Clip files / Local news from the states
Clip files / Local news from the states
This column features selected short items about state health care policy digested from publications from around the country.
New York City discontinues policy of requiring two visits to apply for food stamps or Medicaid benefits
NEW YORK—City officials have ended their controversial policy of requiring residents to visit a public agency twice in order to apply for food stamps or Medicaid. The policy was an explicit attempt to discourage use of public services and to protect the city’s social welfare budget.
The change in policy was made public in late April. Rulings in January by United States Department of Agriculture and a federal judge said the policy violated federal law requiring food stamps applications to be processed without delay.
New York City implemented its two-day application process in April 1998, when it began converting welfare offices into "job centers" where caseworkers urge the poor to rely on relatives, food pantries, and jobs rather than on public assistance.
After hearing testimony in a lawsuit filed by advocates for the poor, Judge William H. Pauley III of Federal District Court in Manhattan barred the city, which had transformed more than a third of the nearly 30 welfare offices into job centers, from converting any more.
—New York Times, April 30
Virginia officials attack hepatitis C among prison population
RICHMOND, VA—Prison officials are dealing with a hepatitis C problem so overwhelming that it promises, in the words of one prison official, to make AIDS look like "a little baby."
Since June, the Department of Corrections has been treating some of the estimated 12,000 inmates infected with hepatitis C at a cost of about $12,000 for drugs alone. About one-tenth of the infected inmates are eligible for the treatment under the state’s screening process.
Virginia officials say they drew from inmate treatment protocols developed in Rhode Island and California in setting up their program.
Jean Auldridge, head of Virginia Citizens United for Rehabilitation of Errants, praised the state’s efforts to treat as many of its inmates infected with hepatitis C as possible.
"They’re coming out and they’re going to infect other people" unless they are treated before they are released, she said.
—Richmond Times-Dispatch, May 3
Anti-smoking advocates blast states’ plans for tobacco settlement
WASHINGTON, DC—About one-third of the states are likely to spend less than 2% of their tobacco settlement funds on tobacco prevention programs, according to the a report by the Campaign for Tobacco Free Kids and the American Heart Association (AHA).
"In too many cases, state legislatures are ignoring the recent evidence showing tobacco prevention programs—especially those aimed at youth—do work," said AHA chief executive officer Cass Wheeler.
Several states are proposing to reduce debt or taxes with the tobacco settlement, the organizations’ report noted. Michigan has proposed college scholarships and South Dakota wants to meet demands for prisoners’ health care.
The state of Washington—whose attorney general, Christine Gregoire, led the states’ negotiating team—was singled out for having the most significant tobacco control effort. The state has allocated to tobacco control $100 million of the first $323 million it is slated to receive from the settlement.
—Campaign for Tobacco-Free Kids/American Heart Association release, April 29
Case-mix reimbursement brings rising costs to Indiana nursing home budget
INDIANAPOLIS—State legislators and administrators are disappointed with the first-year results of Indiana’s case-mix reimbursement system for nursing home care—a 15% increase in costs that is claiming $78 million more than expected during the next two years.
"This is very distressing," said Rep. B. Patrick Bauer, D-South Bend.
The case-mix reimbursement, implemented in October, affects 500 nursing homes that care for about 27,000 Medicaid beneficiaries. Patients are classified in one of 44 categories based on the type of care they receive.
State Medicaid Director Kathy Gifford said she was "as surprised as anyone" by the rising costs. Representatives from the nursing home industry challenged the accuracy of the state’s figures.
—Indianapolis Star/News, April 14
States give mixed reviews to subsidizing employer coverage under CHIP
FRANKFORT, KY—The attempt to expand coverage for children by subsidizing their parents’ employer-based coverage is getting mixed reviews in Kentucky and New Jersey.
Frustrated with the sluggish pace of targeting employer coverage, Kentucky officials announced in April that they will use a second Medicaid expansion to broaden coverage under the state’s Children’s Health Insurance Program (CHIP). At the same time, New Jersey’s most recent increase in children’s coverage calls for employer-based coverage to reach as many as 61,000 children.
A second Kentucky Medicaid expansion with an income cap of 150% of the poverty level could reach 35,000 children. State officials said they would continue to develop the private insurance option for the 20,000 children originally targeted but not addressed in the Medicaid expansion.
The New Jersey employer-based CHIP strategy has two components. The first is designed to enroll 50,000 children in families with incomes between $22,100 and $33,400. The second, for families employed by small businesses, would impose a monthly premium co-pay for families with incomes between $25,050 and $58,450. As many as 11,000 children could be eligible under the second strategy, estimate state officials.
—AP/the Owensboro Messenger-Inquirer, April 24; Newark Star-Ledger, April 21
Dramatic increase in multiple births drives down birthweight in Massachusetts
ATLANTA—A sharp increase in multiple births, especially among women over 35 years of age, is largely responsible for the rising number of low-birthweight babies born in Massachusetts, reports the Centers for Disease Control and Prevention.
In 1996, more than one in 20 Massachusetts births (5.8%) to mothers 35 and older with four or more years of college were multiple births, which is more than twice the rate of multiple births to women under 35 years of age with a high school education or less (2.5%). The low-birthweight (less than 5.5 pounds) rate for singleton deliveries was 4.8%; 48.2% for twins; and 86.1% for triplets and quadruplets.
—Centers for Disease Control and Prevention release, April 16
State Medicaid programs bear high costs of Alzheimer’s disease
TORONTO —About 8.4% of Medicaid patients are diagnosed with Alzheimer’s disease and cost an average of $8,200 annually more than Medicaid patients without the condition, concludes a recent analysis of the Pennsylvania Medicaid program presented at the annual meeting of the American Academy of Neurology, held in April in Toronto.
Nursing home care accounted for 96% of the difference in the cost between patients with and without Alzheimer’s disease, said study author Joseph Menzin, PhD, president of outcomes research company Boston Health Economics. On average, Medicaid enrollees with Alzheimer’s spent 228 days annually in nursing home care, compared to 120 days for a similar population without Alzheimer’s or related dementias.
—American Academy of Neurology release, April 18
Medicaid pharmacy lock-in shown to reduce costs, improve care
MONROE, LA—In addition to improving continuity of care, directing a Medicaid enrollee to a single pharmacy is effective in decreasing polypharmacy, the use of Schedule II drugs, and pharmacy expenditures, a recent study of Louisiana’s lock-in program has found.
The effect of the lock-in varied according to demographic groups within the program and the specific mechanism restricting an enrollee to a single physician, pharmacy, or both. Louisiana Medicaid recipients almost always are free to select their lock-in physicians and pharmacies.
Initial results indicated that cost savings were realized in both the physician-pharmacy lock-in and the pharmacy-only lock-in programs. In most instances, Louisiana Medicaid uses the lock-in mechanism to restrict pharmacy use only.
—Drug Benefit Trends 1999; 11:45-55
HCFA mandates AIDS wasting drug for coverage under Medicaid
WASHINGTON, DC—Reversing a previous position, the Health Care Financing Administration (HCFA) has required states to make available Serostim, the first biotechnology drug approved for AIDS wasting, for coverage under Medicaid.
HCFA officials previously had accepted an argument by Texas officials that Serostim, a drug to help people with AIDS gain weight, primarily was used for cosmetic purposes and therefore could be excluded from coverage.
—National Association of People with AIDS release, April 5
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