Health Care Reform News Around the Nation for the Week of Sept. 29
Seven hospitals and 4,029 primary care physicians have signed up to participate in Connecticut's Charter Oak Health Plan, state officials said at a briefing on Friday, the Hartford Courant reports.
Gov. Jodi Rell (R) hopes the program eventually will enroll about 19,000 state residents who cannot afford insurance but who have annual incomes that make them ineligible for HUSKY, the state's Medicaid program. The state began marketing the plan on Aug. 1.
Only one of the three networks contracted to operate Charter Oak plans had a pre-existing network of physicians and hospitals, the Courant reports. In addition, many doctors are "balking at joining" the networks because of low reimbursement fees, according to the Courant.
The low reimbursements are required to meet Rell's goal of keeping premiums at $250.
Charter Oak also caps benefits at $100,000 annually (Pazniokas, Hartford Courant, 9/20).
Critics also warn that with deductibles as high as $900, the program will not be able to attract the young, healthy members needed to stabilize costs (AP/Hartford Courant, 9/22).
The program has enrolled 843 beneficiaries, and nearly 10,000 people have applied.
Some lawmakers have expressed concern that trying to transfer too many state residents to the program before adequate provider networks are available could limit access to care for beneficiaries (Hartford Courant, 9/20).
Nearly 8,500 Florida Medicaid beneficiaries living in nursing homes have filed a federal class-action lawsuit claiming they are being forced to obtain care in nursing homes rather than in the community, the AP/Miami Herald reports.
Advocates say that nursing homes have sought to increase business by pressuring lawmakers to increase requirements for people seeking coverage of home-based care, according to the AP/Herald. The suit alleges that plaintiffs have been illegally forced to move into nursing homes when they should be able to live where they choose and receive community care.
Advocates for the elderly point to a 1999 U.S. Supreme Court case known as the Olmstead case, in which the court ruled that the unjustified placement of individuals in institutions such as nursing homes amounted to discrimination. The decision stated that states must provide community care if it can be accommodated and would be appropriate.
The defendants named in the suit -- the Florida Agency for Health Care Administration, the Florida Department of Elder Affairs and Gov. Charlie Crist's (R) Office -- say the plaintiffs have not been able to prove that health care providers deemed community care appropriate for each patient (Sedensky, AP/Miami Herald, 9/21).
The Illinois Legislature this week voted unanimously to override Gov. Rod Blagojevich's (D) revisions of a bill to give uninsured Illinois residents a discount on hospital care, the Chicago Tribune's "Triage" reports. The state Senate voted 55-0 on Monday and the state House voted 97-0 on Tuesday to authorize the bill, which now has become law (Graham, "Triage," Chicago Tribune, 9/25).
Illinois hospitals had agreed to limit the amount they charged most uninsured patients to the actual cost plus 35%.
However, Blagojevich's amendatory veto reduced that markup from 35% to 20% and specified that patients with incomes less than twice the poverty level and a family of four with an income of $42,400 or less would not pay any markup.
In addition, the revision raised the qualification for hospital discounts for urban families from 600% of the federal poverty level to 800% and for rural families from 300% to 600% (California Healthline, 9/22).
Under the new law, the cap has been set at 25% of a patient's gross income.
State hospitals have 180 days to comply with the law ("Triage," Chicago Tribune, 9/25).
The state Family and Social Services Administration has proposed a new rule that would restrict Medicaid coverage of nursing home care for people who shift their assets to meet income eligibility thresholds, the Indianapolis Star reports.
FSSA officials said the new rule was proposed to stop fraudulent use of Medicaid funds. Under the proposed rule, residents who contribute the money to a charity or use it as payment to a non-contracted individual, like a family member, for providing care will not be eligible for Medicaid.
Jeff Wells, director of the Indiana Medicaid program, said the changes are needed to meet the requirements of the federal Deficit Reduction Act of 2005, and the proposed rule prevents residents from "gaming" the system by improperly transferring or storing their savings and assets so that they qualify for Medicaid payments.
The rules would apply to some asset transfers made as many as five years ago (Evans, Indianapolis Star, 9/24).
Gov. Martin O'Malley (D) and state Comptroller Peter Franchot on Tuesday mailed 10,000 letters to Maryland families eligible for Medicaid coverage under a program expansion that took effect in July, the Baltimore Sun reports.
The expansion raised the annual income eligibility threshold for parents in the program from 40% of the federal poverty level to 116% of the poverty level.
State Health Secretary John Colmers said Maryland can fund the expanded program for two years without using money from the state's general fund, but future funding will depend on the outcome of a slot machine gambling referendum on the November ballot (Dechter, Baltimore Sun, 9/24).
The average wait time for an appointment with a primary care physician in Massachusetts this year increased to 36 days from 34 days in 2007, according to an annual study by the Massachusetts Medical Society, the AP/Boston Herald reports (AP/Boston Herald, 9/22).
The survey found that among 100 internists in the state, the average wait time for a new patient was 50 days with the longest wait being 100 days, compared with 2004 when the average wait was 47 days and the longest wait was 87 days. The survey also found longer wait times for appointments with ob-gyn's and family practitioners.
State Senate President Therese Murray (D) said that many of the estimated 439,000 residents who obtained coverage under the Massachusetts health insurance law are having a difficult time finding physicians.
The medical society found that 42% of primary care physicians have stopped accepting new patients, compared with 33% in 2004.
In an effort to address the doctor shortage, state lawmakers in July approved a package of incentives to attract primary care physicians, the Boston Globe reports. The law provides $1.5 million for the University of Massachusetts Medical School to increase its class size from 103 students to 125 and to waive tuition and fees for those who agree to work as primary care physicians in the state for four years after they graduate.
In addition, this year the state is spending $1.7 million to help doctors who work in community health centers pay off their student loans, and at least $500,000 to pay off debt for primary care physicians who work for two years in underserved areas. The law also calls on state lawmakers to create a housing grant or loan program to help doctors buy houses in the state (Kowalczyk, Boston Globe, 9/22).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.