Georgia Chapter, American Academy of Pediatrics: August 2012

Thursday, August 30, 2012

Wednesday, August 29, 2012

Children With Neurologic Disorders At High Risk Of Death From Flu

A big year for West Nile | www.ajc.com

Routine screening catches child abuse in ER | Reuters

Little Evidence on Value of Treatments for Autism: Report

Medicaid expansion: Room for compromise? | Georgia Health News

Tuesday, August 28, 2012

Prevention of flu much better than treatment | Georgia Health News

Deal: No Medicaid expansion for Georgia

Deal: No Medicaid expansion for Georgia

12:49 pm August 28, 2012, by Kyle Wingfield AJC

TAMPA — Firming up his earlier stance, Gov. Nathan Deal said Tuesday he “would not have any intention” of expanding Georgia’s Medicaid rolls with federal money from Obamacare.

The expansion to cover anyone who earns one-third more than the federal poverty level, which the law made virtually mandatory by threatening to withhold current Medicaid funds from states that did not cooperate, became optional thanks to a Supreme Court ruling this summer that said Congress had overstepped its bounds in making such a coercive threat. Immediately after the court issued its ruling, Deal said he would wait until November to decide about the expansion, under which the feds would foot 100 percent of the cost of expansion from 2014 to 2016 and less in the years after that.

Tuesday morning in Tampa, during an interview with the AJC, 11 Alive and Politico, he indicated the expansion is off the table:

No, I do not have any intentions of expanding Medicaid. I think that is something our state cannot afford. And even though the federal government promises to pay 100 percent for the first three years and 90 percent thereafter, I think it is probably unrealistic to expect that promise to be fulfilled in the long term, simply because of the financial status that the federal government is in. I am told that that expansion for the federal government will be somewhere in the neighborhood of $100 billion a year. I quite honestly don’t think Congress can find an extra $100 billion a year.

Asked whether this was a change of heart, he replied:

I think for the time being, assuming that things are as they currently are, I would not have any intention of advocating expanding our Medicaid rolls. The reason for saying wait until November is to see whether or not there are going to be legislative changes at the federal level. And we do have a time frame for making the decision that I think, especially on the exchanges, we have just a few days after the election in order to make a final determination on that.

What kind of changes might prompt a reconsideration? “I can’t think of any right now that would induce me to say that we’re going expand our Medicaid population up to 138 percent of the federal poverty level,” he said, adding that the most recent cost estimate puts the state’s portion of the cost at $4.5 billion over a 10-year period.

“We obviously do not have that kind of money,” he said.

One way the state might be able to change its coverage provisions would be if Washington were to change Medicaid into a program where it sends a chunk of money to Georgia and lets the state decide how best to use it. This “block grant” approach was used in the 1990s welfare reform to good effect, and GOP vice presidential nominee Paul Ryan has proposed just such a change for Medicaid.

Deal sounded very supportive of doing so:

I think there are a lot of things in terms of reimbursement rates, in terms of coverage, if a block grant were given to our state, that we could tailor the program to what we think is most appropriate. As you know, it is pretty much a one-size-fits-all [program]. We [in Georgia] are in one of the more modest Medicaid programs in the country. Those states that have seen fit to expand their Medicaid populations, quite honestly I don’t understand how they’re affording it in this downturned economy.

So, what we would have in mind is it would give us the opportunity to design the program as we think is appropriate. We would be trying to find as much efficiency as possible, and perhaps to provide coverage for areas that we currently know are very expensive to us. The aged, blind and disabled category of course is the largest expense category of our Medicaid population, and we think we might be able to come up with some innovative ways to serve that population better and at the same time save money.

Deal was set to return to Georgia this afternoon.

Breast Milk Boosts Beneficial Growth Of Gut Flora

Reducing Children's TV Time Helps Them Lose Weight

Updated Recommendations for Sleep Apnea in Children --Doctors Lounge

Deal says he won’t pursue Medicaid expansion | Georgia Health News

Monday, August 27, 2012

Teen Girls Need Bone Health Advice to Stave Off Osteoporosis

West Nile Outbreak Could Be Biggest Ever: CDC

Most U.S. Schools Do Not Train Staff in Preventing Dating Violence Among Teens

Uninsured Medicaid eligibles will vary in age and race - amednews.com

Retail clinics grow in popularity, but still put only a dent in patient care - amednews.com

Parents And Doctors Worried About New Strain Of Hand, Foot And Mouth Virus

Gallstone Risk Higher Among Obese Children And Teenagers

Friday, August 24, 2012

Father’s Age Linked to Autism and Schizophrenia - NYTimes.com

Deadline passes, health system now out-of-network with UnitedHealthcare

State employees, teachers face big premium hike | Georgia Health News

FTC decision jeopardizes authority of medical boards, doctors say - amednews.com

Spending Time With Parents Has Benefits For A Teenager's Well-Being

Unvaccinated Kids Put Others At Risk

Wednesday, August 22, 2012

GAO: Supplement Medicaid payments to hospitals rising - FierceHealthFinance - Health Finance, Healthcare Finance

Doctor Burnout: Nearly 1 in 2 Physicians Say They’re Exhausted | Healthland | TIME.com

Feds accept KanCare waiver request | Kansas Health Institute

4 tricks for efficient patient communication - FiercePracticeManagement

Vitamin D Supplements May Lower Risk Of Respiratory Problems In Kids

Tuesday, August 21, 2012

When Elmo Likes Apples, Kids Want Them Too

Drop In Circumcision Of Male Newborns Could Add Billions To Health Care Costs

Childhood Obesity Linked With Antibiotic Use In Infants Under 6 Months Old

Vanderbilt University Seeks To Increase Exclusive Breast Feeding In Hospitals

Program helps pediatricians find child psychiatrists for patients

By David Hench dhench@mainetoday.com

Staff Writer

In her practice as a primary-care pediatrician, Andrea Loeffler gets at least a couple of calls every day from families who need help with mental-health issues.

Between the ear infections, immunizations and broken bones, Loeffler said, she has to shift gears and try to assess whether a teenager's irritability and defiance is normal or something requiring specialized treatment.

"The bulk of adolescent mental health lands on our doorstep first," she said. The right response can mean the difference between ensuring mental health services that the patient needs and a suicide attempt.

A growing number of pediatricians are signing on with the Child Psychiatry Access Project, an innovative program that gives primary-care doctors in southern Maine quick access to child psychiatrists.

The psychiatrists provide regular training sessions for pediatricians on such topics as warning signs that a child might need psychiatric care and the effects of various medications and treatment.

The project also helps the pediatricians link patients with counselors -- or psychiatrists, if necessary.

The program seeks to address a chronic shortage of child psychiatrists in Maine, a problem that has been identified nationally by the American Academy of Child & Adolescent Psychiatry, said Dr. Sandra Fritsch, a child psychiatrist who is the program's director.

"The state with the most child psychiatrists per child is Massachusetts ... and that is the state that initiated the first consultative, collaborative care model," she said, referring to that state's program. "Children couldn't get their mental health needs met in the state with the greatest number of providers."

Loeffler, medical director at Martin's Point Medical Group in Brunswick, said pediatricians are seeing more mental health crises and are increasingly called on to diagnose and recommend treatment for mental health issues.

"We have children being raised with a lot of stressors, a lot of stressors that are different than we grew up with," she said. As an example, she said reliance on social media can stunt social skills and maturity.

Doctors involved with the program say it has worked well in southern Maine and the 22 other states that have embraced it, and they would like to see it expanded to the rest of Maine.

Some Maine counties don't have a single practicing child psychiatrist, so families in northern and eastern Maine may have to spend hours traveling to appointments.

Others miss out on treatment altogether.

"There simply aren't enough people to help take care of this community," Loeffler said at a recent lunch-and-learn session that Fritsch held in Brunswick. "Without access to this program, we would be floundering. There are parts of the state that are floundering."

A shortage of psychiatrists led the Maine Association of Psychiatric Physicians to start a program in 2004 in which doctors were linked with psychiatrists they could consult by telephone or email. The program's part-time coordinator is paid with a $7,000 grant from the Department Health and Human Services.

Dr. David Moltz, who developed the program, said it was intended as a stopgap measure until a more comprehensive solution could be found. He said the shortage of child psychiatry in the rural parts of Maine is even more acute than the shortage of adult specialists.

The program gives primary care physicians "curbside consultations" but doesn't have a formal structure that includes training on child and adolescent mental health or direct consulting and services.

Southern Maine's Child Psychiatry Access Project serves an area that includes about 38,000 of the state's 300,000 children.

Fritsch said about 40 percent of the calls the program receives are from physicians trying to determine what resources are available for patients. A similar proportion is for telephone or email consultation. Currently, 34 pediatricians in nine practices are enrolled.

The remaining roughly 20 percent are direct referrals to the program's outpatient services.

Starting in 2009, the program's first three years were paid with a $300,000 grant from Maine Health Access Foundation. For now the program is funded by the Glickman Family Center for Child and Adolescent Psychiatry at Spring HarborHospital.

Expanding the program to include the rest of the state's 300,000 children would cost upward of $800,000, Fritsch said.

Some states, such as Massachusetts, that offer a similar program fund those programs, while others are funded jointly by the state and large research hospitals. Fritsch said another model for funding would charge practitioners enrolled in the program a fee that would work out to about $2.64 per child per year statewide.

The program is free for participating health care practices.

Fritsch believes it's a worthwhile investment in getting better care to children earlier, before problems become more serious.

Pediatricians do relatively little training in mental health issues, compared to psychiatrists who spend years on the topic.

"None of us here trained in that back in the day, but it has been a huge component of our work life," said Dr. Jan Wnek, a pediatrician in Brunswick who has been practicing for 45 years.

In the past, if the mental health issues exceeded a pediatrician's expertise, he or she could either refer the family to a specialist who had a long waiting list or send them to the Emergency Room with huge costs for the family and the health care system.

"As you wait, problems build and build and build. ... Everything you do includes that part of your body."

Providing more rapid care, either through a telephone consultation or by a direct referral to the program, has huge benefits.

"It's more that there are symptoms you can gain control of faster with the right directions," Loeffler said. "The trickle-down effect is enormous. They need less intense care and help because they get at it right away."

"I view this kind of collaborative effort as part of primary care and preventive care," she said. "It is much less costly to us as a society to be able to proactively address concerns and problems than to wait until they're much bigger."

Monday, August 20, 2012

Kids' Vital Cough Reflex Is Impaired By Secondhand Smoke

Doctors ask Congress for role in reforming Medicare programs - amednews.com

Small practices may be least able to take new Medicaid patients - amednews.com

E.coli fears prompt lettuce recall in Georgia, 18 other states - Atlanta Business Chronicle

Savannah strategy: Skip the middleman, cut deals with providers | Georgia Health News

Aetna aims for growth with Coventry deal | Georgia Health News

Benefits of infant circumcision reconfirmed as rates decline – USATODAY.com

Sunday, August 19, 2012

Kids Who Spend Too Much Time On The Couch Have Poorer Motor Coordination

New Research Casts Doubt On Landmark 2007 Study: Babies May Not Have A 'Moral Compass' After All

The Fight Against Childhood Obesity Looks To School Food

Mothers Who Smoke While Pregnant Increase Their Baby's Risk Of Asthma

That $716 Billion Medicare Cut: One Number, Three Competing Visions

That $716 Billion Medicare Cut: One Number, Three Competing Visions

By John Reichard, CQ HealthBeat Editor

By the time this election season is over, even small children may know how much “Obamacare” cuts Medicare. The figure, $716 billion over 10 years, is the subject of already-intense debate over what the health care law will do to, or for, Medicare. And it shows no signs of letting up before November.

It’s a policy fight that reflects three distinctly different visions of how the $716 billion should be used and what it means for the health care that the elderly will receive. How that fight plays out may shape not only the outcome of many election races but also what happens next year in Congress to Medicare and the health care law.

But first, where did the figure come from? Is it accurate? And why is it so much larger than previous estimates?

It’s a surprise to many. That’s because of how often $500 billion has been cited as the Congressional Budget Office’s estimate of Medicare cuts in the health care law.

Little noticed initially, $716 billion first surfaced on Page 13 of the CBO’s recent 22-page letter that analyzed the effects of legislation (HR 6079) repealing the health care overhaul. “Spending for Medicare would increase by an estimated $716 billion over [the] 2013-2022 period,” said the July 24 letter to House Speaker John A. Boehner, R-Ohio.

What might have seemed like a mistake at first was not. Sen. Orrin G. Hatch, R-Utah, issued a statement late that day calling attention to the bigger number. An Obama administration official did not dispute the figure, saying it was higher because it spanned a different 10-year period from the original CBO estimate. The official also noted that House Republicans voted to cut Medicare by the same amount in approving the budget plan written by Budget Committee Chairman Paul D. Ryan, R-Wis.

The original March 20, 2010, CBO score of the cost of the health care law actually put the level of Medicare cuts at about $450 billion, which people have rounded up to $500 billion ($500 billion is actually about the level of reimbursement cuts in the health care law if Medicaid cuts are added to Medicare cuts). The time frame: the 10 years from 2010 through 2019. The updated estimate covers 2013 through 2022. “The second estimate covers nearly 10 years of the bill’s full implementation, versus six to seven years in the first estimate,” notes a new analysis by William Galston and Korin Davis of the Brookings Institution.

In other words, the Medicare cuts didn’t really kick in for the first few years of the initial estimate. So the hit on Medicare was really larger than analysts first said.

The Obama Vision

Advertising by the Romney-Ryan campaign suggests the $716 billion will badly weaken the services that beneficiaries get under Medicare. But the Obama view is that the cuts are taken from sectors that either were previously overpaid by the government, such as private health plans and big pharmaceutical manufacturers, or that would recoup the money in the form of larger numbers of insured patients.

Examples of such providers include hospitals, skilled-nursing facilities and home health agencies. Those health groups will get the money back because the reductions help cover the costs of subsidies for the uninsured to purchase insurance coverage, so their medical costs would be covered.

About one-third of the Medicare cuts are taken from hospitals. The health care law reduces yearly “market basket” payment increases to hospitals by a “productivity adjustment” reflecting gains in efficiency in the overall economy. That generated about $150 billion of the $450 billion in Medicare cuts in the original CBO estimate. Cutting payments to the private health plans that make up the Medicare Advantage program made up close to another third, or $136 billion. Those reductions occur as a result of lower payments to the health plans so that those plans would be paid at the same level as providers in the traditional fee-for-service Medicare program. “Productivity adjustments” in yearly market-basket payment updates to home health agencies and skilled-nursing facilities, along with other reductions, make up about the other third of the cuts.

The White House could point to outside analysts to justify the cuts to private health plans, skilled-nursing facilities and home health agencies. The independent Medicare Payment Advisory Commission had urged reduced increases for the nursing facilities and home health agencies, saying they were overpaid. And it long had urged that payments to Medicare Advantage plans be equal to fee-for-service.

The new $716 billion estimate does not break out sector-specific estimates of the size of Medicare cuts, but presumably they are roughly proportional to those in the original estimate.

The bottom line: The Obama team argued that the Medicare reductions weren’t harming Medicare patients. At the same time, they could argue that the reductions helped to cover the costs of drug coverage in the donut hole, as well as enhanced preventive care benefits, such as mammograms and colonoscopies, without co-payments. And because the cuts meant less money coming out of the Medicare Part A hospital insurance trust fund, the reductions added several years of solvency to that financing mechanism.

The Ryan Vision

Before joining presumed presidential nominee Mitt Romney on the Republican ticket, Ryan championed a budget plan based on repealing the coverage provisions of the health care law but keeping its Medicare cuts. That helped to reduce deficit spending and fund other Ryan priorities, such as bigger tax cuts. It also pushed back the insolvency date of the hospital trust fund, as the health care law does, freeing Congress, at least for a while, from having to increase taxes or cut payments to keep the fund in the black.

Ryan presumed that Medicare could take the hit, as did his fellow House Republicans who voted for his budget plan that included the Medicare cuts. Ryan has argued that by avoiding increases in the federal debt, the Medicare cuts strengthen the federal balance sheet and put it in a better position to cope with Medicare financing challenges in future decades. That’s far better than using the cuts, as the health care law does, to fund a huge new program to subsidize the purchase of insurance by the uninsured, Ryan argues.

The Romney Vision

Romney, however, has another view. He wants to repeal the health care law, which in effect means keeping the $716 billion in Medicare. That stance allows him to argue that Obamacare delivers a big hit to Medicare that he would not. And it helps him blunt Democratic attacks that the plan he and Ryan favor to convert the Medicare entitlement to a premium support system would badly harm health care for the elderly. The pair can counter that they would not take almost a trillion dollars over 10 years out of the program like the president would.

What is the evidence as to whether the Obama cuts would harm Medicare?

Richard Foster, head of the Office of the Actuary for the Centers for Medicare and Medicaid Services, has predicted that the productivity adjustments reducing payment increases could, over time, lead a significant number of hospitals and skilled-nursing facilities to drop out of Medicare.

Foster has also noted another distinct possibility: that rather than see providers drop out, lawmakers will intervene with new payment increases. That means the health care law would cost more than CBO has projected, which in turn suggests it would no longer be budget-neutral.

Medicare Advantage plans warn that cuts will mean an end to the added benefits they’ve been able to offer beneficiaries, and that enrollment in the plans will drop and beneficiary out-of-pocket charges will rise.

There are also suggestions that hospitals may cut back on hiring staff because of the health care law cuts, watering down the quality of their care. The Brookings analysts observe that “it’s technically correct to say that the Affordable Care Act does not cut benefits. The question is whether reductions in payments to health care providers will impair either access to health care services or the quality of those services. While there are some indications that providers are beginning to pull back from the program and that waiting periods for care may be increasing in some jurisdictions, it is too early to know for sure.”

On the other hand, the health care law includes a number of provisions designed to boost the quality of treatment in Medicare. Medicare payments are beginning to financially reward hospitals that score well on clinical performance measures. And the law tests a variety of new forms of health care delivery designed to boost both efficiency and quality.

Defenders of the law also note that Medicare Advantage enrollment continues to grow, contrary to predictions by critics of the law. And they also argue that canceling the cuts would hasten the insolvency of the Medicare hospital trust fund, forcing the Romney team to come up with a new package of Medicare cuts even as they say they oppose such reductions.

Outlook

How will the debate play out? In a sense, Ryan’s vision no longer matters. He says he now supports the position of the man at the top of the ticket. But with deficit reduction a big priority for next year, the idea of cutting Medicare and of using the health care law cuts to reduce deficit spending is hardly off the table.

Because of the complexity of the debate, Democrats and Republicans will have a hard time bringing voters around to their point of view. That suggests that where voters now stand on the health care law and cutting Medicare may not change dramatically. But whoever wins the election will likely argue that their victory is proof that the voters prefer their particular vision.

Friday, August 17, 2012

Revised CPT book includes new codes for care coordination - amednews.com

Thursday, August 16, 2012

When Mom Boozes, Baby Has Effects for Years

Young Drinking Tied to Drinking Problems Later

Retail clinics are becoming more popular, according to a new study by Rand Corporation - baltimoresun.com

White Matter Development In The Postnatal Brain Impacted By External Stimulation

Rapid Growth Of 'Strawberry' Birthmarks When Babies Just Weeks Old

Sedentary Lifestyles Have A Negative Effect On Motor Coordination Skills In Children

Wednesday, August 15, 2012

ACP tells government to stay out of doctor-patient relationship - FiercePracticeManagement

Advocates warn against Public Health budget cuts | Georgia Health News

FDA Warns of Deaths with Postop Codeine in Children

FDA clears new flu vaccine for production by 6 manufacturers - The Washington Post

Docs practice defensive medicine to avoid bad rep - FiercePracticeManagement

Nonprofit providers face more audits - FierceHealthFinance - Health Finance, Healthcare Finance

Epidemic Pertussis in 2012 — The Resurgence of a Vaccine-Preventable Disease — NEJM

The other Paul Ryan plan: $800B in Medicaid cuts | ajc.com

Tuesday, August 14, 2012

Obama pushes for state help on health exchanges | Reuters

Ethical Issues In Prenatal Whole Genome Sequencing

Protective Bacteria In The Infant Gut Have Resourceful Way Of Helping Babies Break Down Breast Milk

Monday, August 13, 2012

The Promise of Telemedicine Runs Into Reality, IOM Panelists Say

The Promise of Telemedicine Runs Into Reality, IOM Panelists Say

By Jane Norman, CQ HealthBeat Associate Editor

An estimated 10 million patients in the United States are served by telemedicine each year, but expanding its reach further and making it an integral part of the health care system will remain a challenge without changes in reimbursement policies and state licensing, panelists said at an Institute of Medicine workshop Wednesday.

Yet plenty of ideas abound, such as using relatively inexpensive personal devices like tablets or cell phones for increased remote monitoring of patients’ chronic conditions, or teledentristy for conducting dental examinations, or even telesurgery using robots directed by a surgeon at a remote console.

The Supreme Court decision upholding the health care law was regarded as a plus for telemedicine because the law seeks to modernize the traditional medical system and increase innovation, including telemedicine pilot projects through the Centers for Medicare and Medicaid Services (CMS). Advocates, though, remain dissatisfied that telemedicine is barred by regulation from playing a major role in the operation of Medicare accountable care organizations.

Telemedicine, in which patients are treated by a provider at a remote site through the use of telecommunications technology, has been in use for decades in the United States. The idea dates back to 1879, when an article in the British journal Lancet discussed how to use the telephone to reduce unnecessary physician visits, said Thomas Nesbitt, a professor of medicine at the University of California, Davis.

Most often it’s used for patients in rural areas, and Nesbitt said that the biggest need is for treatment of people with costly chronic conditions. Traditionally such patients are treated in doctors’ offices when their conditions demand it, rather than in a structure that manages care using frequent patient contact and assessment, he said. The Department of Veterans Affairs health care system has developed a successful system to use telemedicine to treat veterans who live in remote areas and recently eliminated copayments for video health care.

Other common uses of telemedicine are to monitor diabetes or hypertension, perform radiological scans, read pathology slides and prescribe drugs.

The workshop, organized by the Health Resources and Services Administration (HRSA), was intended to look forward and determine what the Department of Health and Human Services should do next, what the special implications of telemedicine are for rural areas and what the evidence shows works in telemedicine.

Jonathan Linkous, CEO of the American Telemedicine Association, said that in its early days, telemedicine was based out of academic medical centers or the largest hospitals. That’s greatly expanded and telemedicine has been absorbed into the larger health care system, including doctor offices, he said.

But there remain “deadly barriers,” including money, regulations, hype and even success, Linkous said. Most Medicare reimbursements for telemedicine remain limited to rural areas rather than underserved urban areas out of fears that overuse or abuse might result, he said. Managed care, with the exception of the VA, does not make much use of telemedicine to control costs, he said. Some companies that see opportunity in telemedicine come into the market without sufficient knowledge or background.

Telemedicine faces problems in operating across state lines because doctors generally must obtain licenses in each state where they practice, despite practitioners who may practice in multiple states and providers that are forming nearly national systems. Linkous said some state regulators now are even requiring in-state consultations with doctors before patients can use telemedicine.

“I think that licensure is a big problem; we need to address that,” Linkous said.

Gary Capistrant, senior director of public policy for the telemedicine association, said people in remote states who need the services of specialists are hindered in their access to providers. The solution for some doctors is multiple state licenses. He said he met an ophthalmologist recently with 15 state licenses. But Capistrant said that “there is a huge price to that” and the system is doing more harm to patients than good. “We can’t even get some states to allow for a physician to talk to another [out of state] physician without being licensed in that other state,” he said.

Other states have adopted a telehealth license, but telemedicine should not be regarded as some subspecialty of medicine, Capistrant said.

CMS is funding the formation of accountable care organizations, but telemedicine faces problems because of numerous Medicare restrictions on how it can be used, Linkous said. Generally, the restrictions take the form of Medicare not reimbursing for telemedicine services for patients in metropolitan areas even if the area is underserved. Linkous said that even though CMS officials have talked up the use of telemedicine in ACOs, they have not waived the restrictions on its use as a central component of health care.

Linkous also said advocates of telemedicine can be “victims of our own hype” because they talk about studies showing telemedicine works, but not the ones that might show some attempts don’t work.

“There are areas in telemedicine that cost too much,” he said. “There are applications that might not work right. If we are going to get serious . . . we have to get serious about this and face these issues.”

Mary Wakefield, HRSA administrator, said she wants to encourage the discussion of telehealth’s role in the health care overhaul. “The importance of this will continue to grow, especially as more and more people in rural and isolated areas across the United States are able to seek a full complement of health care services,” she said.

Friday, August 10, 2012

State revenue jumps in July, but cuts still loom | ajc.com

https://etax.dor.ga.gov/pressrel/July2012_Revenue_PR.pdf

Emerging Neuroscience Shows Adolescents Mature Intellectually Before They Mature Emotionally; Offers Evidence For Courts, Policymakers

Physically Fit Boys And Girls Score Higher On Reading And Math

Health Care Law’s Medicaid Expansion Costs Worry State Officials, GAO Finds

By Jane Norman, CQ HealthBeat Associate Editor

State budget directors are concerned about the cost and complexity of the Medicaid expansion included in the health care law, according to a Government Accountability Office report released Wednesday.

The GAO, in response to a request from Sen. Charles E. Grassley, R-Iowa, surveyed states on how, by Jan. 1, 2014, they plan to implement the expansion of the joint federal-state Medicaid program to childless adults earning less than 138 percent of the federal poverty level.

Grassley’s request and the GAO survey came prior to a decision by the Supreme Court that upheld the law (PL 111-148, PL 111-152) but allowed states to choose to opt out of the expansion. Even before the ruling, state officials were concerned about the fiscal details of the expansion, GAO found, which may account for why some governors have been reluctant to commit to participating in it in the wake of the ruling.

To comply with the expansion, states will need to make major changes in the way they determine Medicaid eligibility for individuals and families, said GAO. States will also need to develop streamlined eligibility and enrollment systems that allow for the coordination of Medicaid, the Children’s Health Insurance Program and insurance offered through state exchanges, the report said. And they will need to deal with some of the costs of doing so, though the federal government will fund 100 percent of the costs of the expansion initially before scaling down to 90 percent.

To figure out the views of state budget directors, the GAO conducted a web-based survey of them and received a 76 percent return rate. The budget directors’ worries about costs centered on three areas. They said they’re concerned about the administrative costs of managing enrollment, the price tag of new information technology and the cost of enrolling people in Medicaid who had been eligible in the past but hadn’t applied.

“Further, most state budget directors reported that their fiscal capacity and the state’s share of Medicaid expenditures create challenges for implementing the Medicaid expansion,” said GAO.

Budget directors also are looking for more guidance from the Centers for Medicare and Medicaid Services, GAO said. “CMS issued regulations and guidance on a range of topics regarding Medicaid expansion and has indicated that additional guidance will be forthcoming,” said GAO. “Concerted and cooperative efforts on the part of CMS and the states will be critical to meeting the implementation deadlines for the Medicaid expansion.”

GAO also picked out six states and asked what they are doing to implement the expansion. Colorado, Georgia, Iowa, Minnesota, New York andVirginia said they are taking steps to get going on it, including assessing changes that need to be made in determining eligibility. They also are replacing or upgrading their information technology systems, said the report.

“At the same time, state officials reported challenges to implementing [the Affordable Care Act’s] Medicaid expansion requirements, including the need for additional federal regulations and guidance in a number of areas,” said GAO. One in particular was how they will use new methodologies to determine applicants’ income.

“States also reported operational challenges that could affect their ability to meet Medicaid expansion and system development deadlines, such as lengthy state procurement processes, the complexities of developing new systems, coordination of multiple programs and systems, and resource limitations,” said GAO.

Thursday, August 30, 2012

Wednesday, August 29, 2012

Tuesday, August 28, 2012

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Friday, August 24, 2012

Wednesday, August 22, 2012

Tuesday, August 21, 2012

Monday, August 20, 2012

Sunday, August 19, 2012

Friday, August 17, 2012

Thursday, August 16, 2012

Wednesday, August 15, 2012

Tuesday, August 14, 2012

Monday, August 13, 2012

Sunday, August 12, 2012

Friday, August 10, 2012

Thursday, August 9, 2012

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