Safety Net Clinics – Minnesota

Safety net clinics in Minnesota face loss of federal funds, By Glenn Howatt, July 27, 2017, Star Tribune: “While the U.S. Congress continues to debate the future of Obamacare and Medicaid, Minnesota’s safety net clinics worry that they will lose $27 million in federal aid that helps pay for health care of the uninsured. Unless Congress acts by October to renew the funding, Minnesota’s 17 safety net providers would have to cut services and possibly close some of the more than 70 clinics across the state…”

Access to Health Clinics and Medicaid Births

Cutting Planned Parenthood would increase Medicaid births, C.B.O. says, By Kate Zernike, March 14, 2017, New York Times: “Cutting off federal funding for Planned Parenthood — a longstanding conservative goal that is included in the Republican bill to replace the Affordable Care Act — would reduce access to birth control for many women and result in thousands of additional Medicaid births, according to the Congressional Budget Office.  Because nearly half of all births nationwide are to Medicaid patients, and many of those babies are Medicaid patients themselves, the budget office estimated that defunding Planned Parenthood even for a year would increase Medicaid spending by $21 million in the first year, and $77 million by 2026…”

Rural Health Care – Nevada, Kentucky

  • Health-care ‘have-nots’: Nevada’s rural residents face fraying safety net, By Pashtana Usufzy, November 19, 2016, Las Vegas Review-Journal: “Tears well up in the eyes of lifelong Tonopah resident Acacia Hathaway as she talks about last year’s closure of Nye Regional Medical Center, the only hospital within 100 miles of her home.  ‘It was … like the end of the world here,’ says the 24-year-old mother of three, including a daughter who suffers from Goltz syndrome, a rare illness that requires frequent care from medical specialists.  Now, instead of visiting the local hospital when 4-year-old Ella suffers one of her seemingly inevitable infections, Hathaway or her husband, Justin, drive to Las Vegas – three hours each way. That’s in addition to twice-monthly trips for regular appointments with her doctors — all eight of them…”
  • In depressed rural Kentucky, worries mount over Medicaid cutbacks, By Phi Galewitz, November 19, 2016, National Public Radio: “For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America’s poorest places, the Affordable Care Act was life altering.  The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years…”

ACA and Free Health Clinics

While more Americans are insured, free clinics still providing a safety net, By Kate Giammarise, March 28, 2016, Pittsburgh Post-Gazette: “The Affordable Care Act and expansion of Medicaid have brought health insurance to millions of previously uninsured Americans. But it’s still mostly business as usual at the Birmingham Free Clinic on Pittsburgh’s South Side, where about 90 percent of patients lack health insurance. The remaining 10 percent of patients at the clinic, located in a Salvation Army building off Carson Street, tend to bounce off and on Medicaid, clinical director Mary Herbert estimated…”

Urban Hospitals and Poverty

Surrounded by poverty, urban hospitals reach out, By Michael Ollove, October 12, 2015, Stateline: “As a child, Bishop Douglas Miles heard the warnings about vans trolling East Baltimore streets, snatching up young African-Americans for medical experiments at nearby Johns Hopkins Hospital. Whether there was any truth behind those stories—Hopkins has always denied them—hardly mattered. The mythology lived on and, combined with the hospital’s very real development decisions, contributed to a persistent view of Hopkins as an imperious, menacing presence amid the largely poor and African-American neighborhoods surrounding it.  ‘Hopkins was viewed with a great deal of suspicion and anger,’ said Miles, who graduated from the school in 1970 and is the bishop of Koinonia Baptist Church in northeast Baltimore. But now, Miles says, that perception could be changing. Johns Hopkins University and the Hopkins hospital and health system have launched an ambitious initiative to fill many more jobs with residents from distressed Baltimore neighborhoods, boost the use of minority contractors and vendors from those areas, and require their partners to follow their lead…”

Community Health Centers – Ohio

Community health centers growing in central Ohio amid Medicaid expansion, By Ben Sutherly, October 12, 2015, Columbus Dispatch: “Last month, Candi Pringle quit her half-pack-a-day habit of 38 years. Since then, Pringle’s blood pressure has dropped, and her back pain has eased. When the urge to smoke surfaces, the 50-year-old Columbus woman said she goes for a walk instead. She credits the positive health strides she has made in part to her local community health center on E. 17th Avenue. Known as St. Stephen’s by many, it’s part of PrimaryOne Health, formerly known as the Columbus Neighborhood Health Center.  Pringle is familiar with the stigma surrounding community health centers such as hers: It’s just for people who are uninsured or on Medicaid…”

Safety Net Clinics – Twin Cities, MN

Twin Cities safety net clinics call state’s rating system unfair, By Glenn Howatt, September 8, 2015, Star Tribune: “Safety net clinics, which serve the Twin Cities’ neediest neighborhoods, are arguing that Minnesota’s quality rating system unfairly penalizes them for serving a poorer, sicker population. The clinics are known for helping their patients not just with medical care, but with such basic needs as food, ­shelter and personal safety…”

Medicaid Patients and Access to Care

  • Subsidized health centers welcome surge of Medicaid patients, By Kathleen O’Brien, February 16, 2015, Star-Ledger: “What comes to mind when you hear the term ‘clinic’? A storefront in the low-rent side of town, with plastic chairs in a crowded waiting room? A cramped examination room with just a curtain for privacy, where worried relatives hover in the hallway? That’s exactly what the old ‘Dover Community Clinic’ looked like a quarter-century ago when it was founded by a newly retired urologist who wanted to treat the poor. Now the Zufall Health Center occupies a renovated bank smack in the center of town, its three-story stone façade conveying solidity and permanence. It has a fancy new name – a Federally Qualified Health Center – and ‘clinic’ is a word consigned to its past…”
  • Medicaid patients struggle to get dental care, By Phil Galewitz, February 15, 2015, USA Today: “When Pavel Poliakov’s clothing shop in this picturesque college town closed last year, he felt lucky to be able to sign up for Medicaid just as Colorado expanded the program under President Obama’s health law. But when Poliakov developed such a severe toothache that he couldn’t eat on one side of his mouth, he was unable to find a dentist -— even though Colorado had just extended dental benefits to adults on Medicaid. Eventually, he turned to a county taxpayer-supported clinic that holds a monthly lottery for new patients…”

Medical-Legal Partnerships

Need a doctor? This anti-poverty program will get you a lawyer, too, By Seth Freed Wessler and Kat Aaron, December 13, 2014, NBC News: “When Tony Cox, 53, woke up in the hospital after suffering a heart attack when he fell off a ladder during a roofing job, he figured he’d hit bottom. ‘All I could think about was getting better and getting back to my family,’ he says. But that day in the hospital was not his lowest point. Over a year later, a sheriff’s deputy arrived at the modest two-bedroom house Cox shares with his wife Donna and their now 16-year-old son bearing a notice that their home was in foreclosure. Out of work from the injury, Cox had fallen behind on mortgage payments. ‘We were getting ready to be homeless, to move in with family,’ Donna says. ‘We would have been separated.’ The couple tried to catch up, to renegotiate their mortgage, but could not make the payments—not until they sought help from a legal services attorney, who brought the foreclosure case to court and compelled the bank to renegotiate the terms of their loan. Over the coming years, the person who saved Cox from the worst consequence of his heart attack was not a doctor but a lawyer…”

Medicaid Computer Systems – North Carolina, New Hampshire

  • N.C.’s new Medicaid payment system a ‘nightmare,’ some providers say, By Lynn Bonner, July 21, 2013, Charlotte Observer: “State officials say the new Medicaid bill-paying system is working better than expected. But for the company trying to get kids wheelchairs, the dentist who hasn’t been paid in a month and the providers who wait days to get their calls for help returned, the system is a near disaster. The state Department of Health and Human Services warned providers to expect a few bumps after the new Medicaid billing system came online July 1. For many, the bumpy weeks have been worse than they imagined, and they have not been told when the frustration will end…”
  • New Medicaid computer system doesn’t end errors, By Nancy West, July 20, 2013, New Hampshire Union Leader: “Four months after the controversial $90 million Medicaid computer system finally began operating, some providers say they aren’t getting paid properly, while another said her office was being paid 10 times the expected amount on some claims. The Medicaid Management Information System has been frequently delayed since being contracted in 2005 to a firm now owned by Xerox. It is causing ongoing frustration, with no end in sight, according to Bruce Burns, Concord Hospital’s chief financial officer…”

Medicaid Expansion and Health Insurers

Medicaid insurers gear up for profit, By Phil Galewitz, March 8, 2013, USA Today: “After his back injury kept him out of work last year, Sergio Mera enrolled his family in Medicaid, the state-federal health insurance program for the poor. These days when they need a doctor, the Meras travel less than a mile from their home to a new clinic. ‘They take good care of you,’ says Mera, 37, as he sits in an exam room with his wife and two kids. The clinic, affiliated with Molina Healthcare, one of the nation’s largest Medicaid managed-care plans, is one of about a dozen facilities the company is opening across the country to handle a wave of new customers in 2014. That’s when about 10 million more people are expected to sign up for Medicaid managed care under the Affordable Care Act, and as states shift enrollees into private plans, according to trade group Medicaid Health Plans of America…”

US Health Care System

This election, a stark choice in health care, By Abby Goodnough and Robert Pear, October 10, 2012, New York Times: “Joyce Beck, who runs a small hospital and network of medical clinics in rural Nebraska, is reluctant to plan for the future until voters decide between President Obama and Mitt Romney. The candidates’ sharply divergent proposals for Medicare, Medicaid and coverage of the uninsured have created too much uncertainty, she explained. ‘We are all on hold, waiting to see what the election brings,’ said Ms. Beck, chief executive of Thayer County Health Services in Hebron, Neb. When Americans go to the polls next month, they will cast a vote not just for president but for one of two profoundly different visions for the future of the country’s health care system…”

Medicaid Eligibility – Ohio

  • Medicaid access made easier, By Catherine Candisky, June 6, 2012, Columbus Dispatch: “Ohio will be the 18th state to make it easier for poor children and pregnant women to get on-the-spot access to tax-funded health care. Under a pilot program starting next week, a handful of community health clinics and hospitals, including Nationwide Children’s Hospital in Columbus, will be authorized to do a quick screening and immediately grant eligibility for 60 days in the state Medicaid program. State officials say they plan to expand so-called ‘presumptive eligibility’ to clinics and hospitals statewide in about six months…”
  • Ohio eases access for Medicaid-eligible patients, By Ann Sanner (AP), June 6, 2012, Coshocton Tribune: “State officials are hoping to more easily grant uninsured pregnant women and children in Ohio access to health care services under Medicaid, if they are likely to qualify for the program that provides coverage to the poor and disabled. A pilot program slated to start next week would allow certain health care providers in Ohio to presume the patient is eligible for Medicaid after an initial screening test. Children and expectant mothers would have to prove residency and provide other biographical details. The patients then could access the Medicaid-funded services immediately for 60 days while they apply for the program…”

Medical Home Network – Chicago, IL

Coordinated care program aims to save Medicaid millions, By By Peter Frost, April 20, 2012, Chicago Tribune: “On Easter, Keontae Barnes doubled over in pain, her back and stomach tightening so much she thought she was in labor. Nearly eight months pregnant with her second child, a girl, Barnes headed straight to the emergency department at Holy Cross Hospital in the Chicago Lawn neighborhood, just a few blocks from her home. After a quick – and costly – examination, doctors determined it was a false alarm; her pains were normal for women in the later stages of pregnancy. The next day, her primary care doctor at Chicago Family Health Center called, asking Barnes what happened and making sure she was OK. ‘I was shocked. I said, ‘How did you know?” Barnes said. ‘She told me to come in the next day, and she gave me her emergency pager and her email. She said if I ever have any questions or concerns, I can always get in touch, any time of day.’  About a week later, Barnes did just that. Instead of rushing to the ER with intense chest pains, she called her doctor. Acid reflux. A trip to Walgreens solved the problem in short order and saved the state’s Medicaid program and Holy Cross thousands of dollars…”

Affordable Care Act

  • Medicaid could be in Supreme Court’s sights, By David G. Savage and Noam N. Levey, March 25, 2012, Los Angeles Times: “Ever since the Democratic Congress passed President Obama’s healthcare law, critics have focused their ire on the requirement that all Americans have health insurance beginning in 2014. But some legal experts believe – and progressives worry – the Supreme Court’s conservatives will instead target another mandate in the new law: the requirement that states expand the Medicaid rolls and provide subsidized healthcare for as many as 17 million more low-income people. On Wednesday, the third day of oral arguments on the law, 26 Republican-led states will argue that the federal pressure to expand Medicaid to all low-income Americans violates states’ rights…”
  • Health care law puts free clinics at a crossroads, By Elana Gordon, March 25, 2012, National Public Radio: “Free health clinics have long been places people turn to when they don’t have health insurance or any money to pay for care. But the health law’s expansion of coverage puts free clinics in uncharted territory. While the law goes before the Supreme Court this week, health providers are already gearing up for a surge in patients with insurance. Around the country, hundreds of free clinics have been established over the past 50 years to treat patients like Patsy Duarte…”
  • Michiganders divided on law reforming health care as Supreme Court takes up challenges, By Patricia Anstett and Robin Erb, March 25, 2012, Detroit Free Press: “On Monday, the U.S. Supreme Court will open three days of hearings on the constitutionality of President Barack Obama’s sweeping health care reform law, one of the biggest cases before the high court in decades. The law, the signature piece of legislation in the president’s administration, will require most Americans without health insurance to buy coverage by 2014 or face penalties. It would also expand Medicaid, require coverage of pre-existing conditions, bar insurers from placing lifetime dollar limits on essential benefits and usher in dozens of other changes affecting everyone from hospitals to businesses to individuals. Some of the changes have already been implemented since the bill was signed into law on March 23, 2010…”
  • 500,000 more in Michigan to be eligible for Medicaid coverage, By Robin Erb, March 26, 2012, Detroit Free Press: “A half-million more Michiganders will be eligible for Medicaid, the government-funded health program for poor people, when the most sweeping provisions of the Patient Protection and Affordable Care Act take effect in 2014. Supporters of the law say covering more poor people is not just socially responsible, it ultimately saves money: Better care keeps chronic conditions in check. But opponents will argue this week to the U.S. Supreme Court that Congress is overstepping its bounds by pushing the expansion onto states, which will lose their federal Medicaid funds if eligibility is not expanded…”

State Medicaid Programs

  • State cuts squeezing the elderly poor and their doctors, By Thanh Tan, March 8, 2012, New York Times: “After Dr. Javier Saenz completed his family-medicine residency in 1985, he returned home to the Rio Grande Valley to open a practice in the impoverished town of La Joya. Today, Saenz Medical Center treats up to 150 patients a day. Dr. Saenz is the volunteer physician for the local high schools and their football teams. A middle school is named after him. Despite his success, Dr. Saenz, 56, said he feels nothing like a hero these days. His practice, he said, is hanging by a thread. His troubles reflect a statewide problem for doctors who treat a disproportionately high number of the reported 320,000 low-income Texans who are dually eligible for Medicare, the federal insurer of the elderly, and Medicaid, the joint state-federal health care program for indigent children, disabled people and the very poor. On Jan. 1, the state reduced its share of co-payments for such patients. Physicians who treat them are seeing less revenue. Many, like Dr. Saenz, are not sure they can make enough money to stay in business…”
  • TennCare hospital reimbursements vary widely, By Tom Wilemon, March 9, 2012, The Tennessean: “Some Tennessee hospitals are questioning why they should continue paying a self-imposed tax to prop up the state’s Medicaid program because competitors are getting back much more in reimbursements while they lose money treating TennCare patients. Hospital executives were shocked to learn that insurance contractors for TennCare, the state health-care program for the poor, were paying more than four times as much to some hospitals as to others for outpatient procedures. In some cases, the disparities amounted to millions of dollars – enough to make or break a hospital’s budget…”
  • Last-minute plan would let FSSA cut Medicaid, By Chris Sikich, March 9, 2012, Indianapolis Star: “As today’s adjournment for the General Assembly quickly approaches, lawmakers are debating a last-minute plan to give the Family and Social Services Administration broad powers to reduce Medicaid spending. In 2011, the General Assembly approved a measure to help the agency cut $212 million from Medicaid to balance spending. The FSSA was granted emergency powers to quickly cut funding or alter or eliminate certain Medicaid programs. The action allowed the agency to bypass public hearings and legislative oversight. Just how long those powers should last has been a matter of debate…”
  • Medicaid cut would hit Florida’s poorest patients, hospitals, By Mary Shedden, March 8, 2012, Tampa Tribune: “Doctors and hospitals treating Florida’s poorest patients face significant pay cuts in the state’s nearly final budget. Legislators will vote by Friday on a $70 billion budget that includes $304 million less to reimburse hospitals. A Florida Hospital Association analysis released Wednesday projects the state’s hospitals will receive $642.8 million less for treating poor children, pregnant women and disabled adults in 2013. This second consecutive year of Medicaid cuts will force hospitals to quickly decide what services to reduce or eliminate, said Kimberly Guy, chief operating officer at St. Joseph’s hospitals for women and children, where the cuts could total $7.3 million…”

State Medicaid Programs

  • State scales back Medicaid shortfall by $300 million, By Jason Stein, January 3, 2012, Milwaukee Journal Sentinel: “In a bit of good news for the state’s strained budget, Gov. Scott Walker’s administration is scaling back by more than $300 million the two-year shortfall projected for state health programs for the poor. But a state health department spokeswoman said that to ensure the state health programs remain affordable, the Walker administration will still seek to proceed with a half-billion dollars in proposed cuts affecting tens of thousands of recipients. In a letter to lawmakers Tuesday, the head of the Department of Health Services said that the shortfall through June 2013 is now expected to be $232 million in state and federal money, down from the $554 million that was projected in September. The change in the projections amounts to about 2% of the funding in the program, Health Services Secretary Dennis Smith wrote in a letter to members of the Joint Finance Committee…”
  • Medicaid payment backlog cripples supportive living centers, By Dean Olsen, January 3, 2012, State Journal-Register: “Medicaid payment delays of up to six months are causing fits for supportive living centers throughout Illinois, and some owners are worried they may have to close if the situation doesn’t improve soon. ‘It’s a crisis for us because reserves and lines of credit are being exhausted,’ Wayne Smallwood, executive director of the Springfield-based Affordable Assisted Living Coalition, said last week. ‘This is the worst we’ve seen, and there’s no relief in sight.’ Illinois’ festering budget problems, the sagging economy and the end of the federal economic stimulus program in June have contributed to growing payment delays that also hamstring nursing homes, hospitals, doctors and other medical providers…”
  • Nowhere to go, patients linger in hospitals, at a high cost, By Sam Roberts, January 2, 2012, New York Times: “Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing. As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost…”

State Medicaid Programs – Arizona, Illinois

  • Ruling: AHCCCS copays break law, By Mary K. Reinhart, August 25, 2011, Arizona Republic: “A federal appeals court ruled Wednesday that mandatory copayments charged to Arizona’s poorest residents violate federal law. The three-judge panel of the 9th U.S. Circuit Court of Appeals said federal health officials failed to show how the copays, imposed in November after a seven-year court battle, served any purpose besides cutting the state’s Medicaid budget. Federal law gives the U.S. Health and Human Services secretary discretion to approve state Medicaid ‘waivers’ as long as the programs have a ‘research or demonstration value.’ Raising copayments for more than 200,000 of Arizona’s poorest residents and making them mandatory, the judges said, helped balance the state budget but didn’t meet that federal standard…”
  • Illinois Medicaid’s managed care effort stumbles, By Judith Graham, August 26, 2011, Chicago Tribune: “It can take years for people with cerebral palsy, autism, schizophrenia or Down syndrome to find trusted physicians to oversee their health. Now, families and advocates say, those medical relationships are being threatened as Illinois rolls out a new program of HMO-style care for people with serious disabilities. Many doctors and hospitals are refusing to join the new Medicaid program, which the state hopes will better coordinate care and lower costs for some of its neediest recipients. The providers’ rationale: They dislike the bureaucratic hassles and cost-cutting measures associated with managed care. The ranks of those who have said no, for the moment, include prominent medical centers and physician practices with a long track record of serving the disabled, among them Northwestern Memorial Hospital, Rush University Medical Center, the University of Chicago Medical Center, Children’s Memorial Hospital and Loyola University Health System. Because of the situation, hundreds if not thousands of vulnerable, chronically ill individuals are being forced to find new doctors, some of whom appear ill-equipped to handle their needs, according to consumer advocates and families…”

Safety-net Health Care – Massachusetts

Demand for safety-net care remains high in Massachusetts, By Noam N. Levey, August 8, 2011, Los Angeles Times: “Massachusetts, whose 2006 healthcare overhaul provided a template for the landmark national law signed by President Obama last year, has already demonstrated that it is possible to achieve almost universal health coverage. Now, the trailblazing state is providing another clue about what may happen when the federal government begins guaranteeing health insurance for all citizens starting in 2014. Massachusetts community health centers and so-called safety-net hospitals – originally created to serve the poor and uninsured – have seen no let-up in demand, even after the state’s reforms, according to new research published Monday in the Archives of Internal Medicine…”

States and Medicaid Changes – Indiana, Arizona

  • Indiana law to cut Planned Parenthood funding is blocked, By Robert Pear, June 24, 2011, New York Times: “A federal judge ruled Friday that the State of Indiana could not cut off money for Planned Parenthood clinics providing health care to low-income women on Medicaid. The judge, Tanya Walton Pratt of the Federal District Court in Indianapolis, blocked provisions of a new state law that penalized Planned Parenthood because some of its clinics performed abortions. The law, she said, conflicts with the federal Medicaid statute, which generally allows Medicaid beneficiaries to choose their health care providers. Planned Parenthood provides services other than abortion, including family planning and screenings for cancer and sexually transmitted diseases. In issuing a preliminary injunction late Friday, Judge Pratt said the state law ‘will exact a devastating financial toll on Planned Parenthood of Indiana and hinder its ability to continue serving patients’ general health needs…'”
  • Arizona Medicaid: New attempt made to block cuts, By Mary K. Reinhart, June 28, 2011, Arizona Republic: “Attorneys for low-income Arizonans filed a motion in Maricopa County Superior Court on Monday to stop sweeping cuts to the state’s Medicaid program from taking effect Friday. It may be the last chance for more than 135,000 people expected to lose coverage in the coming year under the Arizona Health Care Cost Containment System, which Gov. Jan Brewer and state lawmakers cut by more than $500 million to balance the budget. Attorneys for three public-interest groups argue that Brewer and lawmakers are violating the state Constitution and the will of voters, who in 2000 agreed to expand AHCCCS and extend health care to everyone earning less than the federal poverty level. The Arizona Supreme Court last Friday declined to accept a similar case, without explanation…”