Entries in Medicaid (16)


Supreme Court Curbs Health Reform Expansion of Medicaid

iStockphoto/Thinkstock(WASHINGTON) -- While the Supreme Court narrowly ruled the Affordable Care Act constitutional, it did place some important restrictions on a Medicaid expansion that is a backbone of the law’s efforts to insure more Americans.

In addition to requiring citizens to buy health insurance, the law also expanded Medicaid and tied federal funding to that expansion of state programs. In order to provide insurance to more poor people, the law said that states who did not accept the Medicaid expansion would risk losing existing Medicaid funds.

Today the Court said that as long as states who chose not to participate in the law’s expansion of Medicaid do not lose existing funds, the Medicaid the expansion is constitutional. The vote was 5-4 with Chief Justice John Roberts joining the liberal bloc.

The end result could be that more states opt out of the Medicaid expansion, which won’t be enacted until 2014, and the law could end up insuring fewer currently uninsured Americans.

The bottom line from Roberts: “The Court today limits the financial pressure the Secretary may apply to induce States to accept the terms of the Medicaid expansion.As a practical matter, states may now choose to reject expansion; that is the whole point.”

But what is interesting is that liberal justices like Elena Kagan and Stephen Breyer joined the five conservatives to insist that the states couldn’t be threatened with a loss of funding.

“Although many will be surprised that Chief Justice Roberts joined the Court’s progressive bloc to uphold the mandate, the far bigger surprise is that two members of that bloc-Justices Breyer and Kagan-joined the conservatives in holding that the Medicaid expansion exceeded Congress’s power,” says Stephen Vladeck, of American University Washington College of Law.” As a matter of precedent rather than politics, the Breyer and Kagan votes on Medicaid are likely to be far more significant going forward than the Roberts vote on the mandate,” he said.

Paul Clement, an attorney for the states called this part of the ruling a “significant victory." He said, “The states will have a chance to make the choice. They will no longer have the gun to their head.”

Renee M. Landers of Suffolk University Law school says the impact of today’s ruling, “could reduce the number of people who will be eligible for Medicaid because it is easier for the states to opt out.”

Copyright 2012 ABC News Radio


North Carolina Dad Battles Hospital for Guardianship of Comatose Son

Fred Lempe looks in on his comatose son Freddie at a hospital in Raleigh, N.C. (WTVD/ABC News)(RALEIGH, N.C.) -- A North Carolina father is embroiled in a legal battle with a hospital that wants to assume guardianship of his comatose son.

A hearing was held on Tuesday to determine who will make the medical decisions for Freddie Lempe, 18, of Smithfield, N.C. The teenager has been in a coma since a car accident on March 6, 2011.

Lempe was in the passenger seat of a car that spun out of control on Highway 39 in Johnston County, N.C., throwing him out of the car. While the driver walked away with only minor injuries, the accident left Freddie with both brain and spinal cord trauma.

Now, WakeMed, the Raleigh hospital in which he has been receiving care for over a year, has filed a suit in Wake County Courthouse to replace Lempe's father as his legal guardian to ensure that the overwhelming amount of paperwork is completed so that the teenager is eligible for Medicaid.

Freddie Lempe does not have Medicaid coverage -- which reimburses hospitals -- for his care.

"The intent of the guardianship request is to secure Medicaid coverage for which we believe Freddie is eligible," said Heather Monackey, spokesperson for WakeMed. "As written in the court documents, the father has not followed through in filing the appropriate paperwork to get Medicaid approved."

She said that while WakeMed often files for guardianship, it's usually as a result of patients who do not have health care advocates.

Monackey said the hospital is seeking to appoint a third party to advocate for Lempe, and that the hospital would not assume guardianship because it would be a conflict of interest.

"In this case, it is the patient's right to have the financial resources offered by Medicaid. Our intention in seeking a guardianship change is to make sure that the patient has access to these resources," she said.

Monackey said that WakeMed will withdraw the guardian modification request if Mr. Lempe completes the Medicaid application.

A lawyer for the elder Lempe could not be reached for comment at this time.

Lempe's father has created a petition on Facebook to stop WakeMed's attempts to remove him as his son's guardian.

Blair Williams, the chief assistant clerk of court in Wake County who oversaw the hearing, said that Wake County deals with more guardianship issues than any other court in the state.

Williams said that while Mr. Lempe appears to be his son's best advocate, being a guardian is a full-time job.

"Typically when we're doing these hearings, a re-occurring pattern might be that the individual is all of a sudden thrust into an arena where they're not used to having to access all the different community resources that are available."

Williams said the issue at hand is whether or not an individual's guardian is aware of all of the things a particular ward may need.

"If you're a full time care provider, I don't know of any human who would be able to give the type of care that they would need to on a full-time basis without any breaks," he said. "When you're faced with day-to-day decisions for your ward, it's tough to get outside of that and look at the bigger picture.

"It takes a lot of resources to be a good guardian, and a lot of people kind of think that this is what they should be doing. They have all the good intentions and it just ends up being a very difficult job to do," he said.

Williams ruled that Mr. Lempe should be allowed to serve as his son's guardian until July 25, when "hopefully, he would be able to demonstrate that he has been able to plug into everything that Freddie would need."

"There's no one who could care about you more than a family member," he said. "But on the other hand, we're also blessed with having very well educated and caring health care professionals within Wake County to give these guardians assistance."

Copyright 2012 ABC News Radio


16 Million Children on Medicaid Not Receiving Dental Care

Comstock/T​hinkstock(WASHINGTON) -- With more than 16 million low-income U.S. children on Medicaid not receiving dental care in 2009, according to the Pew Center on the States, dentists and ERs say they are treating very young patients with teeth blackened from decay, bacteria and multiple cavities.

"I see it in their eyes before they tell me it's that way," Dr. Gregory Folse told ABC News. "We are able to intervene and take the pain away from their teeth and it brings the spark back. And that's my goal."

Folse's Outreach Dentistry mobile clinic travels to schools around Louisiana, filling cavities and teaching children and parents about the importance of oral hygiene.

In 2007, Congress held a hearing on the issue of children's dental health after Deamonte Driver, a 12-year-old Maryland boy, died when a tooth infection spread to his brain. His mother, Alyce Driver, had been unable to find a dentist to treat him on Medicaid and could not afford to pay out of pocket.

At the time, Leslie Norwalk, then-acting administrator for the Centers for Medicare and Medicaid Services, called his death "a failure on many levels."

And although she said that these types of dental services were covered, many dentists said that Medicaid reimbursement rates are too low.

A study published in May 2011, demonstrated that despite efforts to boost the number of patients and providers in the Medicaid system, low-income families still had limited access to dental care -- except when they were able to pay cash.

The state of Florida got an F in children's dental health in a 2011 report from the Pew Center on the States. In 2009, according to Pew, only 25.7 percent of Florida children on Medicaid saw a dentist.

"The Medicaid rates are so low that dentists are not willing to participate in the Medicaid program," said Dr. Frank Catalanotto of the University of Florida, Gainesville, Community Dentistry. "You can't blame the dentists, really, because the cost of delivering the service is more than the reimbursement they receive."

Florida has some of the lowest rates. Ten pediatric dentists in four counties said they would not accept Medicaid -- even for a child whose face hurt. And more than half of Florida's counties -- 36 -- do not have one pediatric dentist who takes Medicaid, according to Pew.

Dentists say that ignoring teeth can mean life or death. An infection can kill or promote heart disease, stroke, diabetes and osteoporosis. Children who do not receive dental care can suffer root canals and extractions before they reach 10-years-old.

At the Caridad Center in Boynton Beach, Fla., Falguni Patel, a first-year resident in pediatric dentistry, said it made her sad that there were certain groups of children who suffered more than others.

"People think just because you have insurance that you're going to have access to care -- which is not the whole story," she said. "They're very few pediatric dentists that accept Medicaid in this area, so these children have nowhere to go even if they do have insurance. ... It's a big problem."

Copyright 2012 ABC News Radio


Rural States See Spike in Suicides Following Medicaid Cuts

Jupiterimages/Thinkstock(SALT LAKE CITY) -- Suicide is on the rise in rural America -- nowhere so much as in Western Mountain states like Idaho, Wyoming and New Mexico.  Mental health professionals attribute it in part to cutbacks in Medicaid funding, the recession and the culture of the rural West.

In Idaho, somebody kills him or herself every 35 hours, according to a 2009 report to Idaho's governor by the state's Council on Suicide Prevention. Their report calls suicide "a major public health issue" having a "devastating effect" on Idaho's families, churches, businesses and even schools: 65 students aged 10 and 18 killed themselves in a recent five-year period.

Last week, a county sheriff in Bonneville told the Idaho Falls Post Register that his department was getting more suicide calls than in 2010 -- a year in which 290 Idahoans took their own lives.

Historically, the suicide rate in rural states has been higher than in urban ones.  According to the most recent national data available, Alaska has the highest rate, at 24.6 suicides per 100,000 people.  Next comes Wyoming (23.3), followed by New Mexico (21.1), Montana (21.0) and Nevada (20.2).  Idaho ranks sixth, at 16.5.

Suicide is the second-leading cause of death for Idahoans aged 15-34. Only accidents rank higher.

Kathie Garrett, co-chairman of the Idaho Council on Suicide Prevention, says the problem has gotten only worse since the recession.

"The poor economy and unemployment -- those put a lot of stress on people's lives," she explains.

To save money, people skip doctor visits and cut back on taking prescribed medications.  Cuts in Medicaid have also reduced the services available to the mentally ill.

"I personally know people who lost Medicaid who've attempted suicide," says Garrett.

Kim Kane, executive director of Idaho's Suicide Prevention Action Network in Idaho says other factors explain the high rate of suicide in Western Mountain states. One is the greater prevalence of guns: In 2010, 63 percent of Idaho suicides involved a firearm, compared with the national average of 50 percent.

She and Garrett also say the West's pride in rugged individualism can prevent people from seeking help.  Their feeling, says Kane, is that they ought to be able to pull themselves up by their mental bootstraps.  Idaho is the only state not to have a suicide-prevention hotline.

Copyright 2011 ABC News Radio


Man with Breast Cancer Denied Medicaid Coverage 

Photodisc/Thinkstock(CHARLESTON, S.C.) -- For Raymond Johnson it was bad enough being diagnosed with cancer when he was just 26 and without health insurance, but his shock was only aggravated when he was denied Medicaid, because rules say men are not covered for breast cancer.

Johnson, a construction worker from Charleston, S.C., is one of the roughly 2,000 men who develop breast cancer each year -- just 1 percent of all breast cancer cases.

But doctors say even though the numbers of cases may be small compared to the number of women who get the disease, what male breast cancer patients suffer is no less real.

When Johnson developed the lump, he said he ignored it, thinking it was just a cyst and wanting to avoid the cost of a doctor's visit. Besides not having health insurance, he said, his job for a small construction company does not allow him to make ends meet as it is.

But then over the July 4 weekend, he said, the lump caused an unbearable pain and he rushed to the emergency room. "They thought it had to do with my heart, but I showed them the lump and they sent me to get a biopsy," Johnson said. "That Tuesday, I was notified I had breast cancer."

Johnson said he was shocked, because he'd never had health issues before, but more than that he was concerned about how he would pay for treatment.

Though Johnson wouldn't normally qualify for Medicaid in the state of South Carolina because he is a single, non-disabled man with no children, he was advised to apply for a special supplementary program created specifically for those diagnosed with breast cancer whose income is 200 percent of the poverty line ($21,780 per year) -- even those with no dependent children. What Johnson didn't know is that the program, created by the Breast and Cervical Cancer Prevention and Treatment Act, is for women only.

He was sent to the Charleston Cancer Center to seek treatment and arrange for surgery to remove the baseball-sized tumor, according to his medical records at the center.

He and his family met with Susan Appelbaum, a breast cancer navigator and patient advocate for the Charleston Cancer Center, and he told her he had applied to the Department of Health and Human Services for Medicaid.

On July 11, he called Appelbaum to tell her he'd been denied coverage because he's a man.

Though health care reform might have changed Johnson's position, the controversial Affordable Health Care for America Act is facing challenges from dozens of states, and doesn't officially kick-in until after the 2012 election. For now, Johnson is on his own.

Copyright 2011 ABC News Radio


Study Proves Medicaid Helps Recipients

Creatas Images/Thinkstock(CAMBRIDGE, Mass.) -- A study released Thursday proves that being insured through Medicaid benefits low-income people physically, financially, and psychologically -- and that deep cuts proposed at both the state and federal levels could limit beneficial services.

The study, released by the National Bureau of Economic Research, is the first to use a randomly selected group of Medicaid participants, making it the most accurate data available on the program's effects, said MIT economist Amy Finkelstein, the lead author of the report.

The random sample study was made possible by a 2008 Medicaid lottery implemented in Oregon as a way to fairly choose the 10,000 Oregonians the state could afford to cover by the program.  Budget restraints prevented Oregon from accepting all 90,000 applicants.

"The situation in Oregon provided us an opportunity to bring the gold standard of research [random sampling] to important social science and public policy questions," Finkelstein said.

The study found that people enrolled in Medicaid were 25 percent more likely to report their health was very good or excellent, 10 percent less likely to be depressed, and 25 percent less likely to have unpaid medical bills sent to a collection agency than their uninsured counterparts.

"The results are even more positive than we anticipated," wrote Sherry Glied, the Health and Human Services assistant secretary for planning and evaluation, in a White House blog post Thursday.

Insured people also used more preventative medical services.

The probability that Medicaid recipients had their blood cholesterol checked increased 20 percent and insured women were 60 percent more likely to have a mammogram.

Insured people were 30 percent more likely to be admitted to the hospital, 15 percent more likely to use prescription drugs, and 21 percent more likely to go to a clinic or see a doctor.

"The single core finding of the study is that having Medicaid matters," Finkelstein said.

But with steep cuts proposed to the program at both the state and federal levels, those benefits may be short-lived.

Copyright 2011 ABC News Radio


What Drives Variation in Medicaid Spending?

Comstock/Thinkstock(SAN DIEGO) -- Although there’ve been many studies assessing the geographic variability of Medicare coverage costs, only a few have looked at inter-state variability in Medicaid spending and the factors contributing to the differences.  For example, in 2007 the average cost per beneficiary in the U.S. was $5,163, but New York spent almost $8,500 while California only $3,186.  Researchers at the University of California-San Diego sought to find out what is contributing to these differences?
The authors found that the states in the mid-Atlantic region -- New Jersey, New York and Pennsylvania -- have the most expensive regional care, while states in the South central region -- Alabama, Arkansas, Lousiana, Mississippi, Oklahoma, Tennessee and Texas have the least expensive.  The top 10 highest-spending states spent $1,650 above the national average per beneficiary compared to the 10 lowest-spending states which spent $1,161 below the national average, according to the study's findings reported in Health Affairs.

Turns out that the biggest contributing factor to the differences in expenditures is the volume of services delivered.  But other factors mattered as well.  The authors found that higher numbers of hospital beds and specialists increased hospital admissions (and therefore costs), while higher numbers of primary care physicians reduced admissions and thereby lowered costs.  

The lead author states that this finding “suggests that there s a great deal of room for innovation in Medicaid.  By increasing access to primary care and experimenting with team-based delivery models and low-cost providers, states may be able to improve quality while reducing Medicaid spending.”

Copyright 2011 ABC News Radio


Medicare to Cover Costly Prostate Cancer Drug

Paul Tearle/Thinkstock(WASHINGTON) -- The Centers for Medicare & Medicaid (CMS) says it will cover the cost of the pricey drug Provenge, recently approved for men with metastatic prostate cancer.

Provenge is said to extend patient survival by an average of four months, but costs about $93,000 per patient.  A CMS administrator said Thursday that the agency wants to assure patients can get the treatment they need according to their wishes.

"We are optimistic that innovative strategies may improve the experience of care for our beneficiaries who have cancer," said Dr. Donald M. Berwick, a CMS administrator. "CMS is dedicated to assuring that these patients can seek the treatments they need in accordance with their wishes."

Although research says that Provenge can lengthen survival time for men with prostate cancer that has spread beyond the prostate, experts note the drug is a therapeutic treatment and not a preventative one.   

Provenge has also reportedly presented fewer side effects in patients, researchers say.

Copyright 2011 ABC News Radio


Medicaid Coverage Limits Emergency Dental Care for Many Kids

Stockbyte/Thinkstock(CHICAGO) -- Young Medicaid recipients have a harder time getting emergency dental appointments than privately insured youngsters. This is according to a revealing study in which graduate students posed as mothers seeking care for a 10-year-old son who fractured a front tooth in a bicycle accident.

The pretend moms with private insurance coverage got the boys earlier appointments than their counterparts with public insurance.

The findings, published online Monday in the journal Pediatrics, demonstrated that despite efforts to boost the number of patients and providers in the Medicaid system, low-income families still have limited access to dental care -- except when they are able to pay cash.

The study focused on dentists' willingness to provide emergency care to Medicaid patients with front-tooth trauma, a problem that affects one in seven pre-adolescents and nearly one in four teens between the ages of 16 and 19.  About 11 percent of these injuries don't get treated, although they ideally should be seen by a dentist within 24 hours.

For each case, graduate-level research assistants from the University of Chicago placed two calls, a month apart, between February and May 2010, to 85 Chicago-area dental practices, 41 of which participated in the Medicaid/Children's Health Insurance Program.

The pretend-moms followed the same script for both calls: Their son was in pain after breaking his front tooth and was advised by an emergency department to seek dental care.  The only difference was whether the child had private Blue Cross dental insurance or Medicaid/CHIP.  The pretend-moms only revealed the child's insurance status if asked.  If the office declined to take their insurance, they asked about paying cash.

Dr. Karin V. Rhodes, an emergency care researcher at the University of Pennsylvania, and colleagues from the Hennepin County Medical Center in Minnesota, Columbia University dental school in New York, and the Children's Dental Health Project in Washington, D.C., set their study in Cook County, Illinois, the nation's second-largest urban county, where fewer than 15 percent of dental practices participate in Medicaid/CHIP.

Copyright 2011 ABC News Radio


60 Plus Chairman: ‘Factual’ to Attack Democrats for Medicare Cuts

ABC News(WASHINGTON) -- The same Republican-leaning group that attacked Democrats for cutting Medicare during last year’s campaign is this year thanking Republicans for voting for the Paul Ryan budget – a proposal that would phase out Medicare altogether for those under 55 years of age.

Jim Martin, president of the 60 Plus Association, told ABC News on Wednesday that he’s “being factual” by attacking Democrats and defending Republicans, since – he claims – Democrats supported “ending Medicare as we know it” last year by supporting $500 billion in future cuts to the program as part of President Obama’s health care law.

“‘Ending Medicare as we know it’ is the main talking point now of everybody now from the president in the White House to every Democrat on Capitol Hill,” Martin said. “Ending Medicare as we know it happened a year ago in March, when Obamacare passed. Because it radically changed Medicare as we seniors know it by cutting a half a trillion dollars out of Medicare.”

“There's a huge doctor shortage on the horizon. And already rationing has started. I can name you one drug, it's a breast cancer drug called Avastin that has already been declassified by the FDA because of cost and cost alone. That is -- Medicare as we know it changed radically a year ago.”

It’s “absolutely true” that House Budget Chairman Paul Ryan’s plan phases out Medicare for those who are under 55, Martin said. But “at least [Ryan is] trying to save Medicare for the future.”

“If you do nothing instead of being on the path to prosperity, as Mr. Ryan likes to say, we're going to be on the road to ruin with Medicare. Everybody knows it's going under because of the huge cost involved.”

Martin also attacked Democratic-aligned groups for distorting elements of the Ryan plan: “It's time to stop this. It's shameful. And it's time to stop those tactics.”

Copyright 2011 ABC News Radio

ABC News Radio