Health Reform Around the Nation: November 19, 2007
Connecticut Attorney General Richard Blumenthal (D) on Wednesday called for sanctions against Health Net of Connecticut for sending fraudulent computer messages to pharmacies to deny coverage of certain prescription drugs for children enrolled in Medicaid, the Hartford Courant reports.
Health Net, one of four managed care organizations in the state that contracts with Medicaid, uses a "not covered" computer message that falsely leads some pharmacists to believe that certain medications are not covered, when instead, they require prior authorization.
The state Department of Social Services earlier this year conducted an investigation into the computer message practices of the managed care organizations, during which Health Net misled the state into thinking its primary message was not a "not covered" message, according to Randi Mezzy, an attorney with Connecticut Legal Services.
Alice Ferreira, spokesperson for Health Net, said that the company did not intentionally mislead the state with its "not covered" message and said Health Net will correct the problem immediately (Somma, Hartford Courant, 11/15).
New rules took effect in Florida on Nov. 1 that limit the equity interest seniors can have on their homes to qualify for Medicaid coverage of nursing home care, the South Florida Sun-Sentinel reports.
The new rules require that applicants have home equity interest no greater than $500,000, rather than the $750,000 maximum allowed under the federal Deficit Reduction Act of 2005.
Calculations will be based on local fair market rates and will be applied only to unmarried applicants who do not have children younger than age 21 or children of any age who have disabilities and reside in an applicant's home, the Sun-Sentinel reports.
A provision that extends from three to five years the length of time that seniors cannot make significant monetary contributions, such as paying college tuition for an adult child or placing a down payment on a home years ahead of the application for senior home care, will be phased in starting in 2010 (Lade, South Florida Sun-Sentinel, 11/12).
An Illinois legislative rules-making committee on Tuesday voted 9-2 to reject an order issued last week by Illinois Gov. Rod Blagojevich (D) that would have allowed 147,000 parents and caretakers to purchase discounted health insurance through the state's FamilyCare program, the Chicago Tribune reports (Meitrodt/Mendell, Chicago Tribune, 11/13).
The expansion is part of a larger proposal by Blagojevich that was estimated to cost $2.1 billion annually and would have provided coverage for more than 1.4 million residents. The proposal stalled in the state Senate last spring.
Abby Ottenhoff, spokesperson for Blagojevich, said the expansion would cost about $225 million annually, but the administration did not identify a funding source for the expansion.
Under the order, a family of four with an annual income up to 400% of the federal poverty level would have qualified for FamilyCare. Families would have paid at least $360 per month for coverage of physician visits, hospital services, prescription drugs, medical equipment and some dental care.
The Blagojevich administration has requested a permanent rule change for the rejected expansion, and the governor has said he would expand two other state-sponsored insurance programs. Those plans also would require approval from the committee (Meitrodt/Mendell, Chicago Tribune, 11/13).
In other Illinois news, Cook County Judge Diane Larsen declared unconstitutional a 2005 state law that caps noneconomic damages in malpractice lawsuits at $500,000 in cases against physicians and $1 million in cases against hospitals, the Tribune reports.
Larsen ruled that the caps violate a clause in the state constitution that separates the powers of state Legislature and judiciary. The case likely will move to the Illinois Supreme Court, which twice in the past 30 years has stuck down state laws that sought to cap damages in negligence lawsuits (Sachdev, Chicago Tribune, 11/13).
Louisiana is seeking about $2.5 million in federal State Children's Health Insurance Program reimbursements for prenatal care provided to pregnant women who are not U.S. citizens, the Baton Rouge Advocate reports.
The state expanded LaCHIP, its version of SCHIP, earlier this year, and since July, it has provided prenatal care to about 1,061 noncitizens. The expansion cost $3.17 million during the first three months.
According to CMS spokesperson Mary Kahn, undocumented immigrants are ineligible for government-funded health programs or services, including SCHIP, except in emergency situations. Noncitizens who have green cards can become eligible for coverage only after they have been in the country for five years, Kahn said. Kahn said that Louisiana's spending on care for pregnant noncitizens is "not reimbursable" and that labor and delivery is the "only coverage" available for noncitizen pregnant women.
LaCHIP Administrator Ruth Kennedy said the state contends the cost of care should be reimbursed by the federal government because LaCHIP provides coverage for the unborn child, not the mother. Kennedy noted a 2002 change in SCHIP rules that allows states to cover children "from conception to birth and up to age 19" regardless of the pregnant woman's immigration status (Shuler, Baton Rouge Advocate, 11/14).
The Maryland Senate on Friday voted 30-17 to approve legislation that would expand Medicaid eligibility for adults and extend health insurance premium subsidies to small businesses and their employees, the Baltimore Sun reports. The vote comes just months after state lawmakers rejected a similar measure.
The legislation would increase the Medicaid income eligibility threshold for adults from about 40% of the poverty level to 116%. The change eventually would allow an estimated 20,000 uninsured parents to qualify for the program and would draw more children into the program.
The bill also would allow childless adults to receive some health care services under another state program until they receive full Medicaid benefits. More than 50,000 childless adults eventually could be added to the program, the Sun reports.
In addition, the measure would provide subsidies of up to $1,000 per year to small businesses that do not offer workers health benefits, as well as $1,000 per year to each employee who enrolls in an employer-sponsored plan. Small businesses would have to implement employee wellness programs to receive the funds.
When fully implemented, the plan would extend insurance to about 100,000 state residents and cost more than $600 million annually, including federal matching funds and $250 million in additional state revenue. Some of the provisions may be canceled if funding is unavailable, according to the Sun (Smitherman, Baltimore Sun, 11/10).
Fifty-five percent of Massachusetts employers believe a provision of the state's health insurance law requiring businesses with 11 or more workers to offer health insurance or pay a penalty should be expanded to all companies, according to a poll published on Wednesday in the journal Health Affairs, the Boston Globe reports.
Under the law, businesses with 11 or more full-time workers are required to pay an annual fee of up to $295 per employee if they do not offer to pay at least 33% of individual employees' health insurance premiums.
The poll surveyed 1,056 randomly selected Massachusetts firms between February and June and compared the data to a nationwide survey conducted by another organization when appropriate.
According to the poll, support for expanding the requirement was greater among companies with three to 10 employees that are not affected by the current law than among employers with more than 1,000 workers, the Globe reports. However, a majority of small businesses that do not offer health insurance did not want to be subject to the requirement (Dembner, Boston Globe, 11/14).
Complete results of the poll are available online.
New Jersey should create a public-private health insurance system to ensure all state residents have access to affordable health care, state lawmakers and health care experts said at a conference on Tuesday, the Bergen Record reports.
More than 200 health care providers and advocates attended the conference -- including representatives from California, Massachusetts, Maine and Wisconsin, who outlined health care reforms implemented in their states.
State Sen. Joseph Vitale (D-N.J.) said state lawmakers are researching ways to provide appropriate care to undocumented immigrants and uninsured residents, as well as how to keep them from using emergency departments for nonemergency health care (Groves, Bergen Record, 11/14).