JustCare

Tag: Medicaid

  • Half a million people with low incomes unable to get mental health care in states that have not expanded Medicaid

    Half a million people with low incomes unable to get mental health care in states that have not expanded Medicaid

    In 1996, the Mental Health Parity Act was signed into law to guarantee that insurers did not restrict access to mental health care but rather imposed the same or higher annual or lifetime dollar caps on mental health benefits as on medical benefits. Unfortunately, a new study reveals that the 24 states that have not expanded Medicaid eligibility have left hundreds of thousands of people unable to get mental health care. More than half a million Americans with low incomes diagnosed with a serious mental condition struggled to get the mental health care they needed in 2014.

    • People with Medicaid. Medicaid covers a wide range of mental health care services. And, in the 26 states that expanded Medicaid eligibility as a result of the Affordable Care Act, an additional 350,000 people received mental health care.
    • People with Medicare: Medicare covers a wide range of mental health care services. If you’re enrolled in traditional Medicare, Medicare covers 80 percent of the cost of your care from a medical doctor or from another Medicare-certified mental health provider.
    • People with incomes under 138 percent of the federal poverty level ineligible for Medicaid. Today, 24 states have not expanded Medicaid eligibility to people with incomes up to $15,521, even though the federal government pays the full cost of their Medicaid coverage for the first three years. As a result, 569,000 Americans were unable to get mental health services. They were ineligible for Medicaid in their states and lacked the money to pay privately for care. Many of these people end up in jail or homeless at a significant cost to states and local taxpayers.
  • Vast majority of Americans want to expand Medicare and Social Security or keep spending as is

    Vast majority of Americans want to expand Medicare and Social Security or keep spending as is

    A new Kaiser Family Foundation survey of Americans reveals that the public views Medicare and Social Security as the two most important federal programs, slightly more important than federal aid to public schools and the military. Eighty-three percent of the public see Social Security as very important, and 77 percent see Medicare as very important.

    In fact, 41 percent of people want to increase funding for Medicare (48 percent would keep spending where it is) and 50 percent of people want to increase spending for Social Security (43 percent would keep spending where it is). Check out this video to watch Robert Reich make the case for expanding Medicare.

    Overall, seven of ten Republicans and independents and nine of ten Democrats see Medicare as very important. People over 65 value Medicare especially highly, regardless of party affiliation—85 percent of Republicans, 89 percent if independents and 92 percent of Democrats see Medicare as very important. Not surprisingly, people over 65 are more satisfied with their Medicare health insurance than people under 65 with their commercial insurance.

    Support for Medicaid, a program for people with low incomes, differs more significantly based on party affiliation. Fewer than half of Republicans (47 percent) see Medicaid as very important, while 62 percent of independents and 78 percent of Democrats feel Medicaid is very important.

    Read more here about Medicare coverage and the key differences between traditional Medicare and a private Medicare Advantage plan.

  • At 50, Medicare and Medicaid Face the Challenge of Pricey Drugs

    At 50, Medicare and Medicaid Face the Challenge of Pricey Drugs

    Medicare and Medicaid turned 50 last week. Middle age. It’s fair to say both programs are feeling the years, even as they remain basically healthy. Together, the programs insure one in three Americans. Medicare was recently pronounced solvent until 2030. And Medicaid is poised to grow significantly in coming years as more states expand their programs under provisions of the Affordable Care Act, or as it’s often called, Obamacare.

    The challenges to both programs are not going to let up, however. They are forecast to consume ever-larger chunks of the federal budget and state budgets—which of course means taxpayers are on the hook as baby boomers flood into Medicare over the next 10 years, and Medicaid expands.

    Many conservative politicians don’t like the sounds of that and are again proposing reforms to both programs that would weaken the guarantee and scope of coverage and likely shift costs to the elderly (Medicare) and low-income people (Medicaid).

    I suggest they instead support efforts to constrain health care spending overall, which is the root of the problem. There are hundreds of such efforts underway, with a push from Obamacare but also from innovations in every nook and cranny of the healthcare industry. And make no mistake, it’s an industry, very much driven by the profit motive in this country.

    To wit, one emerging challenge deserves special attention: the increasing number of very expensive specialty drugs. For a detailed discussion, see this piece I wrote last month.

    The gist is this:

    • Specialty drugs accounted for 30% ($112 billion) of the $374 billion spent on prescription drugs in 2014, and they drove the bulk of the 13% increase in drug spending that year over 2013, according to IMS Institute for Healthcare Informatics. That leap in drug spending contrasted with low single digit increases for the previous few years.
    • Specialty drugs range in price from $2,000 to $10,000 a month. One source pegs the average at around $36,000 a year. Most are made through bioengineering. They are often referred to as biologics. When there were just a few, it wasn’t a big deal. But now there are a couple dozen. Some treat rare diseases that afflict a small number of people, but an increasing number target cancer, multiple sclerosis, rheumatoid arthritis, immune system disorders, and even heart disease. Some 900 biologics are now in the research pipeline, according to a 2013 industry report. By some estimates, specialty drugs could comprise over 50 percent of all drug spending by 2020.
    • Medicare (via Part D, Part B and Medicare Advantage) pays 25% to 30% of the nation’s prescription drug tab each year. Consistent with IMS’s finding for drug expenditure overall, Medicare drug spending leapt 12.6% from 2013 to 2014, the fastest rise in years. Almost all that increase stems from specialty drugs.
    • One drug alone–Sovaldi for hepatitis C, at $84,000 for a 12-week course of treatment—cost Medicare $4.5 billion in 2014, becoming the single most expensive drug Medicare enrollees received.
    • In a brief commentary this month in the journal Mayo Clinic Proceedings, 118 cancer doctors from leading cancer treatment centers called for immediate steps to lower the price of cancer drugs, the average price of which has increased to over $100,000 a year in 2012.
      • They wrote: “Drug companies keep challenging the market with even higher prices. This raises the question of whether current pricing of cancer drugs is based on reasonable expectation of return on investment or whether it is based on what prices the market can bear.”   They also noted that the structure of both private insurance benefits and Medicare means some cancer patients needing a $120,000 drug can be saddled with out-of-pocket costs as high as $30,000.

    It goes without saying that for lower and middle-income families, that’s simply untenable.

    Are these pricey medicines worth the cost? Do they yield good value? Are they fairly priced? Or are drug companies profiteering, as the cancer doctors imply. And, if specialty drugs are going to remain very expensive, how are we possibly going to afford them?

    The answers to these questions aren’t yet clear. There’s emerging evidence that Sovaldi may be worth it, because it essentially cures hepatitis C.   The same cannot be said of many cancer drugs. There’s not the space to discuss this at length here. It’s a complex issue that involves tough ethical issues, clinical judgments, patient preferences, and contradictory evidence. Suffice it to say that evidence grows steadily that too many new cancer drugs priced at $50,000 to $150,000 a year are buying most patients only a few extra months of life, on average, and those may not be months with good quality of life.

    Solutions? See the cancer doctor’s recommendations. I concur with them.

    Slightly elaborated here are my top 3:

    1. Permit Medicare to negotiate prices directly with drug companies, now explicitly barred by the 2003 Medicare Prescription Drug, Improvement, and Modernization Act.   As Medicare moves swiftly to pay providers based on the quality and value of their care, the same should hold for prescription drugs.
    2. Authorize the Patient-Centered Outcomes Research Institute (PCORI) to evaluate the benefits and value of new drug treatments, and include price in their assessments. That’s now blocked by a provision in the Affordable Care Act, which gave birth to PCORI. Industry and their political allies insisted on the provision. It’s time to repeal it.
    3. Allow people to import prescription drugs for personal use and give FDA the power to monitor the program and certify channels of purchase. An unenforced federal law blocks importation now. (I’d make this a pilot program for five years to immediately give consumers the option.)

    The politics of such measures is difficult, to say the least. I’m hoping it emerges as an issue in the 2016 elections. A Kaiser Family Foundation poll of 1,200 adults released last month found that three-quarters of Americans think prescription drug costs are unreasonable, and they blame the drug companies.

  • ER visits for dental care on the rise, but some states are finding ways to address the problem

    ER visits for dental care on the rise, but some states are finding ways to address the problem

    Data from the American Dental Association reveals that emergency room visits for dental care more than doubled in the 12 years between 2000 and 2012, according to USA Today. Largely because neither Medicare nor standard private health insurance covers dental care, some 2.2 million people ended up in the emergency room because of tooth pain in 2012. But, some states have developed innovative solutions to reduce emergency room visits for dental care.

    A report by the American Dental Association shows that in the majority of cases that people visit the emergency room for dental care, they should be visiting the dentist instead. Nearly 24 percent of emergency room visits for dental care are non-urgent and another 54.8 percent are semi-urgent.

    People often avoid going to the dentist because they lack insurance coverage and don’t want to pay out of pocket for dental care, which can be very expensive. Most insurance does not cover dental care. Medicare never covers dental care. And the Affordable Care Act only covers dental care for children, not for adults. Medicaid pays for some dental services, but what Medicaid covers depends on what state you live in.

    And, most states do not allow dental therapists to provide dental care, even though the data suggests that they can provide several services safely and well and at lower costs. The American Dental Association has blocked dental therapists from providing dental services in all states but Alaska.

    Maine, Michigan and Virginia have developed innovative solutions to reduce the number of emergency room visits for dental care by as much as 72 percent. One Michigan county created a volunteer dental force for patients with low incomes. In Maine, several hospitals are piloting a program that gives patients a painkiller when they present at the emergency room and then refers them to a clinic for treatment. A Virginia pilot program developed an in-hospital urgent dental care clinic to treat patients and reduce costs.

    Emergency rooms must treat anyone who visits, regardless of whether they have insurance or are able to pay for their care. But, they generally only treat the dental pain and do not deliver dental services. As a result, they often end up having repeat visits from people with dental pain. And, by some estimates, the cost for emergency room services is three times more than the cost of a dental visit. For sure, it’s important to choose your emergency room carefully ahead of time, if you have a choice of them, so you get the best care and keep your costs down.

    Here are some ways to get free and low-cost dental care.  Or, contact your local area agency on aging to find out about resources in your community.

  • Eight things you should know about the Affordable Care Act

    Eight things you should know about the Affordable Care Act

    Thanks to the Affordable Care Act (“ACA”), 16.4 million more people in the United States have health insurance, though 13.2 percent of the population is still uninsured. Here’s eight other interesting facts about the ACA in 2015, post King v. Burwell.

    1. The ACA guarantees Americans and permanent legal residents the right to buy health insurance, regardless of whether they have a pre-existing condition; and it forbids insurers from cutting people’s coverage off if they get sick. Undocumented immigrants and legal immigrants in the US for 5 years or less are not eligible for coverage.
    2. The ACA requires insurers to offer “minimum essential health insurance coverage” to everyone who they insure, including mental health care, prescription drugs, having a baby, as well as a range of preventive services with no copay or deductible.
    3. The ACA requires insurers to charge everyone the same rate for the same policy based on their age, regardless of their health status. Also, your out-of-pocket costs must be capped. And, it limits the amount that insurers can profit off the premiums they charge.
    4. The ACA requires everyone eligible for coverage to have coverage, although people can go without coverage if they pay a penalty (2% of income or $325, whichever is higher, 2015).
    5. The ACA requires every state to have a health insurance exchange, a marketplace through which people without insurance from their jobs and small businesses can buy insurance. Either the state can establish the exchange itself or the federal government can establish the exchange for the state. The exchange, which can be accessed online, allows people to compare the costs and benefits of the health plans available to them.
    6. The ACA provides a subsidy—help paying for coverage through a state’s health insurance exchange—for anyone with income up to 400 percent of the federal poverty level, $47,080 for an individual. If you’d like to know whether you’re eligible for a subsidy and the amount, click here. In the 30 states (including Washington DC) that opted to expand Medicaid, people with incomes under 138 percent of the federal poverty level are eligible for it, $16,242 for an individual and $27,724 for a family of three. About 3.7 million nonelderly adults in states that opted not to expand Medicaid fall into a coverage gap.
    7. The ACA allows parents with health care coverage through their jobs to include coverage for their children until they turn 26.
    8. The ACA requires chain restaurants to list calories on their menus.

    If you still have questions, you can call the government at 1-800-318-2596.

  • Long-term care is unaffordable for middle-income families

    Long-term care is unaffordable for middle-income families

    Where you live matters, for all kinds of reasons, including because it affects the long-term services and supports that may be available to you and the people you love. The big headline, though, is that long-term care is too often unaffordable for middle-income families no matter what state you live in.

    As more and more boomers begin to need long-term services and supports, new policy solutions become critical. Today, Medicaid provides the only real safety net for older adults, people with disabilities and caregivers.  But, the adequacy of Medicaid supports varies considerably among the states.  And, long-term care insurance is not meeting people’s needs.

    If you’re interested to know how your state ranks in providing long-term services and supports, AARP has developed a scorecard.  The scorecard looks at how states fare in five areas (1) cost and access, (2) care providers and settings, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions.

    Based on the scorecard, when it comes to long-term services and supports, Minnesota and Washington are the two best states to live in, and Alabama and Kentucky are the two worst states. South Dakota, New York and Montana rank 24, 25 and 26th respectively.

    For simple tips on how to plan for long-term care, click here.

  • Access to care a serious problem in Medicaid managed care plans

    Access to care a serious problem in Medicaid managed care plans

    A recent report by the HHS Office of the Inspector General reveals that private companies offering Medicaid managed care are failing to ensure adequate access to care to their enrollees. Each state has its own law regarding standards for access to care in managed care plans—both appointment availability and wait times for appointments—and different ways of determining compliance with standards.

    Given that the federal government is paying the full cost or a significant part of the cost of these plans, the report makes a strong case for the federal government to step in and create a baseline standard with enforcement mechanisms for managed care plans in every state.

    Disturbingly, the OIG found that appointments were not available from more than half of providers (51 percent) surveyed. More than one-third of providers (35 percent) surveyed were not even at the office listed by the plan. Another 8 percent were not in the plan’s network.  And yet another 8 percent were simply not taking new patients.

    Of the providers with whom appointments were available, the median wait time was two weeks and more than 25 percent of them required enrollees to wait more than a month for an appointment.The OIG surveyed 1,800 providers of care, both primary care physicians and specialists.

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  • Almost one in five people uninsured in states that have not expanded Medicaid coverage 

    Almost one in five people uninsured in states that have not expanded Medicaid coverage 

    Almost one in five people are uninsured in states that have not expanded Medicaid coverage. A recent report from the Urban Institute shows that states which have opted to expand Medicaid coverage show higher rates of insured residents than states that have opted not to expand coverage.  The Affordable Care Act gave states this right and substantial funding for this expansion.At the end of June 2014, states that had expanded Medicaid coverage had a 10.1 percent uninsurance rate.  States that had not expanded Medicaid coverage had an 18.3 percent uninsurance rate.  Overall, 13.9 percent of adults are uninsured.

    As of the end of November 2014, twenty-eight states are expanding Medicaid coverage, including the District of Columbia.  California, Illinois, New York, Pennsylvania and Ohio are all expanding coverage. Florida, Texas, Nebraska and Georgia are among the states that have not expanded Medicaid coverage to date.

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  • Low-income adults value Medicaid

    Low-income adults value Medicaid

    A recent survey of low-income adults reveals that low-income adults value Medicaid. They view Medicaid as health insurance coverage that is as good or better than private insurance in “quality and affordability.” Medicaid was rated less good in terms of “access to doctors and being treated with respect.”  The overwhelming majority, 80 percent, favor Medicaid expansion under the Affordable Care Act. Unfortunately, only one-third said that they were aware of their states’ plans to expand Medicaid in 2014.  The vast majority were misinformed.  Survey respondents were from Kentucky, Arkansas and Texas.

    The ACA provides substantial federal money to states that wish to expand Medicaid to cover a broader swath of low-income adults, people with incomes under 138 percent of poverty.  To date, as a result of  health care reform, 26 states and the District of Columbia have undertaken Medicaid expansion and eight million more adults are enrolled in Medicaid.Nearly 3,000 people between the ages of 19 and 64 were included in the study sample.

    If you like this post, you might also like this:
    Almost 20 percent of residents are uninsured in states that have not expanded Medicaid

  • Four things to think about regarding Medicaid estate recovery

    Four things to think about regarding Medicaid estate recovery

    If you have Medicaid, you will likely have low health care costs.  However, in some instances, after you pass, your state may attempt to get back some of those costs through Medicaid estate recovery.  That could affect what your heirs inherit.  You should understand what your state might do.

    1. Rules: Children may not be able to inherit the home of a parent for whom Medicaid has covered medical costs. Federal law requires that states recover Medicaid costs from the estates of some Medicaid patients and allows states to recover these costs from the estates of other Medicaid patients.
    2. Process: Each state has different laws on whether it will impose a lien on a Medicaid patient’s property.
    3. Timing: States cannot recover any Medicaid costs from the sale of the home of a Medicaid patient living in a nursing home until the patient and his or her surviving spouse living in that home have passed away or the property, which the state has claimed a stake in, is sold.
    4. Waivers: States must have procedures for not taking money from a Medicaid patient’s estate when it would cause undue hardship.
    For more information on Medicaid estate recovery, go to the National Health Law Program here.