Category Archives: Medicaid
In his first two years in office, New York State Health Commissioner Nirav Shah, MD, MPH, has been deeply engaged in the state’s ambitious Medicaid redesign process. Shah oversees the $50 billion state public health agency and has been praised for his health system reform efforts. Moving forward, he is focusing on issues such as securing federal funding for “supportive housing” to offer chronically ill, low-income individuals subsidized living quarters in building complexes that also contain in-house medical and social services.
Shah, an RWJF Clinical Scholar alumnus, discusses this and more in the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars Health Policy Podcast, a monthly series co-produced with Penn’s Leonard Davis Institute of Health Economics and hosted by RWJF Clinical Scholar Chileshe Nkonde-Price, MD.
The video is republished with permission from the Leonard Davis Institute.
Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW). Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*
It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.
Tammy Chang, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.
Over kitchen tables as well as on Capitol Hill, the discussion continues over the Affordable Care Act including who will benefit and what it means for everyday Americans.
To shed light on this debate, my co-author Matthew Davis, MD, MAPP, and I recently published a study that describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act. The study, published in the Annals of Family Medicine, uses a national source of data used by many other researchers who look at national trends—such as high blood pressure and obesity—called the National Health and Nutrition Examination Survey (NHANES).
Sue Birch, MBA, BSN, RN, is executive director of the Colorado Department of Health Care Policy and Financing, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2002).
Now that I have caught my breath, I wanted to share the Colorado report on Obamacare’s October 1st Birthday! Our state has decided to expand our Medicaid program and to form our own marketplace for Coloradans to shop and compare health insurance plans. These changes will help us cover many uninsured Coloradans.
In its first week, Connect for Health Colorado, our state’s health insurance marketplace, successfully attracted more than 162,941unique website visitors, had 9,658 calls and chats to the service center, and 18,174 accounts created. We think this is a strong start and know that it will take time for Coloradans who have not had insurance before to learn about their options and apply for coverage. We are working across state government to help make this happen.
At my department, Health Care Policy and Financing, Coloradans can enroll through our new modularized interoperable cloud-based system, PEAK. We had more than 9,000 applications come through this site in the first 10 days of October. It is foundational to our desire to increase new consumerism and greater client responsibility by walking through a self-enrollment process. Our website is Colorado.gov/PEAK and we have seen record traffic to the application site.
Overall, the marketplace opening went quite smoothly for Colorado—the exchange opened successfully, Medicaid began, and our technology functioned efficiently for being such a large, complex system. With the marketplace now up and running, individuals, families, and small employers can start making appointments with Health Coverage-Guides, learn about plan options, and apply for insurance when ready.
This is an exciting moment in health care history and we are proud to be working with partners across our state and our nation to provide affordable health insurance options to all residents of Colorado!
Human Capital News Roundup: The cost of overtriaging, ‘medical students’ disease,’ the demographics of new Medicaid enrollees, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
People who will be newly eligible for Medicaid after expansion under the Affordable Care Act will be younger and healthier than those currently enrolled in the program, according to a study by RWJF Clinical Scholars alumna Tammy Chang, MD, MPH, and program site co-director Matthew Davis, MD, MAPP. The researchers found that the new Medicaid enrollees will also be less likely to be obese or to suffer from depression, although more of them will be smokers and drinkers. Among the outlets to report on the findings: Reuters, Kaiser Health News, NBC News, NPR’s Shots blog, and Medpage Today.
Medpage Today reports on a study led by RWJF Physician Faculty Scholars alumnus Craig Newgard, MD, MPH, finding that nearly one-third of patients sent to major trauma centers by first responders did not need that level of care and could have been sent elsewhere for diagnosis and treatment. This “overtriaging" raises per-patient health care costs by as much as 40 percent, the study finds. Read more about it.
While in Australia for a conference on reforming health care systems to meet the challenges of aging populations, RWJF Harold Amos Medical Faculty Development Program alumna Alicia Arbaje, MD, MPH, sat down for two interviews—one with The Australian Financial Review on how stereotypes about aging are changing, and one with Australian Broadcasting Corporation Radio about transitional care and reducing readmissions among older adults after they leave hospitals. Read a post Arbaje wrote for the RWJF Human Capital Blog about navigating care across settings and the role of caregivers.
The Real Deal: ACA and the Underserved – Panel Discussion at the National Association of Black Journalists
Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice. As a Robert Wood Johnson Foundation New Connections grantee, his research focuses on the social and economic conditions structuring disparities in the health of African American males.
The Real Deal of the Affordable Care Act (ACA) is that many Americans have many questions regarding how the ACA will affect their health care coverage or if they will be covered at all. Our panel discussion at the National Association of Black Journalists (NABJ) convention revealed many of these questions concerning how Americans will be enrolled, how their existing health insurance plans will change, and what means tests will be used to determine their eligibility. This panel discussion suggested that many Americans were not aware of what the changes will be and if their state will expand Medicaid.
Medicaid expansion will not occur in many states where close to six of ten African Americans reside. This suggests that many African Americans will remain without health insurance or will be under-insured. This is a real challenge to improving health care outcomes and reducing health care costs over time.
In 2009, budget shortfalls spurred California lawmakers to eliminate virtually all dental benefits under its Adult Denti-Cal program, leaving millions in the state without adequate dental care. But in late June, Governor Jerry Brown signed a budget that restores virtually all of those dental benefits to the 3 million low-income Californians who qualify for the program.
The 2013-2014 state budget also expands other health care services for low-income Californians through an expansion of the state’s Medicaid program (Medi-Cal) under the Affordable Care Act. An estimated 1.6 million additional Californians will receive coverage under this expansion by 2015.
The dental benefits won’t be available until May 1, 2014, but California Dental Association President Lindsey Robinson, DDS, issued a statement called it a significant achievement. “We look forward to working with the administration to effectively implement Adult Denti-Cal, a vital service that will benefit the health of millions of Californians,” she said.
Human Capital News Roundup: Oregon’s Medicaid system, ‘healthy’ fast food restaurants, primary care workforce innovation, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:
RWJF Clinical Scholar Alan Teo, MD, MS, is the lead author of a study that finds the quality of a person’s social relationships influences the person's risk of major depression, regardless of how frequently their social interactions take place. “The magnitude of these results is similar to the well-established relationship between biological risk factors and cardiovascular disease,” Teo told Health Canal. “What that means is that if we can teach people how to improve the quality of their relationships, we may be able to prevent or reduce the devastating effects of clinical depression.”
RWJF recently announced the selection of 30 primary care practices as exemplary models of workforce innovation. The practices will serve as the basis for a new project: The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP). Among them is CareSouth Carolina, the Hartsville Messenger reports. Learn more about the LEAP project and the practices selected for the program.
Low-income Oregonians who received access to Medicaid over the past two years used more health care services, and had higher rates of diabetes detection and management, lower rates of depression, and reduced financial strain than those without access to Medicaid, according to a study co-authored by RWJF Investigator Award in Health Policy Research recipient Amy N. Finkelstein, PhD, MPhil. The study found no significant effect, however, on the diagnosis or treatment rates of hypertension or high cholesterol levels. Among the outlets to report on the findings: Forbes, the New York Times, the Washington Post Wonk blog, Health Day, and the Boston Globe Health Stew blog. Read more about Finkelstein’s research on the Oregon Medicaid system.
What the Election Means for Health and Health Care… The Re-Election of President Obama Curtails the Likelihood of Major Medicaid Reductions
Frank J. Thompson, PhD, is a professor at the School of Public Affairs and Administrations and at the Center for State Health Policy at Rutgers, The State University of New Jersey. Thompson is a 2007 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, studying Medicaid: Political Durability, Democratic Process and Health Care Reform. The RWJF Human Capital Blog asked scholars and fellows from a few of its programs to consider what the election results will mean for health and health care in the United States.
Human Capital Blog: What do you think the election will mean for the country’s health care system?
Thompson: It means that the country can go forward with implementing the Affordable Care Act (ACA). My research focuses on Medicaid—the federal grant program to the states that insures some 65 million low-income people. Under the ACA, Medicaid is slated to cover most people with incomes up to 133 percent of the poverty line as of 2014. In the recent election, the differences between the two parties on the ACA and Medicaid were stark. The Romney-Ryan ticket pledged not only to repeal the ACA but to convert Medicaid to a block grant and to cut funding for the program by more than 30 percent over ten years. The degree to which a Romney administration would have achieved these objectives remains an open question. But the reelection of President Obama curtails the likelihood of major Medicaid reductions over the next four years.
Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:
- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.
- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.
- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.
- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.
- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.
- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.
- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.
- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.