Health Reform Around the Nation: December 17, 2007
The Maryland Court of Special Appeals last month ruled that some Medicaid eligibility standards used by the Department of Health and Mental Hygiene were stricter than federal laws allow, and advocates hope the broad standards outlined in the case will be applied universally, the Baltimore Sun reports.
The case involved a woman with Alzheimer's disease who was unable to receive assistance through the Older Adults Waiver Program, a Medicaid program designed to provide services such as nursing and adult day care. Maryland limits eligibility in the program to residents older than age 50 who have incomes less than $1,869 a month and require daily care from licensed health care professionals.
The patient in the case requires daily monitoring but does not require constant care from a physician or nurse, the Sun reports. Attorneys from the Legal Aid Bureau and AARP argued that state and federal laws limit eligibility to residents who regularly require "health-related care and services," such as those that could be provided in a nursing home, but not necessarily daily by a skilled nurse.
Legal Aid attorneys are working on several similar cases. According to the Sun, lawsuits were filed against at least two other states that tried to limit community- and home-based care services programs (Green, Baltimore Sun, 12/10).
A proposed state ballot measure that would extend government-sponsored health coverage to thousands of uninsured children will not include a mandate that could require some parents to purchase private health insurance, state Auditor and Insurance Commissioner John Morrison said, the Billings Gazette reports. Morrison submitted the ballot measure to state officials in October, and he and Gov. Brian Schweitzer (D) are discussing changes to the initiative.
According to the Gazette, the debate between Morrison's office and the Schweitzer administration mostly focuses on the proposal's cost. Morrison estimates the measure would cost about $20 million annually, while the Schweitzer administration estimates the cost at $30 million to $35 million.
Possible changes to the measure include:
- Increasing the income eligibility limit for Montana's version of the State Children's Health Insurance Program from 175% of the federal poverty level to 250% of the poverty level;
- Possible tax credits to help families with incomes between 225% and 300% of the poverty level add their children to private health plans that already cover the parents; and
- Expanding Medicaid eligibility for children (Dennison, Billings Gazette, 12/11).
New York made $5 million in Medicaid overpayments to 135 in-home health care, outpatient and laboratory service providers across the state, according to two audits released by New York State Comptroller Thomas DiNapoli, Long Island Newsday reports.
One of the audits, which spanned a five-year period through September 2006, showed that the state overpaid home health care providers $2.1 million for Medicaid claims of beneficiaries who were living in nursing homes.
The second audit, over a five-year period ending in February 2007, showed that the state overpaid $2.9 million in Medicaid to outpatient and laboratory service providers for services that should have been paid by the facilities that ordered.
The audits said the overpayments are due to ineffective practices of the state Office of the Medicaid Inspector General and home health care providers who either ignored or misinterpreted Medicaid billing rules. The audits also noted that the state does not have a proper Medicaid claims handling system to identify cases of overpayments.
DiNapoli said the state "should take the steps necessary to recoup these costs" (Dowdy, Long Island Newsday, 12/11).
The Pennsylvania Senate voted unanimously to approve an extension of a physician malpractice subsidy through 2008, the AP/Philadelphia Inquirer reports.
The chamber rejected a Democratic proposal to divert part of a surplus from the malpractice reserve to pay for adult health insurance. Gov. Ed Rendell (D) said he will not approve another year of malpractice subsidy funds unless some of the surplus pays for adult health insurance (AP/Philadelphia Inquirer, 12/12).
Rendell earlier this month announced a new funding plan for his Cover All Pennsylvanians initiative that would use half of the revenue from the reserve, which is projected to reach $414 million by Dec. 31.
The account, funded by the state's cigarette tax, was created to offset medical malpractice costs for physicians and hospitals in an effort to keep doctors and specialists in the state. According to Rendell, fewer malpractice lawsuits and lower malpractice insurance premiums have led to a surplus in the account that the state can afford to use (Barnes, Pittsburgh Post-Gazette, 12/9).
The subsidy expires on Dec. 31 (AP/Philadelphia Inquirer, 12/12).
Gov. Jon Huntsman (R) on Monday released a fiscal year 2008 state budget that would increase eligibility for Medicaid and the state's version of SCHIP, the Salt Lake Tribune reports (May, Salt Lake Tribune, 12/12). Huntsman said he is making health care his top priority, calling the current system "simply unsustainable."
The budget includes:
- $30 million to fund efforts to develop a master plan for health system changes;
- $18 million to increase Medicaid provider rates;
- $1.1 million to improve health cost tracking and treatment outcomes, as well as to create a network to help physicians share patients' prescription histories; and
- $5 million to add 30 medical student slots at the University of Utah Medical School (Thalman, Salt Lake City Deseret Morning News, 12/11).
Virginia Gov. Tim Kaine (D) on Wednesday announced a $25.4 million two-year plan that would expand subsidized health care for some uninsured women and small-business employees, the Washington Post reports. The plan is part of Kaine's FY 2008-10 budget proposal, which he will release on Monday.
The plan includes:
- $50,000 for a not-for-profit organization that offers dental care at no or reduced cost;
- $5 million each for three community-based health clinics that serve the uninsured;
- $7.7 million to launch the VirginiaShare program for workers with incomes less than 200% of the poverty level;
- $7.4 million over the two years to offer prenatal care to 400 uninsured pregnant women; and
- $300,000 to expand no-cost breast cancer screenings and cervical cancer tests for some uninsured women.
Kaine said his health plan would be financed in part by savings in other parts of the budget, driven by the softening economy, according to the Richmond Times-Dispatch (Schapiro, Richmond Times-Dispatch, 12/13). 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.