Doulas in California are negotiating with the state’s Medicaid program to secure a higher payment rate, according to the Los Angeles Times. California is transforming its Medicaid program to include services beyond healthcare and into social services, and including doulas was intended to address racial disparities, improve birth outcomes and diversity of California’s healthcare workforce. However, doulas say the state’s initial offer of $450 per birth is too low, with most other states offering reimbursements ranging from $770 to $900 and delayed the start of the program until an agreement is reached.
California’s health insurance marketplace is using automated enrollment and subsidies to reduce un- and under-insurance, according to The Commonwealth Fund. After the end of the COVID-19 public health emergency, California will automatically enroll nearly one-third of people losing Medicaid coverage into low-cost silver plans. The state will also pay the nominal premiums attributed to abortion services, which federal subsidies cannot cover, making more people eligible for $0 premiums. Finally, the marketplace will automatically upgrade some consumers from bronze plans to silver plans that cost the same amount due to subsidy enhancements, effectively lowering individual deductibles from $6,300 to $75.
Colorado’s Center for Improving Value in Health Care (CIVHC) launched an affordability dashboard to provide users with information on healthcare cost drivers, reports CIVHC. The new affordability dashboard cost of care data digs deeper into service categories and new categories for spending, including long-term care and dental services. Additionally, the new dashboard investigates the outpatient service spending category and highlights the subcategories of spending that drive outpatient costs, including other uses (includes radiology, chemotherapy, hemodialysis and physical therapy), emergency department use and pharmacy (drugs administered in an outpatient setting).
Almost half of Coloradans have delayed a recommended medical treatment due to affordability or access issues, reports Colorado Newsline, with 30 percent saying treatment was too unaffordable, while 19 percent said insurance denied them coverage. These results from a survey conducted in mid-January 2022 also found that people thought that the most unaffordable aspects of care were emergency department costs, surprise medical bills, health insurance deductibles, post-care bills and prescription drugs. In addition, just 34 percent of people felt very confident that they could pay for typical healthcare, underscoring affordability burdens felt across Colorado. Furthermore, 62 percent of respondents think that systemic racism is a problem in the country’s healthcare system, with Black and Hispanic or Latino respondents being more likely to see racism as an issue.
A new analysis from Colorado’s Center for Improving Value in Health Care shows that Coloradans received more than one million unnecessary and potentially harmful low-value healthcare services, reports AboutHealthTransparency.org. Low-value services—defined as certain treatments, diagnostic tests, and screenings where the risk of harm or cost exceeds the likely benefit for patients—were identified with 2018-2020 data from Colorado’s all-payer claims database. These services resulted in $134 million in excess costs for Coloradans and health insurers.
The District of Columbia’s Health Benefit Exchange Authority’s Social Justice and Health Disparities Working Group issued recommendations to address health disparities and systemic racism within D.C. Health Link plans, according to Health Affairs Forefront. Immediate actions include changing health insurance policies to eliminate cost barriers to care for conditions that disproportionately impact communities of color, starting with type 2 diabetes, and prohibiting race adjustment in a blood test that checks how well kidneys are functioning. In future plan years, the group will examine a no cost-sharing plan design for pediatric mental and behavioral health services, as well as for adult cardiovascular disease, cerebrovascular disease, mental health and HIV, as well as cancer of the breast, prostate, colorectal and lung/bronchus—other conditions that disproportionately impact communities of color in D.C.
Georgia Governor Brian Kemp signed into law a bill intended to pressure private insurers to improve coverage for mental health conditions, according to an AP article in The Journal Record. The new law asks private insurers to follow established federal requirements to provide the same level of benefits for mental health disorders as they do for physical illness and requires insurers to submit data to the state about their compliance. However, the law does not require health insurers to cover treatment for mental health or substance use disorders.
Illinois Blue Cross Blue Shield members are having trouble finding in-network doctors due to a “ghost network,” reports WCIA. A “ghost network” refers to an insurance company’s inflated patient directory that over-promises and under-delivers on the number of providers who are actually available. While the company denies these claims, a thorough review of the company’s directory reveals that many doctors are not actually in-network, are not available, not taking new patients, and are located too far away, contrary to the directory. The complications arose after the insurance company escalated a contract dispute with Springfield Clinic and kicked all 650 of its providers off the Blue Cross Blue Shield network; patients who cannot find in-network care through the incorrect directory must shoulder high out-of-pocket costs to continue to see their providers.Those who cannot afford to do so may discontinue their care, with dire health consequences.
Following the highly publicized death of a Black doctor named Susan Moore, who alleged racist treatment at a hospital before dying of COVID-19, Indiana’s five major hospital systems are collaborating to create a dashboard tracking racial disparities in patient care, according to the Indy Star. The dashboard currently includes data on diabetes care and will later expand to infant mortality and mental health, although it is unclear when the dashboard will be available to the public.
New legislation signed by Maine’s governor will direct the state’s new Office of Affordable Health Care to take a targeted approach to improving affordability by studying existing affordability barriers and identifying policy solutions focused on making healthcare more affordable for Maine residents and small businesses, according to Consumers for Affordable Health Care. The legislation builds on previous legislation that established the Office and charged it with developing policy solutions to help rein in those high costs and improve efficiencies and coordination within the healthcare system, in addition to providing staff support to Maine’s Prescription Drug Affordability Board.
Officials at the Massachusetts Health Connector have put forward a framework for their 2023 health insurance offerings that would eliminate sick visit copays and cost-sharing on common medications for four chronic conditions for patients enrolled in ConnectorCare plans, reports WWLP. Each year, the Connector sets parameters for plans sold through the insurance marketplace and establishes design elements of the ConnectorCare program, available to residents with incomes at or below 300% of the federal poverty level. In the upcoming year, officials are proposing $0 cost-sharing in the ConnectorCare program for diabetes, asthma, coronary artery disease and hypertension—conditions that disproportionately impact communities of color. Other “equity-minded components” include efforts to enhance behavioral health access, minimize barriers to gender-affirming care and ensure access to care for people with limited English proficiency.
The Hispanic population in Montana has nearly doubled over the last 10 years, but remains below 100,000 classifying it as a “new-growth community” with limited Spanish-speaking resources, reports the Billings Gazette. The state lacks certain basics such as Spanish-speaking healthcare providers and Spanish versions of documents and health questionnaires, all of which can exacerbate health disparities that already exist due to a lack of affordable housing. Community Health Partners in Bozeman provides primary care for all, regardless of ability to pay, and sees much of the Hispanic population. They have managed to flesh out their Spanish options for patients but find it hard to connect patients with specialist services that offer Spanish-speaking providers or translators.
Nevada will join the Northwest Prescription Drug Consortium for prescription drug purchasing, according to the Las Vegas Review-Journal. Once the state joins, all state residents can get a free discount program card and can use whichever pharmacy benefit provides the best price, regardless of their existing coverage or insurance status. The consortium, called ArrayRx Solutions, is coordinated by Oregon and Washington, and enables participating states to combine their drug purchasing power to lower costs and negotiate and establish discounts for consumers.
A survey of New Mexico residents has found that roughly one in two respondents didn’t seek medical care in the past two years due to cost, according to NM Political Report. Notably, Latino/Hispanic and Black respondents were the most worried about paying for care. Most respondents blamed the federal government for the high cost of healthcare, and seventy-two percent said they support a government-administered health plan, sometimes referred to as a public option.
Once on Medicaid, it was easier and less expensive for CJ’s family to get him the care he needs for his autism, oppositional defiant disorder and disruptive mood dysregulation disorder, reports NC Health News. CJ, a 13-year-old from Asheville, North Carolina, became eligible for Medicaid when his dad lost his job and health insurance. For kids like him, the services they need are often not covered at all by private insurance companies, or the company caps the number of times they can receive a service or the company’s deductibles and copays are too expensive. On the other hand, Medicaid is required to provide direct access to services for kids who are clinically eligible, while private insurance does not have this legal requirement. Advocates note that most health insurance companies are required to provide mental health benefits, but there are no state or federal requirements that say they must be equal to the benefits that Medicaid or Medicare provides. Essentially, people with significant behavioral needs are likely to have access to more comprehensive care if they have Medicaid instead of private insurance.
The Ohio Department of Health is awarding 15 contracts for 136 new or expanded school-based health centers throughout the state, according to the Office of the Governor. The clinics will provide primary care and preventative care, including vision, dental and behavioral health in school settings. These clinics will eliminate many barriers to obtaining care, such as transportation, child time out of the classroom, parents missing time at work and a lack of provider or medical home. These clinics have emerged as effective models to improve student access to healthcare and have helped close the gap for children in underserved communities.
The Oregon Health Authority is recruiting teenagers for an advisory council that will decide how to spend $1 million in Covid recovery funds, reports the Oregon Capital Chronicle. The agency wants the money to help alleviate some of the impact of the pandemic on young people and said young people are the best ones to decide how those funds should be spent. The group will have limited constraints on how they spend the money in schools, with guidelines on the agency’s priorities including: enhancing culturally and linguistically specific services in schools; developing youth leadership; mental health and behavioral healthcare; and providing livable wages to unlicensed staff. The council will also define values for recovery, discuss youth needs and health inequities and talk about community engagement.
A report from the Oregon Health Authority found that the annual family health insurance premiums averaged over $19,000, and that doesn’t include out-of-pocket costs, according to The Lund Report. Using data from 2019, the report found that a family’s premium and out-of-pocket costs totaled 13.5% of the median family income. The report said that rising healthcare costs jeopardize the financial security of families, consume some families’ savings and prompt some residents to forego needed care and emphasizes the value of the state’s new cost growth benchmark.
Pennsylvania’s state-based health insurance marketplace has added a new qualifying event that will allow low-income households to enroll in health insurance plans at any time, according to the Office of the Governor. Rather than being restricted to regular open enrollment period in the Fall-Winter, residents with a household income at or below 150% of the federal poverty level will automatically get a qualifying event to start coverage or change their current plan. This is intended to make it easier for low-income residents to stay and get covered.
Healthcare leaders across the state signed a compact to accelerate the adoption of advanced value-based payment models, according to the Rhode Island Office of the Health Insurance Commissioner. These efforts, led by local stakeholders, represent critical strides toward reducing the rate of healthcare spending growth through transforming the way healthcare is paid for and pinpointing the key drivers of healthcare cost growth in the state. The coalition hopes that shifting towards prospective budget-based payment models and away from fee-for-service can improve affordability and quality of care.
Washington State passed legislation requiring the creation of a Prescription Drug Affordability Board by June of 2023, according to NASHP. The Board will conduct affordability reviews of the costliest prescription drugs–brand name drugs costing more than $60,000 per year or with price increases of 15 percent or more in the past year, or 50 percent over the last three years—as well as some biosimilars and generics. Starting January 2027, the Board may then establish upper payment limits for state payers on up to 12 drugs per year. In addition, the legislature lowered the cap on insulin prices from $100 to $35 per month and extended the cap through 2024 while the state’s Total Cost of Insulin Work Group studies long-term cost-lowering strategies.
The Dane County Health Council, the Foundation for Black Women’s Wellness and numerous community health partners have launched ConnectRx Wisconsin, reports Madison365. The initiative is a new care coordination system supporting Black pregnant birthing persons to improve access to healthcare and stabilizing resources, such as food, financial assistance, housing, employment and transportation. The aim is to reduce the occurrence of low birthweight infants and improve birth outcomes for Black birthing persons and babies in the county. Advocates note that in Dane County, babies born to Black mothers are twice as likely to have low birthweight than those born to white mothers. They also note that by providing care coordination and solutions for social needs, they may improve the health of both infants and parents, and hopefully eliminate health disparities.
Oregon and Kentucky are pursuing a Basic Health Program (BHP) to provide residents who find marketplace plans too expensive with a less costly option, reports Politico. Oregon passed a bill in March to establish a BHP and Kentucky lawmakers approved funding for the program in the spring—both states will be able to enroll residents in the program as soon as next year. A BHP uses federal dollars to establish a health insurance plan for people who make up to 200 percent of the federal poverty level and would otherwise qualify for subsidies on the marketplace. It also provides an option for lower-income immigrants who are ineligible for Medicaid coverage. Only New York and Minnesota have taken advantage of the policy since it was established by the Affordable Care Act.