Washington D.C. cuts 20,000 from Medicaid rolls and reduces payments to HMOs, hospitals
WASHINGTON, D.C.—Mayor Marion Barry announced
early this month that the District will save more than $80 million on Medicaid by removing 20,000 recipients who no longer qualify for the program and by cutting payments to hospitals, HMOs and nursing homes.
The cuts have put the brakes on growth in spending on the health insurance program, but they still fall far short of the $134 million in Medicaid savings the mayor predicted he could find in the budget. Mayor Barry said he still believes the city can save more than $600 million in health-care costs by the end of the decade—a prediction that has been disputed by some of his own aides. Paul Offner, the District’s commisoner for Health-Care Finance, acknowledged that it will prove more difficult to keep the costs of the program from growing in the future.
A recent consultant’s study for the D.C. Public Health Commission found that per-patient Medicaid expenditures in the District were 56% greater than the national average. The city paid $3,700 per patient on hospital services last year, compared with the U.S. average of $1,670.
Washington Post, Sept. 6, 1996
Central Kentucky to get Medicaid managed care
FRANKFORT, KY—State health officials told the legislature they plan to move ahead with plans to bring Medicaid managed care to 20 counties in Central Kentucky in January. The Health Care Partnership Program will create eight designated regions in the state. The partnerships will be governed by boards that represent providers and Medicaid recipients. The state will give the partnerships a sum of money and the partnerships will decide how providers will be paid and at what rate. Central Kentucky, which includes Lexington and Frankfort, will be the first of the state’s eight regions to participate in the Health Care Partnership Program, approved by the federal government last year. The partnerships will be open to any provider willing to join and agree to the participation rules. The partnership plans are expected to cover about 470,000 of the state’s 530,000 Medicaid recipients.
Kentucky Post, Aug. 22, 1996.
Alternative care coverage heats up race for insurance commissioner in Washington state
OLYMPIA, WA—A heated debate over individual insurance policies has focused an unusual amount of attention on the insurance commissioner’s race in Washington State. Five Republicans and a candidate from the Natural Law Party have filed to run against incumbent Deborah Senn, who has fashioned herself as the consumer’s guardian in the battle over insurance carriers’ efforts to raise premiums by as much as a third.
Ms. Senn boasts of turning down "a record number" of rate increases. "For the first time ever, the insurers have heard the word no’," she said. Much of the recent controversy has stemmed from the commissioner’s ruling that health insurance policies must cover customers for alternative care. Some of Ms. Senn’s Republican opponents have argued that the rule has meant that thousands of people have to pay for policies that include coverage for naturopaths, massage therapists, acupuncturists and other practitioners they would never use. Ms. Senn’s opponents have also argued that state law prohibiting insurance companies from denying coverage for pre-existing conditions after 90 days has provided an incentive for people to jump into the market when they have major medical expenses and then jump out again a short time later, putting additional pressure on rates.
Seattle Post-Intelligencer, Sept. 4, 1996
Insurer’s plan to discount auto insurance for clients that use its medical network stirs debate in Mass.
BOSTON—A proposal by a Massachusetts-based insurance company to disocunt the cost of auto insurance coverage to customers who agree to use the company’s own health-care network was the subject of sharp debate at a hearing before the state Division of Insurance. Premier Insurance Co. of Worcester, which wants to offer a 15% discount on personal injury and medical payment coverages, argued that its network of 12,000 health-care providers would provide care more efficiently and cheaply while helping to reduce fraud. Premier’s opponents said it was a conflict of interest for Premier to be determining what medical care would be provided to its customers. A string of state lawmakers testified that the proposal requires legislative action rather than just regulatory approval by the insurance commissioner.
Boston Globe, Aug. 27, 1996
Majority of states now paying for new AIDS drugs, but soaring costs put strain on assistance programs
TRENTON, N.J.—Some 30 states are now offering a potent new class of AIDS drugs known as protease inhibitors to those enrolled in state-run Aids Drug Assistance Programs (ADAP) who do not qualify for Medicaid.
But the high cost of the drugs, which work in combination with other AIDS drugs, such as AZT and 3TC, is putting a growing strain on the programs, which provide coverage to those who cannot afford the expensive medication and do not have other coverage.
New Jersey, which this month joined the list of states that will cover the drug through the program, estimates cost of treatment with the new drugs at about $12,000 to $14,000 per year and said they will double the costs of the ADAP from $4.5 million to $9 million a year. Officials dropped six drugs from the list of 44 drugs available to AIDS patients, maintaining that they were used by only a few people.
Health and Senior Services Commissioner Len Fishman warned that the state, in the future, may have to impose a copayment on AIDS patients if there are a large number of new participants in the drug distribution program. States such as
Washington, Kansas, and Illinois have been forced to cut back dramatically on their ADAPs after the introduction of protease inhibitors brought a rush of new applicants.
The Record, Hackensack, N.J., Sept. 4, 1996
Colorado employers may face higher HMO rates
DENVER—Colorado companies will face higher insurance costs starting next year as managed care plans try to make up for sliding profits, predicts Allan Baumgarten, author of the 1996 Colorado Managed Care Review report. Colorado HMOs saw their profit margins drop to 3% in 1995 from 4.5% the year before, the report found. Bill Lindsay, a Denver-based benefits consultant is warning his employer clients to expect HMO rate increases as high as 30% starting next year. However, another consultant, Claire Brockbank, believes premium increases are at least a year to 18 months away. One local employer, Lockheed Martin, isn’t taking any chances. The company locked in its prices for three years.
Rocky Mountain News, Denver, CO, Sept. 6, 1996
Michigan pushes to boost immunization rate
DETROIT—Michigan has launched a high-profile campaign to rid itself of its worst-in-the-nation immunization ranking for 2-year-olds. The immunization rate is 64%, according to the federal Centers for Disease Control and Prevention,.In the latest effort, called "Super Saturday," the state provided free shots at about 100 sites across the state, including McDonald’s parking lots. The state also is using the opportunity to link families with doctors if they do not already have one, said Jean Chabut, chief of health promotion for the state Department of Community Health. Michigan, which is spending $25 million on immunization this year and is building six regional immunization registries. The state also is working with the medical society to educate clinicians to check immunizations during each visit by a child.
Detroit Free Press, Sept. 2, 1996.
Each month, this page features selected short items about state
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