Ohio Health Policy Review

HPIO interim director: Medicaid could cost state extra $1 billion in 2012

2010-07-22T16:10:45-04:00

Testifying at Tuesday’s hearing of the state Budget Planning and Management Commission, Health Policy Institute of Ohio Interim Director Greg Moody told the bipartisan legislative panel that unless the federal government provides more funds or the state takes action, the Medicaid program is going to cost Ohio an additional $1 billion from 2011 to 2012 (Source: “Medicaid to add $1 billion to state budget quandary,” Columbus Dispatch, July 20,2010).

And this comes at a time when the state is already expected to face a budget shortfall estimated at between $5 billion and $8 billion.

Moody said his projection is based on the assumption that federal matching funds, which were increased as part of the federal stimulus package last year, return to normal levels and the state experiences a 6.1 percent increase in spending, as projected by the Congressional Budget Office. Moody's presentation is available here (pdf, 10 pages).

While unlikely to remedy short-term budget challenges for the Medicaid program, Moody outlined a series of cost containment strategies that could reduce long-term costs for the program:

Focus on prevention and primary care
Care coordination and disease management
Price and quality transparency
Payment reforms that reward value
Behavioral/physical health integration
Rebalance Medicaid long-term care

Another speaker at the hearing, John Begala, executive director of the Cleveland-based Center for Community Solutions, said among the short-term options that the state may consider are capping hospital payments and reducing the 12.5 percent administrative allowance for HMOs. Those recommendations were included in Community Solution’s recently published report on the state budget, “Thinking the Unthinkable: Finding Common Ground for Resolving Ohio’s Fiscal Crisis.” (pdf, 50 pages)

HHS awards Ohio $3 million for home visitation program

2010-07-22T16:05:41-04:00

Ohio is set to receive about $3 million in federal funds for programs that provide home visits aims at reducing pre-term births, according to an announcement from the Department of Health and Human Services (Source: "Home Visit Programs To Receive Millions,” HealthLeaders Media, July 22, 2010).

Only three states (Idaho, New York and Texas) and the District of Columbia are set to gain a larger share of the $88 million that were made allocated in health reform legislation. The money is to be used to fund evidence-based programs that enable nurses, social workers and other health professionals to visit at-risk families in their homes, according to an HHS release.

Survey: Central Ohio Doctors pessemistic about health reform

2010-07-22T16:03:36-04:00

An online survey conducted by the Columbus Dispatch and WBNS-TV in Columbus, with the assistance of the Ohio State Medical Association, found that nearly three-quarters of Central Ohio doctors who responded expressed pessimism about the impact of federal health on health-care delivery (Source: “Doctors wary of changes in health care,” Columbus Dispatch, July 18, 2010).

Seventy-eight doctors responded to the online survey and 58 (74 percent) said health-care delivery will be “somewhat worse” or “much worse” after health reform. The results of the survey are not scientific.

Insurers testing new plans that reduce cost, restrict choice of doctors, hospitals

2010-07-22T16:01:34-04:00

Insurance plans have begun testing new plans with reduced premiums that limit participants’ choices of doctors or hospitals (Source: “Insurers Push Plans That Limit Choice of Doctor,” New York Times, July 18, 2010).

The plans may be especially appealing to small businesses struggling with the spiraling cost of coverage, but are also garnering interest from larger employers as well.

“What we’re seeing is a definite uptick in interest because, quite frankly, affordability is the most pressing agenda item,” said Dr. Sam Ho, the chief medical officer for UnitedHealth’s health-care plans.

Insurers anticipate that the lower-cost plans will be popular with individuals and small businesses who will purchase coverage in the insurance exchanges that will take effect in 2014.

Commonwealth report outlines key policy issues for insurance exchanges

2010-07-22T15:59:43-04:00

The Commonwealth Fund released last week a report on state insurance exchanges that outlines areas of consideration for policymakers as they begin setting up state insurance exchanges.

The report, Health Insurance Exchanges and the Affordable Care Act: Key Policy Issues, describes 13 key areas for policymakers to consider.

“Health insurance exchanges are the centerpiece of the private health insurance reforms of the Affordable Care Act of 2010 (ACA),” the report states. “If they function as planned, these exchanges will expand health insurance coverage, improve the quality of such coverage and perhaps of health care itself, and reduce costs. Previous attempts at creating health insurance exchanges, however, enjoyed only mixed results.”

ODH, HPIO release dental Care data brief

2010-07-16T16:03:00-04:00

Researchers at the Ohio Department of Health and the Health Policy Institute of Ohio have released a data brief, titled “Oral Health Findings from the Ohio Family Health Survey, 2008,” (pdf, 2 pages) examining dental care in Ohio, using data from the most recent Ohio Family Health Survey.

The report found that regardless of family income status, dental care was the most pressing unmet health care need for both adults and children.

Some of the findings include:

479,000 Ohio children (or 18.3 percent) were without dental insurance, compared to 111,000 children (4 percent) who were uninsured for medical care
Even though low-income children (those in families earning less than 200 percent of the federal poverty level, or $41,300 for a family of four) had higher rates of dental coverage, they were less likely to have a dental visit in the past 12 months (68 percent of low-income children, compared to 81.5 percent of higher-income children)
3,433,000 (or 39.4 percent) of Ohio adults 18 and older reported having no dental coverage, compared to 1,232,000 (or 14.1 percent) of adults who reported being uninsured for medical care
For adults, family income and job status are associated with a lack of dental coverage

CMS OKs additional payment to Ohio hospitals for Medicaid expenses

2010-07-16T15:56:19-04:00

After lobbying from Gov. Ted Strickland, officials at the federal Centers for Medicare & Medicaid Services have given the go-ahead to a state plan to pay hospitals an additional $87 million this year for the care they provide to low-income Ohioans on Medicaid (Source: “Feds OK plan to let hospitals recoup Medicaid expense,” Columbus Dispatch, July 15, 2010).

The bulk payment, which will be disbursed to hospitals by the end of this month, and a 5-percent increase in Medicaid reimbursement fees effective in October were included in last year's state budget to let hospitals recoup some of the money they were losing through a new state franchise fee.

The fee is projected to cost hospitals statewide $718 million over the two-year budget ending June 30, 2011. The two provisions aimed at offsetting that expense will let hospitals recoup $569 million, according to the Ohio Hospital Association.

Health Affairs, RWJ release brief on extra Medicaid funding to states

2010-07-16T15:53:21-04:00

Health policy journal Health Affairs and the Robert Wood Johnson Foundation have published a new brief that examines whether the federal government should extend its temporary increase in contributions to states for Medicaid funding.

The brief, titled Extra Federal Support for Medicaid, examines how the additional FMAP contributions have helped offset state deficits, since most state budgets by law must be balanced. It also includes proponents' and opponents' views, in particular the debate between the necessity to avoid serious harm to state budgets versus the impact on the federal deficit if the additional assistance isn't offset with spending cuts or revenue increases.

Strickland asks state agencies to prepare tighter budgets for next biennium

2010-07-16T15:49:50-04:00

The Strickland Administration yesterday asked government agencies to submit spending proposals for the next biennium budget that are 10 percent smaller than current levels (Source: “Blueprints for spending sought from state offices,” Toledo Blade, July 16, 2010).

Agencies also were asked to submit separate budgets that hold spending for fiscal years 2012 and 2013 at current levels. However, neither plan would be sufficient to completely address a budget shortfall that some have estimated could be as large as $8 billion, or 16 percent of the current $50.5 billion, two-year budget.

"Some programs will be held harmless and will continue to see current funding," she Strickland spokesman Amanda Wurst said. "Some will see increases. Some will see cuts putting them between 90 percent and current levels, and some will see cuts of more than 10 percent. This is just the traditional beginning of the budget planning process."

Northeast Ohio health systems begin work developing ACO models

2010-07-16T15:47:24-04:00

Two Northeast Ohio health systems — Summa Health System in Akron and University Hospitals in Cleveland — have begun working with National group purchasing organization to create accountable care organizations aimed at improving coordination of care and reforming the way providers are paid (Source: “Alternative to HMOs coordinates treatment delivery,” Akron Beacon Journal, July 5, 2010).

Under the ACO concept, doctors and hospitals would get financial incentives to work together to keep patients healthy and out of the hospital. The partners would coordinate their care and then share in any savings if quality and cost goals are achieved. Federal health reform legislation allows for ACOs through Medicare, beginning in 2012 . Under the law, patients in traditional Medicare will be assigned to an ACO if their normal provider participates.