Children’s Insurance, Other Health Programs Funded — For Now — In Bill

The bill passed by Congress late Thursday to keep most of the federal government funded for another month also provided a temporary reprieve to a number of health programs in danger of running out of money, most notably the Children’s Health Insurance Program, or CHIP.

Funding for CHIP technically expired Oct. 1. States have been operating their programs with leftover funds provided by the Department of Health and Human Services since then. But nearly half of the states were projected to run out of money entirely by the end of January, putting health coverage for nearly 2 million children at risk by that point.

The funding provided by Congress for CHIP — $2.85 billion — is for six months, but it is back-dated to Oct. 1, so it will run out at the end of March 2018. The program covers 9 million children across the country.

This week, Alabama announced it would curtail enrollment and renewals starting Jan. 1, and start disenrolling children currently in the program Feb. 1. On Friday, the state posted a notice on its website that those plans were now canceled. Several other states, including Colorado, Virginia and Utah, have begun the process of notifying families that their coverage could end unless Congress acts.

The funding bill also provided a temporary reprieve for a raft of other health programs that were running out of money, most notably the nation’s community health centers, which provide basic primary care to 27 million Americans. Many centers are already freezing hiring, laying off staff and closing sites due to the uncertain funding stream from Washington.

Other health programs that were set to expire but have been funded, for now, include the National Health Service Corps, which places health practitioners in medically underserved areas, and the teaching health centers program, which trains medical residents in community health centers.

Backers of CHIP complain that short-term funding fixes are disruptive to the program.

“By failing to extend long-term funding for the Children’s Health Insurance Program, Congress falls far short of the reassurance and relief families deserve,” said a statement from the American Academy of Pediatrics.

A coalition of children’s groups, including the Children’s Defense Fund and the March of Dimes, agreed, saying the short-term funding “only causes more chaos and confusion on the ground.”

Both Republicans and Democrats strongly support CHIP, which was created in a 1997 budget bill. What they disagree on is whether its funding — expected to be roughly $8 billion over the next 10 years — should be paid for by cutting other health programs. The House in November passed a five-year renewal that would finance CHIP primarily by reducing the Affordable Care Act’s Prevention and Public Health Fund and by raising some people’s Medicare premiums. Democrats question why CHIP needs to have its funding offset while Republicans are adding $1.4 trillion to the deficit through their tax cut bill.


Source: Kaiser Health News – Medicaid

Not-So-Happy New Year: Alabama Set To Toss Kids Off Insurance Plan Starting Jan. 1

Citing Congress’ failure to restore federal funding of the Children’s Health Insurance Program, Alabama plans to drop 7,000 kids from coverage on New Year’s Day, the first step to shutting down coverage for everyone, state officials said Monday.

Those children, who are up for their yearly renewal in January, will not be allowed to continue in the program, and the state also plans to freeze enrollment at the same time. Then, unless Congress acts, Alabama would close CHIP for all 84,000 children on Feb. 1.

Alabama would become the first state to cut off children’s coverage since Congress failed to renew federal CHIP funding, which expired Oct. 1.

“This will be devastating for many families,” said Cathy Caldwell, director of Alabama’s CHIP program, which is marketed to families under the name All Kids.

Colorado, Virginia and other states recently began sending letters to parents notifying them that officials may soon have to curtail their CHIP programs.

Republicans and Democrats in Congress say they support the program, but they have not agreed on where to get the money to pay for it. A third of states anticipate exhausting CHIP funding by the end of January, according to a Kaiser Family Foundation report out earlier in December. (Kaiser Health News is an editorially independent program of the foundation.)

The Centers for Medicare & Medicaid Services, which oversees CHIP, has been redistributing billions in unspent funds during the past 2½ months while lawmakers work on the issue to help states keep their programs running. CMS officials Monday did not respond to requests about when those dollars would run out.

Caldwell said Alabama estimated it would have enough money to cover claims made only through February. She said it made no sense to continue renewing coverage and adding new enrollees in January if CHIP would be ending a month later. About 7,000 children have their coverage renewed each month, she said.

Caldwell said she estimates most CHIP enrollees won’t find affordable coverage without the program. Fewer than 10 percent would qualify for Medicaid, she said, and many families would find subsidized coverage for children in the Affordable Care Act’s online marketplaces too costly because it often comes with higher premiums, copayments and deductibles.

Nationwide, CHIP covers more than 9 million kids — children typically from families not poor enough to qualify for Medicaid, the state-federal program that covers low-income people.

Income eligibility levels for CHIP vary widely among states, though most set thresholds at or below 200 percent of the poverty level, about $49,000 for a family of four. Alabama has one of the broadest eligibility levels — 317 percent of the poverty level, or $78,000 for a family of four.

Unlike Medicaid, CHIP is usually not free. Enrolled families pay an average premium of about $127 a year.

Since CHIP’s enactment, the share of uninsured children fell from 13.9 percent in 1997 to 4.5 percent in 2015, according to the Medicaid and CHIP Payment and Access Commission.

Alabama’s rate fell from 20 percent to 2.5 percent, Caldwell said.

The Republican-controlled House has voted to extend the 20-year-old program for five years and would fund it by charging richer Medicare enrollees higher premiums and taking money from a public health fund created under the ACA. The Senate has not voted, but Democrats there also refuse to tie any CHIP extension to higher Medicare premiums or siphoning money from the public health fund.

Jim Carnes, policy director of ARISE Citizens’ Policy Project, an Alabama advocacy group, said CHIP is one of the few areas of health policy in which Alabama has led the country.

“We’ve been called a shining star of the South, and this has really been a very efficient and effective program,” he said. “This will really be a huge blow.”

He said freezing enrollment and ending coverage would undo years of expanded coverage. “This sends a terrible message to families … and I can only hope that this decision [by Alabama] adds to the pressure on Congress to act,” he said.

Caldwell said the last time Alabama froze enrollment in CHIP for several months, in 2004, it took several years to convince parents that the program had reopened.

“Once we deny kids and disenroll kids, we know so many of them won’t be able to get back on,” she said.


Source: Kaiser Health News – Medicaid

Pace Of U.S. Health Spending Slows In 2016

U.S. health spending rose to $3.3 trillion in 2016, but the pace slowed compared to the previous two years as demand for drugs, hospital care and physician services weakened, according to a federal study released Wednesday.

The analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) showed a shift from the dramatic escalation in health spending that accompanied the coverage gains in 2014 and 2015 as millions of Americans found insurance under the Affordable Care Act.

The rate at which spending grew last year was lower across many measures — including figures for Medicare, Medicaid, private insurance, prescription drugs and hospitals — than in the previous two years.

Micah Hartman, a statistician in the Office of the Actuary at CMS and the lead author of the study, said he could not recall the last time that happened.

The slow down was more than federal officials had predicted in a report earlier this year.

Health spending was up 4.3 percent in 2016. In 2014 and 2015, spending increased 5.1 percent and 5.8 percent, respectively, as the ACA provided subsidies to help people get private coverage and most states expanded Medicaid.

In effect, national health spending has returned to the moderate growth levels that followed the 2007-2009 recession.

Still, health spending continues to outpace overall spending on goods and services, which increased 2.8 percent in 2016.

“Costs remain reasonably under control but are still [rising] at a rate that is too rapid to be affordable for society,” said Paul Ginsburg, a health policy professor at the University of Southern California.

Health care consumes nearly one-fifth of the U.S. economy, according to the new data.

Amid calls for the Trump administration to do something about rising drug prices, the report found national spending for prescriptions rose just 1.3 percent in 2016, compared to 12 percent in 2014 and 9 percent in 2015.

The report attributed the deceleration in spending to falling prices and the introduction of fewer new drugs. It also noted a decline in  spending for hepatitis C drugs. Their arrival in 2013 sparked a national debate on prices when the first one — Sovaldi — was being sold for $1,000 a pill, or $84,000 for the 12-week course of treatment.

The $329 billion spent on prescription medications in 2016 represents 10 percent of overall health spending. The report noted that share was similar to 2009’s.

Hospital spending — which makes up the highest share of health expenditures — increased by 4.7 percent last year, a full percentage point lower than in 2015, the report said. Slower growth was due to a leveling in the number of people gaining health coverage last year, according to the researchers.

Spending on Medicaid, the federal-state health insurance program for low-income people, rose by 3.9 percent last year, compared to 9.5 percent in 2015 and 11.5 percent in 2014. Republicans in Congress have tried unsuccessfully to cap federal Medicaid spending to states to help control growth in the program, an effort opposed by Democrats and advocates for the poor. The report noted that Medicaid’s costs per enrollee grew less than 1 percent in 2016.

“This is evidence that states are doing a pretty good job at controlling Medicaid spending,” Ginsburg said.

This study will also appear in the January 2018 issue of Health Affairs but was published online Wednesday.


Source: Kaiser Health News – Medicaid

Dangling A Carrot For Patients To Take Healthy Steps: Does It Work?

Patricia Alexander knew she needed a mammogram but just couldn’t find the time.

“Every time I made an appointment, something would come up,” said Alexander, 53, who lives in Moreno Valley, Calif.

Over the summer, her doctor’s office, part of Vantage Medical Group, promised her a $25 Target gift card if she got the exam. Alexander, who’s insured through Medi-Cal, California’s version of the Medicaid program for lower-income people, said that helped motivate her to make a new appointment — and keep it.

Health plans, medical practices and some Medicaid programs are increasingly offering financial incentives to motivate Medicaid patients to engage in more preventive care and make healthier lifestyle choices.

They are following the lead of private insurers and employers that have long rewarded people for healthy behavior such as quitting smoking or maintaining weight loss. Such changes in health-related behavior can lower the cost of care in the long run.

“We’ve seen incentive programs be quite popular in the insurance market, and now we are seeing those ramp up in the Medicaid space as well,” said Robert Saunders, research director at the Margolis Center for Health Policy at Duke University.

Medicaid patients who agree to be screened for cancer, attend health-related classes or complete health risk surveys can get gift cards, cash, gym memberships, pedometers or other rewards. They may also get discounts on their out-of-pocket health care costs or bonus benefits such as dental care.

Under the Affordable Care Act, 10 states received grants totaling $85 million to test the use of financial rewards as a way to reduce the risk of chronic disease among their Medicaid populations. During the five-year demonstration, states used the incentives to encourage people to enroll in diabetes prevention, weight management, smoking cessation and other preventive programs. The states participating were California, Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas and Wisconsin.

Medi-Cal, for example, offered gift cards and nicotine replacement therapy to people who called the state’s smoking cessation line. Minnesota’s Medicaid program handed out cash to people who attended a diabetes prevention class and completed bloodwork.

An evaluation of these programs, released in April, showed that incentives help persuade Medicaid beneficiaries to take part in such preventive activities. Participants said gift cards and other rewards also helped them achieve their health goals. But the evaluators weren’t able to show that the programs prevented chronic disease or saved Medicaid money. That’s in part because those benefits could take years to manifest, according to the evaluation.

Overall, research on the effectiveness of financial incentives for the Medicaid population has been mixed. A report this year by the Center on Budget and Policy Priorities found that they can induce people to keep an appointment or attend a class but are less likely to yield long-term behavior changes, such as weight loss. And in some cases, the report said, incentives are given to people to get exams they would have gotten anyway.

The center’s report also found that penalties, including ones that limit coverage for people who don’t engage in healthful behaviors, were not effective. Instead, they can result in increased use of emergency rooms by restricting access to other forms of care, the report said.

Some of the biggest factors preventing Medicaid patients from adopting healthful behaviors are related not to medical care but to their circumstances, said Charlene Wong, a pediatrician and health policy researcher at Duke University.

That makes administering incentive programs more complicated. Even recruiting and enrolling participants has been a challenge for some states that received grants through the Affordable Care Act.

“The thing that is most likely to help Medicaid beneficiaries utilize care appropriately is actually just giving them access to that care — and that includes providing transportation and child care,” said Hannah Katch, one of the authors of the report by the Center on Budget and Policy Priorities. Another barrier is being able to take time off work to go to the doctor.

But health plans are eager to offer patients financial incentives because it can bring their quality scores up and attract more enrollees. And medical groups, which may receive fixed payments per patient, know they can reduce their costs — and increase their profits — if their patients are healthier.

Providing incentives to plans and medical groups has created a business opportunity for some companies. Gift Card Partners has been selling gift cards to Medicaid health plans for about five years, said CEO Deb Merkin. She said health insurers that serve Medicaid patients want to improve their quality metrics, and they can do that by giving incentives and getting patients to the doctor.

“It is things like that that are so important to get them to do the right thing so that it saves money in the long run,” she said.

Agilon Health, based in Long Beach, Calif., runs incentive programs and other services for several California medical groups that care for Medi-Cal patients. The medical groups contract with the company, which provides gift cards to patients who get mammograms, cervical cancer exams or childhood immunizations. People with diabetes also receive gift cards if they get their eyes examined or blood sugar checked. And the company offers bonuses to doctors if their Medicaid patients embrace healthier behaviors.

The incentives for patients are “massively important for the Medicaid population, because the gaps in care are historically so prevalent,” said Ron Kuerbitz, CEO of Agilon. Those gaps are a big factor pushing up costs for Medicaid patients, because if they don’t get preventive services, they may be more likely to need costlier specialty care later, Kuerbitz said.

Emma Alcanter, who lives in Temecula, Calif., received a gift card from her doctor’s office after getting a mammogram late this summer. Alcanter, 56, had noticed a lump in her breast but waited about two years before getting it checked, despite reminders from her doctor’s office. “I was scared they were going to find cancer,” she said.

Alcanter finally decided to get screened after her first grandchild was born. The gift card was an added bonus, and Alcanter said it showed her doctors cared about her. Her mammogram revealed that the lump wasn’t cancer, and she plans to use the gift card to buy a present for her grandson.


Source: Kaiser Health News – Medicaid

NAHC Executive VP Andrea Devoti on the Path Forward for Home Health

One of the most important additions to the National Association for Home Care & Hospice (NAHC) in many years has been Andrea Devoti, the executive vice president, who came to NAHC with a vision of changing education at meetings to better reflect the needs of our members and non-member attendees. For those few who may…