Ohio Health Policy Review

Parents sue to block rule eliminating Medicaid funding for specialized autistic services

The Ohio Legal Rights Services filed a lawsuit against the Ohio Department of Job and Family Services and the Ohio Department of Mental Health in District Court in Columbus (Source: "Parents sue for autistic services," The Columbus Dispatch, May 9, 2008).  This lawsuit, filed on behalf of some parents with children who have autism, seeks to block implementation of a rule that is to take effect on July 1st.  This rule would eliminate Medicaid funding for specialized autism services that their children had been receiving through the Step by Step Academy in Worthington, Ohio.

According to the Department of Job and Family Services, the Step by Step Academy accounted for half of the $5.3 million spent last year on autism treatment, while only serving 4 percent of all children with autism served under Medicaid.

New study examines efforts of emergency rooms to redirect non-emergency patients to other care settings and to try and establish medical homes

A new analysis of 12 communities under the Studying Health System Change Project examines how hospitals are responding to the pressure of non-emergency use of emergency rooms (Source: "Safety Net Emergency Departments: Creating Safety Valves for Non-Urgent Care," Center for Studying Health System Change, May 7, 2008).  Cleveland is one of the twelve cities studies under this project.

The report finds that many low income people, whether uninsured or on Medicaid, turn the emergency rooms because they lack timely access to care in other settings, even for follow up appointments   Therefore, these patients show up for routine and urgent care at emergency rooms. 

The study reports that most hospitals, especially safety net hospitals, are working to redirect these patients to other, more appropriate and less costly care settings.  However, these efforts are meeting with varied results.

The authors conclude that "a combination of approaches could help stem ED use for non-urgent care, including expansion of community health centers, community clinics and hospital clinics and strategies to improve their accessibility. Alignment of hours of operation and available services among existing providers could increase people's care options at lower costs. Since transportation is a significant barrier for some, bringing services to low-income neighborhoods through mobile vans and school-based services could improve access in a cost-effective way."

Understanding Indiana's high deductible plan-based Medicaid expansion

One year ago Indiana embarked on its effort to create a Medicaid expansion based on high deductible health plans and health power accounts, called the Healthy Indiana Plan (HIP).  After intense negotiations with the Centers for Medicare and Medicaid Services (CMS), Indiana launched this expansion in December 2007.

On the May 1, 2008 Health Affairs Blog, Mitchell Roob and Seema Verma discuss their work in creating this health reform strategy (Source: Indiana: "Health Care Reform Admist Colliding Values," Health Affairs Blog, May 1, 2008).  Indiana's plan has funding to cover up to 120,000 people.  In its first three months 30,000 people had applied for coverage under the program.

Roob and Verma's  discussion identifies the following six key lessons from their experience:

1.  Inaction is not a market solution

2.  Choose reforms that help those who need it, but also increase personal responsibility and utilize market incentives

3.  Be fiscally responsible

4.  Reach out across party lines and to multiple constituencies

5.  Compromise and cut deals

6.  With the exception of compromise, don't take any of the above lessons too seriously

They conclude their discussion by stating, "The unique structure of the plan holds the promise of redesigning the Medicaid program as we know it today. For the first time, HIP brings recipients and the State together in a market based partnership to use resources judiciously, and to promote provider competition resulting in improved transparency, quality and value for all Hoosiers."

Disability Rights Group Block Access to HHS Headquarters

ADAPT, which has a 25 year history of organizing the disability community, effectively blocked all access points into the headquarters of the U.S. Department of Health and Human Services this morning at 10:00 a.m (Source: "ADAPT Takes over HHS Building in DC with List of Demands", Justice for All Blog, April 28, 2008).  With over 500 participants in this direct action, ADAPT presented a list of six demands related to the institutional bias in Medicaid.  These demands included:

• Improve the implementation of the Money Follows the Person Demonstration Projects by increasing flexibility states have;
• IMMEDIATELY eliminate any rules which cause undue burdens regarding case management;
• Eliminate any rules that discourage small grassroots providers from meeting the needs of the consumers they serve;
• Eliminate any regulations and interpretations of “spousal impoverishment” and “risk” which promote institutionalization of persons with disabilities;
• Work with ADAPT on ways to pass the Community Choice Act; and
• Meet with leaders of ADAPT within thirty (30) days of this date to clarify any of the above and identify other barriers to home and community based services in all fifty states.

By the end of the day, ADAPT had received a signed letter from Philo Hall, Counselor to Secretary Leavitt, agreeing to  meeting within 30 day, including a meeting to be held this Wednesday.

New online tool to forecast return on investment for Medicaid quality initiatives

The Center for Health Care Strategies (CHCS) announced today that it has launched a new, web-based tool called The Return on Investment Forecasting Calculator for Quality Initiatives (Source: "CHCS Releases Web-Based Return on Investment Forecasting Calculator for Quality Initiatives in Medicaid," Center for Health Care Strategies, April 23, 2008).  According to CHCS, the ROI Calculator, is designed to help Medicaid stakeholders generate realistic return on investment (ROI) estimates for quality improvement initiatives. States and health plans can use this online tool for an array of purposes throughout the course of program development and implementation.  In particular, the ROI Calculator can be used to support resource allocation, program design, program funding, and monitoring and evaluation of quality improvement initiatives. 

CHCS will host a WebExchange on May 8 from 2-3:30 ET to provide a live demonstration on the ROI Calculator.  This call will also share experiences in using the tool from three states that participated in the Return on Investment Purchasing Institute, a national learning collaborative funded by The Commonwealth Fund and the RWJF

New Medicaid children's expansion misses some families in need

The recent children's health coverage buy-in expansion has created the odd situation that some families with uninsured  children are both too rich and too poor.  The current expansion is open to uninsured children with family incomes above 300 percent of poverty who meet specific critera (for more details on this expansion see Ohio Health Policy Review article from April 3rd).  The existing Medicaid program covers uninsured children to 200 percent of poverty.  Families with incomes between 200 and 300 percent are left currently without an expansion program since the Bush Administration refused to approve Ohio's approval State Children's Health Insurance Plan (SCHIP) expansion to 300 percent of poverty.

This reality has revealed itself most starkly with the beginning implementation of the new expansion.  According to the Columbus Dispatch, the first eight families who applied for coverage under this expansion did not qualify because they did not earn enough money (Source: "Kids go uninsured in eligibility gap," The Columbus Dispatch, April 22, 2008).

The Strickland Administration has stated that it wants to address this situation by lowering the income eligibility for this new expansion to 250 percent of poverty, while raising eligibility for Ohio's Medicaid/SCHIP program to 250 percent of poverty. 

House Energy and Commerce Committee unanimously passes legislation to delay Medicaid regulations

On a 46-0 vote, the House Energy and Commerce Committee passed legislation on April 17th that would delay implementation of seven Medicaid regulations proposed by the Bush Administration until April 1, 2009 (Source: "NCOA Opposes Medicaid Regulations", NCOA's Public Policy Update, April 18, 2008).  HHS Secretary Leavitt sent a letter outlining his opposition to this bill on April 16th.  President Bush has threatened to veto the legislation if passed.

Opponents of the seven regulations contend that they would reduce or eliminate federal funds for school-based outreach for Medicaid, types of rehabilitative services covered, targeted case management, and graduate medical education.  One of the regulations limits payment amounts for public hospitals and other public institutions.  Another of the regulations changes the definition of outpatient services in a manner that is believed to severely restrict payment for "hospital-based physician services, routine vision services, annual check-ups, and immunizations" (Source: "Administration's Medicaid regulations will weaken coveragel harm states, and strain health care system," Center on Budget and Policy Priorities, March 8, 2008).

House Bill 355 focuses on Medicaid fraud

Representative Jim Hughes, R-Clintonville, is sponsoring House Bill 355 which seeks to enhance the tools to combat Medicaid fraud.  This legislation includes provisions that mirror federal regulations such as whisteblower provisions for people who identify fraudulent practices.   For example, it will allow whistleblowers to keep between 25 and 30 percent of any settlement award.  The bill also grants authority for the state to pusue civil action against providers who submit fraudulent claims (Source:"Bill aims to thwart Medicaid fraud," The Enquirer, April 9, 2008). 

This legislation is generating concerns from providers.  According to Mary Gallagher, vice president and general counsel for the Ohio Hospital Association, “We think the bill is unnecessary because it duplicates so many other current state and federal laws that do the same thing.”

CareSource chosen to administer Ohio Children's Buy-in Program

Ohio began a new children's coverage expansion on April 1st.  The expansion is for uninsured children in families with incomes above 300 percent of poverty and who meet specific additional eligibility criteria (see earlier Ohio Health Policy Review article).  This expansion will require families to pay premiums between $250 and $500 a month, depending on income.

On April 9th, CareSource announced that the state has selected it to administer this expansion program throughout Ohio.  Its strong statewide provider network and extensive managed care experience were two reasons for this selection (Source: CareSource named provider for state children's program," Dayton Business Journal, April 9, 2008).

Feds approve expansion of Ohio assisted living Medicaid waiver

Ohio has received Federal approval to changes in the state's Medicaid assisted living program. (Source: Gongwer News report, March 26, 2008.) Originally, the assisted living waivers were only available to "people already in nursing homes or those who received services through other Medicaid waivers such as PASSPORT, Choices and Home Care." Now, though, the waivers will also be avaliable to assisted living facility residents who have qualified for Medicaid by spending down their resources. There were originally 1,800 assisted living slots under the original Medicaid waiver approved by the federal Centers for Medicare and Medicaid Services, but only 424 of those slots ended up being filled--well below state projections.