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.
State AIDS drug assistance programs growing in clients and costs
WASHINGTON, DC—Despite increases in the national budget for AIDS Drug Assistance Programs (ADAPs) and improved program administration, ADAPs continue to face the challenge of meeting the needs of an increasing client base and high drug costs in an area of rapidly changing treatment standards.
A survey of the nation’s ADAPs also found significant variation in these programs across states, and that access to ADAPs is highly dependent upon where one lives. The survey, the fourth in a series, was conducted for the Kaiser Family Foundation in Menlo Park, CA, by the National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network.
"In most states, ADAP programs have been able to fill the gaps in access to prescription drugs for the nation’s low-income HIV-infected population. Federal contributions to ADAPs have been growing, but as treatment standards continue to call for newer, more expensive drugs in combination, these programs will continue to be challenged to meet the needs of their clients," said Drew Altman, president of the Kaiser Family Foundation.
Expenditures for antiretroviral drugs have been the main driver of overall expenditure increases, representing almost 90% of all expenditures in June 1999 and increasing 25% since June 1998. Notably, expenditures for drugs for the treatment and prevention of opportunistic infections and for other non-antiretroviral drugs also increased by 21% in this same period.
Findings from the report show that ADAPs continue to serve clients who are largely low-income and uninsured and represent a mix of racial and ethnic population groups. Specifically, the report found:
• 80% of ADAP clients served in June 1999 had incomes at or below 200% of poverty, and almost half had incomes below the poverty level.
• Only 7% of clients in June 1999 were reported also to be Medicaid beneficiaries, and only 7% were reported to have private health insurance that included some level of prescription drug coverage.
• 40% of ADAP clients in June 1999 were white, almost one-third were African American (31%), and one-quarter were Hispanic (25%).
• Uninsured and underinsured people living with HIV face significant variation in access to ADAP. For example, financial eligibility to ADAPs ranges from a low of 125% of the federal poverty level in Georgia and North Carolina, to a high of more than 500% in New York (in 1999, the Federal Poverty Level was $8,240 for an individual).
—Henry J. Kaiser Family Foundation release
Feds claim Medicaid payments for schools being wasted by states, consulting firms
WASHINGTON, DC—Medicaid payments meant for schools that provide counseling, hearing tests, and other health care for poor children are being siphoned off by states and consultants, leaving some schools with a small fraction of their share, congressional auditors say.
The General Accounting Office (GAO) said it found schools in one state ended up with less than a dime for every dollar spent on health care services for poor students.
About 13 million school-age children are eligible for Medicaid, the federal health program for low-income Americans that is funded with state and federal money.
Schools are entitled to federal reimbursements to recover their costs of providing health care for these children. Expenses incurred with enrolling kids in the program and arranging their appointments are also reimbursable. States spent $2.3 billion for school-based health care in the latest years for which data were available, 1998 and 1999, the GAO said in a report released April 5 at a Senate Finance Committee hearing.
Under the advice of private billing companies, schools charged Medicaid for groups of services, not all of which actually were provided to students, auditors said.
The GAO said the arrangements with consultants, made by both states and school districts, are creating "an environment for opportunism that drains funds away from their intended purposes."
Auditors found $28 million in improper payments in Michigan and questioned an additional $33 million in reimbursements. Federal officials acknowledged that there have been problems with the Medicaid reimbursements and said new policies have been initiated to correct them.
—Los Angeles Times, April 5
CDC reports U.S. birth rate increasing for first time since 1998
WASHINGTON, DC —The number of births in the United States rose in 1998 for the first time since 1990, according to a report released in late March.
"Births: Final for 1998," prepared by the Centers for Disease Control and Prevention’s National Center for Health Statistics, shows that 3,941,553 babies were born in 1998, a 2% increase from 1997.
The birth rate (the number of births per 1,000 population) and the fertility rate (the number of births per 1,000 women ages 15 to 44) also increased slightly in 1998. The increase in the number of births was fueled by increases in birth rates for women in their 20s, the principal childbearing ages, and for women in their 30s. According to the report, the birth rate for women in their early 20s (20 to 24) increased in 1998 after falling 6% during the 1990s, and birth rates for women in their 30s are now at their highest levels in at least three decades.
Meanwhile, the overall birth rate for teens ages 15 to 19 dropped 2% in 1998, to 51.5 per 1,000. Overall, the teen birth rate declined by 18% from 1991 to 1998, with all states recording a decline in the birth rate of 15- to 19-year-olds between 1991 and 1998.
Twin births also continued to increase in 1998, rising 6% to 110,670 — the largest single year increase in several decades — and the number of triplets and other higher order multiple births climbed 13% to 7,625. Since 1980, the twin birth rate has risen 49%, and the triplet and other higher order multiple birth rate has risen 423%.
Driven by the growing number of unmarried women of childbearing age (15 to 44 years), the number of births to unmarried women also rose to 1,293,567 in 1998. The percent of all births to unmarried women also increased from 32.4% in 1997 to 32.8% in 1998, while the birth rate for unmarried women increased slightly to 44.3 births per 1,000 unmarried women ages 15 to 44 in 1998. However, the teen out-of-wedlock birth rate dropped again in 1998, to 41.5 births per 1,000 unmarried teens ages 15 to 19, down 11% from its high in 1994.
—"Births: Final Data for 1998," CDC’s National Center for Health Statistics
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