Medicaid and Access to the Courts | Health Policy and Reform

Image via Wikipedia
by Sara Rosenbaum, J.D. in New England Journal of Medicine

The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California’s appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court’s ruling could fundamentally alter states’ accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid’s essential federal requirements.

The Maxwell-Jolly case was precipitated by a series of deep cuts to provider payments that were enacted by the California legislature and aimed at services used predominantly by the state’s most severely disabled beneficiaries. The payment reductions were halted by the U.S. Court of Appeals for the Ninth Circuit, but this action by no means ended the dispute. Indeed, the question before the Supreme Court is of far greater consequence than that of specific provider payments: it is whether beneficiaries and providers have the right to seek judicial redress when they allege that state conduct abridges federal law and threatens health and safety.
More

HHS Announces Availability of Health Center New Access Point Grants

Image via Wikipedia

U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced today the availability of up to $250 million in grants for New Access Points for the delivery of primary health care services for underserved and vulnerable populations under the Health Center Program.  The funds, made available by the Affordable Care Act, will be awarded by the Health Resources and Services Administration (HRSA).

 

A new access point is a new full-time service delivery site that provides comprehensive primary and preventive health care services.  New access points improve the health status and decrease health disparities of the medically underserved populations to be served. 

 

“These funds reflect the Administration’s steadfast commitment to improving and expanding access to vital primary health care services,” said Secretary Sebelius. “From our cities to our smallest towns, each health center has an important role to play, ensuring access to services in its community. Together they have a critical impact on the health care status of those most in need across the nation.”

 

“New access points will address the unique and significant barriers that stand in the way of affordable and accessible primary health care services.” said HRSA Administrator Mary Wakefield, Ph.D. R.N. “Competitive applications will demonstrate a high level of need in the community, present a sound proposal to meet this need, and show that the organization is ready to quickly put their proposal to work.”

Organizations eligible to compete include public or nonprofit private entities, including tribal, faith-based and community-based organizations who meet health center funding requirements.  Current HRSA grantees may apply, as well as organizations applying for the first time.

 

For more information about National Community Health Center Week, visit http://www.hhs.gov/news/press/2010pres/chc.html, or visit www.grants.gov to find out how to apply. 

The Virginia Gazette - News - Medicare advice: Don’t switch docs

Image via Wikipedia

By Amanda Kerr

excerpts:
Fears at the time were that continuing reductions in Medicare reimbursements would lead physicians to drop Medicare patients, which would be a very big deal in a retirement community like greater Williamsburg. That problem still exists (see “Durable Threat” box).

Peng said that so far denial of services has not become a reality.

..................

A second hospital will likely come at just the right time as the senior population continues to grow. But Medicare access is by no means guaranteed, given what’s going in Washington.

“As we look at issues of health reform and the potential for declining reimbursements, many physicians in the community are concerned,” Peng said. “At this point, that discussion remains hypothetical.”

Peng said it’s too soon to tell what may happen or how doctors will address further cuts to Medicare under health reform.

One local medical practice last year sent letters to patients warning that Medicare cuts would force its doctors to limit the number of Medicare patients. The letter urged patients to contact their congressman to support changing the funding formula and raise the reimbursements.

Jumping from doctor to doctor could lead to a bad outcome of musical chairs.

Read More

Medicaid, CHIP payments to be reviewed by new federal commission :: Jan. 25, 2010 ... American Medical News

By Doug Trapp, amednews staff

A newly appointed commission will examine how Medicaid physician pay affects access to care by Medicaid patients and those in the Children's Health Insurance Program, among other issues.

The Medicaid and CHIP Payment and Access Commission, or MACPAC, will be chaired by Diane Rowland, ScD, executive director of the Kaiser Commission on Medicaid and the Uninsured. The U.S. comptroller general appointed the panel's 17 members Dec. 23, 2009.

MACPAC was created by a provision of the Children's Health Insurance Program Reauthorization Act, signed by President Obama in February 2009. The act instructs the panel to examine the effect of Medicaid pay and other factors on the access and quality of care received by Medicaid and CHIP enrollees.

Continue Reading

AARP and MOAA Join AMA 'House Call' to Alert Seniors, Boomers and Military of Impending Medicare Crisis - Yahoo! News

Image via Wikipedia

Focusing on looming Medicare physician cuts of 21 percent that begin on March 1, the American Medical Association (AMA), AARP and the Military Officers Association of America (MOAA) joined together today in an unprecedented multi-state event. With advocates in Washington, D.C., Madison, WI, Norfolk, VA, Bismarck, ND and Portland, ME, the three groups urged the Senate to permanently fix the Medicare physician payment problem before seniors, military families and baby boomers face a limited choice of physicians and limited access to care.

Continue Reading

Medicare Update: AMA Identifies Access Hot Spots for Physician Care

Image via Wikipedia

The American Medical Association (AMA) recently identified at least 20 states (and the District of Columbia) as "access hot spots" in which Medicare beneficiaries may be facing problems getting physician care.

The AMA believes that the access problems in those states will get worse unless Congress eliminates the scheduled 21.5 percent Medicare payment rate reduction for physician services in 2010 and repeals the current Medicare physician payment formula.

The states identified as "access hot spots" include Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Mississippi, Montana, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, Tennessee, Texas, West Virginia and Wyoming.

For more information (including state specific information), visit the "Access Hot Spots" list and links.
Continue Reading

H.R. 3896: To amend title XVIII of the Social Security Act to improve access to health care for individuals... (GovTrack.us)

Image via Wikipedia

To amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas, and for other purposes.

Sponsor: Rep. Jo Ann Emerson [R-MO8]
Cosponsors:

Full Text

Status:
Introduced Oct 21, 2009
Referred to Committee on Ways & Means

Updated Information

amednews: Ability to find, afford care is deteriorating in many states :: Oct. 19, 2009 ... American Medical News

A national scorecard again ranked Vermont's health system No. 1 and Mississippi's last, but all states have room to improve.
Continue Reading

Airlines Exclude People with Disabilities from Obtaining Information and Entertainment Services | Even Grounds

Image via Wikipedia

On international flights, it is common practice to have flight attendants who speak several languages to accommodate people who do not speak the local language. But who accommodates people with disabilities who need to have the same information?

Read More

Accessible Experts: Dennis Lembree Talks About Accessible Twitter | Even Grounds

Image via Wikipedia

Most of us have done something wrong, even if we knew it, because everyone else was doing it. And it didn't matter if it was wrong or not because it was generally accepted. And sometimes the "right" way was either unproven, unknown or just "no fun". And we didn't care. Like smoking in the mid twentieth century—the public thought it was the right thing to do; it was accepted and very popular. And some even said smoking was good for you! But of course now we know smoking is very bad for your health.

Let's take another example. Centuries ago, it was believed that the earth existed at the center of the universe. This was a widely known "fact"; everyone lived by this rule. And now we know this, of course, not to be true.

Today's Web is Wrong

Read More

H. Res. 621: Ensuring access to affordable and quality health care without increasing the Federal budget or... (GovTrack.us)

Sponsor: Rep. Cathy McMorris Rodgers [R-WA5](no cosponsors) Status: Introduced Jul 9, 2009 Referred to House Judiciary Committee H. Res. 621: Ensuring access to affordable and quality health care without increasing the Federal budget or... (GovTrack.us) Shared via AddThis

Health Insurers Offer to Accept All Applicants, on Condition

By ROBERT PEAR-New York Times -Published: November 20, 2008

The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.

The proposals, put forward by the insurers’ two main trade associations, have the potential to reshape and advance the debate over universal health insurance just as President-elect Barack Obama prepares to take office.

Payment Hassles, Not Just Stinginess, Turn Doctors Off Medicaid

Posted by Vanessa Fuhrmans  in Wall Street Journal Health blog

As Democrats in Congress consider covering more of the uninsured kids by expanding Medicaid, they may want to consider this: Fewer doctors are accepting Medicaid patients not just because fees are so low, but because it often takes months to get paid.

Studies show only half of U.S. doctors don’t restrict or cap the number of Medicaid patients they see, while more than 70% of doctors accept all new Medicare or privately insured patients. Medicaid payments are so skimpy payments in many states that doctors say they’d go bust if Medicaid patients make up more than 20% to 25% of their practices. Some reform efforts, such as Gov. Arnold Schwarzenegger’s ambitious but failed attempt to achieve universal coverage in California last year, have acknowledged this by trying to fund payment increases.

Contrasting Canada and the United States: What Did They Get Right and Wrong About Healthcare?

Every country is struggling with its healthcare system, and each has solved some problems and incurred others. Remember, no country can afford everything for everyone right now, so pick two. Canada gives everything to everyone, but in some instances, not right now. The USA gives everything right now, but not to everyone.[1-3]

Aging Caregivers and Their Adult Children with Developmental Disabilities

This article from today's Washington Post is an example of a growing issue confronting adults with developmental disabilities and their families. Adults with development disabilities are living longer. For those whose care has been provided by their parents without government assistance, it is very difficult to gain access to needed supportive services when the aging parents become unable, either through their own chronic health problems, disability, or death, to continue to provide care. The supply of services, particularly government subsidized services, for adults with developmental disabilities is not adequate to meet the need. The result is long waiting lists for services. An individual may be on a waiting list for more that a year. In many states, the long waiting lists have led to the development of class action law suits against state government. The result court orders and consent decrees mandate the state to take certain actions in regard to the "members of the class." The members of the class are those individuals "known to the system" -- the persons on the waiting list or residing in state institutions. The adults with disabilities who have received support only from parents or other family members are not "known to the system." Disabled Man Died Before Needed D.C. Aid Arrived By Petula DvorakWashington Post Staff Writer Wednesday, October 22, 2008 "Mr. Johnson" badly burned himself while trying to cook. There were roaches on him when he showed up for medical appointments. He had difficulty using the toilet and rarely took his medication. But for years, the 65-year-old was deemed ineligible for help by the District agency that cares for mentally and physically disabled residents. For bureaucratic reasons, he officially did not exist. In February, the District finally approved funding for him. It was for his burial. continue reading the article