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Watch: California Pays Drug Users To Stay Clean

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Thu, 13 Jun 2024 09:00:00 +0000

KFF senior correspondent Angela Hart appeared on Spectrum News 1's “LA Times Today” last week to explain how California is trying to help hard-drug users kick their habit by paying them to stay clean.

California was the first state to expand access to this cutting-edge addiction treatment, called “contingency management,” in its Medicaid program. Washington and Montana have since followed.

California is focusing on stimulants like meth and cocaine. Under the program, participants must pee into a cup regularly, and if the urine is free of stimulants, they get paid with a gift card, starting at $10 for the first test. The longer they abstain, the more they're paid — up to $599 a year.

Click here to watch Hart discuss the treatment on “LA Times Today.”

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You can read Hart's in-depth article about California's initiative. She also wrote about national efforts to encourage other states to adopt the novel approach.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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Title: Watch: California Pays Drug Users To Stay Clean
Sourced From: kffhealthnews.org//article/california-pays-drug-users-to-stay-clean-broadcast-appearance/
Published Date: Thu, 13 Jun 2024 09:00:00 +0000

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Kaiser Health News

KFF Health News’ ‘What the Health?’: GOP Platform Muddies Abortion Waters

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Thu, 11 Jul 2024 20:00:00 +0000

The Host

Julie Rovner
KFF


@jrovner


Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF ' weekly health policy news , “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

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Republicans released a draft party platform in advance of the GOP national convention next week, and while it is being described as softening the party's stance opposing abortion, support from major groups that oppose abortion suggests that claim may be something of a mirage.

Meanwhile, the Federal Trade Commission is taking on the pharmacy benefits management industry as it prepares to file suit charging that the largest PBMs engage in anticompetitive behavior that raises patients' drug costs.

This week's panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Shefali Luthra of The 19th News, and Sandhya Raman of CQ Roll Call.

Panelists

Jessie Hellmann
CQ Roll Call


@jessiehellmann

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Read Jessie's stories.

Shefali Luthra
The 19th


@shefalil


Read Shefali's stories.

Sandhya Raman
CQ Roll Call

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@SandhyaWrites


Read Sandhya's stories.

Among the takeaways from this week's episode:

  • For the first time in decades, the GOP presidential platform will not include a call for a national abortion ban. But Republicans are hardly soft-pedaling the issue: The new platform effectively asserts that abortion violates the 14th Amendment, which guarantees equal protection under the law for all citizens — including, under their reading, human embryos. Under that argument, abortion opponents may already have the constitutional justification they need to defend in court further restrictions on the procedure.
  • Lawmakers in Washington are making early progress on government spending bills, including for the Department of Health and Human Services. Some political issues, like access to gender-affirming care for service members and minors, are creating wrinkles. Congress will likely need to pass a stopgap spending measure to avoid a government shutdown this fall.
  • And a new report from the Federal Trade Commission illuminates the sweeping control of a handful of pharmacy benefits managers over most of the nation's prescription drugs. As the government eyes lawsuits against some of the major PBMs alleging anticompetitive behavior, the findings bolster the case that PBMs are inflating drug prices.

Also this week, Rovner interviews Jennifer Klein, director of the White House Gender Policy Council, about the Biden administration's policies to ensure access to reproductive health care.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: STAT News' “Troubled For-Profit Chains Are Stealthily Operating Dozens of Psychiatric Hospitals Under Nonprofits' Names,” by Tara Bannow.

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Jessie Hellmann: North Carolina Health News' “N.C. House Wants to Spend Opioid Money on Multiple Abstinence-Based Recovery Centers, While Experts Stress Access to Medication,” by Grace Vitaglione.

Shefali Luthra: The Washington Post's “These GOP Women Begged the Party to Abandon Abortion. Then Came Backlash,” by Caroline Kitchener.

Sandhya Raman: Roll Call's “For at Least One Abortion Clinic, Dobbs Eased Stressors,” by Sandhya Raman.

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Francis Ying
Audio producer

Emmarie Huetteman
Editor

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To hear all our click here.

And subscribe to KFF Health News' “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

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Title: KFF Health News' ‘What the Health?': GOP Platform Muddies Abortion Waters
Sourced From: kffhealthnews.org/news/podcast/what-the-health-355-gop-platform-abortion-gender-july-11-2024/
Published Date: Thu, 11 Jul 2024 20:00:00 +0000

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Colorado Dropped Medicaid Enrollees as Red States Have, Alarming Advocates for the Poor

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Rae Ellen Bichell
Thu, 11 Jul 2024 09:00:00 +0000

Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S. government lifted a pandemic-era restriction on removing people from the insurance program.

It's the only blue state in a cluster of red states with high disenrollment rates — a group that includes Idaho, Montana, Texas, and Utah — in the Medicaid “unwinding” underway since spring 2023.

Colorado also is the only state that had all the policy ingredients in place to cushion the fallout from the unwinding, according to Medicaid policy analysts at KFF.

But it seems the cushion hasn't been deployed.

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“There's really a divide in Colorado between our progressive policies and our underfunded and fragmented administration,” said Bethany Pray, chief legal and policy officer at the Colorado Center on Law and Policy, a Denver-based legal aid group.

According to KFF data, during the unwinding Colorado has seen a bigger net drop in enrollment in Medicaid and the Children's Health Insurance Program than any state except Utah.

Advocates for health care access, researchers, and county administrators — the administrators handling the bulk of the Medicaid redeterminations in Colorado — say that the major issues involve outdated technology and low rates of automatic renewals. Both create obstacles to enrollment that undercut the state's progressive policies.

State officials have a rosier view. They say the drop in enrollment is a sign that they did a good job enrolling people at the height of the covid-19 pandemic. Secondly, they say Colorado's economy is doing well, so more people can get insurance through their jobs.

“When we have a really stellar unemployment rate, not as many people need safety-net programs, and we're proud of that. Our people are rising and thriving,” said Kim Bimestefer, who leads the Department of Health Care Policy and Financing and is the state's top Medicaid official. Her department has also said that some people choose not to fill out their eligibility paperwork because they know their incomes are too high to qualify.

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Bureau of Labor Statistics data shows that while it's true Colorado's unemployment rate is lower than the nation's as a whole, it's higher than it was before the pandemic.

State officials say they believe Medicaid enrollments dropped because many of those people found jobs, as reflected by the lower unemployment rates. But that scenario happened in fewer than half of the state's counties, a KFF Health analysis found. Notably, in 11 counties where unemployment stagnated or increased from January 2020 to April 2024, the share of the population covered by Medicaid shrank. A low unemployment rate does not necessarily mean there is less of a need for Medicaid coverage, because many employed people earn wages low enough to still qualify for the program.

Colorado increased enrollment in Medicaid and the related Children's Health Insurance Program by 35% during the covid public health emergency, compared with about 30% nationally and among Medicaid expansion states.

“We grew more, which means, logically, we're going to disenroll more,” said Bimestefer.“We went up higher, we're going to come down lower, because our economy is stellar.”

Her department's website initially claimed Colorado's Medicaid enrollment grew more than any other Medicaid expansion state except Hawaii. But data from the Centers for Medicare & Medicaid Services shows pandemic enrollment growth in other states, including Indiana, North Dakota, Virginia, and Nevada, also exceeded that of Colorado.

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Even if it had grown the most, the argument that what comes up must come down doesn't hold water, Medicaid policy analysts said.

“A counterargument to that is we know that there was never a full participation in Medicaid prior to the pandemic,” said Jennifer Tolbert, deputy director of the KFF Program on Medicaid and the Uninsured.

Tolbert said she was surprised by the extent of Colorado's Medicaid enrollment losses, given it was the one state in the nation that met all the criteria that KFF expected would cushion the effects of the unwinding. Those policies include adopting the Affordable Care Act's Medicaid expansion and the automatic processing of renewals.

Tolbert was among several policy researchers who said that even if unemployment returned to pre-pandemic levels, they would expect a higher, not lower, share of Coloradans to be enrolled in safety-net coverage.

Ally Sullivan, a spokesperson for Gov. Jared Polis, a Democrat, said one complicating factor in Colorado's system is that it's among the handful of states where most of the eligibility verification work falls on counties, “which added complexity to the state's unwind process.”

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“Colorado is committed to ensuring that Coloradans who no longer qualify for Medicaid coverage are connected to other affordable sources of coverage as soon as possible, and the state is going to great lengths to do so,” the statement said.

Minnesota is another state where verifying eligibility is largely left to the counties. Yet it disenrolled just 26% of its Medicaid population in the unwinding, compared with Colorado's 48%. Like Colorado, Minnesota is led by a Democratic governor. Minnesota also mirrors Colorado in its population, pandemic-era increase in enrollment, the percentage of its residents living in prosperous areas, and its better-than-national unemployment rate. But Bimestefer dismissed any comparison.

“I don't care about Minnesota,” Bimestefer said. “This is Colorado. I don't care what Minnesota did.”

Advocates for health care access and researchers said a cluster of technological and administrative issues have contributed to Colorado's high disenrollment rate.

First, Colorado's eligibility database, the Colorado Benefits Management System, is outdated and clunky, according to people who use it or are familiar with systems in other states.

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“It's like still using the old flip phone where you're trying to play Snake,” said Sarah Grusin, an attorney at the National Health Law Program. “We have better stuff.”

Grusin and Pray's organizations filed a civil rights complaint with several federal agencies saying that the system issues that terminated disabled Coloradans' coverage amounted to discrimination.

“It took many months to fix something that doesn't sound that complicated,” Pray said.

Bimestefer said her department is working on a plan to improve the system, which is managed by Deloitte under a $354.4 million contract that lasts until 2027. A recent KFF Health News investigation of eligibility systems managed by Deloitte found widespread problems. In Colorado, a state-commissioned audit in 2020 found that many Medicaid beneficiaries were sent incorrect notices and deadlines.

Kenneth Smith, a Deloitte executive who leads its national human services division, said that Deloitte is one player among many who together administer Medicaid benefits, and that the states own the technology and make the decisions about their implementation.

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Colorado's technology woes have also weakened its ability to use a powerful tool in enrollment: automatic renewal.

Last fall, Bimestefer said, her agency had to choose between fixing the system so that it would stop disenrolling children who shouldn't lose coverage, or start automatically renewing people with no income or with income below the federal poverty level. It couldn't do both, she said.

Experts such as Tricia Brooks, a research professor with the Center for Children and Families at Georgetown University, said it's especially important to increase automatic renewals in states like Colorado where most of the renewal work falls on county government staff.

“What happens when you're not getting a high rate of automated renewals? You're sending out those renewal forms,” Brooks said — meaning more disenrollments. “They didn't get the mail. The notice was confusing. They tried to get help through the call center. The list goes on as to why people don't renew.”

Indeed, two-thirds of disenrolled Coloradans lost coverage for procedural reasons. That's in line with the national average, according to KFF. But paired with Colorado having disenrolled so many people overall, that means more than 500,000 Coloradans, or about 9% of the state's people, were disenrolled for procedural reasons — more than the population of its second-largest city, Colorado Springs.

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At least a third of those disenrolled were later determined to be eligible for Medicaid.

Officials at Colorado community health centers and mental health centers say they're seeing a rise in uninsured patients coming through their doors — a sign, they say, that Coloradans dropped from Medicaid aren't necessarily moving on to greener health insurance pastures.

Fifty-eight percent of those who were disenrolled have returned to Medicaid, or now have another form of insurance. But the state doesn't yet know what happened to the remaining 42% of people who were dropped and said it would conduct a survey to find out.

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By: Rae Ellen Bichell
Title: Colorado Dropped Medicaid Enrollees as Red States Have, Alarming Advocates for the Poor
Sourced From: kffhealthnews.org/news/article/colorado-medicaid-unwinding-blue-red-states/
Published Date: Thu, 11 Jul 2024 09:00:00 +0000

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‘A Bottomless Pit’: How Out-of-Pocket TMJ Costs Drive Patients Into Debt

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Brett Kelman and Anna Werner, CBS
Thu, 11 Jul 2024 11:31:00 +0000

Over three decades of relentless pain, Jonna Tallant has tried about every TMJ treatment: mouthguards, six sets of braces, dental crowns and appliances, drugs, physical therapy, Botox, massage, acupuncture, chiropractic care, and surgery.

Nothing has helped. Tallant, 51, of Knoxville, Tennessee, said she lives in agony and cannot eat any food that must be chewed. Despite spending a small fortune on treatment, she can barely open her mouth enough to squeeze in a toothbrush.

Tallant estimates she has paid at least $200,000 for TMJ care. She provided medical records showing more than $60,000 in out-of-pocket spending in just the past decade. She has exhausted her savings and borrowed money, she said, and her family sold a plot of land to help pay the bills.

Tallant will need another jaw surgery later this year, which could cost as much as $75,000. Her insurance is unlikely to pay for any of it, she said.

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“It's a bottomless pit,” Tallant said, choking up, as she leafed through a pile of medical records splayed on her dining table. “It has consumed so much of my life that there is not much left.”

Temporomandibular joint disorders, known as TMJ or TMD, cause pain and stiffness in the face and jaw and are believed to afflict as many as 33 million Americans. Scientific studies have found that women experience TMJ disorders two to nine times as often as men, and while minor symptoms may not require treatment, severe symptoms can include disabling pain that makes it challenging to eat, work, talk, or sleep.

Despite the commonness of TMJ disorders, treatments are often not covered by medical or dental insurance, leaving patients with out-of-pocket bills that can range from a few hundred dollars to tens of thousands of dollars. Many medical insurers consider TMJ treatment too dental-focused for medical insurance, while dental insurers consider it too medical for dental insurance, leaving patients stuck in a “medical-dental divide” that hinders care and increases cost, according to the National Academies of Science, Engineering, and Medicine.

Worse still, researchers warn that the meager insurance coverage available for TMJ often excludes the safest forms of care while steering patients toward surgery — a riskier and irreversible option that the National Institutes of recommends “staying away” from.

Terrie Cowley, a longtime TMJ patient who leads the TMJ Association, an advocacy group, has spoken with patients who refinanced their homes and cashed out retirement accounts to afford the out-of-pocket costs for their care.

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“It bankrupts them,” Cowley said. “But it isn't nearly as horrible as when the treatments go wrong.”

Insurance woes are just one facet of the problems with TMJ care in the United States. In April, a joint investigation by KFF Health News and CBS News found that TMJ disorders have been widely misunderstood by many dentists for decades, so some patients fall into a spiral of ineffective care and futile surgeries that do more harm than good. Dentistry has tried to correct course in recent years with the promising new specialty of orofacial pain, which treats TMJ disorders with a more conservative approach, but these specialists are few and rarely covered by insurance, so their services remain beyond the reach of many patients.

Tony Schwartz, president of the American Board of Orofacial Pain, said the specialty is still fighting for widespread acceptance from insurance companies and some dentists, who cling to “old, debunked theories” that TMJ disorders are caused by misaligned teeth or a bad bite.

“This is the basis for why insurance companies have been so reluctant to, over the years, pay for any treatment,” Schwartz said. “Because there has been so much controversy about what works and what doesn't work.”

For this article, KFF and CBS News interviewed 10 patients with severe TMJ disorders who have been in treatment for years, if not decades. Almost all the patients described spending thousands of dollars out-of-pocket at every stage of their care, usually because treatment fell outside their medical and dental insurance coverage. Some patients said their medical bills mounted just as debilitating pain forced them to leave jobs or abandon careers. Some underwent expensive TMJ surgeries offered by only a small group of surgeons who generally do not accept insurance.

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Kyra Wiedenkeller, 45, of New York state, said she worked as a manager in the music industry, including on “American Idol,” before her “unrelenting pain” became too great.

Wiedenkeller, who is now on disability, said she's spent at least $100,000 out-of-pocket on TMJ treatment and provided medical documents showing she had been billed for at least that much.

“Every doctor I've seen has made me progressively worse,” Wiedenkeller said. “I paid an exorbitant amount of money. I wiped out my 401(k) for these treatments in hopes of getting better time and time again. And just get worse and worse. I feel like there is no end.”

Wiedenkeller's story echoes findings of the national academies, which conducted a comprehensive study of TMJ in 2020 that included input from more than 110 patients. The study found that TMJ patients are “often harmed” during “overly aggressive” treatment, which frequently falls into a chasm between medical and dental insurance, leaving most bills paid out-of-pocket at costs of up to tens of thousands of dollars.

As an example, the study describes how dental splints — a common TMJ treatment — have been considered to be medical care by some dental insurers and considered dental care by some medical insurance programs, and are “therefore not covered” by either.

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And when TMJ is covered by insurance, it tends to exclude “low-risk, effective treatments,” like those used by orofacial pain specialists, but covers “higher-risk” options, like jaw surgery, according to the national academies study. This leads to patients receiving “the care that is best reimbursed, rather than the care that is best,” the study said.

Other researchers have come to the same conclusion.

James Fricton, an orofacial pain specialist who studies the lack of insurance coverage for TMJ care, said that even though surgery is appropriate for few patients, it is the only treatment covered by most insurance plans in most states.

“Patients will assume that insurance companies know what they're doing,” Fricton said. “If that's all that's covered, what do you think they are going to get? Surgery.”

In contrast, insurance coverage appears to be weakest at the other end of the treatment spectrum.

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“Orofacial pain,” officially recognized by the American Dental Association in 2020, is now taught in residency programs at a dozen U.S. colleges at least, including the universities of Michigan, Minnesota, and North Carolina. The specialty avoids making irreversible changes to the bite or jaw and instead treats TMJ disorders with tools like counseling, dietary changes, medication, physical therapy, and removable dental splints. Many TMJ patients can be treated by orofacial pain specialists for a few thousand dollars.

The national academies study describes this approach as one of the few promising options for TMJ patients, citing studies that showed improvement among patients who are taught how to manage their pain. But the national academies also said it is a “particular challenge” that this treatment is “often not considered reimbursable by insurance.”

In separate interviews, six orofacial pain specialists with clinics around the country said insurance coverage for this specialty care is patchy, poor, or nonexistent. Several said their specialty is often absent from dropdown menus on standard insurance forms. Most said the insurance industry had fallen behind on the evolving science of TMJ, missing a chance to help patients and cut costs.

“It's a no-brainer,” said Jeffrey Okeson, dean of the University of Kentucky's College of Dentistry. “If I was an insurance person, I'd want to supply $1,000 to a patient to do conservative treatment … instead of $15,000 or $30,000 for surgery. Think of the money that can be saved there.”

Okeson and the other orofacial pain specialists said unreliable insurance coverage has hamstrung the specialty by making it less attractive to the next generation of dentists.

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Currently there are fewer than 300 certified orofacial pain specialists in the United States, according to a database maintained by the American Board of Orofacial Pain. At least 20 states have no certified specialists, and eight other states have only one or two.

Deepika Jaiswal, the only certified specialist in Iowa, said some patients with TMJ disorders drive across the state to see her.

However, most of her patients — and many of her fellow dentists — remain unaware of the orofacial pain specialty, Jaiswal said, so insurance companies likely feel little pressure to include it in their coverage.

“People don't even know around the area that we exist,” Jaiswal said. “When there are more providers providing this service, I think at that point there will be more insurance.”

CBS News producer Nicole Keller contributed to this article.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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By: Brett Kelman and Anna Werner, CBS News
Title: ‘A Bottomless Pit': How Out-of-Pocket TMJ Costs Drive Patients Into Debt
Sourced From: kffhealthnews.org/news/article/tmj-disorders-orofacial-pain-specialty-out-of-pocket-costs-medical-debt/
Published Date: Thu, 11 Jul 2024 11:31:00 +0000

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