State News

A real estate agent and mother of two enlisted the help of the media to share her story when she received an unexpected medical bill that she was unwilling to pay, reports Kaiser Health News. She was charged twice for an outpatient procedure by a facility that offered her a discount on coinsurance that it was not authorized to provide, and her bill was sent to a collection agency. An investigation, prompted by a reporter’s call, verified the patient’s version of events, including a breakdown in the facility’s customer complaint process that should have prevented the bill from going to collections. While the issue was unintentional, it could have had serious financial consequences for a patient that lacked the time, resources or will to fight.

Indiana became the first state to receive a 10-year extension from the federal government for its alternative to traditional Medicaid expansion, the Healthy Indiana Plan, reports the Indianapolis Star. The plan provides benefits while at the same time requires beneficiaries to contribute in order to participate. Typically, states only receive a 2- or 3-year extension of their Medicaid expansion alternative health plan. The Healthy Indiana Plan currently insures more than 572,000 low-income Indiana residents, which is 100,000 more people than this time last year. The 10-year extension provides funding security for the next decade, while maintaining flexibility for Indiana to request federal approval to make improvements to the program down the line.

The State Treasurer of North Carolina, who manages the state employees’ health plan, has spent years trying to persuade hospitals to accept lower payments, but has struggled to discover the existing rates the plan pays each hospital and enact policies, reports Kaiser Health News. In North Carolina, hospital inpatient prices for private insurers, which typically drive health premiums, rose by 10 percent from 2014 to 2018. In an effort to help the state control healthcare costs, the Treasurer proposed to base prices on a percentage of Medicare rates, a form of reference pricing, giving hospitals 175 percent of what Medicare reimbursed for inpatient services and 225 percent for outpatient services—a move that would resulted in payment cuts to most hospitals. In response, the North Carolina Healthcare Association warned customers that if no agreement could be reached with the state plan, the hospitals would be considered out-of-network providers. In many states, hospital associations are political powerhouses, with lobbyists and influence from being the largest employer in many legislative districts.

Louisiana legislators passed several health-specific pieces of legislation during the latest special session, according to The Advocate. The legislature passed 71 bills in total, including: requiring the Department of Health to submit documentation to the CMS to receive financial relief for providers that provide care to people with developmental disabilities; directing the Louisiana Board of Pharmacy to study and make recommendations relative to pharmacists' ability to test, screen and treat certain health conditions; and authorizing a study of the decline in health insurance coverage among children in the state.

With no protections in place, Kansans remain among the most vulnerable in the country to surprise medical bills, reports KCUR. Studies cited in an issue brief by the Kansas Health Institute found that Kansas had the second highest rate of out-of-network charges for inpatient hospital care in 2016. Ultimately, one in four Kansas patients received out-of-network services through an in-network hospital. Another study analyzing claims from 40 states found that Kansas ranked fifth for out-of-network charges billed to emergency room patients. Despite ample evidence, the state has yet to take action to address surprise medical bills. A 2020 proposal to establish partial protections failed in the Legislature, in addition to a proposal to require doctors and hospitals to give patients better cost estimates prior to care. 

Behavioral health experts are partnering with primary care physicians in 30 UCHealth primary care clinics across Colorado so that patients can easily get their mental and emotional needs met in the same setting, reports KOAA News5. The goals of this program are to increase access to behavioral health services and decrease stigma by normalizing these services for patients.

Telehealth improved access to behavioral health and speech language pathology services in Maine, through usage still remained low, according to a study in the Journal of Rural Health. Telehealth usage increased to 0.28 percent of Maine’s population in 2016, up from 0.02 percent in 2008, based on data from Maine’s all-payers claims database. Telehealth usage varied by area: speech language pathology was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for more than 70 percent of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. The study identified provider shortages, broadband, and Medicare and commercial coverage policies as barriers to telehealth access and implementation in rural areas.

Residents in North Carolina face serious hurdles to accessing dental care, reports the Carolina Public Press. In 2019, residents in 98 of the state’s 100 counties lived in a region designated by the federal government as a Dental Health Professional Shortage Area. Even if residents can find a provider, cost may still be a barrier. Many low-income residents may not have dental insurance and those who qualify for “medically necessary” dental care through Medicaid may have difficulty finding providers who take Medicaid.

The lack of maternal care in many areas of Louisiana—forcing women to travel long distances for routine checkups, emergency visits and deliveries—likely contributes to one of the nation’s highest maternal mortality rates, reports NOLA.com. The research from March of Dimes found that 35 out of 64 parishes have little to no access to maternal care, including Evangeline Parish, where there is just one OB/GYN for a population of more than 33,000 people. Due to scarcity of care, researchers estimate that one in four pregnant women in Louisiana may need to travel outside of their parish for the many services necessary to monitor a pregnancy: ultrasounds, blood tests, glucose screenings, specialist appointments and delivery. Traveling is not always possible for women who have transportation or time constraints. Women in these "maternity care deserts" had a threefold higher risk for death directly related to the pregnancy, such as severe bleeding or preeclampsia, a dangerous complication involving high blood pressure.