH issues, but in small-scale studies, rates of follow-up after screening have been reported to be low.

This study examines the relationship between BH screening and the receipt of BH services in Massachusetts Medicaid children. Nearly 60% of children identified with BH problems received BH services, but only 30% of newly identified children received BH services. (Read the full article)

Although the rates of antipsychotic medication treatment are rising for children and adolescents, little is known about the factors associated with this practice.

This study provides some of the first data regarding when and why clinicians decide to use antipsychotic medications. It reveals clues as to how prescribing might better follow best practice guidelines. (Read the full article)

Medicaid made substantial investments in enhanced prenatal and postnatal care programs to address maternal and infant health, including infant mortality. Evaluations of population-based programs are few, and although some have reported reductions in infant mortality, they have methodological limitations.

A population-based home visitation program can be a successful approach to reduce infant mortality. The reduced risk of infant death is consistent with previous findings on the effects of the program on health care utilization and birth outcomes. (Read the full article)

NEW CASTLE (Aug. 1, 2019) – As a way to improve the health of Delawareans who are covered by Medicaid, while potentially reducing overall health care spending, the Department of Health and Social Services’ two Medicaid managed care organizations are making the YMCA’s Diabetes Prevention Program available to their members who meet eligibility criteria. The […]

DHSS Secretary Dr. Kara Odom Walker says, “In the midst of the opioid crisis we are facing in Delaware and across the country, (these facilities) are another resource we can use to better serve our Medicaid clients in need of treatment for substance use disorder.” NEW CASTLE (Aug. 5, 2019) – The Department of Health […]

NEW CASTLE (Sept. 26, 2019) – The Centers for Medicare and Medicaid Services (CMS) recently awarded the Delaware Department of Health and Social Services a $3.58 million planning grant to increase the treatment capacity of Medicaid providers to deliver substance use disorder treatment and recovery services to Delawareans in need. Delaware was one of 15 […]

BACKGROUND:

Medicaid plays a critical role during the perinatal period, but pregnancy-related Medicaid eligibility only extends for 60 days post partum. In 2014, the Affordable Care Act’s (ACA’s) Medicaid expansions increased adult Medicaid eligibility to 138% of the federal poverty level in participating states, allowing eligible new mothers to remain covered after pregnancy-related coverage expires. We investigate the impact of ACA Medicaid expansions on insurance coverage among new mothers living in poverty.

METHODS:

We define new mothers living in poverty as women ages 19 to 44 with incomes below the federal poverty level who report giving birth in the past 12 months. We use 2010–2017 American Community Survey data and a difference-in-differences approach using parental Medicaid-eligibility thresholds to estimate the effect of ACA Medicaid expansions on insurance coverage among poor new mothers.

RESULTS:

A 100-percentage-point increase in parental Medicaid-eligibility is associated with an 8.8-percentage-point decrease (P < .001) in uninsurance, a 13.2-percentage-point increase (P < .001) in Medicaid coverage, and a 4.4-percentage-point decrease in private or other coverage (P = .001) among poor new mothers. The average increase in Medicaid eligibility is associated with a 28% decrease in uninsurance, a 13% increase in Medicaid coverage, and an 18% decline in private or other insurance among poor new mothers in expansion states. However, in 2017, there were ~142 000 remaining uninsured, poor new mothers.

CONCLUSIONS:

ACA Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among poor new mothers. Opportunities remain for expansion and nonexpansion states to increase insurance coverage among new mothers living in poverty.

Background and Objectives:

The goal of this study was to decrease admission and readmission rate for the 2296 Medicaid patients in our clinic. Our focus was to eliminate patient identified barriers to care that led to decreased quality of care. The identified barriers for our clinic included distance to care, poor same-day access, communication, and fragmented care. A team-based, collaborative approach using members from all aspects of patient care.

Methods:

An initial survey identified which barriers to care our patients felt obstructed their care. With this data, along with a national literature review, our team used biweekly quality team meetings with LEAN methodology and Plan-Do-Study-Act cycles to create a 4-phase quality improvement project. A home-visit program to decrease distance to care, walk-in clinic to improve same-day access, strengthened collaboration with outside care managers and clinic staff to improve communication, and the introduction of an in-house phlebotomist to improve fragmented care were created and studied between June 2015 and December 2018. Admission rate, avoidable readmission rate, as well as other quality of care measurements were assessed with electronic medical record reports and through North Carolina Medicaid data reports.

Results:

Overall Medicaid admissions decreased 32.7% from starting numbers, 40.2% below expected benchmarks. Avoidable readmissions decreased 41.8%, 53.8% below the expected benchmark. Improvements in same-day access numbers and lab completion rate were also seen.

Discussion:

The team-based approach to eliminating patient-identified barriers decreased both admissions and avoidable readmissions for our Medicaid patients. It also improved quality-of-care measures. This approach has been shown to be beneficial at our clinic and can easily be replicated in other settings.

OBJECTIVE

Diabetes is a chronic health condition contributing to a substantial burden of disease. According to the Robert Wood Johnson Foundation, 10.9 million people were newly insured by Medicaid between 2013 and 2016. Considering this coverage expansion, the Affordable Care Act (ACA) could significantly affect people with diabetes in their management of the disease. This study evaluates the impact of the Medicaid expansion under the ACA on diabetes management.

RESEARCH DESIGN AND METHODS

This study includes 22,335 individuals with diagnosed diabetes from the 2011 to 2016 Behavioral Risk Factor Surveillance System. It uses a difference-in-differences approach to evaluate the impact of the Medicaid expansion on self-reported access to health care, self-reported diabetes management, and self-reported health status. Additionally, it performs a triple-differences analysis to compare the impact between Medicaid expansion and nonexpansion states considering diabetes rates of the states.

RESULTS

Significant improvements in Medicaid expansion states as compared with non–Medicaid expansion states were evident in self-reported access to health care (0.09 score; P = 0.023), diabetes management (1.91 score; P = 0.001), and health status (0.10 score; P = 0.026). Among states with large populations with diabetes, states that expanded Medicaid reported substantial improvements in these areas in comparison with those that did not expand.

CONCLUSIONS

The Medicaid expansion has significant positive effects on self-reported diabetes management. While states with large diabetes populations that expanded Medicaid have experienced substantial improvements in self-reported diabetes management, non–Medicaid expansion states with high diabetes rates may be facing health inequalities. The findings provide policy implications for the diabetes care community and policy makers.

Medicaid and other parts of the healthcare safety net get left behind in the Trump administration's plans for distributing aid to battle the coronavirus.

House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-NJ) and Senate Finance Committee Ranking Member Ron Wyden (D-OR) called on the Trump administration to address the lack of financial relief for Medicaid providers fighting the COVID-19 pandemic. The two Committee leaders voiced concerns that, to date, roughly $70 billion has been distributed to health care providers under the CARES Act in a way that discriminates against Medicaid-dependent health care providers. “HHS’s continued neglect for the needs of Medicaid-dependent providers struggling to deal with the COVID-19 crisis is unacceptable,” the members wrote. “The country is in the middle of a pandemic. The Medicaid program is a first responder, and the providers it relies on must be treated with equity. At a bare minimum that should include expeditious access to the [provider fund] as intended by Congress.”  The Provider Relief Fund that Congress created as a part of the CARES Act, within the Public Health and Social Services Emergency Fund (PHSSEF), was intended to support health care providers including those who participate in Medicare and Medicaid. However, to date only Medicare-enrolled providers have been able to access funds, and these funds are being allocated according to a methodology that rewards providers with high levels of privately-insured individuals while providers supporting the safety net are left waiting. This imbalance discriminates against critical health care providers that primarily service the Medicaid population, such as frontline hospitals, nursing homes and home-based providers, behavioral health providers, maternal health care providers and pediatricians. In the letter, sent to Health and Human Services (HHS) Secretary Alex Azar, Pallone and Wyden called on the Trump administration to describe how much funding will go to Medicaid-dependent providers and the steps it has taken to understand the needs of these providers during the pandemic. The full letter is available here. ###

Informa Connect-CBI’s 22nd Annual Medicaid and Government Pricing Congress
May 19-21, 2020 | Orlando, FL
www.cbinet.com/medicaidandgovernment

Exclusive Offer: Register by April 10th and save $500* (mention promo code MDCDC5).

With a volatile healthcare system combined with an election year upon us, the stakes are incredibly high for life sciences manufacturers. Staying on the pulse of industry trends, policies and regulations has never been more critical. The 22nd Annual Medicaid and Government Pricing Congress delivers critical updates and industry best practices to effectively contract, report and comply with state and federal healthcare programs. Gain timely, up-to-the-minute insights on:

• State Invoicing and Disputes
• GTN Models
• Innovative Contracting Strategies
• State Price Transparency and Reporting Requirements
• 340B Oversight and Compliance
• Preparing, Negotiating and Implementing FSS Contracts
• Bona Fide Service Fees and FMV
• And many other critical topics

Download the complete program agenda.

The 2020 agenda features 75+ speakers and 50+ sessions customizable by company type and size, as well as 10 hours of dedicated networking. Bio/pharma, regulatory and government experts representing HHS, Pfizer, Daiichi Sankyo, Sobi, Maryland Department of Health, BMS, Jazz, Novartis, Amneal, J&J, Sunovion, Gilead, VA, Granard, Insmed, UCB, Alnylam, Louisiana Department of Health, AstraZeneca, CMS, CSL Behring, Astellas, Lilly, Oklahoma Healthcare Authority, Theravance, Indivior, Sandoz, Alvogen, Takeda, OIG, AMAG, Aimmune, Exelixis, South Dakota Department of Healthcare Services, Regeneron, Sun Pharma, Teva and many others are set to drive the dynamic dialogue.

Drug Channels readers can register today and use promo code MDCDC5 to save $500.

*Discount offer valid through 4/10/2020; applies to standard rates only and may not be combined with other offers, categories, promotions or applied to an existing registration. Offer not valid on workshop-only or non-profit registrations.

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

The U.S. economy is in a medically-induced coma. Unemployment is soaring. Companies are teetering on the brink of bankruptcy. It is unclear when our lives will return to their pre-pandemic state.

One thing seems apparent: As people lose jobs and health insurance, Medicaid enrollment will jump, perhaps by as much as 20% to 30%. This will have profound implications for the drug channel.

Today, I focus on how this increase will affect retail pharmacies and pharmacy benefit managers (PBMs). Below, I review Medicaid enrollment trends, how states manage prescriptions, and the factors driving the coming boom in Medicaid enrollment.

As I explain, many (but not all) retail pharmacies will benefit from Medicaid growth. PBMs, however, will not fare as well. Read on and see if you agree.

In early May, Drug Channels Institute will host two live video webinars: Industry Update and COVID-19 Impact: Retail & Specialty Pharmacies (May 1) and Industry Update and COVID-19 Impact: PBMs & Payers (May 8). CLICK HERE TO LEARN MORE AND SIGN UP. DCI will donate 20% of all profits from these events to The Center for Disaster Philanthropy’s COVID-19 Response Fund.

Read more »

The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid. From 1993 to 2004, UMDNJ’s University Hospital submitted claims to Medicaid for outpatient physician services that were also being billed by doctors working in the hospital’s outpatient centers.

The state of New York and New York City have agreed to pay $540 million to settle allegations that they knowingly submitted, or caused to be submitted, false claims for reimbursement for school-based health care services, primarily speech therapy and transportation, provided to Medicaid eligible children from 1990 to 2001. The settlement is a record federal recovery by the Justice Department for the Medicaid Program.

Mylan Pharmaceuticals, UDL Laboratories, AstraZeneca Pharmaceuticals and Ortho McNeil Pharmaceutical have entered into settlement agreements for a total of $124 million to resolve claims that they violated the False Claims Act by failing to pay appropriate rebates to state Medicaid programs for drugs paid for by those programs.

The United States and the Commonwealth of Virginia have intervened in a False Claims Act suit in the Western District of Virginia against the Medicaid providers Universal Health Services Inc., Keystone Marion LLC and Keystone Education and Youth Services LLC.

Eon Labs Inc. has agreed to pay the United States $3.5 million to resolve False Claims Act allegations relating to the company's drug Nitroglycerin Sustained Release (SR) capsules.

The United States and the Commonwealth of Virginia have filed a False Claims Act complaint in the Western District of Virginia against Medicaid providers Universal Health Services Inc., Keystone Marion LLC and Keystone Education and Youth Services LLC.

The United States has intervened in a False Claims Act lawsuit alleging that Satilla Health Services Inc., dba Satilla Regional Medical Center, and Dr. Najam Azmat submitted claims for medically substandard and unnecessary services to Medicare and Medicaid.

The Health Alliance of Greater Cincinnati and one of its former member hospitals, The Christ Hospital, have agreed to pay the United States $108 million to settle claims that they violated the Anti-Kickback Statute and the False Claims Act by paying unlawful remuneration to doctors in exchange for referring cardiac patients to The Christ Hospital in a pay-to-play scheme.

John D. Archbold Memorial Hospital Inc. has paid the United States a total of $13.9 million to settle allegations that the hospital submitted false claims to the state of Georgia’s Medicaid program.

Universal Health Services Inc. (UHS) and two subsidiaries have reached a settlement in a False Claims Act lawsuit with the United States and the Commonwealth of Virginia, the Justice Department announced today.

Veronica Dale and Alchico Grant, who jointly ran a stolen identity refund fraud ring that attempted to defraud the United States of millions of dollars over several years, were sentenced to federal prison today, the Justice Department and Internal Revenue Service (IRS) announced. Veronica Dale, of Montgomery, Ala., was sentenced to 334 months and Alchico Grant of Lowndes County, Ala., was sentenced to 310 months in prison. In addition, Dale and Grant were both ordered to pay over $2.8 million in restitution to the IRS.

Healthpoint Ltd. and DFB Pharmaceuticals will pay up to $48 million to resolve allegations that Healthpoint caused false claims to be submitted to Medicare and Medicaid for an unapproved drug, Xenaderm, which was ineligible for reimbursement by those programs.

Radiation oncology providers in Pensacola, Fla., will pay $3.5 million to the government and the state of Florida to resolve allegations that they billed Medicare, Medicaid and TRICARE – the health care program for uniformed service members, retirees and their families worldwide – for radiation oncology services that were not eligible for payment.

Caremark LLC, a pharmacy benefit management company (PBM), will pay the government and five states a total of $4.25 million to settle allegations that it knowingly failed to reimburse Medicaid for prescription drug costs paid on behalf of Medicaid beneficiaries, who also were eligible for drug benefits under Caremark-administered private health plans.

WASHINGTON, D.C. – Five lawmakers introduced a bipartisan bill giving a full range of medical services to families with children who have life-limiting illnesses and who qualify for Medicaid, which currently has gaps in such coverage.

The Children’s Program of All-Inclusive Coordinated Care (ChiPACC) Act (H.R. 6560) would let states create comprehensive care programs for these children. Its authors are the Co-Chairs of the Congressional Childhood Cancer Caucus: Representatives Michael McCaul (R-TX), Jackie Speier (D-CA), G.K. Butterfield (D-NC), and Mike Kelly (R-PA), together with Representative Diana DeGette (D-CO), a senior member of the House Energy and Commerce Committee.

“Families with children facing life-limiting illnesses need all the support they can get, and they should be empowered to seek out that support,” the bill’s sponsors said in a joint statement. “We owe it to these kids and their loved ones to help ensure more compassionate care in their most trying times.”

Gaps in Medicaid coverage of hospice and palliative services have deprived many beneficiaries of the care they need because the program does not cover some of children’s unique medical needs.

Under this bill, the family of every child who qualifies for Medicaid will receive a specialized care plan covering a range of services – palliative, counseling, respite, expressive therapy and bereavement – providing them and their families greater comfort and peace of mind.

###

 

Henry Aaron, senior fellow in Economic Studies, discusses the Trump administration’s announcement to authorize states to enact job requirements for Medicaid eligibility. Aaron explains that these requirements could be detrimental to low-income citizens who need medication to work or are unable to work because of their medical conditions. He also predicts that this authorization will…

Summary Craig Garthwaite, John Graves, Tal Gross, Zeynal Karaca, Victoria Marone, and Matthew J. Notowidigdo study the effect of the Affordable Care Act Medicaid expansion on hospital services, with a focus on the geographic variations of its impact, finding that it increased Medicaid visits, decreased uninsured visits, and lead the uninsured to consume more hospital…

Among adults with mental health disorders, losing Medicaid coverage was found to lead to lasting reductions in overall healthcare use and in outpatients

In the past two decades, many federal and state Medicaid initiatives have been designed to rebalance the long-term services and supports (LTSS) system by increasing access to home and community-based services (HCBS) in order to reduce the use of expensive institutional care.

Mathematica experts will showcase their expertise in providing business analytics and data quality development for the Medicaid and CHIP (Children’s Health Insurance Program) Business Information Solution (MACBIS) at this year’s Medicaid Enterprise Systems Conference in Chicago.

Mathematica’s Jonathan Morse and Clint Eisenhower will team up to share their thoughts on state impacts and expectations for the Centers for Medicare & Medicaid Services Medicaid program integrity strategy at this year’s NAMPI Annual Conference in Atlanta.

Mathematica will showcase state Medicaid services and support for CMS projects to modernize data analytics for Medicaid and the Children’s Health Insurance Program at the National Association of Medicaid Directors fall conference.

Cambridge, Mass. : National Bureau of Economic Research, 2020

By using an enterprise risk management approach, state Medicaid agencies can meet new federal program integrity requirements, serve more clients, improve the quality of care, and contain costs.

Paul Messino offers insights on challenges states face as they implement health payment and delivery system reforms and the ways that Mathematica applies methods expertise, deep policy knowledge, and understanding of state contexts to help navigate to better outcomes.