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Health Policy Hub - Community Catalyst
A Blog by Community Catalyst
Updated: 3 years 7 weeks ago
We talk a lot about Medicaid Expansion on this blog because we know it is vital to improving access to health care for millions of people. But sometimes it’s helpful to review how it will help people. According to a new study, one such way is by improving access for mental health.
Last week the National Alliance on Mental Illness (NAMI) released a report illustrating one of the many things states have to gain by taking the federal funds to expand Medicaid. Nationwide, more than 2.7 million uninsured people with mental illness can get covered if all states accept the federal funds. While the nation-wide impact provides important context, the report also includes a chart with the state-by-state numbers of people with mental illness who would be helped (see page 9 of the report).
In Florida, 244,000 people are not getting the mental health care they need. Even though the federal government is willing to pay for 100 percent of their care, these people will not be helped because their state legislature will not support expanding Medicaid. In Michigan, currently a “maybe” expansion state, 105,000 people need access to mental health care. California, a state accepting the expansion, and Texas, a state that has not yet accepted, each have more than 255,000 residents who would benefit!
The chart also lists the percentages of uninsured people with mental illness who would be eligible for Medicaid. Some of the states are staggering. More than 30 percent of people without insurance who would be eligible for Medicaid in Minnesota and Nebraska have mental illness. Yet sadly only one of those states, Minnesota, will expand in 2014.
Mental illness has risen to such importance that it was the focus of today’s White House conference. The President reminded us that the brain is a part of the body and deserves treatment just like our broken hearts and bad hips. Advocates were heartened to hear that Secretary Sebelius reaffirmed the Administration’s commitment to finish mental health parity regulations this year, as they stated in January. With fewer than half of Americans with mental illness receiving treatment, Medicaid expansion can help improve the situation dramatically. The tragic shooting in Newtown, Connecticut and other awful events are reminders about the importance of treating this often hidden disease.
The NAMI report highlights the concerning status of mental health in our country—and yet the substance use disorders treatment situation is even more dire. Only 1 in 10 people with addiction receives the treatment they need, making addiction the most undertreated illness in our nation. Thankfully the Affordable Care Act includes benefits for this chronic disease and expands parity to help ensure this coverage is meaningful. (There is more work necessary at the state level to ensure these benefits are implemented so they most benefit consumers. For more, see our substance use disorders page.) The new health insurance marketplaces will help higher income uninsured people get covered, and those who live in expansion states will have Medicaid as an option.
Mental health and substance use disorders affect millions of uninsured Americans, but whether many will get help in 2014 is undetermined. The solution to each problem is the same: expand Medicaid. Take the federal money to help people get access to much needed care. Sixteen states are still “on the bubble” – advocates need to take the behavioral health message to their leaders so that people with brain diseases can get the help they so desperately need.
– Tom Emswiler, Policy Analyst
As we near open enrollment in new health plans, all eyes are on insurance premiums and the rates they are based on. As we have blogged about here before, industry-backed sources have been fueling the media with doomsday scenarios about cost increases due to the ACA. But what if those increases never materialize?
In a number of states that have recently released proposed premium rates for plans under the ACA, including California, Washington and Maryland, prices are reasonable and lower than many anticipated. And in Oregon, as the post below details, public posting of the insurance premiums actually lowered prices from their original bids. While certain interests continue to stress concern over the “rate shock” myth, the reality is that the ACA is meeting its promise in bringing greater transparency and competition between health plans to keep prices fair.
Oregon, as the below post from Jesse Ellis O’Brien of OSPIRG indicates, is a success story in reviewing premiums rates. While many states do not have the same regulatory infrastructure as Oregon, there are steps advocates can take to push for more accountability from insurers. Interested in learning more about these advocacy strategies? Read Jesse’s blog (originally posted here) and check our new toolkit.
Something remarkable just happened to health insurance costs here in Oregon. Last week, after the state’s health insurers posted their proposed premium rates for next year, two insurers publicly reversed course and moved to cut their prices.
Why? Because thanks to Oregon’s new health insurance exchange, Cover Oregon, insurers will be competing head to head for customers, and those customers will be able to make true apples-to-apples comparisons between plans for the first time. And thanks to an OSPIRG-backed law, the state’s insurance regulators now post proposed rates and all supporting documents online, enabling the public to compare rates—and insurers’ justifications for their rates—before they go into effect.
Looking at these proposed rates, it is easy to see why insurers like Providence and FamilyCare would backtrack. To bring in customers, their rates must be competitive, and the rates they proposed are more expensive than the competition.
Why is this exciting? Because in our fragmented health insurance market, this kind of competition is new, and now we have concrete evidence that competition on a health insurance exchange can help bring down premium costs.
The events of the past week have shown that Oregon’s approach—advancing transparency and fostering head-to-head competition between insurers—can lead to real gains for consumers. But as experts warn that a third or more of health care spending wasted on things that do not improve health, we know we can do better. See OSPIRG Foundation’s recent report, Advancing Accountability, Cutting Health Care Waste, for ideas about how Oregon can take the next steps to tackle this waste and bring down the cost of care for all Oregonians.
– Jesse Ellis O’Brien, Health Care Advocate
May 3, 2013 at 10:00 a.m. found me driving through miles of pecan groves in the southern part of New Mexico. I was heading to the first event in Health Action New Mexico’s (HANM) spring series, “It’s a New Day for Health Care in New Mexico.” These gatherings are cultural events aimed at educating communities about their new health insurance options under the Affordable Care Act. (ACA)
With 25 percent of New Mexicans currently uninsured or underinsured, we estimate that nearly 170,000 people will be eligible for the Medicaid Expansion in New Mexico, and another 200,000 for the Marketplace. HANM is hosting these cultural learning events to bring greater awareness about health insurance options to communities. If our first event is any indication, people are excited to find out about the changes that are occurring, and feeling empowered to make healthy decisions for themselves and their families.
The first event was held in San Miguel, a small village in Doña Ana county. I was pleasantly surprised to be greeted by more than a hundred welcoming faces ready to celebrate the Cinco de Mayo and hear about the new health insurance opportunities in New Mexico! Our co-host for the event, Concilio Campesino, a non-profit organization that offers community services to residents in southern New Mexico, was vital to ensuring the wonderful turnout.
The program began with celebratory music to commemorate el Cinco de Mayo. Then, after the Concilio Campesino team welcomed attendees, HANM stepped in with a brief presentation in Spanish to discuss the benefits the ACA will offer families, focusing on both the Medicaid Expansion and the state’s health insurance Marketplace. This presentation was an introduction, providing attendees with the basics of eligibility, the application processes, and what help exists should they encounter any challenges in enrolling.
We also introduced the community to the next step of our project; entitled “You Are Not Alone.” This effort will create collaboratives of local community leaders to help individuals enroll in Medicaid or the Marketplace. Afterwards, we made sure to leave plenty of time for a question and answer period, and closed the event with a return to the music.
In addition to the great turnout, the participants were enthusiastic to learn about various health options, asked great questions, and committed to sharing the information with others.
Our key strategy in these community events is to share factual information in the simplest, most actionable terms possible. HANM’s goal is for New Mexican families to be able to take their health care into their own hands; we made sure to leave everyone with a checklist that walks them through their eligibility for these new health insurance options.
HANM will be holding more events throughout the spring to celebrate a new day in health care with live music and important information.
– Joe Martinez, Consumer Outreach Coordinator
Health Action New Mexico
Advocates, stakeholders, federal and state governments are busy planning strategies for enrolling millions of newly eligible people into health coverage in 2014. But last week, CMS quietly released guidance that could lighten the load on everyone.
The May 17 guidance lays out five state policy options. If elected, these options will increase the number of new eligibles who enroll in coverage on day one and remain covered throughout the year, while also easing the administrative burden of processing these applications.
The guidance allows states to enroll adults who we already know are eligible based on:
- • Supplemental Nutrition Assistance Program (SNAP) eligibility. Most households who qualify for SNAP have incomes that will also qualify them for Medicaid . The recent guidance empowers states to take advantage of their SNAP data by enrolling adults on that program straight into Medicaid, without requiring a new application. This option expires at the end of 2015.
- • Children’s income eligibility. States have a rich database of hundreds of thousands of potentially-eligible parents—those whose children are currently enrolled in Medicaid or CHIP . The guidance would allow states to enroll parents who are deemed eligible based on their children’s income eligibility, without requiring a new application. This option is also time-limited.
For both of these options, the process is not quite as seamless as enrolling the identified adults straight into coverage. States still need a signature (which can be written, electronic, oral or telephone-based) from the eligible adults and to verify some non-income eligibility criteria such as citizenship status. The guidance lays out several options for states to get this missing information as simply and expediently as possible.
The guidance also allows states to guarantee adults 12 months of coverage regardless of income fluctuations. Low-income households often experience small fluctuations in income that put them just above and below the Medicaid-eligibility level. To help states reduce the churn and administrative costs associated with these income changes, the guidance allows them to offer 12-month continuous eligibility to adults. 32 states already offer continuous eligibility to children in Medicaid or CHIP, but this is the first time that option has been available to adults.
Finally, the guidance includes two policy options aimed at easing the administrative burden on states from adopting a new income-counting methodology (Modified Adjusted Gross Income, or MAGI.)
The key to all these options is that they are just that: options. States must submit waivers to take advantage of them. Our work over the next few months is to encourage states to adopt these common-sense strategies for connecting families to the coverage they need.
– Katherine Howitt, Senior Policy Analyst
After a long gestation, the federal government this week birthed new guidance designed to help managed care for Medicaid long-term services and supports (MLTSS) grow up into a more consumer-friendly, homey program. This is good news for the hundreds of thousands of people nationwide with mental and physical disabilities who depend on these services to help them live full lives.
Among the great new requirements are that states set up independent advocates or ombudsman for consumers in these programs, establish a state-level stakeholder advisory group and require managed care organizations to establish member advisory committees. In addition, states must provide independent counseling to consumers about their enrollment choices, and give them time to choose a managed care plan before they are automatically assigned. States must also use payment mechanisms that promote the home and community-based care that consumers prefer over nursing home care.
The guidance document from the Center for Medicaid & CHIP Services sets out 10 elements that federal regulators will use as they decide whether to approve new or revised LTSS programs in the states. The recommendations apply to LTSS programs designed using waivers of federal rules, called 1115 or 1915(b) waivers.
The Center summarized the elements in a four-page document. The elements are: Adequate Planning, Stakeholder Engagement, Enhanced Provision of Home and Community Based Services, Alignment of Payment Structures and Goals, Support for Beneficiaries, Person-Centered Processes, Comprehensive Integrated Service Package, Qualified Providers, Participant Protections and Quality.
The guidance doesn’t go as far as we’d like in some areas – for example, the ombudsman isn’t required to collect examples of systemic problems and recommend improvements to MLTSS. Also, the guidance doesn’t set specific standards to prevent disruption of care to consumers whose current providers are not in their new managed care plan. And requirements for transparency of managed care records are limited.
But the guidance lays a foundation on which to build. Advocates can use it to press states to do better for the many people eligible for Medicaid who need help with daily activities, personal care, chores and other services. In addition, the Center says they are open to refining the guidance as they and states develop more experience with managed care for LTSS. We’ll take them at their word on that, and offer a more detailed analysis on how the guidance can be strengthened in the coming weeks and months.
- Alice Dembner, Project Director
At Community Catalyst, we believe everyone should have a say in the decisions that affect their health. Many governors are now making decisions that affect the health of thousands of veterans and their families.
According to a report published by the Urban Institute, 1.3 million veterans of our armed forces currently do not have health insurance coverage. Under the Affordable Care Act’s (ACA) Medicaid expansion, more than 40 percent of these uninsured nonelderly veterans would gain health coverage. Being covered by Medicaid would not preclude veterans from using the U.S. Department of Veterans Affairs (VA) system if they qualify, and would allow them to gain access to greater health care choices at a lower cost.
However, more than half of all poor uninsured veterans (with incomes below 100 percent of the federal poverty level), are in states that may opt out of the Medicaid expansion. Because many states with large populations of veterans currently oppose expanding Medicaid, it’s a critical time to raise awareness among veterans who may qualify for Medicaid. In states such as Florida that are not committed to expanding Medicaid, and where military presence is particularly high, there are more than 40,000 uninsured veterans who will qualify if the program is expanded. Similarly, Georgia, Michigan, North Carolina, Ohio, and Texas are all on the fence about expanding Medicaid, yet they have high numbers of uninsured veterans who stand to gain coverage under the option.
To help advocates engage the veteran community and encourage them to be a voice for supporting the Medicaid expansion, we’ve gathered resources in our fact sheet, Engaging Veterans in Medicaid Expansion Campaigns. It includes a summary of information that can be helpful to health care advocates as they engage veterans—and those who work with veterans—in building a meaningful and powerful campaign narrative that prioritizes access to the quality, affordable health care they deserve.
For many veterans, this is a time of transition – away from military life and back into a civilian one. Let’s honor our veterans by ensuring access to health insurance is just one more way to ease that transition.
– Jeanelle Roman, National Urban Fellow
Building anything new is tough. That’s why we turn to blueprints and experts.
The same principle applies to the federal demonstration projects for people eligible for Medicaid and Medicare (dual eligibles) that are under construction in more than 20 states across the country. These projects are building complex new systems of care for millions of the most vulnerable people in the nation that are supposed to combine services paid for by both Medicaid and Medicare into a coherent, coordinated program. Fortunately, the federal government is supplying sketches for the states to work from, and requiring states to consult the experts – in this case, the consumers who will be served.
But to help these projects succeed, the states and the delivery systems that will operate these projects need a detailed blueprint for how best to engage those consumer experts. Today, Community Catalyst is supplying that blueprint, A Seat at the Table: Consumer Engagement Strategies Essential to the Success of State Dual Eligible Demonstration Projects, drawing on engagement that’s working elsewhere.
The blueprint starts with the federal requirement already in place that each state establish a plan for meaningful consumer input in the demonstrations. Then, it adds structures at the federal, state, delivery system and community levels to ensure consumers and their family members are at the decision-making tables, shaping the projects, and helping to fix flaws before they can undermine the whole enterprise.
Key elements of the blueprint:
- • Detailed state plan for consumer engagement in formal oversight, planning and monitoring of everything from enrollment practices to provider networks to quality improvement. This includes broad consumer membership on statewide oversight councils and workgroups, requirements for managed care companies (MCOs) and managed fee-for-service delivery systems to implement engagement strategies, and established timetables and mechanisms for collecting feedback from individual consumers
- • MCO and delivery system inclusion of consumers on their governing boards or establishment of consumer advisory committees
- • State measurement of the effectiveness of consumer engagement as part of quality assurance and adjustment of both the engagement plan and implementation as needed. Measures might include program changes resulting from consumer engagement, the number of consumers engaged at each stage and each level, and the degree to which those involved reflect the diversity of the demonstration population
- • Federal funds made available to states for consumer engagement activities
- • Training for consumers to help them be effective in these roles
- • Stipends for consumer time and travel to participate
- • All consumer engagement conducted in a manner fully accessible to those with disabilities, and linguistically and culturally competent
- • Consumer membership on oversight or advisory committees that reflects the diversity of participants in the demonstration projects
- • CMS oversight to ensure follow-through
More details and examples are included in the full blueprint. In addition, other resources on consumer engagement in delivery systems are available in a separate Community Catalyst report. To fully build this out will require federal and state policymakers, MCOs, delivery systems and consumers working together. Advocates can help by urging full adoption of the blueprint.
– Alice Dembner, Project Director
This week advocates in the South received yet another good reason to push for expanding Medicaid in their states. A new poll from the Joint Center for Political and Economic Studies found that residents in five of the most conservative states in the nation strongly support expanding Medicaid and implementing the core pieces of the Affordable Care Act. Residents in the deep Southern states of Alabama, Georgia, Louisiana, Mississippi, and South Carolina not only support expansion overall, but the support spans across racial lines. This evidence of strong support among the very people they serve should be a clarion call for Southern state lawmakers to expand Medicaid.
The Joint Center conducted a poll of 2,500 Southern residents between March and April of this year to examine how the public in conservative states view key parts of the Affordable Care Act generally and the Medicaid expansion specifically. Among the findings:
- • 62 percent support Medicaid expansion
- • 75 percent support the creation of health insurance Exchanges
- • Nearly 69 percent support financial help (premium subsidies) for low-income individuals
- • Expansion draws support across all ethnic groups
There are nearly 15 million uninsured people in the South – the highest number and proportion of any region of the country. Expanding state Medicaid programs will provide insurance coverage to 7 million people, greatly improving the health and productivity of Southern residents. This dramatic increase in health care coverage through Medicaid will also address health disparities in reducing death and disease among nonelderly adults, racial and ethnic minorities, and residents of low-income areas. With the federal government covering the full cost of expansion for the first three years, expanding Medicaid will also be a great economic benefit to states. This should be a no brainer for the South.
But even with these clear cut health and economic benefits, nine Southern governors stand in opposition to accepting federal funding for expansion – with only, Arkansas, Kentucky, and Florida in favor. And even in Southern states with a supportive governor, challenges remain, especially when it comes to persuading state legislators.
The voices of their constituents should serve as a powerful motivator for policymakers who say they are representing the will of the people. The case for expanding Medicaid is clear. And advocates in the South will add this strong evidence of support to their efforts to mobilize and engage key constituencies. State policymakers have a responsibility to not just speak into their own megaphones but to listen to the voices in the crowd. These poll findings clearly show that the will of the people is to expand Medicaid in states across the Deep South.
Ongoing debates during the 2013 legislative sessions showed signs that even within the most conservative states expanding Medicaid was not completely off the table. Statements from Governor Bentley (AL) that Medicaid will not be expanded “as it exists under the current structure,” suggest that expansion remains possible. In addition, a number of governors and legislators are considering alternative models such as Arkansas’ premium assistance model to expand Medicaid.
As these poll results show, and to borrow from Mark Twain, reports of the demise of Medicaid expansion in the South have been greatly exaggerated. For economic, political, and moral reasons, expanding Medicaid is a top priority for advocates in the Southern states. At Community Catalyst, we will continue to lift up and promote all the reasons why Southern states should move forward with expanding Medicaid and implementing the Affordable Care Act. Advocates will discuss their Medicaid expansion campaign strategies at the 6th Annual Southern Health Partners convening in Atlanta, Georgia this July. There is no doubt the findings of this report will be an integral part of the conversation.
– Dara Taylor, Project Director
Southern Health Partners
As patients and consumers, we face more and more choices about our health care each year.
We all support consumer empowerment in decisions about their care, but consumers don’t always have all the information they need to choose between different prescription drugs.
And the billions of dollars that the drug industry spends on advertising to patients and doctors is designed to make things worse. Industry advertises expensive new drugs, but not equally effective and lower-cost alternatives.
But trends are changing. State laws promoting the use of generic medications have saved consumers hundreds of billions of dollars. Employers are educating their employees to emphasize value — getting an equally effective drug that costs one-tenth as much as a brand-name option. For example, skipping the $200-a-month Nexium, and choosing Prilosec — made by the same manufacturer with the same active ingredient — for just $27.
Whether you or your organization’s members are uninsured, have high copays, or just want to be sure to get the best value for their health care dollar, these resources can help advocates, doctors, and patients make better choices for their health – and their wallets.The Truth About Generics – safe and affordable
Generics are as safe and effective as their brand-name counterparts, but can cost 90 percent less. Go here to see why generic drugs are an affordable option used by nearly all patients.New Generic Drugs Coming this year, and next!
Is your drug going generic soon? Dozens of expensive brand-name drugs like Cipro and Provigil have become generic, and their prices are dropping… Generic Plavix costs less than $15 even without insurance. See this year and next year’s newest generic drugs.Uninsured? Here are some ultra-low cost options
Go here to see why, and see how you can find hundreds of drugs for $4 or $5 — many of the same drugs that you may be taking now, available at a lower cost. And learn why drug costs can vary so much from pharmacy to pharmacy.If an expensive brand name drug is your only option, and you meet other insurance and income qualifications, a local hospital or community health center may be able to help you find low cost medicines. Find out more here. Is that drug coupon a good thing? Maybe not!
Did you find a coupon by a drug manufacturer online? You should think twice about using it to make Nexium or some other drug more affordable. Read this to see how these coupons can actually turn over your personal private health information to the drug company, and cost you more in the long run. If you have drug coverage through Medicare or Medicaid, using a manufacturer coupon is prohibited by federal law.Please help us share these resources!
These consumer resources were created through the generous support of the California HealthCare Foundation, and are intended to be shared freely with the public, including on other organization’s websites.
Please contact us at wwilkinson(at)communitycatalyst.org if we can help you share these resources with your members, assist you posting them on your website, or if you want to host a guest blog on ways to find affordable medications.
– Wells Wilkinson, Project Director
Prescription Access Litigation