Federal policy

Graphic of the week


New analysis from the Health Policy Institute of Ohio found that the number of firearm-involved deaths among Ohio children increased sharply in recent years, as illustrated above.
According to data from the Ohio Department of Health’s Ohio Public Health Data Warehouse, there were 104 deaths involving a firearm of children ages 0-17 in Ohio in 2022, or a rate of 4.05 deaths per 100,000 children. That is more than double the rate of 2007, when the death rate was 1.76 per 100,000 Ohio children.
What Works for Health, an online tool developed by the University of Wisconsin Population Health Institute to identify evidence-informed health policies, includes a number of potential options that local and state leaders can consider to increase firearm safety for children.

U.S. health officials urge more testing after syphilis cases surge among newborns


Alarmed by yet another jump in syphilis cases in newborns, U.S. health officials are calling for stepped-up prevention measures, including encouraging millions of women of childbearing age and their partners to get tested for the sexually transmitted disease (Source: “Syphilis cases in US newborns skyrocketed in 2022. Health officials suggest more testing,” Associated Press, Nov. 7).

More than 3,700 babies were born with congenital syphilis in 2022 — 10 times more than a decade ago and a 32% increase from 2021, the Centers for Disease Control and Prevention said Tuesday. Syphilis caused 282 stillbirth and infant deaths, nearly 16 times more than the deaths in 2012.

The 2022 count was the most in more than 30 years, CDC officials said, and in more than half of the congenital syphilis cases, the mothers tested positive during pregnancy but did not get properly treated.

The federal agency wants medical providers to start syphilis treatment when a pregnant woman first tests positive, rather than waiting for confirmatory testing, and to expand access to transportation so the women can get treatment. The CDC also called for rapid tests to be made available beyond doctors’ offices and STD clinics to places like emergency rooms, needle-exchange programs and prisons and jails.

Feds consider adding limits to ultra-processed foods in new dietary guidelines

The committee responsible for the federal government’s dietary guidelines is, for the first time, examining the link between poor health outcomes and ultra-processed foods (Source: “Dietary guidelines may soon warn against ultraprocessed foods,” Washington Post, Nov. 7).

Ultra-processed foods are Industrially manufactured foods that have unusual combinations of flavors, additives and ingredients, many of which are not found in nature. These include things like chicken nuggets, sweetened breakfast cereals, boxed macaroni and cheese, frozen dinners, potato chips and fast food.

In recent years, dozens of studies have found that people who consume a lot of ultra-processed foods have higher rates of cardiovascular diseasecancerdiabetes and other chronic diseases.

Nutrition experts say that highlighting ultra-processed foods in the upcoming guidelines could have a significant effect on the country’s diet and national food programs. The dietary guidelines help determine which foods can be served to the approximately 30 million American children who participate in the National School Lunch Program. The guidelines influence the food industry, food assistance programs, and agricultural production. They affect the types of meals served in government buildings and on military bases.

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.

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.

Hospitals push Congress to halt planned $8 billion reduction in Medicaid funding

Healthcare representatives from across the United States are urging Congress to halt cuts to funding that funds hospital care for uninsured or low-income patients who rely on Medicaid (Source: “Hospitals plead with Congress to avert $8 billion in cuts in Medicaid funding,” Ohio Capital Journal, Sept. 18).

More than 250 hospitals and health systems appealed to House and Senate leadership in a letter asking the lawmakers to avert or delay a forthcoming $8 billion cut to “America’s health care safety net.”

The reduction to the Medicaid disproportionate share hospital funding is scheduled for Oct. 1, as mandated under the Patient Protection and Affordable Care Act. The deadline comes as Congress faces partisan roadblocks to fund the government and renew a number of expiring federal programs by the end of the fiscal year, or Sept. 30.

The fund compensates hospitals that treat a disproportionate number of uninsured patients or low-income patients whose government-provided Medicaid coverage pays a lower rate than private insurance or Medicare. The ACA provision, written under the premise that rates of uninsured people would continue to decrease, requires $8 billion per year in cuts from 2024 to 2027.

CMC proposes increased staffing standards for nursing home

The nation’s most thinly staffed nursing homes would be required to hire more workers under new rules proposed last week by the Biden administration, the greatest change to federal nursing home regulations in three decades (Source: “Federal Officials Propose New Nursing Home Standards to Increase Staffing,” New York Times, Sept. 1).

The proposed standard was prompted by the industry’s troubled performance earlier in the coronavirus pandemic, when 200,000 nursing home residents died. But the proposal falls far short of what both the industry and patient advocates believe is needed to improve care for most of the 1.2 million Americans in nursing homes.

The proposal, by the Centers for Medicare and Medicaid Services (CMS), would require all facilities to increase staff up to certain minimum levels, but it included no money for nursing homes to pay for the new hires. CMS estimated that three-quarters of the nation’s 15,000 homes would need to add staff members. But the increases at many of those facilities would be minor, as the average nursing home already employs nurses and aides at, or very close to, the proposed levels.

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.

U.S. must tackle mental health, addiction crises simultaneously, top federal official tells Congress

At a House oversight hearing this week, the Biden administration’s top drug policy official emphasized the need to address both mental illness and drug addiction simultaneously to reduce fentanyl deaths (Source: “Mental illness, drug addiction go hand in glove, Biden’s drug czar tells lawmakers,” Stat News, July 27).

Rahul Gupta, the director of the White House Office of National Drug Control Policy, testified that “mental illness and drug addiction go hand in glove,” emphasizing that “it’s really important that we address both mental health, social isolation as well as addiction.”

Tackling these dual crises is an ongoing effort in Congress, with the Bipartisan Mental Health and Substance Use Disorder Task Force passing seventeen bills co-led by a Democrat and Republican in the previous 117th Congress.

Areas of bipartisan interest included addiction treatment in the criminal justice system, with both Rep. Anna Paulina Luna (R-Fla.) and Rep. Maxwell Frost (D-Fla.) inquiring about rehabilitation programs. Released inmates are 129 times more likely to die from overdose within two weeks after release as compared with other residents, Gupta pointed out.