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This column features selected short items about state health care policy.
PORTLAND, ME—The federal Medicare program reimbursed Maine hospitals $115 million less than what it cost them to care for elderly patients in 1999, according to a new report done for the Maine Hospital Association.
The shortfall has prompted hospitals to make up the difference by charging other patients more money, a practice that pushes up the price of health insurance in the private market for individuals and businesses.
"There is now broad consensus," the report stated, "that the Medicare shortfall is one of the major contributors to Maine’s high health-insurance premium rates."
Hospital charges in Maine could be cut 12%, the report said, if hospitals were paid what it actually cost them to provide care to Medicare patients. Hospital charges for all patients added up to $2.44 billion in 1999, so a 12% reduction would amount to $300 million, a figure that reflects the markups hospitals take to cover their shortfalls.
—Portland Press Herald, July 17
COLUMBUS, OH—Despite reports of layoffs and a sluggish manufacturing base, Ohio’s welfare caseload last month hit its lowest mark in more than 34 years.
Largely rural Huron County, south of Sandusky, has become the first Ohio county since the 1960s to clear its adult caseload completely. Not a single adult was on the county’s cash-assistance rolls in June, a milestone it had briefly reached in January.
The zero-caseload achievement was short-lived. A former resident of Ottawa County just moved into Huron, raising its caseload to one, according to Judy Fegen, director of the Huron Department of Job and Family Services.
In all, 196,622 adults and children were on Ohio’s welfare rolls last month, the lowest figure since March 1967. The rolls peaked in March, 1992, at 748,717.
—Toledo (OH) Blade, July 19
WASHINGTON, DC—Members of the National Rural Health Association (NRHA) went to Capitol Hill in late July to tell lawmakers that their hospitals need help. After a session on rural health issues held by the American Hospital Association, NRHA members fanned out to try to convince lawmakers of their urgent need for relief on several of those issues. The hospital representatives planned to inform their congressional delegation of such issues as work force shortages, especially for nurses; cost competition with urban hospital pay scales; transportation and ambulance diversion issues; and the need for more adequate Medicare reimbursement.
Without help from Congress on these issues, several members said that their hospitals would soon have to begin shutting down beds and that some would have to close altogether.
Health and Human Services Secretary Tommy Thompson announced the formation of a Health and Human Services Rural Task Force that will examine how the department can better serve rural communities. In his announcement, Thompson said the internal task force would search for existing regulatory and statutory barriers to serving individuals and families in rural areas. The task force will explore ways to improve state health and social service delivery systems and identify places where additional funding may be needed. The task force will begin work immediately and is expected to complete its review within three months. Marcia Brand, director of the Health Resources and Services Administration’s Office of Rural Health Policy, will head the task force.
—American Hospital Association, July 26
WEST PALM BEACH, FL—The Palm Beach County Health Care District has been ordered to reimburse $108,291 to Medicaid for improperly charging for care provided to AIDS patients who are poor.
State auditors found the district billed Medicaid for AIDS patients at the county’s nursing home in 1999 and 2000 without getting prior approval from the state Medicaid office. The district had 31 HIV-positive residents in 1999. The home averages 143 residents.
District officials blamed clerical errors and said the money would be repaid.
In a separate review, Palm Beach County’s internal auditor found further evidence that the district mishandled Medicaid billings.
Checking bills for patients in May 2000, auditors found instances where Medicaid was both overcharged and undercharged, according to a report released last month. District officials acknowledged that billing procedures were lacking. They also blamed computer glitches in the billing system.
—The Palm Beach Post, July 26
HELENA, MT—Nearly 67,000 low-income Montana adults lack health insurance and don’t qualify for Medicaid because eligibility requirements are too high, a health care advocacy group says.
The report, conducted by Families USA, is part of a national survey of health insurance needs.
As with other states, the study concluded that income standards for Medicaid eligibility in Montana are at such levels that many lower-income people who don’t have health insurance also do not qualify for the government health insurance program.
The U.S. Department of Health and Human Services puts the poverty level for an adult at $8,590 a year, and $14,630 a year for a family of three.
The Families USA study defines "low income" as up to double the poverty level, meaning that an adult making up to $17,180 a year and a family of three making up to $29,260 would be considered low-income.
Based on its definition, the study concluded more than 47,000 low-income Montanans without children lack insurance and do not qualify for Medicaid.
In addition, 27,618 low-income parents in Montana lack insurance, and 67.4 % of them also are ineligible for Medicaid, the study said.
—Associated Press, July 20
WASHINGTON, DC—The slowing economy hit many state governments hard in the past year as income weakened, spending rose, budget gaps increased, and savings shrunk, according to a new report.
The immediate financial future promises to be even tighter, although the National Conference of State Legislatures concluded states were managing the shortfall well. The group’s annual review also found that states overall continued to cut taxes despite the worries.
The study assessed the finances of 46 states for the fiscal year that — for most — ended in June and the current year that began in July. Massachusetts, New York, and North Carolina had not passed budgets in time for the report, and Tennessee’s budget remains unresolved.
In the fiscal year that ended in June, states’ spending was up 9.1%, but revenue grew only 4.5%. Economists blamed a significant part of the spending rise on growing Medicaid costs, although prisons and schools accounted for cost overruns in several states, too.
As the fiscal year ended in 2000, budget surpluses were the states’ biggest financial headaches. Autumn brought the first signs of weakness, with weak holiday sales taxes in the winter and revenues clearly sliding by February.
By midyear, budget shortfalls were a problem for more than a third of the states. Nine states slashed budgets, with Kentucky cutting $121 million from its budget, Alabama slicing 6.2% from its education trust fund, and South Carolina passing an across-the-board 1% cut for state agencies. The economy made balancing the states’ 2001-02 budget difficult, too, as 20 states had to either tap reserves, cut spending, increase taxes or delay purchases.
—Associated Press, Aug. 1
WASHINGTON, DC—Uninsured women in Utah, Idaho, South Dakota, Illinois, Indiana, and Montana are now eligible for medical coverage for breast and cervical cancers, as each state has taken advantage of the federal Breast and Cervical Cancer Prevention and Treatment Act. The federal legislation, which was signed into law in October 2000, allows states to offer medical benefits to uninsured women suffering from either cancer who have been diagnosed through the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program. Other states participating in the program are Rhode Island, New Hampshire, West Virginia, and Maryland. For more information, go to www.hcfa.gov/Medicaid/bccpthm.htm.