If you care about Medicaid, vote on November 6th with Medicaid in mind. Consider how candidates for representatives in the West Virginia statehouse and in the U.S. Congress stand on Medicaid. Some candidates have pledged to repeal the Affordable Care Act - that means the Medicaid expansion. Others understand that Medicaid is vital for one-third of West Virginians - as the source of affordable health care, as the key payer for opioid addiction prevention, early intervention, and treatment, and as a generator of jobs in our economy
Do your research. Do your homework. Ask questions. Be informed. Participate in democracy. Voting does matter.
And you are not alone.
A new report by the nonpartisan Government Accountability Office was released yesterday, showing that low-income adults in states that expanded Medicaid report better access to health care. The New York Times reports on key findings:
- Nearly 20 percent of low-income people in states that did not expand Medicaid said they passed up needed medical care in the past 12 months because they couldn't afford it. That compared to 9.4 percent in states that expanded the program.
- About 8 percent of those in states that did not expand Medicaid reported they either skipped medication doses to save money or took less medication than prescribed. That compared to about 5 percent in states that expanded. For people with chronic conditions such as high blood pressure, diabetes and asthma, staying on a medication schedule is considered essential.
- About 22 percent of those in states not expanding Medicaid said they needed but could not afford dental care, as compared to 15 percent of similar low-income adults in expansion states.
- About 11 percent of those in non-expansion states said they needed to see a specialist but weren't able to afford it, as compared to about 6 percent of those in expansion states.
Individuals with disabilities are significantly more likely to be employed in states that have expanded Medicaid coverage as part of the Affordable Care Act, new research from the University of Kansas has found. Similarly, individuals who report not working because of a disability have significantly declined in expansion states, while neither trend happened in states that chose not to expand Medicaid. West Virginia - one of the first states to expand Medicaid under the Affordable Care Act - was included in the states studied.
The trends have broad policy implications as many states are considering work requirements for Medicaid eligibility, and they also have the potential to show similar employment benefits for individuals without disabilities. "In effect, Medicaid expansion is acting as an employment incentive for people with disabilities," the researchers wrote.
The study, authored by Jean Hall, professor of applied behavioral science and director of KU's Institute for Health and Disability Policy Studies; Adele Shartzer of the Urban Institute; Noelle Kurth, senior research assistant in KU's Institute for Health and Disability Policy Studies; and Kathleen Thomas of the University of North Carolina, was published in the American Journal of Public Health.
PERCENTAGE OF INDIVIDUALS WITH DISABILITIES IN MEDICAID EXPANSION STATES REPORTING EMPLOYMENT AND NOT WORKING BECAUSE OF DISABILITY
From one of West Virginia Together for Medicaid's national partners, Community Catalyst:
2018 Ohio Medicaid Group VIII (Medicaid Expansion Population) Assessment – This August 2018 report (executive summary here) from the Ohio Department of Medicaid highlights how Medicaid expansion has positively impacted enrollees (sometimes referred to as “Group VIII”). The findings show that Medicaid helps people to get and stay healthy, and provides family stability, employment opportunity, and financial security.
Of particular note are the 290,000 people who received Medicaid benefits post-expansion that have since left the rolls because they were started working or began earning more. Most of the recipients told the state that having insurance helped them find or keep their job. Some additional findings:
- Family Stability- More than three-fourths (75.7%) of the continuously enrolled expansion population studied who are family caregivers reported that Medicaid made it easier for them to care for their family member(s), as did more than four-fifths of parents (81.6%).
- Employment Opportunity- A large majority of employed Medicaid expansion enrollees (83.5%) reported that Medicaid made it easier to work; most unemployed enrollees (60.0%) reported that Medicaid made it easier to look for work. Many Group VIII enrollees reported that Medicaid made it easier to work because they were able to obtain care for previously untreated health conditions. In the words of one enrollee: “[Medicaid] allows me to get surgery which has allowed me to return to work.”
- Physical Health- When asked what Medicaid meant to them, 35.7% of survey respondents specifically mentioned either their health or access to care. In the words of one respondent: “If it wasn’t for Medicaid, I would not have been able to pay for surgery that was needed for a heart condition I was born with.”
- Health Risk Behaviors- More than one third (37.0%) of Medicaid expansion enrollees who quit smoking in the last two years said that Medicaid helped them to quit. This translates to approximately 26,000 Ohioans.
Ohio state officials released a report on Tuesday showing Medicaid expansion has reduced the uninsured rate, and has made it possible for people to continue working or seek jobs. Like West Virginia, Ohio expanded Medicaid in 2014.
Dr. Akram Boutros, a fellow of the American College of Healthcare Executives, is president and CEO of The MetroHealth System in Cleveland. His commentary in the Cleveland Plain Dealer is worth a read.
CLEVELAND -- You might know Mary. Maybe you shop at the same grocery store, belong to the same church or have the same favorite Indians player.
Mary takes medication to control her diabetes. A few years back, she lost her job and could no longer afford her medicine or her regular visits to the doctor.
When her symptoms got bad, she got scared and went to the emergency room. It happened more than once.
Then, in 2014, Ohio expanded Medicaid, the government program that provides health coverage to low-income adults, children, pregnant women, the elderly and the disabled.
Mary qualified for the expansion and was able to find a primary care doctor at MetroHealth. She got back on her medication and regained her health. Then she found a new job.
We learned this past week that her story is not unusual. There are at least 290,000 people just like Mary in Ohio - folks who got coverage through Medicaid expansion and then unenrolled when they found a new job or saw their income rise.
That statistic is part of a new Ohio Department of Medicaid report measuring the impact of the 2014 expansion. The findings reveal lots of good news: Expanding the program has slashed the uninsured rate; it's improved the health of enrollees; and it's eased financial worries for Ohio families.
But the most significant news from the report is that Medicaid expansion hasn't done many of the things opponents predicted it would:
* It hasn't become a lifelong entitlement. As Mary and the hundreds of thousands of people just like her show, coverage through expansion is often a temporary benefit. Since 2014, almost 1.2 million Ohioans have received coverage. Almost 500,000 of them are no longer on Medicaid.
* It hasn't diminished recipients' motivation to work. In fact, it's increased it. Fifty percent of recipients are now employed, compared to 43 percent in 2016. Significant majorities of enrollees say coverage has either made it easier to work or easier to look for work.
* It hasn't blown up the budget. During a presentation of the report's findings on Wednesday in Cleveland, Ohio Budget Director Tim Keen revealed that each recipient of Medicaid expansion costs the state less than $21 a month. "Medicaid expansion is manageable and affordable," he said, "now and into the future."
MetroHealth saw how well expansion could work before almost anyone. In 2013, a year before the state expanded coverage, the federal government gave us permission to see how it might work in practice. The program, called CarePlus, offered health coverage to about 30,000 uninsured Cuyahoga County residents. The results were better than we expected: Enrollees saw significant improvements in care and outcomes, and the cost of caring for them came in about 30 percent below the government's estimate.
Last week's report is more proof of what we at MetroHealth have seen firsthand. Medicaid expansion has proven to be a lot like a lifeguard: When members of the community start to splash and sink because of a lost job, a sick relative or a sudden crisis, expanded coverage is there to help them, to pull them onto solid footing, allow them to catch their breath - and then dive back into work and life.
We should all feel a bit more comfortable knowing that Medicaid expansion is protecting our community pool.
Lots of people deserve credit for the success of Ohio's Medicaid expansion. Two of the most deserving are Gov. John Kasich and Department of Medicaid Director Barbara Sears. Both went against the wishes of many of their fellow Republicans and saw the true conservative benefits - controlled costs, personal responsibility, moral imperatives - of Medicaid expansion. Because of their courage and determination, life is better for hundreds of thousands of Ohio families. That's quite a legacy.
I'll speak for those families, for Mary and for those of us fortunate enough to have not needed Medicaid expansion: Thank you.
Let's all work to make sure the next resident of the governor's mansion knows the importance and success of this program - and that he keeps the lifeguard on duty.
Any caregiver or guardian for a child or adolescent on Medicaid should know about EPSDT- the Early and Periodic Screening, Diagnostic and Treatment benefit. EPSDT provides comprehensive health preventive and treatment services for all children under age 21 who are enrolled in Medicaid. It is a guarantee that children and adolescents receive all of the physical and mental health care that they need when they need it.
In West Virginia, the Medicaid EPSDT program is called “HealthCheck.” More information about HealthCheck is online here.
Here is what that hard-to-remember benefit stand for:
Early – EPSDT benefit covers a range of testing to identify any health problems early.
Periodic – The benefit provides a systematic approach to check the child’s overall health at periodic, age-appropriate intervals.
Screening – EPSDT provides physical, mental, developmental, dental, hearing, vision, and other screening tests to detect any potential health-related problems. Screening services include:
- Comprehensive health and developmental history
- Comprehensive unclothed physical exam
- Appropriate immunizations
- Laboratory tests
- Health education (guidance including child development, healthy lifestyles, and accident and disease prevention)
- Vision services
- Dental services
- Hearing services
Diagnosis – Based on screening findings, EPSDT covers diagnostic tests to follow up whenever a health risk is identified. When a screening examination indicates the need for further evaluation of a child’s health, then diagnostic services must be provided. Necessary referrals are expected to be made without delay and there should be follow-up to ensure the enrollee receives a complete diagnostic evaluation.
Treatment – When a screening examination indicates the need for further evaluation of a child’s health, then diagnostic services must be provided. The Medicaid program must cover services necessary to control, correct or reduce any health problems found in children and youth in the screening and diagnostic process, by financing a very broad range of appropriate and necessary pediatric services.
There are few limits to the EPSDT benefit. Services need to be deemed “medically necessary” by a qualified health practitioner. The concept of medical necessity in EPSDT is intentionally expansive, consistent with promoting children’s healthy development and maximizing their health and function. Service limits that state Medicaid programs may impose on adults, such as a limit on therapy sessions, or a maximum number of prescriptions per month, cannot be applied to children.
If requested, states must also offer the enrolled youth or family assistance with scheduling appointments, or with transportation, to access the services to which the child is entitled. Furthermore -- for very young children, for example -- services may be provided directly to the parent or caregiver, on behalf of the enrolled child, to address the identified healthcare need of that child, without regard to the Medicaid eligibility status of that parent or caregiver.
The EPSDT provisions in the Medicaid program require West Virginia to:
- Inform all Medicaid-eligible individuals under age 21 that EPSDT services are available;
- Inform them of the need for age-appropriate immunizations;
- Provide or arrange for the provision of screening services for all children;
- Arrange (directly or through referral) for corrective treatment as determined by child health screenings; and
- Report EPSDT performance information to CMS annually.
Assistance Finding a Doctor or Other Provider. The West Virginia Medicaid programs must provide Medicaid enrolled children or their parents/guardian with referral assistance for any treatment services their providers might not cover, that are found to be needed because of conditions identified or disclosed during the screening and diagnostic processes. Specifically, such referral assistance must include giving the family or recipient the names, addresses, and telephone numbers of providers who will furnish services at little or no expense to the family.
EPSDT rules also require West Virginia to make available a variety of individual and group providers qualified and willing to provide EPSDT services in all areas of the state. West Virginia must also make appropriate use of state health, vocational rehabilitation and maternal and child health programs, as well as other public health, mental health, and education programs and related programs, such as Head Start, Title XX (Social Services) programs, and the Special Supplemental Food Program for Women, Infants and Children (WIC), to provide an effective and comprehensive child health program.
A new lawsuit argues that imposing work requirements in Medicaid is “threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country.”
One of West Virginian Together for Medicaid’s national allies, The National Health Law Program, filed the lawsuit against the Trump administration this week for approving work requirements in Arkansas. The lawsuit asserts that Medicaid work requirements are not within the Trump administration’s authority under the Medicaid statute without action from Congress. In June, a federal judge blocked similar Medicaid work requirements in Kentucky, the first court test for the Trump administration’s initiative.
It is likely that this issue will end up before the U.S. Supreme Court. The Court will have to decide about the future of the Medicaid program and whether the President and the Executive branch alone – without action by Congress – can undermine the statutory purpose of Medicaid and add new eligibility restrictions to Medicaid.
If Brett Kavanaugh is confirmed as a new U.S. Supreme Court Justice, many consumer protections for Medicaid enrollees could be lost. (See more about Judge Kavanaugh and the critical vote of Senator Manchin here and here.)
We worry that if our state moved in this direction, West Virginia Medicaid enrollees could be harmed by a work requirement. Not for failing to work if they are deemed capable, but by simply failing to meet reporting requirements.
"However, since one in three Medicaid adults never use a computer or the internet and four in ten do not use email, many enrollees would face barriers in complying with work reporting requirements to maintain coverage," according to a new Kaiser Family Foundation brief.
According to the West Virginia Department of Health and Human Resources (DHHR), 66% of adult and child Medicaid enrollees in WV are in families with a worker. They are servers in restaurants, home care workers, retail workers, child-care workers and others. Some enrolled in the Medicaid expansion don’t work for wages but take care of elderly parents or children. Others are in school or looking for work or they are in-between jobs. Still others have chronic health problems, a mental illness or substance abuse disorder that makes it difficult to work. Many of these workers have seasonal jobs or other types of employment with fluctuating hours and/or temporary lay-offs.
New data released by the state of Arkansas this week show Medicaid enrollees who are subject to the work requirement struggle to comply. The data show that those who must tell the state what they're doing to meet the requirement are overwhelmingly failing to do so.
In July — the second month in which the work requirements were in effect — 12,722 people either failed to report their activities to the state or didn't meet the 80-hour-a-month requirement.
The vast majority of those people — about 12,587 — didn't log on to the state's Medicaid website and report their activities. The remaining 135 people did report their activities but failed to meet the 80-hour threshold.
A new study released Monday afternoon by Health Affairs found that in states that expanded Medicaid, there was a 40 percent increase in patients filling their diabetes prescriptions. The chronic health condition, which requires daily medication to maintain, is prevalent among West Virginians of all incomes. The price of insulin has increased sharply in the last decade. Untreated, diabetes can lead to more serious complications like kidney damage or heart disease.
As reported by Kaiser Health News, the study “shows that the Medicaid expansion can help patients manage their health and also limit unnecessary spending. An analysis by the Centers for Disease Control and Prevention cited by the study shows that each diabetic patient who is treated for the condition can lead to a $6,394 reduction in health care costs (in 2017 dollars) because of fewer hospital admissions.”
In March, Secretary of Commerce Wilbur Ross directed the Census Bureau to add a citizenship question to the 2020 census. This proposal discourages participation, threatening the accuracy of the count and goes directly against the vital need to address the census’ historical under-counting of immigrants, low-income people, people of color and other under-served communities. Census data are used to appropriate hundreds of billions of dollars in federal funds for critical health and social programs, including Medicaid.
What Health Advocates Can Do
Submit a comment letter to the Department of Commerce urging Secretary Ross to remove the citizenship status question from the Census. Submit your comments online HERE by August 7.
West Virginians Together for Medicaid strongly opposes the addition of a citizenship question to the 2020 Census. Asking an untested question about citizenship status will increase fear in immigrant communities – among people with undocumented status, legal non-citizen status and U.S. citizens alike – and decrease Census participation
We believe a full, fair and accurate census and the collection of useful, objective data about our West Virginia communities is very important. The federal government uses census-derived data to direct at least $800 billion annually in federal assistance to states, localities and families. About 61% of all funding guided by Census data is related to health programs. A full, fair and accurate census is critical for the functioning of many key health programs and for the health and well-being of all West Virginia communities.
We are particularly concerned about the impact on funding for Medicaid and the Children’s Health Insurance Program (CHIP), which improve access to care and health outcomes and reduce disparities. The data used to calculate the federal funding states receive to run their Medicaid and CHIP programs are derived from the Census, so any systematic undercounting of low-income communities could put Medicaid and CHIP funding in jeopardy. Any cuts to funding would almost certainly translate to fewer services for people receiving coverage through these programs, putting access to care and health outcomes at risk for low-income children, adults and people with disabilities, including citizens.