Access to care

Advocates push state to use more federal dollars for school-based health clinics

Ohio child advocacy groups and doctors are pushing for more state funding to add additional school-based health clinics in the state (Source: “Child advocacy groups, doctors want to see more state funding for school-based health clinics,” News 5 Cleveland, Oct. 20).

The Children’s Defense Fund-Ohio and other child advocacy groups are asking the state to allocate $25 million from the American Rescue Plan Act for the next two years to help set up clinics for additional districts in the state.

Ohio received about $5 billion from the federal government as part of the American Rescue Plan Act. So far, about $3 billion has yet to be allocated. According to the Treasury Department, funds must be incurred by Dec. 31, 2024.


Study finds mortality improvements after rural hospitals merge

A new study published this week in JAMA Network Open found improved mortality rates across multiple common conditions when compared to equivalent facilities that remained independent (Source: “Rural hospitals saw mortality improvements after acquisition deals, study finds,” Fierce Healthcare, Sept. 21).

“The findings of this study regarding the positive outcomes associated with mergers in rural hospital quality challenge a common argument in prior research that hospital consolidation is likely to result in greater market power and higher prices but poorer quality,” researchers from the Agency for Healthcare Research and Quality and IBM Watson Health wrote in the journal.

The researchers noted that their findings differed from other studies that monitored quality changes following consolidation within urban markets, which found either no change or a decline following hospital acquisition.

The difference, they theorized, could be that rural hospital mergers more often allow these facilities “to improve quality of care through access to needed financial, clinical and technological resources, which is important to enhancing rural health and reducing urban-rural disparities in quality. This hypothesis needs to be assessed using data sources that capture data both on quality and hospital resources,” the researchers wrote.


Ohio to push for reinstatement of Medicaid work requirement

Ohio will appeal a move by the Biden administration to rescind federal approval of a work requirement that the state wants to use to determine Medicaid eligibility, Gov. Mike DeWine announced Thursday (Source: “Ohio seeks to reinstate Medicaid work requirement in appeal to Biden administration move,” Columbus Dispatch, Sept. 9).

Attorney General Dave Yost filed a notice of appeal with the Centers for Medicare & Medicaid Services weeks after the agency withdrew its approval for the "community engagement" requirement. The measure would require all new adult group beneficiaries under 50 years old to complete 80 hours per month of employment, education or job skills training.   

Federal officials approved Ohio's requirement under former President Trump in 2019, but the COVID-19 pandemic prevented it from going into effect this year. DeWine and other Republicans say it's necessary to encourage self-sufficiency and relieve the burden on taxpayers.


COVID vaccination rates for Medicaid enrollees lag overall population

Medicaid enrollees are getting vaccinated against COVID-19 at far lower rates than the overall population as states search for the best strategies to improve access to the shots and persuade those who remain hesitant (Source: “Medicaid vaccination rates founder as states struggle to immunize their poorest residents,” Kaiser Health News via Ohio Capital Journal, Sept. 1).

Efforts by state Medicaid agencies and the private health plans that most states pay to cover their low-income residents have been challenging amid a lack of access to state data about which members are immunized. The problems reflect the decentralized nature of the health program, funded largely by the federal government but managed by the states.

It also points to the difficulty in getting the message to Medicaid populations about the importance of the COVID vaccines and the challenges they face getting care.


States begin lifting temporary telehealth rules waivers

States have begun rolling back pandemic workarounds for telehealth that temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located (Source: “Telehealth’s Limits: Battle Over State Lines and Licensing Threatens Patients’ Options,” Kaiser Health News, Aug. 31).

At least 17 states, including Ohio, still have waivers in effect, according to a tracker maintained by the Alliance for Connected Care, a lobbying group representing insurers, tech companies and pharmacies.

As those rules end, “it risks increasing barriers” to care, said Dr. Brian Hasselfeld, medical director of digital health and telemedicine at Johns Hopkins.

The rollbacks come amid a longer and larger debate over states’ authority around medical licensing that the pandemic — with its widespread adoption of telehealth services — has put front and center.

“Consumers don’t know about these regulations, but if you all of a sudden pull the rug out from these services, you will definitely see a consumer backlash,” said Dr. Harry Greenspun, chief medical officer for the consultancy Guidehouse.


Increased access to care insufficient for closing racial health gap, new studies find

A series of studies in the Journal of the American Medical Association found that while access to care has improved in recent years, the racial health gap has remained (Source: “Racial Inequities Persist in Health Care Despite Expanded Insurance,” New York Times, Aug. 17).

The new issue of JAMA offers studies on disparities in the utilization of health care services and in overall health spending. Together, the findings paint a portrait of a nation still plagued by medical haves and have-nots whose ability to benefit from scientific advances varies by race and ethnicity, despite the fact that the ACA greatly expanded insurance.

The racial health gap did not significantly narrow from 1999 to 2018, despite decreases in uninsured rates due to the passage of the Affordable Care Act, according to one study whose author said it was tantamount to “a comprehensive national report card.”

Despite innovations like Medicare Advantage, which increased access to health care overall, Medicare beneficiaries who are minorities — defined as Black, Hispanic, Native American or Asian-Pacific Islander — still have less access than white or multiracial individuals to a physician who is a regular source of care.

Overall, Black women face a much higher risk of dying from pregnancy complications than white women, with maternal mortality rates of 41.7 per 100,000 live births for Black women, compared with 13.4 per 100,000 live births for white women.


Biden administration revokes permission for Ohio Medicaid work requirements

The federal Centers for Medicare and Medicaid Services told the Ohio Department of Medicaid this week that it cannot proceed with its plans to require some people on the health coverage program to work to keep their coverage (Source: “Biden administration nixes Ohio’s Medicaid work requirements,” Cleveland Plain Dealer, Aug. 11).

In a 23-page letter, sent to the state on Tuesday, CMS says that work requirements do not “ promote the statutory objectives of Medicaid” because they would likely result in thousands of people losing coverage.

This is a change from the administration of former President Donald Trump, which had approved the state’s work requirements program in 2019. The Ohio Department of Medicaid was directed to submit a work requirement program by the Ohio General Assembly in the 2017 budget bill.

Work requirements were supposed to begin Jan. 1, but were postponed because of the coronavirus pandemic.


Medicare eligibility drives down racial disparities, study finds

Access to Medicare may help address racial disparities in insurance coverage, access and self-reported outcomes, according to a new study (Source: “Medicare eligibility erases many healthcare disparities in US,” Healthcare Dive, July 26).

The research, published in JAMA Internal Medicine, tracked more than 2.4 million Americans and found that immediately after turning 65, and thus becoming eligible for Medicare, coverage for Black respondents increased from 86.3% to 95.8%. Among Hispanic respondents, coverage increased from 77.4% to 91.3%.

The JAMA study has validated the importance of Medicare in terms of leveling the playing field for Americans when it comes to healthcare access — a gap that has been exacerbated by the COVID-19 pandemic. Whereas there are significant gaps in access to healthcare and disparities among ethnic groups, reaching Medicare age wipes much of them out.

Disparities in insurance coverage were cut by 53% between Black people and white people, and 51% for Latino people versus white people. The proportion of Black and Latino people who self-reported their health as poor also dropped significantly after they became eligible for Medicare.


Ohio Senate pushes for another re-bid of Medicaid managed care contracts

After a more-than-two-year effort to overhaul Ohio's Medicaid managed care system, state senators are asking for what could amount to a redo of the whole thing (Source: “Ohio announced huge contracts for companies to handle Medicaid managed care. Lawmakers want a redo,” Columbus Dispatch, June 3).

The state in April had chosen six companies to handle Medicaid for most Ohio enrollees. But at least two of the companies who lost out on contracts filed complaints against the Ohio Department of Medicaid.

Those complaints have turned into legislative action.

Senate Republicans on Tuesday inserted language into the state budget bill requiring the state to complete a new procurement process, with the stipulation that new contracts with Medicaid managed care organizations must include those based in Ohio.


Wealthier counties in Ohio also have highest COVID vaccine rates

ounties in Ohio with the highest incomes also have the highest vaccination rates, according to analysis from the Columbus Dispatch (Source: “Wealthier Ohio counties more likely to have higher COVID vaccination rates,” Columbus Dispatch, April 19).

The Dispatch found a 27-percentage point difference in vaccination rates between Ohio's wealthiest and poorest counties. Delaware County, the wealthiest county in the state, is also the most vaccinated against COVID-19.

The connection does not come as a surprise to most experts who see it as a result of long-term disparities in health care.

In Ohio, vaccines were distributed to each county mostly based on population and a few risk factors. But the state didn't require Ohioans to get their shots in their counties of residence, meaning people with the time and the means could travel to get vaccinated.

People with more flexibility in their jobs tend to make more money and have good access to transportation, said HPIO President Amy Rohling McGee. That translates to more access to COVID-19 shots and health care services as a whole, she said.