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Clip files / Local news from the states
This column features selected short items about state health care policy.
Medicaid overhaul approved
Jefferson City, MO—Missouri lawmakers have given final approval to the biggest issue of their session: an overhaul of the Medicaid health care program for the poor sought by Gov. Matt Blunt. The legislation passed by the House and Senate would place a greater emphasis on preventive health care in a renamed "MO HealthNet" program and restore certain health benefits to some whose services were cut two years ago by Blunt and the Republican-led legislature. The Senate passed the health care legislation 26-7; the House followed suit with a 92-67 vote that sent the bill to Blunt just 45 minutes before the mandatory adjournment.
"I feel like we've taken a giant step in really transforming the Medicaid program," said Rep. Rob Schaaf, a Republican physician from St. Joseph who handled the bill in the House. Blunt declared it "an extraordinarily successful session."
House Democrats, however, boycotted the jovial paper toss.
The Medicaid legislation would implement health risk assessments for the state's roughly 825,000 enrollees—part of an effort to better coordinate their care and catch budding health problems before they become serious. The Department of Social Services, in conjunction with an 18-member oversight committee, would come up with several health plans, with varying levels of coordinated care. Everyone would be enrolled in one of those options, dubbed health improvement plans, by 2011. Dental and eye care benefits would be restored to thousands of adults whose coverage was cut two years ago as part of a budget-saving move. Medicaid coverage also would be restored or improved for a few thousand working disabled residents whose benefits were cut in 2005. Coverage would be expanded to several thousand children of lower-income parents.
And an estimated 82,500 lower-income women ages 18 and older, without employer-sponsored health insurance, could receive government-paid pelvic exams, cancer screenings, and family planning services.
—AP/Jefferson City News Tribune, 5/19/07
Legislation overhauls state system
BATON ROUGE, LA—The Louisiana Senate has signed off on the framework of a state health care restructuring plan that emphasizes preventive and primary care to keep people healthier. At the heart of the plan is the establishment of "medical networks of care."
Under the plan, the state would oversee managed care networks that public and private health care providers would put together. Primary care physicians and clinics would provide "medical homes" and act as the gatekeepers—referring patients to specialists and hospitals as needed. The provider networks would have to agree to work under standards of care proven to produce healthier people.
Senators voted 35-0 for the bill and it went to the House for consideration. The concept is the state's answer to a health care delivery crisis that grew increasingly worse in the wake of hurricanes Katrina and Rita. It moves in a different direction from a private health insurance care model promoted by U.S. Health and Human Services Secretary Mike Leavitt.
The plan would be tested in the New Orleans and Lake Charles areas, where there continues to be federal health care dollars available for recovery efforts.
—Baton Rouge Advocate, 5/24/07
Study: More SCHIP funding could create 4,564 jobs
INDIANAPOLIS—Federal funding for health insurance to cover Indiana children in low-income families would triple under legislation before Congress and generate an estimate 4,564 new jobs in this state, a report released by a consumer group said. The 10-year-old State Children's Health Insurance Program is up for reauthorization by Congress this year, and both the Senate and the House have passed budget resolutions that call for raising funding from the current $25 billion per year to $75 billion per year. That's more than double what President Bush has proposed. Families USA, a Washington, DC-based health care advocacy group, issued a report saying Indiana would receive about $960.4 million over five years in additional SCHIP funds and that money could be used to extend health insurance to some of the estimated 160,000 Indiana children without coverage. As that money circulates from health care providers into other sectors of the economy, that money would generate 4,564 new jobs in Indiana, $142.9 million in increased wages, and $394.9 million in more business activity, based on an economic model used by the federal Bureau of Economic Analysis, the report said.
"This additional money could go a long way to expanding coverage to children," Ron Pollack, the group's executive director, said in a teleconference with reporters. "It also impacts other parts of the economy."
—AP/Fort Wayne News Sentinel, 5/24/07
Dirigo's funding method is upheld
AUGUSTA, ME — A Maine Supreme Court decision upholding a key funding mechanism in Gov. John Baldacci's Dirigo health initiative was a victory for working families and small businesses, Baldacci said after the ruling. He said he hopes the ruling will "put an end to all these lawsuits and all the parties can get back to the original intent of Dirigo Health." Other supporters said the ruling gives encouragement to those who want to expand a program designed to move Maine closer to universal health coverage. In a 5-1 ruling, the court sided with the Baldacci administration on one of the most contentious elements of Dirigo: savings offset payments, which are assessments made to insurers based on savings created by the program. Former Insurance Superintendent Alessandro Iuppa found that Dirigo produced $44 million in savings in its first year.
Writing for the majority, Chief Justice Leigh Saufley acknowledged that the statute was vague on "aggregate measurable cost savings" and gave deference to Iuppa's "reasonable interpretation of an ambiguous statute." Justice Donald Alexander, the lone dissenter, said the insurance superintendent needed specific criteria for coming up with the disputed number. "Reasonable people do differ, and differ geometrically, in guessing at the meaning of the 'cost savings' provision. And the statute provides no guidance as to how these differences may be resolved," he wrote.
Maine's Dirigo Health Reform Act is designed to contain health care costs and expand health coverage to the 130,000 Mainers who lack insurance. That was supposed to result in reduced charity care and bad debt for insurers, who are required to return the savings to the state in offset payments. But the Maine Association of Health Plans and two other groups sued over the $44 million savings figure set by Iuppa and the Dirigo board, telling the Supreme Judicial Court that they included additional categories of savings not envisioned by state lawmakers.
—Associated Press, 6/5/07
Public schools to offer free flu vaccinations
HONOLULU—Hawaii is the first state in the nation to offer free flu vaccinations to all elementary and intermediate school students in an effort to slice the number of people who come down with the illness each year. The $2.5 million program will kick off this fall and will be voluntary, with parents having to complete and sign consent forms before students can be inoculated. Either flu shots or nasal flu mist will be administered. "It's such an opportunity to keep children healthy," said state schools superintendent Pat Hamamoto at a news conference. The state last year ran a pilot program at three Mililani-area schools and is expanding it this year to all students — including most private school students — ages 5 to 13, with funding coming primarily from the federal Centers for Disease Control and Prevention. Last year, there were 15 outbreaks of flu illness reported at Hawaii's public schools. The state said that in some flu seasons, more than 10% of schoolchildren came down with the illness, which can be marked by high fever, muscle aches, nausea and days in bed.
—Honolulu Advertiser, 6/7/07
Tougher guidelines approved to protect children from lead
CONCORD, NH—The New Hampshire House has approved tougher guidelines to protect children from lead paint. It approved a bill to cut in half the level of lead in a child's blood that triggers a state investigation. The guidelines would reduce the lead limits that both trigger a doctor's report to the state and an investigation into the possible source from 20 mcg to 10 mcg. The bill also would expand where investigators could look. Currently, investigators can only check the apartment where the child lives. The bill would let them check other apartments in the building for possible lead contamination.
Supporters said New Hampshire can't afford to leave the threshold at the current level because that most likely will lead to permanent brain damage. Critics argued better education and closer attention to housing for immigrants would take care of many of the problems without imposing broad changes that could hurt the rental market.
Property owners opposed the bill. They asked for a study of alternatives. They said costs escalate rapidly once the state orders landlords to abate the problem. Currently, landlords must remove lead paint within two years if the paint is identified as the cause of a child's lead poisoning. The bill lets landlords take a variety of other measures as long as the child isn't at risk. If the hazard is found in a unit where a child doesn't live or regularly frequent, interim controls, such as painting, can be used for an extended period. The bill also creates a commission to study ways to prevent lead poisoning.
—Manchester Union-Leader, 6/7/07