State News

Washington D.C.’s Department of Health Care Finance (DHCF), the District’s Medicaid agency, announced that it will transition nearly 22,000 individuals currently in the Medicaid fee-for-service program to a Medicaid managed care program in addition to launching two major changes that will improve equity and value for the Medicaid, Alliance and Immigrant Children’s Programs. First, DHCF will expand value-based purchasing requirements in the managed care program to promote an enhanced focus on health outcomes for Medicaid enrollees. Second, DHCF will implement universal contracting for critical providers in the city’s healthcare market to even the playing field and improve access to needed healthcare providers for all Medicaid enrollees. Given DHCF’s role as the payer for 40 percent of the District’s population, these changes are expected to have a broader positive impact for the District’s healthcare delivery system, as well.

States use the Commonwealth Fund’s 2019 Scorecard on State Health System Performance to identify places where their health care policies are on track, and Rhode Island particularly made strides in the areas of coverage and behavioral health, reports the Commonwealth Fund. The state uninsured rate among adults dropped from 17 percent in 2013 to 7 percent in 2015 and 6 percent in 2017. In addition, the percentage of adults with any mental illness reporting an unmet need dropped from 27 percent in 2010–11 to 18 percent in 2014–16. The state also saw significant reductions in the percentage of children with unmet mental health needs.

A new Colorado law will establish a legally protected process for communication with patients and/or their families and a format for resolution after an adverse healthcare incident, according to the National Law Review. Participation by healthcare facilities and providers is voluntary and the process must be initiatied by the healthcare provider involved in the adverse incident or by another provider jointly with the health facility involved. If the process is initiated by the patient or their family/representative, the discussion will not be protected. If followed correctly, this complicated process can significantly benefit nursing homes and assisted living facilities in investigating, communicating and resolving compensation issues related to adverse resident outcomes. 

Private insurance companies are expecting to pay out a record of at least $1.3 billion in rebates to consumers this year based on their share of premium revenues devoted to healthcare expenses in recent years, according to a Kaiser Family Foundation analysis. In the individual market alone, insurers will pay out the highest rebates in Virginia, followed by Arizona and Texas. Arizona’s individual market rebates are expected to reach $92.3 million.

Montana has received a $19 million awared from the Centers for Medicare and Medicaid Services (CMS) to support a statewide health information exchange (HIE), according to HIT Consultant. The HIE will give providers access to patient data in real-time with participating providers across the state to improve quality of care and reduce healthcare costs. A coalition of healthcare providers and public and private health plans created a nonprofit organization, Big Sky Care Connect, to develop the HIE, which will begin sharing healthcare data in 2020. 

Over six years ending in June 2018, the University of Virginia Health System and its doctors sued former patients more than 36,000 times for over $106 million, seizing wages and bank accounts, putting liens on property and homes and forcing families into bankruptcy, a Kaiser Health News and Washington Post analysis has found. Uninsured patients are left to cover bills that are sometimes twice what a commercial insurer would have paid due to insurer discounts and negotiated rates. Under a Virginia program designed to help state and local governments collect debt, the health system also seized $22 million in state tax refunds to patients with outstanding medical bills in the last six fiscal years — most of it without court judgments, in addition to billing them for legal costs and interest on their unpaid bill. This nonprofit hospital system offers charity care and other community benefits to patients, but savings of only $4,000 in a retirement account can disqualify a family from aid, even if its income is barely above poverty level. Health system representatives have defended themselves, stating that suing patients and using collections agencies are last resorts. Contributing to the problem, standards for community benefit requirements are vague—the American Hospital Association merely requires hospitals to have a financial assistance policy and make “reasonable efforts” to determine whether a patient qualifies before initiating collections. 

California passed a measure to require Kaiser Permanente to join other insurers in providing more detailed information on expenses and revenue, reports The Sacramento Bee. Moving forward, Kaiser must report expenses and revenue for each of its facilities; break down revenue by type of payer (Medicare, Medi-Cal or private insurance) at each facility; and break down rate increases by type of service (hospital, physician services, pharmacy, radiology and laboratory). Consumer advocates support the increased transparency, citing that Kaiser has had a fairly broad exemption from much of the state’s rate review processes that other insurers have to follow. This bill ensures that Kaiser will provide the same types of information justifying their rates as other health insurers. 

The University of Missouri is one of five institutions nationwide to receive nearly $5 million in federal funds to address the looming shortage of primary care physicians, reports the St. Louis Post Dispatch. Most of the money will go toward the expansion of programs already in progress to recruit college students from rural areas to pursue rural medicine; while also exposing more medical school students to doctors in small-town clinics instead of specialists at large teaching hospitals. A smaller portion of the money will fund the development of a new family medicine residency program at the Bothwell Regional Health Center in rural Sedalia.

More than 100,000 Alabamians are employed but cannot afford healthcare, according to the Alabama Political Reporter. Around 50,000 Alabamian women who are employed cannot afford the healthcare provided by their employers or private insurance, as well as 58,000 employed men in the state, according to a report by Alabama Arise. Alabama is one of 14 states that has yet to expand Medicaid, which advocates and the Alabama Hospital Association say would help provide affordable and rural medical care to those who are working but cannot afford care.