Will Humble Family Planning, Medicaid, Prevention, Wills Blog

US Supreme Court Declines to Hear Appeal Regarding Reproductive Health

This week the US Supreme Court declined to hear a case that would have given them an opportunity to overturn a lower court ruling that found that Medicaid agencies can’t exclude providers offering preventive reproductive health services like annual health screens, contraceptive coverage and cancer screening because they also offer abortion services.  Lower federal courts had ruled that while states have broad authority to ensure that Medicaid health care providers are qualified, that power has limits. 

The case isn’t about elective abortion services per se (the Hyde Amendment from 1977 makes it clear that federal funds can’t be used to pay for abortions except in cases of rape, incest, or life endangerment). The question is whether providers can be excluded from Medicaid contracts for preventive services like annual health screens, contraceptive coverage and cancer screening because they also separately offer abortion services outside of their public dollar contracts. 

The Supreme Court’s decision to decline the case will have implications here in Arizona. In 2016, Governor Ducey signed a bill giving the director of the AHCCCS the power (at his or her discretion) to disqualify any provider that doesn’t fully segregate the public dollars they get and ensure that none of those funds went toward providing elective abortions- including overhead expenses like rent, lights and A/C.

While that law is still on the books (as ARS 36-2930.05), it hasn’t been implemented. After a lawsuit was filed back in ’16, attorneys for AHCCCS agreed not to implement the law and stipulated that AHCCCS won’t try to cut family planning dollars from Planned Parenthood or any other organization because it hasn’t fully segregated out the costs of abortion services to the satisfaction of the director.  The implementation hold agreed to in the stipulation was until Rules (Administrative Code) could be adopted- which they estimated would take about 2 years.

In exchange, the attorneys for the providers agreed to drop their lawsuit challenging the legality of the measure until there are actual rules in place.  I checked on the AHCCCS and Secretary of State’s website and can’t find any Rules fleshing out the criteria- but I might have missed them.

In any event- the fact that the US Supreme Court this week declined to hear a case similar to Arizona’s suggests that- at least for now- the status quo remains…  and Arizona’s Managed Care Organizations that contract with AHCCCS are free to contract with Planned Parenthood or other providers even though they may not be segregating expenses as required in ARS 36-2930.05.Of course- that could change at any time if the Supreme Court changes their mind and agrees to hear a similar case in the future.

Will Humble Prevention, Vaccination, Wills Blog

Support School Attendance Vaccination Requirements

Please express your support for immunization requirements for public school attendance and informed use of appropriate vaccine exemptions by signing on to this letter of support to the Governor.

By simply clicking here you can add your name to the growing list of Arizonans that believe that it’s important to protect Arizona children against vaccine preventable diseases and protect community immunity that protects the most vulnerable among us. Here’s the letter:

Dear Governor Ducey,

We, the undersigned, want to express our full support for this resolution adopted by the Arizona Medical Association (ArMA):

“ArMA supports adopting requirements that parents (or guardians) who do not wish to have their children vaccinated receive public health-approved counseling that provides scientifically accurate information about the childhood diseases, the available vaccines, the potential adverse outcomes from catching diseases, the risks unvaccinated children pose to children who cannot be vaccinated for medical reasons, the risks of vaccine side effects, and the procedures that are implemented to exclude unvaccinated children if an outbreak of disease occurs in the area administered by the local or state public health agency.

ArMA also supports adopting requirements that parents annually sign an affirmative statement that acknowledges the risks they are accepting for their own children and the children of others by claiming a personal exemption from mandatory vaccination requirements.”

As residents of Arizona, we actively support and encourage you to work with the Arizona Department of Health Services (ADHS), all County Health Departments, and longstanding partners of The Arizona Partnership for Immunization (TAPI) to maintain high levels of immunization coverage rates in our schools and our communities…to keep your constituents safer and healthier.

 

Will Humble Oral Health, Wills Blog

Action for Dental Act Passed

The Action for Dental Health Act of 2018 was overwhelmingly passed by congress last week providing an opportunity to improve oral health across the country.  The bill will provide (once signed by the President) additional resources to the CDC to increase funding for groups and organizations to qualify for federal grants that develop programs and expand access to oral health education and care in states and tribal areas.

Grantees are expected to include dentistry and hygiene programs working in rural and underserved areas as well as organizations helping to increase oral health literacy and disease prevention in low-income and minority communities.  The Bill is expected to a=invest an additional $133M over the next four years.

CDC will be entering into contracts with state, county, or local public officials and other stakeholders to develop and implement initiatives to: (1 improve oral health education and dental disease prevention;  2) reduce geographic barriers, language barriers, cultural barriers, and other similar barriers in the provision of dental services; 3) establish dental homes for children and adults; 4) reduce the use of emergency departments by individuals who seek dental services more appropriately delivered in a dental primary care setting; or 5) facilitate the provision of dental care to nursing home residents.

CDC will still need to flesh out the grant guidance in the coming months before they put out their announcement with the application and expectations.

Will Humble Federal Budget, Nutrition, Wills Blog

Action Alert to Save Nutrition Education Programs

The Farm Bill is currently in its final negotiations, and important funding for SNAP-Ed programs in Arizona and across the country is at stake. We need your help to urge Congress to maintain the Senate version of the Farm Bill to save this critical support for these programs.

The SNAP-Ed program provides nutrition education and resources to thousands of Arizonans. If the Senate version of the funding is not maintained in the final Bill (expected to be approved before this congress exits), Arizona won’t be able to offer effective food and nutrition programs to low-income communities who need it, especially in Congressional Districts 1 and 3.  

The new House of Representatives funding formula would significantly shift SNAP-Ed grants away from more than 15 other states, thus ending programs for people in hundreds of low-income communities throughout the country. 

Click here to urge Congressman Tom O’Halleran and Congressman Raúl Grijalva to maintain the Senate version of the Farm Bill to save this critical support for these programs!

Will Humble State Legislature, Wills Blog

State Legislature Health Committees

Senate Health & Human Services Committee

The Senate Health and Human Services Committee will meet this Session on Wednesday mornings at 9 am in Senate Hearing Room #1.  The Chair will be Senator Kate Brophy McGee with Sen, Heather Carter as the Vice Chair.  Other committee members will be Tyler Pace, Rick Gray, Sylvia Allen, Rebecca Rios, Tony Navarette, and Victoria Steel.

House Health & Human Services Committee

The House of Representatives Health and Human Services Committee will meet this Session on Thursday mornings (no room named yet).  The Chair will be Rep. Nancy Barto with Jay Lawrence serving as Vice Chair.  Other members are Representatives John Allen, Gail Griffin, Becky Nutt, Kelli Butler, Pamela Powers-Hannley, Alma Hernandez and Amish Shah.

Will Humble Public Health, State Legislature, Wills Blog

State Agency Budget Requests

Here’s a summary of some of the budget requests that were made by state agency directors for the upcoming fiscal year:

Department of Health Services

  • Seeks increased compensation for “key” positions to reduce turnover & vacancy rates.  No dollar figure is attached.

  • Requests an increase of $4.1 M lump sum from Health Licensing Fund & ongoing Radiation Regulation appropriation increase of $600,000 from Health Service Licensing Fund to cover administrative expenditures & ongoing growth & workload for Licensing Division.

  • Asks for $550,000 from the General Fund for an “administrative shortfall” at the Arizona State Hospital.

  • Requests $500,000 from the ADHS Indirect Fund for the public health emergency fund.

  • Seeks $200,000 from the Land Fund to pay for higher costs for services at the State Hospital for pharmacy, dietary, EHR, housekeeping, etc.

  • Asks for an appropriation increase of $600,000 from the Newborn Screening Fund to cover administrative costs.

  • Asking for a $240,000 in state general funds for the Behavioral Risk Factor Surveillance Survey (under a cooperative agreement with CDC).

 

AHCCCS 

  • Requesting a net increase of $44.7 M over the current year.

  • Seeks an overall acute capitation rate increase of 1.9% over the blended rates from the prior year

  • Asks for overall weighted capitation rate increase of 2.5% over baseline across all populations.

  • Anticipates the FMAP rate (federal matching rate percentage) for the acute traditional members of 69.48%

  • Includes a $7.9M dollar figure if state law is modified to prevent freezing KidsCare (because of the reduction in federal payments (FMAP) moving from the current 100% to 90% beginning October 1, 2019)

 

AZ Department of Economic Security

  • Requests $41.6 M in increased funding to help providers cover some of the costs that providers of services for folks with developmental disabilities to cover costs for the coming increase in the minimum wage next fiscal year. 

  • Pursues use of federal Child Care Development Block Grant of $55.8 M (OF) which would allow child care rates to increase from 2000 to 2010 market rate and serve an additional 5,000 children

Will Humble Health Insurance, Prevention, Public Health, Wills Blog

Merger of CVS & Aetna Finalized

Last week CVS Health completed their acquisition of Aetna. You know CVS through their pharmacy stores- and Aetna through their health insurance businesses (in AZ that includes Mercy Care and Mercy Maricopa Integrated Care). 

Aetna will be a stand-alone unit within CVS and led by members of its current management team.  It’s essentially a vertical integration- as it combines Aetna (primarily a health care insurer) with CVS (primarily a retailer).

The US Justice Department required Aetna to divest its Medicare prescription drug business to WellCare Health Plans before approving the merger.

One of the goals of the merger is to integrate Aetna’s medical information and analytics into CVS Health’s pharmacy data- creating a new model of care delivery.

The new company says they’ll be introducing new programs to target more efficient management of chronic disease with services focusing on self-management for patients with chronic conditions, expansion of chronic care management services at MinuteClinic, nutritional and behavioral counseling and benefit navigation support.  The plan includes expanded preventive health screenings to better manage high cholesterol, high blood pressure and diabetes.

A major focus will be on better managing five chronic conditions: diabetes, cardiovascular disease, high blood pressure, asthma and behavioral health.

There are some academics and other analysts that suggest the merger is anticompetitive and won’t result in better care or outcomes- but it looks to me like it has a pretty good chance of improving outcomes- especially if they focus on better management of chronic medical conditions combined with more convenient and numerous service sites.

CVS has been moving their mission from its traditional pharmacy business model for some time- bringing it more in line with providing health care and other services.  Several years ago- as this new model was emerging, CVS decided to stop selling cigarettes etc. as they rightly saw those sales as inconsistent with that of a business focusing on improving health outcomes.

Will Humble Affordable Care Act, Health Insurance, Wills Blog

Marketplace Open Enrollment Ends December 15

December 15 is the last day to apply for Marketplace health insurance.  Most people get health insurance through their employer, Medicare or Medicaid, but about 87,000 Arizonans get their insurance though the Federally Facilitated Marketplace.  Nearly 9 out of 10 people in Arizona that get coverage from www.healthcare.gov receive tax credits – financial help – to make coverage more affordable. 

Each year many Arizonans meet with an Assister, thinking they will buy a www.HealthCare.gov plan, but find out they are in fact eligible for AHCCCS (Medicaid). Some learn their children are eligible for very low cost KidsCare (Children’s Health Insurance Program). 

To find out what a comprehensive plan may cost go to www.healthcare.gov/see-plans. By simply entering your zip code, age, number of family members and projected 2019 income, you can look at available plans and find out if you qualify for a discount.  If a single person earns less than $48,560 they may qualify for financial help.  A family of four can earn up to $100,400 and qualify for financial help.

No matter where you live in Arizona, help is available. You can call 1-800-377-3536 or go to www.CoverAZ.org  and click on “Send a Message” to get your questions answered, or visit www.CoverAZ.org/Connector and make an appointment to meet with a local Assister.

Will Humble Affordable Care Act, Health Insurance, Wills Blog

Feds Open Door to Subsidizing non-ACA Plans

Last week CMS released new guidance urging states for states to start offering federal subsidies to people buying plans that don’t comply with the ACA.  Their objective is to provide subsidy options for short-term and association health plans, which offer fewer benefits and consumer protections but at a lower cost.  They’ve branded the new subsidy system “State Empowerment and Relief Waivers. 

If the program stands up to a judicial review, states will be able to who is eligible for health insurance subsidies. Under the ACA, anyone with an income 400% of the federal poverty line is eligible for subsidies on the insurance marketplace. This new guidance would allow states to add to that regulation, like prioritizing younger, healthier populations over lower-income residents.  Importantly, any waiver request would still need to meet the ACA standard that it ensures the waiver plan meets the four statutory standards relating to comprehensiveness, affordability, coverage, and federal deficit neutrality.

Included in last week’s announcement is a provision giving states a way to better manage risk in their Marketplace plans. The Risk Stabilization Strategy that they announced gives states a way to implement reinsurance programs or high-risk pools. Reinsurance programs can lower premiums by providing some protection from expensive risk pools.  Examples are a “claims cost-based model”, a “conditions-based model”, and a hybrid conditions and claims cost-based model.

Will Humble Climate Change, Public Health, Wills Blog

Global Climate Change Research Program Report

Profound Public Health Impacts Identified

The Global Change Research Act of 1990 mandates that the U.S Global Change Research Program deliver a report every 4 years to analyze the effects of global change on the natural environment, agriculture, energy demand, land and water resources, transportation, human health and welfare, human social systems, and biological diversity.  The statutory charge for the report is to “… inform decision-makers, utility and natural resource managers, public health officials, emergency planners, and other stakeholders by providing a thorough examination of the effects of climate change on the United States”.  The 2018 report was issued on the day after Thanksgiving. 

The Report issued last week focuses on the elements in their statutory mandate for 10 regions and 18 topics.  Chapter 14 focuses on public health.  Many of the public health challenges and impacts in the report are things readily observable today.  For example, one of the acute is the public health and policy struggles this year will be surrounding prioritization, use and conservation of increasingly limited water supplies here in Arizona.   As the Colorado River basin continues to have less snow pack and earlier melting- there’s no doubt that allocating a permanently reduced water supply.  We’re likely to see these negotiations play out at the national and state level in the coming months.

At first, I was planning to write my own summary of the public health chapter- but the Executive Summary of that chapter does a pretty good job- so I’ll paste that section for you instead:

Climate-related changes in weather patterns and associated changes in air, water, food, and the environment are affecting the health and well-being of the American people, causing injuries, illnesses, and death. Increasing temperatures, increases in the frequency and intensity of heat waves (since the 1960s), changes in precipitation patterns (especially increases in heavy precipitation), and sea level rise can affect our health through multiple pathways. Changes in weather and climate can degrade air and water quality; affect the geographic range, seasonality, and intensity of transmission of infectious diseases through food, water, and disease-carrying vectors (such as mosquitoes and ticks); and increase stresses that affect mental health and well-being.

Changing weather patterns also interact with demographic and socioeconomic factors, as well as underlying health trends, to influence the extent of the consequences of climate change for individuals and communities. While all Americans are at risk of experiencing adverse climate-related health outcomes, some populations are disproportionately vulnerable.

The risks of climate change for human health are expected to increase in the future, with the extent of the resulting impacts dependent on the effectiveness of adaptation efforts and on the magnitude and pattern of future climate change. 

Obviously, there is allot more in the report that really requires a deeper dive.  The report is certainly worth book marking in your Favorites section for reference as you conduct your public health work.

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