Clip files / Local news from the states
Clip files / Local news from the states
Increase in uninsured keeps pace with population growth, reaching all-time high of 44.3 million, says Census Bureau
WASHINGTON, DC—Health insurance coverage throughout the states during the last three years has been most prevalent among residents of Hawaii, Minnesota, and Wisconsin, while Arizona and Texas are near the bottom in a recent Census Bureau ranking.
State-level averages for 1996 to 1998, as well as recent individual years, are found in the bureau’s Health Insurance: 1998. The number of uninsured Americans is at an all-time high — 44.3 million — but the proportion of uninsured — 16.3% — is not statistically different from 1997, states the report. It found that the status of children’s health care coverage did not change significantly from 1997 to 1998, with 11.1 million, or 15.4%, of all children under age 18 uninsured.
Data in the report are from the March 1999 Current Population Survey.
A copy of the report is available on the Web at www.census.gov/hhes/ www/hlthin98.html.
Tennessee, Louisiana win approval for CHIP proposals
WASHINGTON, DC—Louisiana and Tennessee will expand their Medicaid program under Children’s Health Insurance Program (CHIP) proposals recently approved by the Health Care Financing Administration.
In an expansion of its existing CHIP coverage, Louisiana will extend Medicaid to an estimated 10,000 children between birth and age 19 who are in families with incomes between 133% and 150% of the federal poverty level.
In total, the state expects to enroll over 38,000 children by September 2000. LaCHIP currently covers children between the ages of 6 and 19 in families with incomes at or below 133% of the federal poverty level. The federal poverty level is $16,700 per family of four.
Tennessee’s CHIP implementation will expand Medicaid to cover children born before Oct. 1, 1983, who are under age 19, in families with incomes at or below 100% of the federal poverty level, and who could not have been enrolled under the operating rules for the state’s Medicaid demonstration program before April 1, 1997. The federal poverty level is $16,700 for a family of four. The state expects to cover nearly 10,000 children under its CHIP program. The full Medicaid package of benefits will be offered and there will be no family cost-sharing.
—HCFA releases, Aug. 23, Sept. 3
Four states, District of Columbia snag $20 million each for reducing rate of out-of-wedlock births and abortions
Alabama, California, the District of Columbia, Massachusetts, and Michigan each will receive $20 million for reducing the rate of out-of-wedlock births between 1994 to 1995 and 1996 to 1997. The awardees reported the following reductions: California, 5.7%; the District of Columbia, 3.7%; Michigan, 3.4%; Alabama, 2.0%; and Massachusetts, 1.5%.
The awards, established by the 1996 welfare reform legislation, require that recipients also reduce the rate of abortions, defined as the number of abortions divided by the number of births.
Health Care Financing Administration (HCFA) officials recognized that three of the four years covered by the bonus program predated the welfare reform initiatives to reduce the rate of out-of-wedlock births, and that Medicaid waiver programs likely contributed to the reported declines.
—HCFA release, Sept. 13
Academic medical center MCOs tend to get sicker patients, concludes JAMA analysis
Managed care organizations run by academic medical centers bear the brunt of the sickest patients in Tennessee’s Medicaid managed care program, says an analysis in the Journal of the America Medical Association. Such adverse selection may pose "serious financial risks" for the academic medical centers that participate in managed care, the authors conclude.
The state’s three academic managed care organizations were more likely than statewide organizations to care for TennCare patients in five of six high-cost chronic conditions, by factors that ranged from 2.4 to 14.1. Only in prematurity was the prevalence comparable. Academic medical centers also saw sicker patients, compared to statewide MCOs, in 22 of 27 additional conditions. Comparisons between academic medical center and regional MCOs yielded similar results.
Development of risk-adjustment payments and other public policy measures are needed to ensure academic medical centers’ expertise in "providing highly complex care, service to the poor, medical research, and physician training."
—Bailey JE, Van Brunt DL, Mirvis DM, et al. Academic managed care organizations and adverse selection under Medicaid managed care in Tennessee. JAMA 1999; 282:1,067-1,072.
Patient-level inpatient data now available through centralized database at AHCPR
All payer, patient-level data from hospitals in 11 states are now available from a centralized repository at the Agency for Health Care Policy and Research (AHCPR) in Rockville, MD.
Database records contain more than 100 clinical, financial, and administrative variables describing an inpatient stay. The databases contain the universe of each state’s inpatient discharge abstracts translated into a uniform format that allows multistate analyses. In some instances, a record may contain information, such as a patient’s race, not uniformly available from all states.
The 11 states, California, Colorado, Iowa, Maryland, Massachusetts, New Jersey, New York, Oregon, South Carolina, Washington, and Wisconsin, are among the 22 who participate in the agency’s Healthcare Cost and Utilization Project (HCUP).
The other 11 states in HCUP initiative — Arizona, Connecticut, Florida, Georgia, Hawaii, Illinois, Kansas, Missouri, Pennsylvania, Tennessee, and Utah — are considering joining the centralized database, said AHCPR spokeswoman Karen Migdail.
Information about the project is available at (805) 681-5876 or by e-mail at [email protected].
—AHCPR release, Sept. 27
Drive-through deliveries don’t increase risk of rehospitalization for newborn — JAMA study
Decreasing the length of stay for full-term newborns doesn’t seem to increase their risk of being re-hospitalized, according to a JAMA study of almost 103,000 neonates born to Ohio women receiving Medicaid from 1991 to 1995.
While the mean length of stay decreased 27%, from 2.2 (1.0) to 1.6 (0.9) days over the course of the study, re-hospitalization rates within seven and 14 days of discharge decreased by 23%, from 1.3% to 1.0% (P=.01), and by 19%, from 2.1% to 1.7%, respectively. Primary care visits increased within 14 days of birth increased 117%.
—Kotagal UR, Atherton HD, Eshett R, et al. Safety of early discharge for Medicaid newborns. JAMA 1999; 282:1,150-1,156.
Judge backs Atlanta’s domestic-partner insurance plan, scolds foot-dragging
ATLANTA—The state insurance commissioner’s refusal to approve the city of Atlanta’s domestic-partner benefits was "outside the scope of his statutory authority and . . . abuse of his discretion," a Fulton County Superior Court judge declared in late September.
Judge Wendy Shoob ordered Georgia Insurance Commissioner John Oxendine to approve the city’s plan to let employees cover straight or gay dependent, domestic partners.
The city’s domestic partner benefits were first proposed in 1993. Subsequent legal challenges brought the issue to state Supreme Court, which upheld the benefits in 1997. Mr. Oxendine, however, has refused to approve the change.
Attorneys for the city and a gay rights group suggest that the ruling clears the way for other employers to grant domestic partner benefits.
—Atlanta Journal-Constitution, Sept. 23
AIDS expert to replace Richardson as head of Medicaid
WASHINGTON, DC—AIDS policy expert Timothy Westmoreland was selected in late September to replace Sally K. Richardson as director of the Center for Medicaid and State Operations. Mr. Westmoreland, 45, is a lawyer and has worked on the House Energy and Commerce Committee’s subcommittee on health under Rep. Henry Waxman, D-CA.
TennCare’s director of eight months resigns amid praise from hospital and doctor groups
NASHVILLE, TN—Brian Lapps, the high-profile TennCare director who acknowledged having "foot-in-mouth" disease, resigned unexpectedly in late September, just eight months into the job.
John Tighe, recently named the state’s deputy finance commissioner with oversight responsibilities for TennCare, will temporarily assume his duties.
"I think it is appropriate that I step down as director at this time so that John Tighe can build his team from the ground up," Mr. Lapps said in a prepared statement.
Lapps was the sixth director at TennCare in five years.
—Nashville Tennessean, Sept. 28
New York hospital agrees to pay $45 million in response to claims of Medicaid overbilling
In the largest recovery by one state in the history of Medicaid, Staten Island University Hospital in New York has agreed to pay $45 million to settle allegations that it overbilled the program for outpatient services for nearly five years.
The 635-bed hospital also will have an outside monitor for five years, a measure that no State Medicaid Fraud Unit has before imposed, said assistant deputy attorney general Thomas Staffa.
The settlement calls for a $4.5 million cash payment and the remaining $40.5 million to be withheld in Medicaid payments through 2019. In addition, the hospital is required to provide $39 million in uncompensated care during the next 20 years.
—Compliance Hotline, Oct. 4
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