Kaiser Health News, February 21, 2020

The Trump administration’s top Medicaid official has been increasingly critical of the entitlement program she has overseen for three years.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has warned that the federal government and states need to better control spending and improve care to the 70 million people on Medicaid, the state-federal health insurance program for the low-income population. She supports changes to Medicaid that would give states the option to receive capped annual federal funding for some enrollees instead of open-ended payouts based on enrollment and health costs. This would be a departure from how the program has operated since it began in 1965.

In an early February speech to the American Medical Association, Verma noted how changes are needed because Medicaid is one of the top two biggest expenses for states, and its costs are expected to increase 500% by 2050.

“Yet, for all that spending, health outcomes today on Medicaid are mediocre and many patients have difficulty accessing care,” she said.

Verma’s sharp comments got us wondering if Medicaid recipients were as bad off as she said. So we asked CMS what evidence it has to back up her views.

A CMS spokesperson responded by pointing us to a CMS fact sheet comparing the health status of people on Medicaid to people with private insurance and Medicare. The fact sheet, among other things, showed 43% of Medicaid enrollees report their health as excellent or very good compared with 71% of people with private insurance, 14% on Medicare and 58% who were uninsured.

The spokesperson also pointed to a 2017 report by the Medicaid and CHIP Payment and Access Commission (MACPAC), a congressional advisory board, that noted: “Medicaid enrollees have more difficulty than low-income privately insured individuals in finding a doctor who accepts their insurance and making an appointment; Medicaid enrollees also have more difficulty finding a specialist physician who will treat them.”

KHN opted to look at those issues separately.

Click here for more.

Washington, D.C. – On February 12, 2020, U.S. Senator Bob Casey (D-PA), Ranking Member of the U.S. Senate Special Committee on Aging, held a hearing entitled, “There’s No Place Like Home: Home Health Care in Rural America.” During the hearing, Senator Casey highlighted his bill, the Home and Community-Based Services (HCBS) Infrastructure Improvement Act, which would invest in community supports for older adults and people with disabilities in rural areas through increased Medicaid funding for states.

“In Pennsylvania, there are more than 13,000 older adults and people with disabilities waiting for home care and support services. My bill, the Home and Community-Based Services Infrastructure Improvement Act, aims to change that–to make home-based care and services a reality for all who need it. An investment in home health care is an investment in the future of rural America. It is an investment in access to care, an investment in the direct support workforce and an investment in the economy,” said Senator Casey.

Senator Casey invited Francis Adams, a home care worker from Washington, PA, to testify about the barriers to improving home care jobs. “We can’t truly improve the long-term care that seniors and people with disabilities rely on unless we tackle the major obstacles that are holding working people back, including low wages, lack of benefits and basic worker protections and inadequate training,” said Mr. Adams. “It isn’t that we don’t have enough people to do this work that creates a workforce shortage, it is that our country, as a whole, undervalues this work and so nobody wants to fill the positions. We have to fix this. We have to invest in long-term care for all and we have to finally respect the work home care workers do.”

 Read more about the HCBS Infrastructure Improvement Act here.

With health care costs rising and U.S. life expectancy declining for three consecutive years, the personal-finance website WalletHub today released its report on 2020’s Healthiest & Unhealthiest Cities in America as well as accompanying videos.

To identify the places where health is a priority, WalletHub compared more than 170 of the largest U.S. cities across 43 key metrics. The data set ranges from cost of medical visit to fruit and vegetable consumption to fitness clubs per capita.

Key Stats

• Overland Park, Kansas, has the lowest share of physically unhealthy adults, 7.60 percent, which is 2.5 times lower than in Detroit, the city with the highest at 19.20 percent.
• Laredo, Texas, has the lowest cost per doctor’s visit, $58.33, which is 3.3 times less expensive than in Boston, the city with the highest at $191.62.
• Portland, Maine, has the lowest share of adults eating fruit less than once daily, 28.20 percent, which is 1.8 times lower than in Gulfport, Mississippi, the city with the highest at 51.80 percent.
• Amarillo, Texas, has the lowest average monthly cost for a fitness-club membership, $10.17, which is 8.1 times less expensive than in San Francisco, the city with the highest at $82.83.

To view the full report and your city’s rank, please visit:
https://wallethub.com/edu/healthiest-cities/31072/

The Pennsylvania Department of Health has released it’s 2020-2023 Strategic Plan.  A tremendous effort went into creating this strategic plan, from community partners and employee surveys to workshops, interviews, and data analysis. This plan is the Department’s roadmap for pursuing the greatest public health challenges faced by Pennsylvanians and illustrates their commitment to health equity, collaboration, continuous quality improvement and evidence-based decision making. The Department will build upon the great work already being done to promote healthy behaviors, prevent injury and disease, and to assure the safe delivery of quality health care for all people in Pennsylvania.

This plan sets the course to achieve five overarching strategies that we will work toward accomplishing over the next three years:

1. Maintain and enhance emergency services and public health preparedness
2. Continually develop our talents to significantly advance public health in PA
3. Promote public health with awareness, prevention, and improvement of outcomes where the need is greatest
4. Use data, measures, and technology to enable public health performance
5. Improve staff, customer and partner experience with consistent, efficient and effective services and work processes

On February 13, 2020, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma announced a Request for Information (RFI) to seek public comments regarding rural maternal and infant health care.

Through CMS’ Office of Minority Health, the agency is seeking information related to opportunities to improve access, quality, and outcomes before, during, and after pregnancy, and to develop and refine programs and policies that ensure all rural women have access to high quality maternal health care that results in optimal health.

To review the RFI, please visit go.cms.gov/ruralhealth.

Responses to this RFI will be used to inform future discussions among stakeholders and future work by CMS toward the development and refinement of programs and policies that ensure rural women have access to high quality maternal health care that results in optimal health outcomes.

CMS encourages all stakeholders to review the RFI at go.cms.gov/ruralhealth and submit comments to RuralMaternalRFI@cms.hhs.gov. Comments will be collected starting Wednesday February 12 through Sunday, April 12 at 11:59pm ET.

For more information and updates about this RFI, please visit the CMS Rural Health website at go.cms.gov/ruralhealth or email questions to RuralMaternalRFI@cms.hhs.gov.  

In January 2020, Pennsylvania Governor Tom Wolf announced a focused all-agency effort and anti-stigma campaign, ‘Reach Out PA: Your Mental Health Matters,’ aimed at expanding resources and the state’s comprehensive support of mental health and related health care priorities in Pennsylvania.

The governor announced several initiatives and reviews the administration will undertake for commonwealth agencies to bolster the effort. Furthermore, over the coming weeks, agencies will announce additional initiatives. The governor was joined by mental health advocates, social workers, educators, military veterans, and cabinet secretaries in making the announcement.

“For those struggling with their mental health, we have one message: Your mental health matters and it’s okay to reach out for help,” Gov. Wolf said. “We are stepping up our efforts to ensure every Pennsylvanian can access mental health care and more agencies can respond to the challenges facing Pennsylvanians struggling with their mental health. The act of reaching out for help – or to help – can make a huge difference for someone struggling.”

According to a 2017 study from the University of Southern California, approximately 1 million adult Pennsylvanians struggled with serious psychological distress at least once in 2015. Of those adults, more than 27 percent had an unmet need for mental health care. That population includes 42 percent who did not receive mental health care because they could not afford it.

Strengthening Mental Health Care Access

The Department of Human Services will take steps to incentivize the integration of physical and behavioral health services to remove barriers to coordinating care and treatment. DHS will create financial incentives to encourage managed care organizations that provide Medical Assistance benefits to create, maintain, and continuously improve collaboration between the entities and providers that coordinate and deliver physical health benefits and mental health benefits.

These steps will mark the beginning of a large-scale effort to combat mental health issues in Pennsylvania. Reach Out PA, the Suicide Prevention Task Force, and other Wolf Administration focuses will continue to bust the stigma surrounding mental health, and work together in a multi-pronged push.