The Affordable Care Act: Opportunities for States in 2013 Robert Greenwald, Maggie Morgan and Emily Broad Leib, Center for Health Law and Policy Innovation.

The Affordable Care Act: Opportunities for States in 2013

Robert Greenwald , Maggie Morgan and Emily Broad Leib, Center for Health Law and Policy Innovation of Harvard Law School

February 2013

• Part 1: The Affordable Care Act: Overview of Where We Are and Where We Are Going

• Part 2: Medicaid Expansion: a Key National Advocacy Priority

• Part 3: Medicaid Chronic Health Homes: A Model for Diabetes

• Part 4: Medicaid Preventive Services: Essential Care without Cost-Sharing

PRESENTATION OUTLINE

Part 1: The Affordable Care Act:

Overview of Where We Are & Were We Are Going

Where We Are:Status Quo = Access to Care Crisis

U.S.. Rates of Uninsured:We are Moving in the Wrong Direction

See: http://www.gallup.com/poll/156851/uninsured-rate-stable-across-states-far-2012.aspx?version=print

High Rates of Uninsured Across the Nation & Particularly in the South

TX

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• Cannot be denied insurance because of diabetes or other health condition, even if you don’t currently have coverage (2014)

• Health plans cannot drop people from coverage when they get sick (in effect)

• No lifetime limits on coverage (in effect)

• No annual limits on coverage (2014)

WHERE WE ARE GOING: ACA Reforms Private Insurance and Reduces Discriminatory Insurance

Practices

WHERE WE ARE GOING: ACA Reforms Private Insurance and Reduces Discriminatory Insurance

Practices

• Consumer-friendly Exchanges to purchase insurance• As of February 15, 2013, 18 states and the District of Columbia have

decided to establish a State-based Exchange (SBE), and another seven states have chosen a Partnership Exchange. The remaining 26 states have defaulted to an exchange run by the federal government.

• Federal subsidies with income between 100-400% FPL • (Up to ~$44K for an individual/~$92K for family of four)

• Plans cannot charge higher premiums based on health status or gender

• Plans must include Essential Health Benefits

ACA Promotes Access to Subsidized Private Insurance through Exchanges in 2014

ACA Promotes Access to Subsidized Private Insurance through Exchanges in 2014

Status of State-Based Exchanges

ACA Essential Health Benefits For All Newly Eligible Medicaid

Beneficiaries

For Most New Individual and Small Group

Private InsuranceBeneficiaries

ACA Benefits Also Include an Essential Health Benefits Package

• Ambulatory services • Emergency services • Hospitalization • Maternity/newborn care • Mental health and substance use

disorder services• Prescription drugs • Rehabilitative and habilitative services• Laboratory services • Preventive and wellness services and

chronic disease management • Pediatric services

ACA Increases Access to Medicare Drug Coverage & Preventive Services

ACA Increases Access to Medicare Drug Coverage & Preventive Services

• Part D “donut hole” phased-out by 2020

• 50% discount on all brand-name prescription drugs

• Free preventive services – Among others, for adults, includes mammograms, colonoscopies and

other cancer screenings, diabetes screenings, counseling for tobacco use and certain types of pre-natal care. Treatments for the prevention of alcohol abuse, depression and obesity.

ACA Expands and Improves Medicaid in 2014 ACA Expands and Improves Medicaid in 2014

• Expands Eligibility to Medicaid by eliminating the disability requirement for those with income up to 138% FPL (~$15K for an indiv/~$32K for family of four)– Every low-income U.S. citizen and legal immigrant (after 5

years in U.S.) is now automatically eligible

• Based on Supreme Court decision federal government can’t withhold all federal Medicaid funds if states refuse to implement Medicaid expansion

Medicaid expansion is optional and will be decided state-by-state

• Improves reimbursement rates for primary care providers (up to Medicare reimbursement rate) for 2013 and 2014

• Gives states the option to provide cost-effective, coordinated and enhanced care and services to people living with chronic medical conditions through Medicaid Health Home Program

• Gives state the option to provide free preventive services, including diabetes screening and treatment for the prevention of obesity

ACA Includes Other Medicaid Improvements: Supports Primary Care Providers, Medicaid Health

Homes, and Free Preventive Services

ACA Includes Other Medicaid Improvements: Supports Primary Care Providers, Medicaid Health

Homes, and Free Preventive Services

Where We Are Going: Great Potential but Relies on Successful Implementation

Improves Medicaid: Expands eligibility (state option); provides essential health benefits (EHB) (federal and state regulations); improves reimbursement for PCPs (only 2013-14); includes health home (state option); free preventive services (state option for Medicaid)

Creates Private Insurance Exchanges:Provides subsidies up to 400% FPL (federal and state regulation); eliminates premiums based on health/gender; provides EHB (federal and state regulation); supports outreach, patient navigation and enrollment (federal and state regulation)

Only with Successful Medicaid Expansion Will We Dramatically Improve Health Outcomes, Address Disparities, and Meet Prevention Goals

Part 2: Medicaid Expansion:

A Key National Advocacy Priority

ACA Will Dramatically Decrease Uninsured Rates By Requiring Everyone to Have Health Insurance

The area in red is the Texas Medicaid expansion populationThe area in blue is the Texas subsidized insurance population

Source: Texas Health and Human Service Commission: http://www.hhsc.state.tx.us/news/presentations/2012/071212-ACA-Presentation.pdf

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ACA Implementation with Medicaid Expansion = Income-Based Early and Comprehensive Health Care Coverage

ACA Implementation

Source: http://library.cppp.org/files/3/HC_2012_06_BR_MHMClineMurdock.pdfTexas HHSC, Pink Book 2013 (http://www.hhsc.state.tx.us/medicaid/reports/PB9/PinkBook.pdf)

Texas HHSC estimates that ACA Implementation with Medicaid expansion would provide health care to 2.6 million of the 5.5 million uninsured people in Texas.

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Rice University research estimates that up to 4.4 million out of 6 million currently uninsured Texans will obtain insurance, with Texas seeing the largest gain in insurance coverage in the country

with only 5.8% of Texans remaining uninsured.

Current Medicaid Program = Disability (Not a Health Care) Program for Low-income Uninsured

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%

Prescription Drugs

Outpatient

Other Acute

Inpatient

Long Term Care

Source: Kaiser Family Foundation. Analysis of 2007 MSIS data provided by the Urban Institute (http://www.kff.org/hivaids/upload/8218.pdf)

% of Medicaid Expenditures by Type of Service

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Waiting for people to be disabled before providing access to care is not sustainable

Medicaid Expansion Is a New and Different Program

As Chief Justice Roberts stated in the ACA decision:

“Congress’s decision as to title is irrelevant… The Medicaid expansion, accomplishes a shift in kind,

not merely degree.“

It isn’t a disability program. It is a prevention-based early access to affordable health care

program.

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High Rates of Uninsured Are a Vicious Cycle Forcing More People to Drop Coverage

Source: Texas Medical Association. http://www.texmed.org/Uninsured_in_Texas/20

Early Access to Comprehensive Health Care Matters

• Improves overall physical, social and mental health status• Prevents disease and disability• Leads to detection and treatment of health conditions• Improves quality of life• Reduces preventable death• Increases life expectancy

Uninsured people are less likely to receive medical care, more likely to have poor health status, and more likely to die early

See: http://www.healthypeople.gov/2020/default.aspx

Having an Ongoing Source of Care Matters

• People with a usual source of care have better health outcomes, and fewer disparities and costs

• Having a usual primary care provider increases the likelihood that patients will receive appropriate care

• Access to evidence-based preventive services prevents illness by detecting early warning signs or symptoms before they develop into a disease and detects disease at an earlier, and often more treatable, stage

See: http://www.healthypeople.gov/2020/default.aspx

Early Intervention Is Cost-Effective and Improves Individual and Public Health Outcomes for People Living

with Diabetes and other Chronic Conditions

• Many interventions intended to prevent/control diabetes are cost saving or very cost-effective *– i.e., regular preventive care, proper use of insulin or oral

medication, and supported self- management can reduce the risk of diabetes complications

• Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent heart attacks and strokes**

• Early intervention treatment for mental illness does not increase costs and is highly cost-effective when compared with standard care***

* Li Rui, et. al., Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review, 2010; ** William Weintraub, Value of Promordial and Primary Prevention for Cardiovascular Disease, 2011; *** Paul McCrone, Cost-effectiveness of an early intervention service for people with psychosis, 2010

Expanding Medicaid Will Provide a Lifeline to Uninsured Diabetics

Expanding Medicaid Will Provide a Lifeline to Uninsured Diabetics

Because of traditional Medicaid’s restrictive eligibility requirements, many uninsured people with type 2 diabetes are not receiving the care they need to manage the disease and prevent complications

– Nearly half of uninsured adults with diabetes are undiagnosed

– Low-income adults with diabetes who are not currently eligible for Medicaid enter care late, are often experiencing advanced disease progression, and incur high costs related to preventable conditions

Source: Health Affairs

Medicaid Can Be An Even More Critical Source of Care for Low-Income People with Diabetes with Expansion Medicaid Can Be An Even More Critical Source of Care for Low-Income People with Diabetes with Expansion

Medicaid beneficiaries with diabetes have much easier access to vital care than diabetics without insurance

– Uninsured adults with diabetes are more than 3 times as likely to report being unable to get needed care & more than 5 times as likely to delay needed care as diabetics on Medicaid

– Uninsured adults with diabetes report high rates of problems acquiring necessary prescription drugs

Source: Health Affairs

Federal and State Policy Making Matters

In all other industrialized democratic countries every citizen is guaranteed access to health care yet they spend less

Average per capita health spending

% of GDP

Medicaid Expansion is Not Just for the Unemployed: Low-Wage Workers and Small Business Owners are

Increasingly Uninsured

“Small Businesses Hit Hard by Economy Consider Dropping Health Coverage,” New York Times, Feb 3, 2009.27

Expanding Medicaid Helps State Hospitals: Either Way Federal Support of Uncompensated Care Declining

Source: Milliman ACA Impact Analysis , December 2012

• In addition to individual and public health related cost savings, Medicaid expansion will dramatically reduce federal and state uncompensated care costs•If a state doesn’t expand Medicaid, costs will increase, as the federal government is reducing funding to cover uncompensated care in favor of funding Medicaid expansion

ACA Will Reverse The Trend of Fewer Medicaid Providers: Greatly Increasing Access to Cost-Effective Primary Care

ACA Will Reverse The Trend of Fewer Medicaid Providers: Greatly Increasing Access to Cost-Effective Primary Care

With $120 billion in funding over the first 10 years of Medicaid expansion implementation, economic gains will include:

~ $276 Billion in general business activity~ Over 300,000 new jobs

Based on best estimates: Fast Facts on Texas Hospitals, THA, 2012-2013

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The Medicaid Expansion Will Have A Multiplier Effect on the Economy

Medicaid Expansion: Where the States Are

Medicaid Expansion Is Increasingly Non-Partisan and Being Assessed on Its Merits

Conservative Republican Governors are starting to see Medicaid Expansion as cost saving and a great deal for their states

Medicaid expansion greatly reduces state mental health services burden- Nevada anticipates saving $16 million in just 2 years on mental health and predicts the state would spend and extra $16 million without expansion. Governor Sandoval, Nevada

Federal funds from Medicaid expansion boost state economies and will protect rural and safety net hospitals from being pushed to the brink- Arizona estimates saving $353 million in just 3 years. Governor Brewer, Arizona

It comes down to are you going to allow your people to have additional Medicaid money that comes at no cost to us, or aren't you? We're thinking, yes, we should.

Governor Dalrymple, North Dakota

Medicaid expansion will not only save money each year, we can expect revenue increases that will offset the cost of providing these services in the future.

Governor Martinez, New Mexico 32

If a state doesn’t expand Medicaid, its citizens’ federal tax dollars will instead go to fund health care in states that do, like NY and CA!

The Final Challenge

Part 3: Chronic Health Homes:

A Model for Diabetes Care

Part 3: Chronic Health Homes:

A Model for Diabetes Care

People on Medicaid are Much More Likely to Have Diabetes

People on Medicaid are Much More Likely to Have Diabetes

As of 2008, 1 in 10 low-income adults on Medicaid were diagnosed with diabetes compared to 1 in 20 low-income, uninsured adults– 82% of these beneficiaries have at least one

additional chronic condition This is incredibly high comorbidity—requiring an

immediate and comprehensive approach to chronic health care.

Sources: National Academy for State Health Policy; Kaiser Family Foundation

More than 9 million Medicaid recipients qualify because of a disability and 45% of these have 3 or more chronic conditions:

– Treating patients with multiple chronic conditions costs up to 7 times as much as patients with only one.

In fact, just 5% of Medicaid enrollees account for almost 50% of total health care spending

States need a way to contain costs while still providing quality treatment.

Sources: National Academy for State Health Policy; Kaiser Family Foundation

The Current System for Treating Diabetes is Falling Short!

The Current System for Treating Diabetes is Falling Short!

Few patients meet the evidence-based recommendations for proper care

– Only 7% of patients in one study met the recommendations for A1C, blood pressure, and LDL cholesterol

– Nearly 90 percent of U.S. adults with diabetes—more than 16 million adults aged 35 and older —do not receive proper treatment for blood sugar, blood pressure and cholesterol

– Racial, cultural and ethnic disparities, limited literacy, and poor self-management among affected populations are also persistent barriers to effective diabetes care

Source: Gabbay RA, et al "Multipayer patient-centered medical home implementation guided by the chronic care model" Joint Comm J Quality Patient Safety 2011; 37(6): 265-273

A Promising Model: Patient Centered Medical Homes

A Promising Model: Patient Centered Medical Homes

“People with diabetes should receive medical care from a physician-coordinated team.

Such teams may include, but are not limited to, physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacists, and mental health professionals with expertise and a special interest in diabetes.

It is essential in this collaborative and integrated team approach that individuals with diabetes assume an active role in their care.” American Diabetes Association, Standards of Medical Care in Diabetes

Characteristics of a Medical Home Model Characteristics of a Medical Home Model Coordination and integration of whole person care • Each patient has a personal physician who arranges care with subspecialists and

consultants, and oversees and coordinates the team• Exchange of health-related information through electronic health records;

patient registries; care coordinator services• Comprehensive care including preventive and end-of-life care

Enhanced access• Flexible scheduling system; easy access to members of the team

Quality and safety• Decision support based on updated practice guidelines

Payment• Quality-based payment and sharing of savings achieved from reduced care

costs; reimbursement for care coordination; recognition of complexity and severity of illness

Taken from “Joint Principles of Patient-Centered Medical Homes, American Academy of Family Physicians; the American Academy of Pediatrics; the American College of Physicians; and the American Osteopathic Association.

Many programs have demonstrated that patient centered medical homes (PCMHs) can improve diabetes outcomes and lower costs

A recent study by Penn State researchers found : •A rise in yearly foot assessments for neuropathy from 50% to 69%•More yearly screenings for nephropathy and diabetic retinopathy•Increase in pneumonia and flu shots over baseline•Providers used more therapies shown to lower morbidity/mortality•Patients on statins jumped from 36% to 57%; those on an ACE inhibitor or an angiotensin receptor blocker rose from 42% to 56% •Improvements in key clinical parameters such as blood pressure and cholesterol

Gabbay RA, et al "Multipayer patient-centered medical home implementation guided by the chronic care model" Joint Comm J Quality Patient Safety 2011; 37(6): 265-273

The ACA Health Home Option (Section 2703 of the ACA)

The ACA Health Home Option (Section 2703 of the ACA)

• The Affordable Care Act authorizes a new state option in the Medicaid program to implement health homes for individuals with chronic conditions

• This model builds on the PCMH models already implemented in many states to focus specifically on people living with chronic conditions

• Development of health homes can help states: - Improve care for people with chronic conditions- Restrain growth in Medicaid costs

Medical Homes vs. Health Homes

Similar goals but a few important differences:

•Unlike PCMHs, Health Homes must coordinate with behavioral health providers

•Health Homes are required to help enrollees obtain non-medical supports and services (e.g. public benefits, housing, transportation)

•Health Homes can move coordination beyond primary care

Health Homes offer flexibility to address the specific needs of the chronically ill

States’ Move Towards Health HomesStates’ Move Towards Health Homes

As of 2/15/13, 8 States have had their Health Homes SPAs approved by CMS:

• Missouri (2 SPAs approved 10/20/11 and 12/22/11)

• Rhode Island (2 SPAs; approved 11/23/2011) • New York (approved 2/3/12)• Oregon (approved 3/13/12)• North Carolina (approved 5/24/12)• Iowa (approved 6/8/12)• Ohio (approved 9/17/12)• Idaho (approved 11/21/12)

What services are included in the ACA Health Home Option?

What services are included in the ACA Health Home Option?

• Comprehensive care management• Care coordination• Health promotion• Comprehensive transitional care/follow-up• Patient & family support• Referral to community & social support

services

Who is eligible for a Health Home?Who is eligible for a Health Home?

Medicaid Beneficiaries who:• Have 2 or more chronic conditions • Have one chronic condition and are at risk for a

second• Have one serious and persistent mental health

condition Chronic conditions listed in the ACA: mental health,

substance abuse, asthma, diabetes, heart disease, and being over weight.

What are the Financial Benefits to States? What are the Financial Benefits to States?

• 90% FMAP for health home services for the first two years– After 2 years match rate reverts to the state’s normal

FMAP– Enhanced match applies only to the specific health home

services (e.g. care coordination) listed in the statute – A state may receive more than one period of enhanced

match, but will only be allowed to claim the enhanced match for a total of 8 quarters for one beneficiary

• States are also eligible for up to $500,000 in planning funds to explore the feasibility of creating health homes

States Have Considerable Flexibility to Design Their Own Health Homes

States Have Considerable Flexibility to Design Their Own Health Homes

States can determine their own • Population • Providers• Payment

Selection of Health Home PopulationSelection of Health Home Population

• States determine which chronic conditions to cover– Most have adopted the chronic conditions listed in the ACA -

including mental health, substance abuse, asthma, diabetes, heart disease and being overweight

• NC and MO consider certain diagnoses such as diabetes to place a person at risk for other qualifying conditions.

– States can also target individuals with chronic conditions outside the ACA list with CMS’ approval

• Oregon includes people with HIV, cancer and Hepatitis C

• Can be limited to certain acuity levels/ those with more severe conditions

• Can be limited to specific geographic areas, but all states have chosen to implement statewide

Selection of Health Home ProvidersSelection of Health Home Providers• Designated provider

– May be a physician, clinical/group practice, rural health clinic, community health center, community mental health center, home health agency, pediatrician, OB/GYN, or other provider

• A team of health professionals operating w/ desig. provider– May include physicians, nurse care coordinators, nutritionists,

social workers, behavioral health professionals, or others– Can be free-standing, virtual, hospital-based, or a community

mental health center or another appropriate setting • Health team

– Must include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral health providers, chiropractic, licensed complementary and alternative practitioners

Design of Payment MethodsDesign of Payment Methods

Payment methodologies:– Monthly management care fee

(most states)• Can vary based on the severity of a

person’s condition or the capabilities of health home provider

– Fee-for-service

– State may propose alternative approach

Some Challenges facing States Some Challenges facing States

• Coordination of Health Homes into Existing State Services

• Ensuring Necessary Infrastructure and Training

• Budgetary Priorities and Planning• Health Information Technology • Evaluation

Coordination with Existing ProgramsCoordination with Existing Programs

1) Health homes can complement or augment existing medical home initiatives or primary care case management programs– 23 states have medical home initiatives in their Medicaid

and CHIP programs – A medical home program is NOT a prerequisite to

establishing a health home option (Examples: New York and Oregon)

2) However, health homes must be distinct– States will need to avoid duplication in their existing care

management services, including managed care programs (Examples: New York and Rhode Island)

Infrastructure and Training Infrastructure and Training

Providers need to be trained and ready to go from the start of the SPA because the funding is temporary •Training (Practice coaching, Learning collaborative, etc) •Infrastructure (staff and information technology)

Challenges

• Training of small and medium-sized practices• Payments beyond funding received for health homes

Budgetary Priorities and Planning Budgetary Priorities and Planning 1) Other ACA activities states are implementing:

– The Medicaid expansion in 2014– State-based insurance exchanges – Upgrading IT systems

2) State Budget PlanningStates must work within state budget cycles to: 1) identify their 10% share of health home program spending; and 2) determine how to identify savings that result

– Careful planning will help ensure that state funding continues once the enhanced rate expires

Adopting the health home option has the potential for significant cost savings

Data Sharing Data Sharing CMS strongly encourages states to use health information technology (IT) to provide and track HH services

In doing so, states are running into a few major challenges:

Privacy Concerns

Health Information Technology

Evaluating OutcomesEvaluating Outcomes

ACA mandates 2 Congressional reports to evaluate states’ Medicaid Health Homes programs

– 2014 interim report– 2017 final report and evaluation

The reports will look at: – Effects on hospital admissions, ER utilization, admissions to skilled nursing facility admissions– Effects on hospital readmission rates, chronic disease management, coordination of care for the chronically ill

States have flexibility in their SPA’s to develop state-specific goals and to determine how to collect outcome and quality measures

Advocating for Health Homes Advocating for Health Homes Advocates should encourage state legislators and Medicaid officials to adopt Health Homes because: • Flexibility

– Can adjust to State realities• Tangible Results

– Improved Care – Cost Containment– Reduced Health Disparities– Change in how Care is Delivered– Address the Needs of the Mentally Ill

Source: Families USA

Part III:Medicaid Preventive Services:

Essential Care Without Cost-Sharing

Part III:Medicaid Preventive Services:

Essential Care Without Cost-Sharing

Medicaid Preventive Services Medicaid Preventive Services

Section 4106 of the Affordable Care Act lets states to receive a one percentage point increase in its FMAP if the state covers, without cost sharing, the full list of:

– Preventive services rated grade “A” or “B” by the U.S. Preventive Services Task Force (USPSTF),

– Immunizations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP)

What Diabetes-related Services Does USPSTF Recommend with a Grade of “A?

What Diabetes-related Services Does USPSTF Recommend with a Grade of “A?

Aspirin to prevent cardiovascular disease For men ages 45 to 79 years and women ages 55 to

79 years when proper risk assessment is done

Blood Pressure Screenings For adults aged 18 and older

Cholesterol abnormalities screeningFor all men 35 and older and women aged 45 and

older if found to be an increased risk for coronary heart disease

What Diabetes-related Services Does USPSTF Recommend with a Grade of “B”?

What Diabetes-related Services Does USPSTF Recommend with a Grade of “B”?

Type 2 Diabetes Screening For asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg)

Cholesterol Abnormalities Screening For men younger than 35 & women younger than 45 if at risk for CAD

Healthy Diet Counseling For adults with hyperlipidemia and other risk factors for cardiovascular and diet-related chronic disease (provided by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians)

Obesity Screening and Counseling Tobacco Use Counseling and InterventionsDepression Screening (for adults only)

Prevention recommendations for people with diabetes?

Prevention recommendations for people with diabetes?

There is no universally accepted screening interval

ADA: - For adults at normal risk for diabetes: screenings every 3 years for pre-diabetes and diabetes beginning at age 45- For adults at high risk for diabetes: screenings at a younger age or more frequently ( 1 to 2 year intervals)

USPSTF: - Screening only for asymptomatic adults with sustained high blood pressure greater than 135/80 mm Hg (as the current USPSTF recommendations focus on managing the risk of heart disease rather than on preventing diabetes itself)

However, without broader screening, many of the estimated seven million adults with undiagnosed diabetes may remain unaware of their condition until

they develop complications

% of Diabetes Diagnosed with Current Screening Standards

% of Diabetes Diagnosed with Current Screening Standards

28.1

73.9

0

10

20

30

40

50

60

70

80

Percent of Undiagnosed Diabetes Eligible for Screening under USPSTF vs ADA recommendations

USPSTF

ADA

Source: Diabetes Advocacy Alliance

Federal Opportunities for Advocacy in 2013

Federal Opportunities for Advocacy in 2013

The USPSTF has scheduled diabetes screening for a priority review in 2013, so advocacy opportunities include:

•Recommend that USPSTF consider the best available evidence on risk-based diabetes screenings without limiting review to data from randomized controlled trials •Recommend that USPSTF consider the growing evidence showing a link between obesity and diabetes, as well as their joint contribution to other diseases

Source: Health Affairs

What do States Currently Cover? What do States Currently Cover?

Preventive Services for Chronic Conditions

•Blood pressure screenings--47 states•Screenings for cholesterol abnormalities--46 states• Prophylactic aspirin--37 states (copays for 17 states)•Osteoporosis screening (45 states)

Coverage of diabetes screenings --46 states•31 states don’t require a copay for diabetes screenings

Source: Kaiser Family Foundation Survey of States Coverage of Preventive Services in Medicaid, August 2012

Alcohol, Diet, Obesity and Tobacco Services

Alcohol, Diet, Obesity and Tobacco Services

• As of August 2012, 31 states reported covering all of the recommended preventive services in this category – 16 states did so without cost-sharing– 5 states didn’t cover any of these preventive services for adults

(Alabama, Florida, Georgia, Louisiana, and South Dakota).– The most commonly covered service was alcohol misuse

counseling (40 states)

• Nearly every state covering healthy diet counseling services also covered obesity screening and counseling– 11 states report cost-sharing for these two services

• 38 states reported covering tobacco use counseling in October 2010– 25 states did so without cost-sharing

Source: Kaiser Family Foundation Survey of States Coverage of Preventive Services in Medicaid, August 2012

State Opportunities for Advocacy in 2013State Opportunities for Advocacy in 2013

Advocates should contact their legislators and Medicaid officials to urge that they cover all of the preventive services recommended by USPSTF at no cost• Though many state Medicaid programs cover some of the recommended preventive services, only 25 states cover 40 or more of the services, leaving many low-income people without access to vital care • Medicaid beneficiaries in Georgia and Nebraska, for example, lack access to diabetes screenings• Only 31 states cover diabetes screenings without co-pays and only 28 states cover blood pressure screenings without co-pays

Remind state officials they have opportunity to receive enhanced federal funding for providing free preventive care that is much

cheaper than later treatment !!!

For an electronic copy of this presentation and other information about the Affordable Care Act, see:

http://www.law.harvard.edu/academics/clinical/lsc/clinics/health.htm

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This presentation was funded in part through a grant from Bristol-Myers Squibb, with no editorial review or discretion