A group of Tennessee Medicaid recipients has filed a lawsuit seeking to halt a plan that would make contentious changes to the state's program designed to provide medical coverage to low-income earners in the state, according to Modern Healthcare. The Tennessee Justice Center — who is representing the recipients — claims the federal government exceeded its authority in approving the proposal. Block grant supporters argue that the current system gives states little incentive to control expenses because no state pays more than half the total cost. However, opponents and health advocates have expressed concern that spending caps might cause states to purge their rolls or reduce services.
A new Montana law aimed at reducing healthcare costs will allow healthcare providers to contract directly with patients for certain basic care, such as annual checkups, office visits, vaccines, bloodwork and stitches, reports the Flathead Beacon. Currently, eight clinics in Montana are working as direct primary care providers as allowed under a 2017 memo issued by the then-Insurance Commissioner. The new law allows dentists, chiropractors and other health providers to offer similar direct care contracts to patients. Supporters of the law argue that direct care coverage can be used in combination with lower-cost catastrophic health coverage or a healthcare sharing ministry to reduce costs.
The Tennessee Health Care Campaign’s Rural Equity Report shows three-fourths of the state’s 25 remaining essential access rural hospitals are at high risk of closure in the next few years, reports The Rogersville Review. The report includes a toolkit for rural communities with vulnerable hospitals that offers solutions to rural health inequities, including: prioritizing infrastructure improvements in roads, broadband and emergency call centers; state oversight of hospital ownership transfers; increased financial investment in rural health; and increasing coverage for Tennesseans in rural areas. The report also includes interviews with stakeholders that share their experiences and perceptions of rural hospital closures.
An old Massachusetts policy called “automatic retention” stopped residents from losing their health coverage, reports Tradeoffs. The results of an NBER working paper show that this unique feature protected 14% of adults per year from losing health insurance coverage due to payment lapses. Because in CommCare (Massachusetts’ pre-ACA health insurance exchange) there was always one plan option with zero premium available to people making 100-150% of the federal poverty limit, if someone missed a payment for another plan, they were switched automatically to the premium-free plan. Researchers found that the adults who benefited from this policy were often younger and healthier, keeping the market risk pool balanced.
A new analysis found large variations in commercial health insurance payments compared to Medicare payments across Colorado hospitals, reports the Center for Improving Value in Health Care. Colorado hospitals received commercial payments for inpatient and outpatient services that were anywhere from 108% to 508% of Medicare rates for the same services at the same hospitals. In particular, outpatient services in Colorado are among the most expensive in the state and a driver of rising healthcare costs.
Omitting social determinants of health (SDOH) data from CMS’ Hospital Readmissions Reduction Program misallocated penalties attributable to SDOH to hospitals with the largest share of high-risk patients, according to a Health Affairs study. Researchers used 2012-2016 data from New York City to project the program’s penalties by augmenting CMS’ readmission model for heart attack, heart failure and pneumonia with SDOH scores created to measure geographic levels and individual-level social risk. They found that including these scores affects projected penalties for hospitals treating the highest proportion of patients with high SDOH scores. If CMS continues to omit this relevant patient and geographic data from this readmission model, penalties due to SDOH and social risk factors are misallocated to hospitals serving the largest share of these populations.
Newly passed legislation in Maryland, the Maryland Health Equity Resource Act, will reduce inequality in health, reports Maryland Matters. The bill will fund grants in neighborhoods that have suffered from health disparities and poor health outcomes, offering communities in those neighborhoods funding opportunities for programs to reduce health disparities, improve outcomes, boost access to primary care, prevent illness or reduce hospital use. The neighborhoods eligible for the grants will likely mirror those that qualified for Maryland’s previous Health Enterprise Zone program in 2016.
A study from WalletHub ranked states across many key health metrics, including children’s health and access to healthcare—where Hawaii earned the top rank, reports State of Reform. Hawaii earned second place overall for children’s healthcare, only just behind the District of Columbia. The state also earned a high score for lowest percentage of uninsured children, children with unaffordable medical bills and percentage of overweight children. However, Hawaii had the second to last ranking for children’s oral health.
West Virginia has passed legislation to extend Medicaid coverage to low-income women up to one year after giving birth, reports U.S. News & World Report. The state’s Governor indicated that the state’s health department will opt into the state plan option indicated in the American Rescue Plan, noting that the state’s population has many lower-income families and pregnant women in need of comprehensive health coverage.
The United Hospital Fund published a report identifying the most effective ways to present meaningful and user-friendly pricing information to New York consumers, following a 2020 directive to create a consumer-friendly website, NYHealthcareCompare. Some recommendations include: using the “allowed amount,” as it best reflects the actual underlying price of healthcare services, using commercial claims data for the first iteration of the transparency website, and displaying pricing information for public insurance programs.