Health Care Reform News Around the Nation for the Week of Dec. 22
Unemployed Florida residents will be able to enroll in Cover Florida without having been uninsured for six months, as the program requires of some other beneficiaries, Florida Health News reports.
The requirement that residents be uninsured for six months to qualify for the program was intended to prevent employers and individuals from dropping their health coverage to join the state-sponsored program.
Cover Florida will offer 25 privately operated plans managed by six insurers that lack some elements required under state law so that they can be sold at more affordable prices.
The state last week signed contracts with the insurers, and residents can begin enrolling in the program on Jan. 5, 2009.
However, those who have recently lost their jobs and already signed up for COBRA insurance will not be eligible for Cover Florida.
The exemption from the six-months-of-uninsurance requirement applies to people who have:
- Recently lost their jobs;
- Lost, either through death or divorce, a spouse through whom they had employer-sponsored coverage; and
- Exhausted the coverage they held through COBRA (Gentry/Jordan Sexton, Florida Health News, 12/12).
Kentucky Gov. Steve Beshear (D) has proposed a budget plan that includes 4% spending cuts for public health agencies but that would avoid cutting Medicaid funding as long as a 70-cent-per-pack cigarette tax increase is approved, the Louisville Courier-Journal reports.
The cuts would affect agencies that provide prenatal care, childhood immunizations, health education and smoking-cessation programs.
Beshear said that the Medicaid program must be protected from cuts because enrollment is increasing at a rate of 3,000 beneficiaries per month and that the program already faces an estimated budget shortfall of $183 million in the current fiscal year.
Beshear added that he hopes the federal government will approve a temporary increase in funding for state Medicaid programs (Yetter, Louisville Courier-Journal, 12/12).
Last week, the Louisiana Joint Health and Welfare Committee unanimously approved a plan that would allow the administration of Gov. Bobby Jindal (R) to apply for a federal waiver to overhaul the state's Medicaid program, the New Orleans Times-Picayune reports (Moller, New Orleans Times-Picayune, 12/19).
Under the "Louisiana Health First Plan," managed care pilot programs would be established in New Orleans, Baton Rouge, Lake Charles and Shreveport. Medicaid beneficiaries would work with state-approved counselors to choose between two or more private health plans.
Insurers would be paid a flat monthly fee per beneficiary, which would vary depending on the beneficiary's health.
Plans then would negotiate fees with doctors, hospitals and other providers in the network and collaborate to provide coordinated care. Eventually the plan would expand coverage to 106,000 uninsured state residents.
The plan would be funded by asking the federal government to excuse debt owed by the state for past overspending and by redirecting money that now goes to LSU Charity Hospital System for treating uninsured patients (California Healthline, 12/8).
On Dec. 19, the Joint Legislative Committee on the Budget was scheduled to vote on whether to apply for the waiver. If approved, the waiver application will be submitted to CMS.
According to the Times-Picayune, CMS typically takes six months or more to decide on Medicaid waivers, but the agency could take longer because of the administration change over (New Orleans Times-Picayune, 12/19).
In state budget news, Louisiana Department of Health and Hospitals Secretary Alan Levine on Monday said the agency is preparing for funding cuts of between $125 million and $178 million as the state seeks to fill a $341 million budget shortfall for FY 2009, the Baton Rouge Advocate reports.
He said, "The lion's share of (the cuts) is going to come out of the state's $7 billion-plus Medicaid program."
The funding cuts could result in Medicaid losing more than $500 million when federal matching funds are counted (Shuler, Baton Rouge Advocate, 12/16).
Last week, the New Jersey Senate approved legislation that would require physicians at outpatient surgery centers to inform patients about how their services will be billed and whether the doctors have any financial interests in a referral to such centers, the Bergen Record reports.
Under the bill, physicians would be required to notify patients in writing if they have any financial interest in a referred surgery center and whether the care would be billed as out-of-network services.
The bill includes exemptions for new surgery centers that are jointly owned by hospitals and physicians and protects centers for past violations of self-referrals. The Assembly is expected to vote on the measure in January (Layton, Bergen Record, 12/15).
Last week, Gov. David Paterson (D) proposed a plan to close the state's $15 billion budget shortfall for the current and following fiscal year through $4 billion in taxes and fees and $9 billion in cuts, mostly aimed at education and Medicaid, the New York Times reports.
Under the plan, higher taxes would be imposed on health insurers (Hakim/Peters, New York Times, 12/15).
Medicaid payments would be delayed as part of a plan to generate $1.1 billion in one-time revenue (Quint, Bloomberg, 12/16).
Health care officials said the cuts to public health programs will impose restrictions on health care services for low-income state residents.
The plan also calls for reducing inpatient detoxification payments by $96.9 million statewide; increasing an annual fee on tobacco retailers that would generate $18.5 million; shifting reimbursements from acute care to primary care or preventive care; and phasing out 6,000 nursing home beds and replacing them with "community alternatives" over five years to save $8.7 million (Ochs, Long Island Newsday, 12/17).
Paterson also has proposed expanding the state-sponsored Family Health Plus insurance program to more state residents and eliminating certain eligibility requirements for Medicaid, such as fingerprinting and in-person interviews. Paterson is relying on federal funding to help expand the program.
He also proposed diverting $282 million from graduate medical education programs to fund care of the uninsured at teaching hospitals, and increasing funding for veterans' programs, no-cost cancer screenings and obesity prevention (Madore/Amon, Long Island Newsday, 12/15).
During the final meeting of the Legislature's Health System Reform Task Force last week, Utah lawmakers unveiled a plan to overhaul the state's health insurance market, the Salt Lake Tribune reports.
The proposal, the first part of a 10-year health reform plan, would expand the range of health plans in the state by allowing HMOs and PPOs to more easily offer lower-cost coverage that is exempt from some state-mandated benefits.
Plans that are exempt from state-mandated benefits would have to be offered through an Internet portal that allows state residents to compare insurers' rates, coverage and histories of honoring claims.
The plans also would require contributions from employers. Small businesses would be allowed to make contributions to employees' health savings accounts instead of offering benefits.
Employees could not be denied coverage based on pre-existing health conditions, and insurers would be protected from an increase in costly claims through assistance from the Utah Health Re-Insurance Pool, a not-for-profit organization that would be created within the state's Department of Insurance.
In addition, insurers would be required to offer a new basic benefit package that is designed to provide coverage to workers between jobs and would be less costly than COBRA insurance.
The proposal also would change the definition of a "small group" from a minimum of two employees to one, which would allow individuals to have access to "guaranteed issue" plans (Rosetta, Salt Lake Tribune, 12/16).
Last week, Gov. Tim Kaine (D) unveiled a revised plan to address a projected $2.9 billion shortfall in the state's two-year budget that includes doubling the state's 30-cent-per-pack cigarette tax and freezing Medicaid enrollment, the Virginian-Pilot reports.
The current budget period ends July 2010 (Fiske/Walker, Virginian-Pilot, 12/17).
Under Kaine's plan, about $418 million would be saved by freezing Medicaid enrollment, limiting qualifications for certain services under Medicaid or reducing the program's reimbursement payments to providers (Nolan/Whitley, Richmond Times-Dispatch, 12/18).
The plan also would close the last state-operated mental health hospital for children in Virginia, as well as a facility for adults, thereby reducing the number of institutionalized state residents by a third.
In addition, Kaine proposed that more resources be diverted to community-based mental health programs (Craig/Kumer, Washington Post, 12/17).
Kaine said the cigarette tax increase could generate an additional $148 million for the state Medicaid program, but Republican lawmakers oppose the tax hike, saying it could hurt employment in the state (Emerling, Washington Times, 12/18).
Gov. Chris Gregoire (D) released a budget proposal last week that would suspend plans approved in 2007 to expand SCHIP to cover children in families with incomes up to 300% of the federal poverty level by 2010, the AP/Seattle Post-Intelligencer reports.
The expansion was passed by the Legislature on the condition that funding would be available upon implementation (Woodward, AP/Seattle Post-Intelligencer, 12/17).
A public interest law firm based in Charleston, W.Va., is planning to file a lawsuit against the state's Medicaid office, alleging it has violated federal law by reducing benefits for children whose parents do not sign a "personal responsibility" statement that allows them to receive enhanced benefits, the Charleston Gazette reports.
Under the revamped program, known as Mountain Health Choices, children enrolled in Medicaid can receive expanded benefits as long as their parents sign the pledge stating they will make efforts to improve their children's health.
The enhanced plan is intended to encourage beneficiaries to see a physician regularly, keep appointments and avoid using emergency departments in exchange for better Medicaid benefits.
Children whose parents fail to sign this pledge are automatically enrolled in a "basic" plan that provides fewer benefits than traditional Medicaid.Ninety percent of West Virginia children enrolled in Medicaid have had their benefits reduced because their parents have not signed the pledge (Eyre, Charleston Gazette, 12/16). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.