A Tough Roe to Hoe: How Republican Policies are Leaving Rural Health Care in the Dust, is a new report released this week by one of West Virginians Together for Medicaid’s many collaborating organizations, Protect Our Care. The report finds that since 2010, 84 rural hospitals have closed. The vast majority – 90 percent – were in states that had refused to expand Medicaid at the time of the hospital’s closure. And remember that the Medicaid expansion is a bargain for the states - the federal government pays at least 90 percent of the costs of the program.
In West Virginia, our legislature had the wisdom and the compassion to be one of the first states to expand Medicaid. The Medicaid expansion in 2014 has allowed more than 180,000 West Virginia adults – of which about 2/3rds work but don’t have health insurance benefits at their low-wage jobs – have quality and affordable health insurance. With Medicaid, these West Virginians can go to a doctor and get the medical care they need to stay healthy and productive.
- uncompensated care costs fell 43%
- Medicaid revenue as a share of total hospital revenue rose 33%
- operating margins increased by 4 percentage points (difference between total revenues & operating costs)
There is no question that the Medicaid expansion in West Virginia has been a life-line for our rural hospitals.
During the 2018 West Virginia legislative session, a couple rumors circulated about proposals to change the non-emergency medical transportation (NEMT) benefit in our state's Medicaid program. For a rural state like West Virginia, this is a critically important benefit. Luckily, these proposals did not gain traction and the NEMT benefit remained intact.
For example, a woman on Medicaid diagnosed with breast cancer who is getting treatment at WVU hospital's Betty Puskar Breast Cancer Center is able to getstate-of-the-art care and treatment. However, if she lives in the Eastern Panhandle or in the southern counties of our state, she can face a long drive - 3 hours or more - to receive that treatment. The cost of gas alone can be more than a patient can afford.
For others, just getting to the local doctor can be challenging because they don't have a car and family members work and can't just take off to help.
Here's some facts about the non-emergency medical transportation benefit in Medicaidand and why it is a good investment for West Virginia.
NEMT is Cost-Effective
A study of non-emergency medical transportation and health care access found that NEMT benefits are cost-effective or cost-saving for all 12 medical conditions analyzed, such as prenatal care, asthma, heart disease and diabetes.
While NEMT makes up less than one percent of total Medicaid expenditures, emergency room visits result in 15 times the cost of routine transportation.
Another estimate calculates $11 saved for up to each dollar spent on NEMT if one percent of total medical trips resulted in avoiding an emergency room visit.
NEMT Benefits Help Medicaid Expansion Populations Access Important Preventive Services
An independent evaluation of Indiana’s NEMT waiver found that transportation was identified by the largest proportion of members as the “most common” reason for missing an appointment.
Expansion populations are more likely to use the benefit to access cost-effective preventive services than traditional Medicaid populations.
Transportation Barriers Lead to Delayed or Missed Care for Consumers
Evidence shows that adults who lack transportation to medical care are more likely to have chronic health conditions and without adequate transportation, these conditions are likely to go unmanaged and eventually lead to costly emergency care and treatment that could have been prevented.
A January 2016 report by the United States Government Accountability Office concluded that the NEMT benefit “can be an important safety net for enrollees as research has identified the lack of transportation as affecting Medicaid enrollees’ access to services.”
On Wednesdays, West Virginians Together for Medicaid will feature a blog for Medicaid Policy Wonks....you know who you are!
With help from our national allies, we will feature a deeper dive into federal and state Medicaid proposed policy changes and bills.
Today we are featuring a new issue brief by the Center on Budget and Policy in Washington, DC that takes a look at the Medicaid bills that are part of the package of legislation addressing the opioid epidemic that the House is considering over the next two weeks.
While not a comprehensive approach to the opioid epidemic, several of the Medicaid provisions likely to reach the House floor would take small but positive steps toward increasing provider capacity, ensuring a full continuum of care, and preventing people with SUDs from experiencing gaps in treatment. But the costliest of the bills, which would allow Medicaid to pay for institutional care, goes in the opposite direction: it could undermine current state and federal efforts to ensure that people with SUDs have access to the full continuum of SUD treatment. READ MORE ABOUT THIS NEGATIVE PROPOSAL
We can fight opioid abuse by expanding Medicaid: this opinion piece by a small-town North Carolina chief of police underscores the role that Medicaid expansion plays in helping to fight the opioid use epidemic.
"Coming face-to-face with this epidemic has shown me opioid use disorders can ensnare anyone. It is happening right here in our communities to families from all walks of life. Most people with opioid use disorders want badly to escape their substance use disorder, but breaking the bonds of opioid use disorder usually requires not only remarkable grit and resolve but also professional treatment...."
"After Vice President Mike Pence [expanded Medicaid] when he was governor of Indiana, his Department of Health said, 'A lack of health insurance was one of the first barriers to testing and treatment...[health insurance coverage] helped address that gap and opened door to medical care and treatment that have been life-changing.' "
A new study led by a Boston University School of Public Health researcher Megan Cole finds the first two years of Medicaid expansion under the ACA, 2014 and 2015, bolstered the quality and receipt of care for millions of low-income patients, especially those in rural areas.
The study, published in the June issue of Health Affairs, looked at community health centers, which mostly serve low-income and disproportionately uninsured patients. The researchers found community health centers in expansion states saw an 11.44 percentage point decline in uninsurance, compared with similar community health centers in non-expansion states. Rural community health centers also showed improvements in asthma treatment, body mass index screening and follow-up, and hypertension control, along with substantial increases in 18 types of visits—particularly for mammograms, abnormal breast findings, alcohol-related disorder, and other substance use disorders.
At rural community health centers, Medicaid expansion was associated with approximately 437,000 visits for depression, 141,000 visits for Pap testing, and 457,000 visits for hypertension over the two-year period.
Community health centers in rural areas also saw improvements over their non-expansion counterparts in several treatment areas, including a 3.5 percentage point increase in patients with asthma receiving appropriate pharmacologic treatment, and a a 6.7 percentage point increase in adults receiving a BMI screening and follow-up if needed. The researchers also found a 2.1 percentage point increase in blood pressure control for hypertensive patients, with the greatest relative gains in this area seen among Hispanic patients in rural areas, who had a 5.2 percentage point increase.
The authors wrote that they may not have seen an association between more visits and Medicaid expansion at urban community health centers because patients in urban areas have greater access to other providers, whereas rural patients have fewer choices and so are more likely to continue going to a community health center when they gain insurance coverage.
“Hopefully policymakers are attentive to the fact that scaling back eligibility could reverse these important gains,” Cole says.
If you are reading this and you rely on Medicaid, consider Sharing Your Story through this website. Our new Story Collection Coordinator, Lara Foster, will follow up with you privately and talk with you about opportunities to share your story publicly. She can help you write your story or present it to others. You will control how and when your story is used to educate the public and law-makers.
Another way to share your story is by writing an Op-Ed (Opinion Editorial) or LTE (Letter to the Editor) and sending it to your local paper. Our Op-Eds and LTEs – Just Do It fact sheet can help you draft and submit your own Op-Ed or LTE. West Virginians Together for Medicaid is about bringing the voices of individuals in our state who rely on Medicaid forward to educate the public and lawmakers. With one-third of West Virginians enrolled in Medicaid at some time during a year, the program is a life-line for family, friends, and neighbors. If you live in West Virginia, you know someone on Medicaid – even if you don’t realize it.
We are at a defining moment in our country as more and more people rely on Medicaid for affordable, quality health care even as opponents push out ugly misperceptions about the program and the people who rely on Medicaid. We are seeing Medicaid threatened with funding cuts and harmful changes again and again. To save Medicaid, it is critical that we showcase the human stories of individuals and families benefiting from the Medicaid program – low-income children, pregnant women, people with disabilities, seniors, families with a loved-one who needs long-term care, and people who work lower-wage jobs with no health benefits.
Funny wonky name, huh? Here's the answer: The West Virginia Medicaid Substance Use Disorder (SUD) 1115 Waiver gives our state a set of new tools to fight the opioid addiction crisis confronting our rural communities. The federal Secretary of Health and Human Services can let states deviate from certain Medicaid rules when necessary to implement demonstration projects (also called section 1115 waivers) that further Medicaid’s core objectives, including improving coverage or beneficiaries’ health outcomes. Following guidelines developed by the Obama Administration, West Virginia was the first state to submit and be approved for a SUD 1115 waiver. The waiver allows West Virginia to cover critical SUD treatments and services with federal Medicaid matching dollar by:
Paul Smith, long-time West Virginia advocate for the rights of people with disabilities, has worked closely with WV Together for Medicaid to protect the program from federal and state attacks and funding cuts. His OpEd today in the Charleston Gazette addresses the right of people with disabilities to live independently and productively. Medicaid pays for critical supports that help people with disabilities stay in their homes and live in the community. West Virginia has made progress eliminating and shortening waiting lists for these services - but more funds are still needed. And remember - for every $1 the state invests in Medicaid, the federal government provides $2.9 in matching funds.
"....Who of us without a disability would ever choose to live our adult life in a segregated group setting where we make no choices about where we live, who lives with us, or what our own daily activities will be?
For West Virginia to regress to any form of institutional care, whether it be in a large group home or a segregated community, is inhumane treatment of vulnerable individuals.
Institutional care is, ironically, often proposed by well-intentioned individuals as the safest option possible; but, in fact, it has always eventually resulted in being the worst and most dangerous option. West Virginia should work harder to see that supports to succeed at home or on the job are appropriate and meet the individual needs of people with disabilities....
To take any steps backward in this day and age is unimaginable and would be a tragic loss for all West Virginians. With waiting lists for Waiver services, no new funding to address them and increased funding for institutional services, we must change direction. We must move forward, not backward.
We must ensure that the civil rights of individuals with disabilities are protected; that people are not placed in settings that isolate them from the broader community; that individuals have choices, have control over their own lives, are integrated in and have full access to the greater community...."
3.5 million women in the United States are living with a history of breast cancer. Approximately 1 in 8 women will be diagnosed with breast cancer during their lifetime. In 2018, there will be an estimated 266,000 new cases of female breast cancer and 40,920 deaths attributable to breast cancer, according to a new fact sheet on breast cancer screening and prevention from the Kaiser Family Foundation.
Breast cancer is the most common cancer among West Virginia women, making up almost 25% of all female cancers. The majority of breast cancers are found in women; however, it does occur in men. Getting a routine breast cancer screening is the best way to lower your risk of dying from breast cancer. Screening can help find cancer at an early state when treatment is most effective. For more information about breast cancer, check-out www.breastcancer.org.
The West Virginia Breast and Cervical Cancer Screening Program provides free or low-cost breast and cervical cancer screening and diagnostic services for eligible women in West Virginia. To be eligible for the Program, a woman must be a West Virginia resident between the ages of 25 and 65 years, be uninsured or underinsured, and be at or below 250% of the federal poverty level ($30,350 income per year for 1 person; $51,950 income per year for a family of 3). Women who are diagnosed with breast or cervical cancer through the Program may be eligible to receive treatment through West Virginia Medicaid. For more information about the Program call 1-800-642-8522 or visit www.wvdhhr.org/bccsp.
Our neighbor state of Virginia looks to be finally ready to follow in the footsteps of West Virginia and expand Medicaid to more low-income adults without health insurance. Virginia's expansion will cover as many as 400,000 low-income people. West Virginia expanded Medicaid back in 2014. Virginia will become the 33rd state, along with Washington, DC, to expand Medicaid under the Affordable Care Act (Obamacare).
The Senate voted today, May 30th, to approve a budget that will allow the Medicaid expansion. The House had already voted in favor of the expansion but will have to vote again before the bill can go to Governor Northam (D). The Governor supports the expansion and has made it a priority for his administration. Virginia will rely on provider taxes to fund the cost of the expansion.
Many of us in West Virginia are thrilled to see our neighbors in Virginia take this important step forward.