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Tag: Medicaid

  • March Medicaid Madness | Kaiser Health News

    March Medicaid Madness | Kaiser Health News

    The Host

    Julie Rovner
    KHN


    @jrovner

    Read through Julie’s tales.

    Julie Rovner is chief Washington correspondent and host of KHN’s weekly health and fitness policy information podcast, “What the Wellness?” A observed qualified on well being coverage issues, Julie is the creator of the critically praised reference guide “Health Care Politics and Coverage A to Z,” now in its 3rd version.

    With Medicare and Social Safety apparently off the desk for federal finances cuts, the target has turned to Medicaid, the federal-state health program for these with lower incomes. President Joe Biden has manufactured it apparent he wants to defend the method, alongside with the Economical Care Act, but Republicans will most likely suggest cuts to both equally when they existing a proposed finances in the upcoming several weeks.

    In the meantime, confusion in excess of abortion constraints continues, especially at the Fda. A single lawsuit in Texas phone calls for a federal decide to briefly halt distribution of the abortion capsule mifepristone. A independent accommodate, even though, asks a various federal decide to temporarily make the drug a lot easier to get, by taking away some of the FDA’s safety restrictions.

    This week’s panelists are Julie Rovner of Kaiser Wellness Information, Alice Miranda Ollstein of Politico, Rachel Cohrs of STAT Information, and Lauren Weber of The Washington Post.

    Panelists

    Rachel Cohrs
    Stat News


    @rachelcohrs


    Study Rachel’s tales

    Alice Miranda Ollstein
    Politico


    @AliceOllstein


    Study Alice’s tales

    Lauren Weber
    The Washington Write-up


    @LaurenWeberHP


    Read through Lauren’s tales

    Amongst the takeaways from this week’s episode:

    • States are doing work to evaluation Medicaid eligibility for millions of individuals as pandemic-period protection rules lapse at the end of March, amid fears that many People kicked off Medicaid who are eligible for free or around-cost-free coverage less than the ACA won’t know their possibilities and will go uninsured.
    • Biden promised this week to end Republicans from “gutting” Medicaid and the ACA. But not all Republicans are on board with cuts to Medicaid. Amongst the party’s narrow greater part in the Home and the fact that Medicaid pays for nursing residences for several seniors, cutting the system is a politically dicey shift.
    • A nationwide team that pushed the use of ivermectin to deal with covid-19 is now hyping the drug as a therapy for flu and RSV — inspite of a deficiency of clinical evidence to guidance their statements that it is powerful in opposition to any of people health problems. Even so, there is a motion of persons, lots of of them physicians, who believe that ivermectin performs.
    • In reproductive wellness news, a federal judge lately ruled that a Texas legislation are not able to be used to prosecute groups that support gals travel out of condition to get abortions. And the abortion situation has highlighted the job of lawyers typical around the place — politicizing a formerly nonpartisan state submit. –And Eli Lilly introduced strategies to slice the rate of some insulin items and cap out-of-pocket costs, although their factors may perhaps not be fully altruistic: An skilled pointed out that a change to Medicaid rebates next yr means drugmakers shortly will have to spend the federal government just about every time a patient fills a prescription for insulin, which means Eli Lilly’s approach could conserve the corporation funds.

    In addition, for “extra credit,” the panelists advise health coverage stories they read through this 7 days that they believe you should really read through, far too:

    Julie Rovner: The New York Times’ “A Drug Enterprise Exploited a Security Requirement to Make Cash,” by Rebecca Robbins.

    Alice Miranda Ollstein: The New York Times’ “By itself and Exploited, Migrant Young children Function Brutal Work opportunities Across the U.S.,” by Hannah Dreier.

    Rachel Cohrs: STAT News’ “Nonprofit Hospitals Are Failing Americans. Their Boards May well Be a Motive Why,” by Sanjay Kishore and Suhas Gondi.

    Lauren Weber: KHN and CBS News’ “This Dental Unit Was Offered to Repair Patients’ Jaws. Lawsuits Declare It Wrecked Their Teeth,” by Brett Kelman and Anna Werner.

    Also described in this week’s podcast:

    Credits

    Francis Ying
    Audio producer

    Emmarie Huetteman
    Editor

    To listen to all our podcasts, click right here.

    And subscribe to KHN’s What the Overall health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or anywhere you hear to podcasts.

    KHN (Kaiser Health Information) is a nationwide newsroom that provides in-depth journalism about health problems. With each other with Policy Examination and Polling, KHN is 1 of the three major operating plans at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit group giving facts on health problems to the country.

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  • Florida Cancer Specialists & Research Institute a Top Performer in the Center for Medicare & Medicaid Innovation’s Oncology Care Model

    Florida Cancer Specialists & Research Institute a Top Performer in the Center for Medicare & Medicaid Innovation’s Oncology Care Model


    Point out-huge neighborhood oncology observe shares success from OCM last wave in freshly produced situation review.



    FORT MYERS, Fla.


    ,


    March 2, 2023


    /PRNewswire/ —

    Florida Cancer Experts & Exploration Institute, LLC (FCS)

    , a reliable prime performer amid the 126 U.S.-dependent oncology tactics that participated in the Center for Medicare & Medicaid Innovation (CMMI) Oncology Treatment Model (OCM), shares its final results in the payment and delivery model’s last wave which finished in

    June 2022

    in a recently introduced

    scenario analyze

    .

    The intent of the OCM was to make improvements to the high-quality and price of treatment for oncology individuals. Doctor practices enrolled in the application were being accountable for offering a higher good quality of treatment at a lessen expenditure by giving enhanced products and services for Medicare beneficiaries, this sort of as treatment coordination, navigation, and adherence to countrywide treatment tips for treatment. The design tracked money and overall performance measures for episodes of care around the administration of chemotherapy to cancer patients.

    In the closing payment interval (PP10) of OCM, FCS claimed a internet

    $24.3 million

    in cost savings to Medicare beneficiaries. FCS Medicare expenses were being 3.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} decreased when as opposed to other OCM participating techniques and 5.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} lessen than all tactics offering most cancers treatment.

    FCS established a treatment administration program throughout the early waves of the OCM to increase coordination of care and help with symptom administration to assist stop pointless crisis department (ED) visits and hospitalizations, situations that substantially travel up the charge of care. Efforts from this workforce successfully reduced inpatient admissions, observation stays, and ED visits during the duration of the OCM.

    From inception by means of the present-day PP10 performance results, FCS has created developments to rework care supply in the course of its participation in the OCM. The price tag financial savings sustained stem from exercise-extensive initiatives inclusive of adopting optimized scientific procedures and technological improvements to positively influence client results.

    In the course of this last OCM analysis period, FCS skilled 18.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} less expenses toward inpatient admissions, 1.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} much less expenditures in observation stays, and 29.1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} less expenditures in ED visits when in contrast to other participating OCM practices. Also, as opposed to all methods providing oncology treatment, FCS expenses have been 21.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} decreased in inpatient admissions, 15.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} lower in observation continue to be, and 43.4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} decrease in ED visits.

    Chemotherapy and precision medication constitute a wide volume of oncology bills resulting in around 65-70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the benchmark threshold. FCS pioneered the utilization of biosimilar medicine and suitable choice therapies, a essential factor to its results whilst taking part in the OCM. PP10 the penultimate to the last reconciliation interval resulted in about

    $24M

    in internet personal savings to CMS.

    “Biosimilars have been a accurate disruptor,” claims FCS President & Managing Medical professional


    Lucio N. Gordan

    , MD

    . “Adhering to our mission of supplying patient-centered treatment, we, as vendors, must always do what is finest for our client. The introduction of these medications alleviated a substantial portion of the price associated, without the need of sacrificing the high-quality of care.”

    Based on the outcomes through each and every of the 10 established payment durations, collaborating practices have an chance to knowledge shared financial savings with CMS must they meet up with or exceed the thresholds in location. Considering that the OCM’s inception in 2016, FCS has efficiently reduced expenses in contrast to the recognized payment methodology Medicare beneficiaries ensuing in approximate

    $210 million

    and a lot more than

    $98 million

    in internet CMS discounts.

    “These final results are a direct reflection of our team’s commitment to making sure we continue to provide environment-class oncology care to our people. Many years of preparing, coordination, evaluation, re-analysis and administration above a number of programs within our practice have led us to the accomplishment we have seasoned with the Oncology Care Product,” remarked FCS Main Govt Officer


    Nathan H. Walcker


    . “In switch, we have been ready to apply these learnings throughout the payer continuum, creating supplemental alternative payment versions and mirroring comparable quality and expense-saving initiatives so that all people, no issue their coverage, have obtain to the ideal achievable care.”

    FCS has

    submitted its formal software

    to participate in the CMMI Enhancing Oncology Model (EOM), a voluntary 5-calendar year model, set to get started on

    July 1, 2023

    . Legitimate to its title, the EOM will build upon the top quality and price tag-preserving specifications of the OCM, with an more emphasis on addressing health care inequities. Upon receipt of the EOM Participation Agreement, FCS will diligently consider the EOM model to further more benefit-dependent care in parallel to other Substitute Payment Designs (APMs) across the payer continuum.


    About Florida Most cancers Professionals & Exploration Institute, LLC: (FLCancer.com)

    Identified by the American Culture of Clinical Oncology (ASCO) with a nationwide Scientific Trials Participation Award, Florida Cancer Specialists & Research Institute (FCS) features sufferers obtain to a lot more scientific trials than any non-public oncology observe in

    Florida

    . The majority of new most cancers prescription drugs not too long ago authorized for use in the U.S. had been studied in clinical trials with Florida Most cancers Specialists participation.* Skilled in prestigious health care faculties and analysis institutes, our doctors are constantly rated nationally as Top Medical practitioners by U.S. News & Globe Report.

    Started in 1984, Florida Most cancers Experts has built a countrywide status for excellence that is reflected in outstanding and compassionate individual care, driven by modern scientific analysis, cutting-edge systems and advanced therapies, such as targeted therapies, genomic-based cure, and immunotherapy. Our best values are embodied by our remarkable crew of hugely educated and focused medical professionals, clinicians and workers.


    *Prior to approval

    Cision
    Perspective authentic content to obtain multimedia:

    https://www.prnewswire.com/news-releases/florida-cancer-professionals–investigate-institute-a-top-performer-in-the-middle-for-medicare–medicaid-innovations-oncology-treatment-model-301761120.html

    Resource Florida Most cancers Specialists & Investigation Institute

  • Medicaid and Abortion Top Health Agenda for Montana Lawmakers

    Medicaid and Abortion Top Health Agenda for Montana Lawmakers

    Keely Larson

    HELENA, Mont. — Montana lawmakers stated lowering fees and increasing patient entry will be their major overall health treatment objectives for the new legislative session. But they also will have to contend with creating variations to Medicaid, a management disaster at the Montana Condition Medical center, and proposals to regulate abortion.

    Republicans, who hold a veto-evidence bulk, stated they will focus on 3 places of wellbeing treatment: transparency, prices, and individual alternatives.

    Party leaders intention to preserve “taking tiny bites that are going the ball in the appropriate way on people three significant factors,” Senate Republican spokesperson Kyle Schmauch claimed.

    Democrats, who are the minority social gathering and have to have Republican help to move their charges, determined lowering health and fitness treatment fees, shielding Medicaid coverage, and preserving reproductive liberty as their priorities.

    As the 90-day Montana session enters its 2nd 7 days, right here are some of the top wellness troubles on the agenda:

    Growing Affected individual Entry

    Increasing telehealth and building it easier for capable providers from outdoors the state to observe in Montana are two approaches Republican Gov. Greg Gianforte proposes to enhance wellbeing care accessibility, claimed spokesperson Brooke Stroyke.

    Residence Speaker Matt Regier (R-Kalispell) agreed that telehealth is essential to improving upon access. Republicans program to establish on a law passed in the 2021 session that created everlasting some of the pandemic-pushed crisis regulations that loosened restrictions on telehealth.

    Schmauch mentioned legislators will think about shelling out proposals to expand Montana’s broadband arrive at to make telehealth a feasible selection for far more people, specifically rural people.

    Other proposals meant to give rural patients with restricted accessibility to treatment additional alternatives are prepared, this sort of as letting doctors to dispense prescription medications to clients, and making it possible for pharmacists to prescribe certain medicines, Schmauch mentioned.

    Medicaid

    Eleven Montana nursing residences declared closures in 2022, with officers citing staffing shortages and lower Medicaid reimbursement rates as the major motives for the industry’s ongoing struggles.

    Lawmakers will discussion boosting reimbursement rates for nursing households and numerous other forms of overall health vendors soon after a state-commissioned review observed they had been way too low to address the price of treatment.

    “Increasing supplier prices at the study’s advisable level will be certain a potent health and fitness care workforce and should be a precedence for this legislature,” reported Heather O’Loughlin, govt director of the Montana Price range and Coverage Centre, a nonprofit firm that analyzes the point out funds, taxes, and economic system.

    Gianforte’s spending plan proposal contains reimbursement level raises that slide short of what the examine recommends. A bill by Rep. Mary Caferro (D-Helena) would foundation supplier prices on the study’s results.

    Federal principles dictated that any person enrolled in Medicaid could not be dropped from the system all through the community health and fitness emergency. But the omnibus spending bill lately passed by Congress allows states to commence reviewing the eligibility of their beneficiaries in April, and thousands and thousands of men and women throughout the U.S. are at risk of shedding coverage as a consequence.

    “That will have an inherent end result of getting rid of people who skilled for Medicaid but because of this method getting so intricate, they’ll drop it,” Caferro explained.

    Caferro stated she ideas to introduce legislation that restores 12-month steady eligibility for grown ups enrolled in Montana Medicaid. The evaluate is probable to be opposed by legislative Republicans and Gianforte, who co-signed a letter to President Joe Biden in December indicating the general public wellbeing emergency experienced artificially expanded the Medicaid populace.

    Montana Point out Healthcare facility

    The Montana Condition Healthcare facility dropped its federal accreditation immediately after a spate of injuries and fatalities, earning administration of the psychiatric healthcare facility and the availability of behavioral health and fitness products and services a leading priority of the session.

    Stroyke mentioned Gianforte’s two-12 months budget plan, which is a starting off stage for legislative finances writers, includes $300 million for the condition healthcare facility and for growing accessibility to intense behavioral health and fitness treatment throughout the point out.

    Legislators are taking into consideration actions that would shift care for some individuals from the state-operate clinic to community-centered wellbeing expert services. Regier explained shifting additional public wellness companies from point out establishments to community suppliers would decrease some pressure on amenities like the Montana Condition Clinic.

    Abortion

    Lawmakers from equally functions have submitted extra than a dozen monthly bill draft requests working with abortion. A person from Regier would limit the sort of abortions that can be carried out in the point out, and, at the other conclusion of the discussion, a proposal by Sen. Ryan Lynch (D-Butte) would codify abortion obtain in state regulation. The Gianforte administration also not too long ago proposed an administrative rule that would make it far more tricky for women to have an abortion paid for by Medicaid.

    But the Republican the greater part is limited from enacting a sweeping abortion ban in the wake of the U.S. Supreme Court’s 2022 choice to overturn Roe v. Wade. Which is mainly because a 1999 Montana Supreme Court ruling decided the point out constitution’s proper-to-privacy safety covers abortion obtain. The state is trying to get to overturn that precedent just after a decide blocked 3 anti-abortion laws passed by the 2021 legislature.

    Clinic Oversight

    Lawmakers also will think about proposals to maximize oversight of the way nonprofit hospitals report community positive aspects.

    State overall health officers have desired to established standards for the charitable contributions those people hospitals make in exchange for their tax-exempt standing. A KHN investigation discovered that Montana’s nonprofit hospitals put in about 8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of their full once-a-year costs on charity gains in 2019, which is underneath the countrywide typical.

    Keely Larson is the KHN fellow for the UM Legislative Information Company, a partnership of the University of Montana University of Journalism, the Montana Newspaper Association, and Kaiser Wellbeing Information. Larson is a graduate university student in environmental and natural resources journalism at the College of Montana.

    KHN (Kaiser Health and fitness News) is a national newsroom that creates in-depth journalism about overall health issues. Collectively with Policy Evaluation and Polling, KHN is a person of the a few main running packages at KFF (Kaiser Loved ones Foundation). KFF is an endowed nonprofit firm giving details on overall health concerns to the country.

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  • More States to Consider Extending Postpartum Medicaid Coverage Beyond 2 Months | Healthiest Communities Health News

    More States to Consider Extending Postpartum Medicaid Coverage Beyond 2 Months | Healthiest Communities Health News

    Lawmakers in quite a few conservative-led states — such as Montana, Wyoming, Missouri, and Mississippi — are expected to contemplate proposals to deliver a yr of steady health and fitness protection to new mothers enrolled in Medicaid.

    Medicaid beneficiaries nationwide are confirmed continual postpartum coverage for the duration of the ongoing COVID-19 public well being unexpected emergency. But momentum has been building for states to increase the default 60-day required coverage period of time forward of the emergency’s eventual conclude. Somewhere around 42{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of births nationwide are protected below Medicaid, the federal-state wellness insurance policy plan for low-revenue individuals, and extending postpartum coverage aims to decrease the chance of pregnancy-relevant fatalities and diseases by making certain that new mothers’ health-related treatment is not interrupted.

    The thrust arrives as a provision in the American Rescue Plan Act helps make extending postpartum Medicaid coverage much easier because states no longer require to utilize for a waiver. A renewed target on maternal health amid significant U.S. maternal mortality fees also is driving the proposals, as is the expectation that much more women of all ages will need postpartum treatment as state abortion bans proliferate in the wake of the U.S. Supreme Court’s final decision to get rid of federal protections.

    30-five states and Washington, D.C., have presently extended, or program to prolong, postpartum eligibility in their Medicaid courses. That selection contains Texas and Wisconsin, which did not employ the ARPA provision but have proposed restricted extensions of 6 months and 90 times, respectively.

    The 15 states that restrict postpartum Medicaid eligibility to 60 days are predominantly a swath of Republican-led states that stretch from the Mountain West to the South. But that could change when legislative periods start out in the new 12 months.

    In Montana, Republican Gov. Greg Gianforte and Division of Community Overall health and Human Solutions Director Charlie Brereton provided 12-thirty day period postpartum eligibility in the governor’s proposed state finances. It would price $9.2 million in federal and condition funding in excess of the upcoming two yrs, in accordance to the proposal, with the federal federal government covering just about 70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}.

    A 2021 U.S. Division of Wellness and Human Services report estimated about 2,000 females in Montana would reward from the adjust. Point out well being office spokesperson Jon Ebelt stated state officials’ estimate is 50 percent that variety. The reason for the disparity was not straight away distinct.

    Brereton considers the “extension of protection for new mothers to be a professional-everyday living, pro-family members reform,” Ebelt reported.

    To come to be law, the proposal should be authorised by point out lawmakers the moment the legislative session begins in January. It has currently acquired enthusiastic aid from the senior Democrat on the committee that oversees the wellness department’s spending budget. “Continuous eligibility for females immediately after they have a infant is genuinely important,” stated point out Rep. Mary Caferro in the course of the Children’s Legislative Discussion board in Helena on Nov. 30.

    The top Republican on the committee, point out Rep.-elect Bob Keenan, stated he has not dug in on the governor’s spending budget proposal but extra that he ideas to study his fellow lawmakers and overall health treatment companies on the postpartum extension. “I wouldn’t dare venture a guess as to its acceptance,” he explained.

    Nationwide, additional than 1 in 5 mothers whose pregnancies have been lined by Medicaid shed their insurance policies in just 6 months of giving start, and 1 in 3 being pregnant-connected deaths happen among a week and a 12 months immediately after a delivery occurs, in accordance to federal health officers.

    The U.S. had the highest overall maternal mortality level, by considerably, between rich nations in 2020, at 23.8 fatalities for each 100,000 births, in accordance to a report by the Commonwealth Fund, a basis that supports investigate concentrated on health care challenges. The charge for Black women in the U.S. is even bigger, 55.3 fatalities.

    “Many maternal deaths outcome from skipped or delayed chances for cure,” the report explained.

    The maternal mortality price in Montana is not publicly offered because the Facilities for Ailment Control and Avoidance suppressed the state facts in 2020 “due to trustworthiness and confidentiality constraints.” Ebelt, the point out health office spokesperson, could not offer a amount in advance of this article’s publication.

    Annie Glover, a senior research scientist for the College of Montana’s Rural Institute for Inclusive Communities, explained the governor’s proposal to lengthen postpartum Medicaid protection could make a considerable variance in bettering total maternal overall health in Montana. The university was awarded a federal grant this calendar year for these attempts, specifically to lessen the mortality charge among the Native People, and Glover mentioned the state measure could further more minimize prices.

    “The cause truly has to do with preserving accessibility to care throughout this extremely significant period,” Glover explained. That goes for helping moms with postpartum despair, as very well as medical problems like significant blood stress that have to have follow-ups with a doctor very well just after shipping, she mentioned.

    In Wyoming, a legislative committee voted 6-5 in August to introduce a invoice in the up coming session dissenters cited the charge and their reluctance to even more entangle the state in federal government packages.

    About a third of Wyoming births are lined by Medicaid, and condition officers estimate about 1,250 females would advantage from the improve.

    Postpartum eligibility charges are also envisioned to be taken up by legislators in Missouri and Mississippi, two states that have earlier grappled with the situation. The two states have outlawed most abortions due to the fact the U.S. Supreme Courtroom lifted federal protections in June, and Mississippi leaders have mentioned more postpartum care is essential due to the fact of the thousands of added births envisioned as a consequence of the state’s ban.

    A proposed protection expansion died in the Mississippi House last session, but Lt. Gov. Delbert Hosemann claimed the Senate will revive the measure, in accordance to Mississippi These days.

    Previous yr, federal officers approved a Medicaid waiver for Missouri that will allow the condition to lengthen postpartum eligibility. But state officials delayed employing the modify to determine how enrollment would be affected by Missouri voters’ choice in August 2020 to develop Medicaid eligibility to more persons. The hold off prompted a invoice to be filed previous session that would have prolonged postpartum protection by a 12 months. That measure died, but a point out lawmaker has pre-submitted a monthly bill that will bring again the discussion in the impending session.

    In Idaho, a children’s advocacy team stated it will push lawmakers to approve a postpartum eligibility extension, between other steps, following the point out banned approximately all abortions this calendar year.

    KHN Montana correspondent Katheryn Houghton contributed to this report.

    This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health and fitness problems and a significant running method at KFF (Kaiser Family Foundation). It has been republished with permission.

  • Yet another attempt to expand Medicaid in NC

    Yet another attempt to expand Medicaid in NC

    By Anne Blythe

    For all those waiting with bated breath to find out whether Medicaid will be expanded to nearly 600,000 more North Carolinians, take a pause.

    Republicans in the state House of Representatives are not ready to embrace the policy whole hog. Instead, there will be one more study and more planning, while the lawmakers campaign for elections in November.

    The proposal to create a legislative committee with members from both chambers that will hear a Medicaid Modernization Plan to be developed by the state Department of Health and Human Services comes out of negotiations between state House and Senate leaders over a spending plan for the coming fiscal year. This committee would come on the heels of a different study committee that met six times from February to April this year. 

    The new way forward toward embracing Medicaid expansion, according to SB 408, should:

    • Add Medicaid coverage for adults with annual incomes up to 133 percent of the federal poverty level, or slightly more than $17,000 in earnings for an individual.
    • Increase what hospitals pay for the expanded health care coverage. This means that hospitals will foot the bill for whatever share of the tab is not being picked up by the federal government.
    • Invest $1 billion in programs and treatment for the opioid, mental health and substance use crisis.
    • Include recommendations for increasing access to health care in rural areas.
    • Direct the secretary of commerce to collaborate with others to address the health care workforce shortage, amid predictions of worsening patient-to-caregiver ratios.
    • If the secretary of the state Department of Health and Human Services comes back from negotiations with federal regulators with a plan that the General Assembly is happy with, lawmakers have said they’d return to Raleigh no later than Dec. 15 to have the actual, final vote on the plan.

    “In December, should this go into law, there will be a vote,” Tim Moore, the Republican from Kings Mountain who’s speaker of the state House of Representatives, told the House Rules committee on Tuesday. In the past, bills to expand Medicaid have made it through the House committee hearing process only to never reach a vote on that chamber’s floor.

    This time, Moore says he’ll bring the bill to a vote in the House of Representatives.

    “The bill will either pass or the bill will either fail,” he said Tuesday. “Those who wonder whether there is some kind of trick — there wouldn’t be a bill voted on — absolutely not. The bill will be voted on and it will either pass or fail at that time on its merits. Based on what people have told me where they are on it, if the plan meets that, I think it will pass.”

    The call for further study comes after longtime advocates for Medicaid expansion have been on a rollercoaster ride, of sorts. First, they climbed the steep hill of winning over Senate leader Phil Berger (R-Eden), who stood in the way of the state Senate taking up the topic for close to a decade. That gave the advocates momentum until they hit another ascent after Rep. Donny Lambeth (R-Winston-Salem), who led a  Medicaid expansion study committee this spring, said many members of the House remained a tough sell.

    “We’re not lukewarm in the House,” Lambeth told reporters in February after the first meeting of the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion. “It is still rather chilly. It is a heavy lift to convince our House caucus that this is the right direction to go. Now is it impossible? No. I wouldn’t be here if I thought it was impossible.”

    Roller coaster ride

    At the start of this month, Medicaid expansion advocates thought they were getting ready for a downhill thrill ride when Berger, the longtime critic, introduced a health care omnibus bill that called for adding hundreds of thousands of low-income North Carolinians to the Medicaid rosters.

    Berger’s proposal, which passed the state Senate with all but two votes, included several provisions that did not thrill hospitals and physicians. The Berger bill would change rules for how some health care facilities are regulated and give advanced practice nurses more autonomy from physicians that oversee them now.

    Moore has said those provisions were difficult for some House members to endorse, and they were not part of the bill the full House passed Tuesday evening 102 to 4. The Senate had gone home for the night by the time the full vote happened around 7 p.m. It would need approval from the Senate to then move to the desk of Gov. Roy Cooper, a longtime expansion advocate.

    Berger played it coy earlier Tuesday when asked about the prospects in his chamber for the newest Medicaid expansion bill proposal.

    “Let’s see what the House passes and then we’ll figure out what the Senate’s response will be,” Berger said.

    Moore, who was standing beside the Senate leader quipped: “We’re happy with that response. We’re going to send him a good product.”

    Berger quipped back: “Not as good as ours.”

    Preview of $27.9 billion spending plan

    All of the back-and-forth between the House and the Senate over Medicaid expansion comes in the midst of the annual tussle over the state budget. While the General Assembly is dominated by Republicans in both the Senate and House of Representatives, each chamber has its own priorities and there’s always backroom dealing to see which will prevail in the final budget plan. 

    Tuesday evening Moore and Berger spoke to reporters about their $27.9 billion spending plan for the fiscal year that begins on July 1.

    Key parts of the plan:

    • Gives teachers pay raises of 4.2 percent, a number that includes raises already called for in the previous fiscal year.
    • Sets aside $1 billion for an “inflationary reserve” to help offset problems brought on by high gas prices and other problems from the current state of inflation.
    • Sets funds aside to expand the school resource officer program but did not commit to beefing up school counseling programs.
    • Dips into sales tax revenue to support transportation projects that have been underfunded.
    • It keeps $6 billion in revenue surplus, $2 billion of which will be recurring funds.
    • Sets aside funds for redeveloping legislative and administrative buildings, a Raleigh development plan that could further reshape the downtown.

    Some of the health-related spending in the plan:

    • Provide $14.8 million for mental health resources;
    • Set aside $32 million for school safety projects;
    • Gives more support to the crisis helpline; and
    • Gives rural counties a better shot at school safety grants.

    More will become clear about the budget as the budget is more fully explained on Wednesday at a Joint Appropriations Committee meeting. The lawmakers have said they plan to vote on the proposed budget by the end of this week.

    “Medicaid expansion is not in the budget,” Berger acknowledged to a room full of reporters and TV crews.

    The reason, Moore told his House members before the vote on Tuesday, was: “There are not the votes in this chamber right now to put an outright expansion on the floor.” 

    Nonetheless, Moore was able to persuade all but four members of his chamber to take the only palatable path forward for skeptical Republican members of the House. One unwritten rule Moore has followed in the past has been to only bring legislation to the floor when a majority of his Republican caucus is in favor.

    ‘Not a trick’

    Democrats, who have waited years to see progress from the Republicans on Medicaid expansion, voted for the bill that Moore shepherded through the House with hopes that it would not be the end of the discussion.

    “This is not the bill I had hoped to vote on tonight,” said Gale Adcock, a Democrat from Cary and nurse practitioner. Adcock has been an advocate of giving nurses a broader scope of practice without the oversight of physicians, a proposal that often hits a roadblock among powerful health care lobbying groups.

    “As we look at expanding access to health care we need to look at striking the balance of not just having the demand side addressed, but also the supply side,” she told the House.

    Lambeth summed up his thoughts on the House Medicaid expansion bill by recounting a trip he and his wife took to Asheville recently. They took the backroads, a detour of sorts, that allowed them to see the beauty of parts of the state they might not otherwise have seen,

    As Kinsley develops a plan to bring back to lawmakers, he will learn from the federal government and teams of lawyers if North Carolina can add a work requirement to the expansion rules, something that’s failed in every other state that’s proposed it. He can also figure out a parachute for the state to opt out if the federal government tries to cut back on its funding share of 90 percent for every new Medicaid expansion beneficiary.

    “I kind of view this as we’re taking a little bit of a detour,” Lambeth said. “This gives us an opportunity to go down a path — we’re taking a little bit of a detour here — to get this right.”

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    by Anne Blythe, North Carolina Health News
    June 29, 2022

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  • Should North Carolina operate its Medicaid oral health program as fee-for-service or transition to managed care?

    Should North Carolina operate its Medicaid oral health program as fee-for-service or transition to managed care?

    By Anne Blythe

    As lawmakers ponder whether to expand Medicaid to add some 600,000 more people to the rolls, the North Carolina Oral Health Collaborative is looking at a different aspect of the federal- and state-sponsored insurance program.

    Nearly a year ago, North Carolina transformed its Medicaid program from a fee-for-service-based plan to a system managed by private insurers.

    The oral health portion of the program, however, was not part of the Medicaid transformation. It is still managed by the state.

    Zachary Brian, director of the North Carolina Oral Health Collaborative and vice president of impact, strategy and programs at the Foundation for Health Leadership and Innovation, said recently in a telephone interview that his organization has partnered with the North Carolina Institute of Medicine and The Duke Endowment to launch the Oral Health Transformation Initiative. (Disclosure: The Duke Endowment is a NC Health News sponsor).

    In July, a task force with members from diverse vantages in oral health care delivery will begin a year-long process in which members consider whether oral health care provided through Medicaid should remain a fee-for-service program or be overseen by private insurers.

    “The traditional fee-for-service payment system incentivizes costly, more invasive procedures,” Brian contended while announcing the joint initiative.

    “Nationally, we see a movement in remodeling our health care delivery system in many ways,” Michelle Ries, associate director of the North Carolina Institute of Medicine, added in the same video announcing the initiative. “As North Carolina has moved to managed care for primary health care and behavioral health services, we believe we owe it to the consumer and provider communities to thoroughly look at the current landscape for oral health and make recommendations based on an analysis of what other states are doing and lessons learned from the rollout of Medicaid managed care so far in North Carolina.”

    Whole-body care

    For too long, many public health advocates say, oral health care has been in a silo, of sorts, the mouth separated from the body. This is increasingly out of step with the systemic “whole-body” approach being advocated for more recently.

    A look into someone’s mouth can reveal evidence of heart disease, cancer, autoimmune syndromes, viruses, diabetes and gastrointestinal problems.

    Public health advocates say that integrating oral health care with primary care could not only make many communities and populations healthier but also reduce costs. People who do not have routine access to dental care often end up in emergency rooms with toothaches or infections in the oral cavity. Those visits can be far more costly for the patient, the provider and the insurer.

    Many communities in North Carolina face challenges accessing “optimal oral health care,” according to the Oral Health Collaborative.

    Four counties in North Carolina do not have a regularly practicing dentist, according to data collected from 2020 by the Cecil G. Sheps Center for Health Services Research. They’re in the northeastern tip of the state — Camden, Gates, Hyde and Tyrrell counties.

    Will more dentists participate?

    The collaborative says roughly 35 percent of the dentists in North Carolina participate in Medicaid or the Children’s Health Insurance Program, or CHIP as it’s often called.

    Dave Richard, head of Medicaid at the state Department of Health and Human Services, said his office puts that number closer to 40 percent. 

    Nonetheless, that number can pose a challenge for children and adults in need of care, often in the state’s rural reaches, public health care advocates note. Only 18 percent of adult Medicaid recipients in North Carolina use the dental care option, according to the collaborative’s statistics.

    Richard said that in 2021, the state’s fee-for-service Medicaid oral health program paid $24 million in claims for children in the CHIP program. The program paid $300 million for children ages 6 to 20 in the Medicaid program, and $104 million for adults 21 and older.

    Richard took no stance on whether it would be better to shift the oral health program to managed care or keep it as a fee-for-service program.

    Instead, he posed several questions.

    “What value add would you bring if you move to managed care?” Richard asked. He also wondered whether the state would lose or gain more dentists through such a shift.

    That’s what the task force plans to study over the next year with hopes of delivering a report and potential series of recommendations for a reimagined oral health care system. Their goal is to get something that policymakers and lawmakers can have to review in time to decide whether the state should make the shift before the next contracts are negotiated in 2024.

    “So often we don’t have the opportunity to really slow down and take a year, 18 months and dig in and engage with other states and engage with experts and really bring people to the table,” Stacy Warren, program officer for The Duke Endowment, said when the initiative was announced. 

    “We can’t just fund a lot of programs,” she said, although she said that’s actually happening. “We fund school-based oral health programs. We fund medical-dental integration programs, but what we’ve learned and the North Carolina Oral Health Collaborative has certainly helped teach us this over the years, is that these programs can’t exist successfully in isolation of true systems change.”

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      North Carolina Health News



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      North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org. (on the web, this can be hyperlinked)

    by Anne Blythe, North Carolina Health News
    June 14, 2022

    1