Access to care

Uninsured rate for children dropped during pandemic, federal data shows

The rate of children without health insurance declined during the COVID-19 pandemic, likely the result of a provision passed by Congress that barred states from dropping anyone from Medicaid during the public health emergency (Source: “More Children Have Gained Health Insurance During Pandemic,” Pew Stateline, Sept. 21).

According to an analysis of new U.S. Census Bureau data by Georgetown University’s Center for Children and Families, the child uninsurance rate in 2021 was 5.4%, compared with 5.7% in 2019, the year before the pandemic took hold.

The center described that change as a “small but significant decline,” equating to 200,000 more children with health insurance in 2021 than in 2019. Overall, about 4.2 million children were uninsured in 2021, according to the analysis.

The data comes from the Census Bureau’s American Community Survey, which provides annual estimates of income, education, employment, health insurance coverage and housing costs and conditions for U.S. residents. The Census Bureau did not release standard results in 2020 because of difficulties in data collection in the pandemic’s first year.

The Georgetown analysis speculated that the downward trend in child uninsurance was the result of Congress’s provision in the Families First Coronavirus Response Act, passed in March 2020, that prohibited states from involuntarily dropping anyone from Medicaid, the health plan covering lower-income Americans.


Federal report finds telehealth fraud during pandemic cost Medicare $128 million

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.
 
A report released last week by federal government investigators found that nearly $128 million in telehealth claims submitted during the first year of the pandemic may have been fraudulent (Source: “'Guardrails' needed? Telehealth fraud cost Medicare $128M in first year of COVID pandemic, feds say,” USA Today, Sept. 11).
 
Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.
 
Before 2020, Medicare largely restricted telehealth to people who accessed medical care via video and audio connections set up in rural clinics. Amid the pandemic, Medicare allowed recipients in cities and suburbs to get care remotely, often from their home, via a phone call or a video chat. Medicare also more than doubled the types of services eligible for reimbursement to make it easier for people to get care without the risk of COVID-19 exposure during a visit to a clinic or hospital.


First month of new 988 crisis line leads to jump in calls, texts

The new 988 Suicide and Crisis Lifeline is already reaching more Americans in distress – and connecting them to help faster — than the old 10-digit suicide prevention line it replaced July 16 (Source: “New 988 mental health crisis line sees jump in calls and texts during first month,” NPR, Sept. 10).

New data released last week by the U.S. Department of Health and Human Services show that in August – the first full month that 988 was operational — the Lifeline saw a 45% increase in overall volume of calls, texts and chats compared to August 2021.
 
The number of calls answered went up from 141,400 to 216,000 – a more than 50% increase, according to HHS officials. And texts answered went up by a whopping 1000% – from 3,400 in August, 2021, to 39,900 in August of this year. The number of chats on the Lifeline's website that were answered saw a 195% increase.
 
While the 988 Lifeline is accessible nationally, with a national network of call centers, it essentially functions as a state-run system. And states vary vastly in how much they have invested in the former 10-digit Lifeline and associated services. According to a recent analysis by the National Institute of Mental Illness, very few states have passed legislation to supplement the recent federal funds into 988 (Ohio has partial 988 implementation legislation pending).


CMS proposes rule change to simplify Medicaid, CHIP enrollment

A proposed federal rule change was introduced last week that aims to make the Children’s Health Insurance Program (CHIP) and Medicaid enrollment easier (Source: “Proposed CMS rule would streamline Medicaid, CHIP enrollment,” Healthcare Dive, Sept. 1).

The Centers for Medicare and Medicaid Services on Aug. 31 issued a proposed rule with the goal of reducing coverage gaps by streamlining the application and renewal process for Medicaid enrollees and other programs such as CHIP by limiting renewals to once a year, establishing standardized statewide renewal processes and giving applicants 30 days to respond to information requests.

The proposed rule comes as states begin to notify Medicaid beneficiaries about potential losses of coverage due to the impending end of the COVID-19 public health emergency.

Earlier this year, HPIO released an Ohio Medicaid Basics update, Trends in Enrollment and Expenditures During the COVID-19 Pandemic, that provides information on enrollment and spending changes to the Ohio Medicaid program during the pandemic.


CMS approves Ohio Medicaid coverage extension for new moms

Federal officials have approved Ohio Medicaid’s plan to extend benefits for new mothers from 60 days to 12 months after the birth of their child (Source: “Ohio Medicaid extends postpartum coverage for new mothers,” Dayton Daily News, Aug. 17).

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), on Tuesday approved the state’s request to extend the coverage.

“Maternal health is a strong predictor of a child’s health, so by extending health coverage for new moms, we are helping to provide the healthiest possible start in life for Ohio’s children,” said Gov. Mike DeWine.

The American Rescue Plan Act (ARPA) provided the option for states to expand this Medicaid coverage for new moms from 60 days to 12 months. The state of Ohio’s budget included this expanded coverage in its portion of Medicaid funding. DeWine said the state of Ohio began this extended coverage on April 1 and CMS’s final approval is the last step to continuing those services.


HHS designates $60 million to address rural health workforce shortages

The federal Department of Health and Human Services (HHS) announced this week that it has designated $60 million to strengthen healthcare workforces in rural communities through a number of initiatives (Source: “HHS investing $60M to boost rural healthcare workforce,” Healthcare Dive, Aug. 9).

According to an HHS press release, About $46 million in funding through the American Rescue Plan will go to 31 recipients with the goal of expanding healthcare capacity in rural and tribal areas by creating job development, training and placement programs for dental hygienists, medical assistants, doulas and other community-based healthcare professionals.

Another $10 million will go to 13 organizations to create new medical residency programs in rural communities to boost the number of physicians training in those areas. And about $4 million will go to 18 recipients with the goal of improving health outcomes and quality for rural patients and veterans living in those communities.

About 14% of Americans live in rural communities, though those areas represent nearly 75% of primary care health professional shortage areas in the county, according to a February report from the Center for American Progress, a left-leaning think tank.


Federal lawsuit could end ACA free preventive services

A federal lawsuit heard in Texas last month could upend or even eliminate the preventive care requirement in the Affordable Care Act (Source: “Lawsuit Could End Free Preventive Health Checkups,” Pew Stateline, Aug. 9).

A group of patients and employers are arguing that the requirement is unconstitutional. The federal judge hearing the case, Reed O’Connor of the U.S. District Court for the Northern District of Texas, in 2018 struck down the Affordable Care Act as unconstitutional, only to be overturned by the U.S. Supreme Court in 2021.

According to a July report by the Urban Institute, a nonprofit research organization, health plans now cover more than 100 preventive health services with no out-of-pocket cost to patients. Among them are screening and counseling for alcohol misuse and obesity, screenings for blood pressure and depression, and immunizations.

Eliminating the preventive care mandate, many health policy analysts agree, could have far-reaching and dramatic effects, potentially causing millions of patients to put off or neglect health screenings that could detect diseases early. More than 60 professional medical organizations, including the American Medical Association, published a joint statement last month warning of a dire impact of striking down the provision.


Study: Access to trauma care improving in U.S.

A new study has found that access to trauma care improved nationally in the 2010s (Source: “Access to trauma care is improving across the country, but progress remains uneven,” Stat News, Aug. 9).

The new research, published in the Journal of the American Medical Association, mapped the distance from each census block to the nearest trauma center, taking into account air and land transport. The researchers found that 91% of people in the U.S. could get to a trauma center within 60 minutes by air or land travel, up from 78% in 2013.

Trauma centers differ from regular hospitals — they have to meet certain benchmarks on care and have specific staff on call around the clock.

The study, which looked at trauma centers verified by the American College of Surgeons, found that access differed across regions. Native Americans faced the lowest access to trauma care at 70%, as well as the smallest improvement to access among any group. The share of people living in proximity to a trauma center was also lower in rural states like Wyoming, Montana, and South Dakota, and in the South, where it dipped below 50% in two states.


Ohio to spend $84 million in federal funds on behavioral health for children

Gov. Mike DeWine announced Monday that Ohio will spend $84 million in federal American Rescue Plan funding to increase access to services and support for behavioral health care for children (Source: “Ohio investing $84M in initiative to improve behavioral health care for children,” Mahoning Matters, May 16).

The Pediatric Behavioral Health Initiative will use American Rescue Plan funds that were allocated in House Bill 168.

  • Akron Children’s Hospital
  • Cincinnati Children’s Hospital Medical Center
  • Dayton Children’s Hospital
  • ProMedica Russell J. Ebeid Children’s Hospital
  • University Hospitals Rainbow Babies & Children’s
  • Appalachian Children’s Coalition — Integrated Services for Behavioral Health
  • Appalachian Children’s Coalition — Hopewell Health Centers

Uninsured rate drops for all races in Ohio, with biggest reduction among Asian and Black Ohioans

UninsuredRatesByRace_StandAloneGraphic_Small

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The percent of Ohioans who are uninsured dropped by almost half from 12.3% to 6.4% between 2011 and 2019 (see graphic above).

Every race saw a drop in the percent of uninsured, with the percentage of Asian and Black Ohioans dropping most dramatically compared to other groups. Despite these gains in access, however, Ohioans of color are still more likely to be uninsured than white Ohioans.

Much of the drop in Ohio’s uninsured population is attributable to the state’s 2014 decision to expand Medicaid eligibility as part of the Affordable Care Act. In HPIO’s 2021 Health Value Dashboard, Ohio ranked seventh out of the 50 states and the District of Columbia for access to care — the first time Ohio has ranked in the top quartile on any Health Value Dashboard domain.

While access is clearly a bright spot for the state, the Dashboard found that Ohio’s population health outcomes remain poor. Access to care is critical, particularly for Ohioans with serious health conditions. But the Dashboard and national research shows that health is shaped by many factors, including social, economic and physical environments.

This April, HPIO is creating a series of data graphics in recognition of National Minority Health Month