Access to care

CMS begins paying for health care for people who are homeless outside medical settings

As of Oct. 1, the federal Centers for Medicare & Medicaid Services began allowing public and private insurers to pay “street medicine” providers for medical services they deliver anyplace people who are homeless might be staying (Source: “Health Care ‘Game-Changer’? Feds Boost Care for Homeless Americans,” Kaiser Health News, Oct. 19).
Previously, these providers weren’t getting paid by most Medicaid programs, which serve people with low incomes, because the services weren’t delivered in traditional medical facilities, such as hospitals and clinics.
The change comes in response to the swelling number of people experiencing homelessness across the country, and the skyrocketing number of people who need intensive addiction and mental health treatment — in addition to medical care for wounds, pregnancy, and chronic diseases like diabetes.
“It’s a game-changer. Before, this was really all done on a volunteer basis,” said Valerie Arkoosh, secretary of Pennsylvania’s Department of Human Services, which spearheaded a similar state-based billing change in July.
California led the nation when its state Medicaid director in late 2021 approved a new statewide billing mechanism for treating people who are homeless in the field, whether outdoors or indoors in a shelter or hotel. Hawaii and Pennsylvania followed. And while street medicine teams already operate in cities like Boston and Fort Worth, Texas, the new government reimbursement rule will allow more health care providers and states to provide the services.

Coverage of weight-loss drugs on employer plans expected to double in 2024, survey finds

The number of U.S. employers who cover obesity medications could nearly double next year, according to a survey (Source: “U.S. employers covering weight-loss drugs could nearly double in 2024 – survey,” Reuters, Oct. 10).

The survey of 502 employers by Accolade, a company that provides healthcare programs for employers, and research firm Savanta said 43% of the employers it polled could cover GLP-1 drugs in 2024 compared to 25% that cover them now.

GLP-1s, short for glucagon-like peptide 1 agonists, are used to treat type 2 diabetes and weight loss. Nearly all the companies that are covering GLP-1 drugs plan to keep covering them next year, according to the survey.

Employers that cover weight-loss drugs are facing a spike in their healthcare costs because of their growing popularity. Sales of Novo Nordisk's Wegovy and its diabetes drug Ozempic have surged in the last year. Ozempic is being used "off label" for weight loss as well.

1 in 3 Medicaid recipients with opioid use disorder not receiving medication to treat it, federal report finds

A new federal report has found that more than half a million Medicaid recipients diagnosed with opioid use disorder did not receive medication to treat it in 2021 (Source: “A Third of Medicaid Recipients With Opioid Use Disorder Aren’t Getting Medication to Treat It,” New York Times, Sept. 29)

The report, released last week by the inspector general of the Department of Health and Human Services, examined the use of addiction treatments that almost all Medicaid programs are now required to cover, also found major disparities in medication rates across states, ages and racial groups. It said the Centers for Medicare & Medicaid Services, an agency of the Health and Human Services Department, should work to close the gaps.

“Medicaid is uniquely positioned to achieve these goals given that the program is estimated to cover almost 40% of nonelderly adults with opioid use disorder,” the report said.

The half-million people who did not receive treatment amounted to about one-third of all Medicaid recipients with opioid use disorder. The authors of the report expressed concern that, when a five-year mandatory coverage period issued by the federal government ends in September 2025, some states could again start restricting access.

The report also found that almost a quarter of Medicaid enrollees with opioid use disorder lived in New York, Ohio or Pennsylvania.

Graphic of the week

Click to enlarge

September is National Hispanic Heritage Month, and analysis from HPIO’s 2023 Health Value Dashboard has found that the uninsured rate for Hispanic Ohioans is 2.5 times worse than for white Ohioans, and Hispanic Ohioans are 2.4 times more likely than white Ohioans to be unable to see a doctor due to cost. If disparities were eliminated, 23,892 fewer Hispanic Ohioans would be uninsured and 32,000 fewer Hispanic Ohioans would face cost barriers to seeing a doctor, according to Dashboard analysis.

Included in the Dashboard are equity profiles, which explore gaps in outcomes among groups of Ohioans and analyze the barriers to health that contribute to these gaps. “Every Ohioan should have the opportunity to live a long and healthy life, free from environments and experiences that expose them to harm,” the report states. “However, many Ohioans continue to face unhealthy conditions and barriers to health in their homes, schools, workplaces and communities.”

Employer health costs expected to increase next year, healthcare consultants say

U.S. employers are bracing for the largest increase in health insurance costs in a decade next year, according to forecasts from healthcare consultants, but workers may be somewhat spared this time around in a tight labor market (Source: “US employers to see biggest healthcare cost jump in a decade in 2024,” Reuters, Sept. 20).

Benefit consultants from Mercer, Aon and Willis Towers Watson see employer healthcare costs jumping 5.4% to 8.5% in 2024, due to medical inflation, soaring demand for costly weight-loss drugs and wider availability of high-priced gene therapies.

A survey conducted by Mercer found over two-thirds of employers either do not plan to shift any cost increase to their staff or will pass on less than the expected rise in 2024.

U.S. consumer prices accelerated 3.7% in the 12 months through August, down from a peak of 9.1% in June last year. However, medical cost increases usually lag general inflation as contracts between insurers and hospitals for the prices of procedures are signed months or even a year in advance.

Rural Medicaid enrollees face additional challenges during Medicaid unwinding

Experts say that procedural disenrollments from Medicaid related to the end of the pandemic public health emergency could disproportionately affect people living in rural areas (Source: “How Will Rural Americans Fare During Medicaid Unwinding? Experts Fear They’re on Their Own,” KFF Health News, Sept. 20).

A brief recently published by researchers at the Georgetown University Center for Children and Families noted that rural Medicaid recipients face additional barriers to renewing coverage, including longer distances to eligibility offices and less access to the internet.

Having navigators in rural communities to help people in person is an ongoing challenge, said Joan Alker, who is one of the brief’s co-authors and the executive director of the Center for Children and Families. But the unwinding circumstances make it an especially important moment for navigators in guiding people through complex insurance processes, she said.

Medicaid-eligible people who are not enrolled more likely to delay care, face worse health outcomes

Adults who are eligible for Medicaid but not enrolled in the program are more likely to delay care due to costs, according to analysis released this week (Source: “Medicaid-eligible people who aren’t enrolled far more likely to delay care,” The Hill, Aug. 29).

The survey, published by the Urban Institute, found 21.4% of non-Medicaid enrolled individuals delay medical care due to the cost, compared to only 7.3% of enrollees and 9.5% of Medicaid-eligible individuals with private insurance.

Eligible but unenrolled adults were less likely than Medicaid enrollees to have visited a doctor in the last year, 23.4% compared to 65.4%. Unenrolled adults were also less likely to have a prescription filled, 27.8% to 67%, and less likely to have stayed in a hospital, 2.5% versus 12.6%. The analysis found uninsured Medicaid-eligible adults also spent more on out-of-pocket health expenses.

“Researchers conclude that being eligible for Medicaid does not equate to being covered by Medicaid or private insurance, as some have suggested,” a brief on the analysis stated. “People enrolled in health insurance face fewer obstacles and better outcomes.”

Graphic of the week


HPIO analysis has found that over the past decade, about 84% of the increase in spending on the Medicaid program in Ohio has been paid from federal funds, with the state accounting for 16% of the increase. As illustrated in the graphic above, between state fiscal years 2012 and 2022, total federal and state spending on Ohio’s Medicaid program grew by an average of 6.7% per year, from about $18.4 billion in SFY 2012 to more than $35 billion in SFY 2022.
The analysis was included in HPIO’s Ohio Medicaid Basics, a primer that provides an overview of the Medicaid program in Ohio. HPIO has released Medicaid Basics every two years since 2005.
The 2023 edition, which was released in May, includes information on Medicaid eligibility, covered groups and services, delivery systems, financing, spending and recent policy and programmatic changes.

Proposed state constitutional amendment on abortion access OK’d for November ballot

Ohio voters will decide this fall whether the right to an abortion should be added to the state constitution, after officials said this week that enough signatures were gathered to get the proposal on the ballot (Source: “Ohio voters will decide on abortion access in November ballot,” Associated Press, July 25).

However, it’s an open question how much support the amendment will need to pass, as Republican lawmakers have set a special election next month on whether to raise the threshold from a simple majority to 60%.

In language similar to a constitutional amendment that Michigan voters approved last November, the measure would require restrictions imposed past a fetus’ viability outside the womb — which is typically around the 24th week of pregnancy and was the standard under Roe v. Wade — to be based on evidence of patient health and safety benefits.

Secretary of State Frank LaRose determined Tuesday that Ohioans United for Reproductive Rights submitted nearly 496,000 valid signatures, comfortably enough to put the amendment before voters on Nov. 7. The coalition had submitted more than 700,000 signatures.

HHS investigation finds Medicaid contractors deny care at high rates

Private health insurance companies paid by Medicaid denied millions of requests for care for low-income Americans with little oversight from federal and state authorities, according to a new report by U.S. investigators published last week (Source: “Insurers Deny Medical Care for the Poor at High Rates, Report Says,” New York Times, July 19).

The report by the inspector general’s office of the U.S. Department of Health and Human Services details how often private insurance plans contracted with Medicaid refused to approve treatment and how states handled the denials.

The report emphasized the crucial role that state and federal officials should play to ensure the denials were justified. “People of color and people with lower incomes are at increased risk of receiving low-quality health care and experiencing poor health outcomes, which makes ensuring access to care particularly critical for the Medicaid population,” the investigators said.