MEDICAID

Special Needs Kids

North Dakota became the first state to implement a new federal program aimed at helping low- and middle-income families with special-needs children. Governor John Hoeven signed SB 2326 into law, creating a Medicaid buy-in program for families that otherwise would not be eligible. To qualify, a family must have incomes below 200 percent of the federal poverty limit—$41,000 for a family of four—and have a special-needs child with medical bills. “Basically, there are these families we know who could lose their insurance, their home and their job because of the expense of caring for a family member,” bill sponsor Senator Tim Mathern told the Bismarck Tribune. The program comes from the federal Dylan Lee James Act of 2005, which allows any state that wants to participate in the buy-in program to do so. The federal government will then contribute part of the costs for the program. To be eligible, families must pay 5 percent of their income to Medicaid for coverage of their child. Families may supplement that coverage with private insurance.

MENTAL HEALTH

Inmates to Get Better Care

The New York Department of Correctional Services reached an agreement with the state’s inmate population with mental illness, settling a lawsuit in which the prisoners claimed inhumane treatment. The agreement was negotiated after five years of litigation and two weeks of a non-jury trial in federal court. The agreement will add mental health counselors and resources such as new beds for mentally ill inmates. It will also prevent cruel and unusual punishments such as “stripping naked mentally ill inmates suffering an acute psychotic episode, segregating them in a Plexiglas-walled cubicle and leaving them with nothing but a thin pad on a cement floor and the use of punitive ‘restricted diets,’ a loaf made from bread and cabbage, for punishment,” according to the Albany Times Union. The agreement will also add two to four hours of therapy outside of the cell for mentally ill inmates in solitary confinement. Governor Eliot Spitzer has called for an additional $60 million over three years to fund additional services for this population. Approximately 8,000 of the state’s 63,000 inmates suffer from serious mental illness.

QUALITY

Nursing Home Compliance

Nursing homes with repeated safety compliance problems usually face only minimal penalties from the federal government, according to a report from the Government Accountability Office. Congress established "stringent" standards for nursing homes in 1987, but a 1998 GAO report found nursing homes that repeatedly harmed residents were insufficiently penalized. The federal government and the nursing home industry since have announced a number of initiatives to improve care. However, homes with a long history of harming residents are rarely held accountable for the poor care provided, with some of the homes continuing to receive Medicare and Medicaid reimbursement despite repeat infractions, says the report. As an example, the GAO points to a California nursing home in which a patient choked to death in part because machinery needed to save his life was broken. The facility had been cited for more than 170 serious deficiencies but still was open in late 2006, according to the report. Additionally, the report found that the Bush administration rarely denies federal payments to nursing homes with compliance problems and usually imposes fines that are much smaller than the maximum of $10,000 per day. Nursing homes facing exclusion from Medicare and Medicaid often avoid penalties by temporarily improving care quality and then resuming noncompliant practices, the report found. The GAO recommends more frequent inspections and closer scrutiny of nursing homes with a history of compliance problems, in addition to making information about compliance problems at specific nursing homes available to the public.

States Dropping the Ball on Hospices

A report from the Inspector General’s Office at the Department of Health and Human Services has found that some states have not kept up with inspection and certification of Medicare hospice programs. A number of states have gone as much as nine years without checking up on their programs. State visits are the primary method HHS uses to track the quality of care in hospices. The report fingered three states—California, Illinois and Michigan—as being the furthest behind in their inspections, accounting for 41 percent of past-due certifications. The OIG also found health deficiencies in 46 percent of hospices surveyed, primarily dealing with patient-care planning and quality. Some recommendations include:

• Providing guidance to state agencies and HHS regional offices regarding analysis of existing data and identification of at-risk hospices;

• Including hospices in federal comparative surveys and annual state performance reviews;

• Seeking regulatory changes to establish specific requirements for the frequency of hospice certification; and

• Seeking legislation to establish additional enforcement remedies for poor hospice performance.

Currently, HHS’ only enforcement mechanism is terminating a hospice from the Medicare program.

HIV/AIDS

HIV Increasing Among American Indians

The number of American Indians with HIV/AIDS is on the rise, according to new figures from the American Foundation for AIDS Research. American Indians have the third highest rate of infection among ethnic groups at 10.6 out of 100,000. By comparison, rates are 72.8 for African-Americans, 28.5 for Hispanics, 9.0 for Caucasians and 7.6 for Asians. The vast majority of infections come from male-on-male interactions, followed by intravenous drug use. What makes the situation even worse is that many American Indians are in poverty and live in rural areas, making access to care more difficult. Additionally, many Indians are mistrustful of government services and are loathe to utilize them, according to Dr. Monica Ruiz with AMFAR. “When you think about the history of American Indians in the U.S and how they have been treated by the federal government, you know there is mistrust,” Dr. Ruiz told the Yuma Sun. Reccomendations for stemming the virus include increased prevention education programs and outreach that is culturally acceptable.