Improving healthy birth outcomes in the Midwest is focus of 2017 MLC chair's initiative
State policymakers are increasingly realizing that beyond the importance of early childhood development lies its foundation, a healthy birth outcome for parents and their newborns.
The phrase “healthy birth outcome” can encompass numerous initiatives — safe-sleep education to reduce incidents of Sudden Infant Death Syndrome, mentoring and support for new and expectant mothers to combat child and infant mortality, and even the somber task of collecting child and infant mortality data. It can also include public education campaigns to raise awareness of not-always-apparent health hazards (such as congenital cytomegalovirus) and to reduce stress on new parents and parents-to-be. More »
More states requiring women to be notified that breast density can skew mammogram results
Mammograms are perhaps the best-known tool to detect breast cancer, but their effectiveness can be diminished if the breast tissue itself is dense enough to hide the tumors. And this potential problem is fairly common: 40 percent of women age 40 and older have dense breasts, according to DenseBreast-info, an education and advocacy group for patients and practitioners.
Connecticut in 2009 became the first state to require practitioners to notify women that they have dense breast tissue and should consider following up with three-dimensional breast scans. (Starting this year, the state also requires insurance companies to cover 3-D mammograms.) Now, 27 U.S. states have such notification requirements in place, including Michigan, Minnesota, North Dakota and Ohio (as of January, North Dakota’s law was scheduled to sunset on July 31). More »
The first bill signed into law in Minnesota this year will provide relief to the state’s 125,000 residents who purchase their health insurance in the individual market and are not eligible for subsidies under the Affordable Care Act.
The cost of premiums for Minnesotans in this population is rising by 55 percent in 2017.
According to The (Minneapolis) Star Tribune, eligible residents will get a rebate of 25 percent, at a cost of $327 million to the state. Another provision in HF 1/SF 1 allows for-profit health maintenance organizations to be part of the state-run, individual health marketplace, notes Session Daily, a news service of the Minnesota House. In addition, agricultural cooperatives can now offer group health insurance to members.
In a fall study of states’ insurance exchanges under the Affordable Care Act, Kaiser Family Foundation researchers found that premium hikes in 2017 would be more severe than in previous years. These increases, Kaiser found, are partly the result of losses experienced by insurers and a phasing out of the federal law’s reinsurance program. Its analysis focused on premiums being paid by health consumers in a major city in every U.S. state. The highest increases in the Midwest were reported in Minnesota (55 percent), Illinois (48 percent), Kansas (46 percent) and South Dakota (45 percent).
Illinois now requiring some schools to test for lead
Some schools and day care facilities in Illinois must have their water tested for lead under a bill passed and signed into law in January.
The new requirements apply to buildings constructed before 2000 where pre-kindergarten through fifth-grade classes are held.
According to the Illinois attorney general’s office, the lead tests will average $15 per drinking-water sample. If samples exceed 5 parts per billion of lead, the families of students must be notified. SB 550 authorizes community water suppliers to impose a “lead hazard cost recovery fee.” But minus such a fee, the tests will likely be paid by school districts, which can tap into existing funds set aside for safety or legal issues, the Chicago Tribune notes. As part of the new law, too, community water supplies will provide Illinois officials with an inventory of their lead service lines.
Other Midwestern states have also passed new laws in the aftermath of the drinking water crisis in Flint, Mich. Ohio’s HB 512 (enacted in 2016) requires water suppliers to test for lead and copper and to map areas being served by lead service lines. It also mandates training on how to identify lead in drinking water and control corrosion. And Michigan‘s HB 5120, signed into law in December, calls on water suppliers to alert the public within 72 hours after they learn that lead levels exceed prescribed “action levels.”
To stop opioid deaths, Michigan allows schools to stock naloxone
In an effort to save young lives at risk due to drug overdoses, the state of Michigan is giving its schools the chance to stock naloxone, an “opioid antagonist” drug.
SB 805 and 806, signed into law in December, set several parameters for school districts. They must have at least two employees trained on how to administer naloxone; call 911 when a student is having an overdose; and alert parents or guardians about the incident. Under another new Michigan law (HB 5326), a prescription will not be needed for pharmacists to dispense opioid antagonists to the family members and friends of recovering addicts.
New state laws are being adopted across the Midwest to address the rise in opioid use and overdoses. Examples include prescription drug monitoring programs and “Good Samaritan” laws that waive drug-possession penalties for individuals who report an overdose. According to the U.S. Centers for Disease Control and Prevention, three Midwestern states had among the nation’s highest number of drug-overdose deaths in 2015:
• Ohio, 3,310 deaths, second-highest;
• Michigan, 1,980 deaths, seventh-highest; and
• Illinois, 1,835 deaths, eighth-highest.
Midwest, led by Minnesota, shows well in report ranking nation’s healthiest states
Midwestern states were healthier, overall, than the country as a whole in 2016, according to the United Health Foundation’s newest “America’s Health Rankings Annual Report,” released in December 2016 (based on data as of October). More »
Results coming in from states’ drug testing of welfare recipients
by Jon Davis ~ December 2016 ~ Stateline Midwest »
A yearlong pilot program in Michigan to screen welfare recipients for drug use found no substance abusers, legislators were told.
The program tested 14 of 443 participants (either applicants or recipients) of the state’s Family Independence Program in three counties between October 2015 and September 2016, according to The Detroit News. Only one applicant was found to have a “reasonable suspicion of use of a controlled substance and required a substance use test,” said a report from the Department of Health and Human Services. (That person dropped off the welfare roll before being drug-tested, for an unrelated reason, the report said.)
Kansas and Wisconsin are the only other Midwestern states that currently require welfare recipients to take drug tests. In Kansas, 5,541 adults were subject to that requirement from January through September 2015. Of the 260 people actually tested, 66 tested positive.
Since November 2015, Wisconsin tested 1,305 applicants in the Wisconsin Works and Transform Milwaukee Jobs programs, with 30 referred for drug screening. Of those, eight failed and were referred for treatment; two failed and refused treatment.
States put greater emphasis on lead testing after water crisis in Flint
When the problem of tainted drinking water created a public health crisis in the Michigan city of Flint, the state’s legislators had two clear missions to fulfill.
First, fix the problem, with strategies — both immediate and longer-term — that help affected residents, bring back some normalcy to their lives, and then assist in the entire community’s recovery.
Second, find ways to prevent the problem from ever occurring in another Michigan city. And that idea of prevention has spread well beyond the borders of Michigan, with legislators in nearby states taking notice of the crisis and beginning to think more about the safety of the water supply in their own districts. More »
Group of Wisconsin lawmakers unveils plan to boost health workforce, services in rural areas
An informal group of 20 to 24 lawmakers in Wisconsin will concentrate its efforts in 2017 on proposals to boost the state’s supply of rural health care workers and services.
The Rural Wisconsin Initiative unveiled its legislative agenda during the latter part of 2016. More »
Some states turning to
provider taxes to pay their share of Medicaid expansions
Starting in January, states that chose to expand their Medicaid programs under the Affordable Care Act will have to begin paying part of the associated costs, and three of the Midwest’s expansion states say they will rely at least in part on revenue from their taxes on health care providers. More »
Ohio looks to fill gaps in resources for young people, families in crisis
In early 2012, a 17-year-old stood up in a high school cafeteria in northeast Ohio and began shooting. Three students died, three were injured.
For the leaders of Ohio’s systems of mental health and developmental disabilities, that tragic incident became a call to action. What could the state do to help fill those resource gaps? How could it assist families and communities wanting to help a troubled young person?
In part, the response has been the creation of Strong Families, Safe Communities. More »
New state laws, voluntary
hospital initiatives aim to
reduce deaths from sepsis
For patients who develop sepsis, the ability of a health professional to recognize it early on can mean the difference between life and death, or between full recovery and permanent organ damage.
For doctors and nurses, though, early recognition of this condition (caused by the human body’s response to an infection) can be difficult. Four years ago, that early detection did not take place in a case that led to the tragic death of a 5-year-old girl in Illinois. Gabby’s Law (SB 2403), signed into law this summer after receiving unanimous legislative approval, puts in place new statewide requirements for hospitals, which will now have to establish and then periodically implement evidence-based sepsis protocols. More »
Iowa launches plan to better meet children’s mental health, other needs
Right now in Iowa, it’s no sure bet that a child in need of mental health services is going to get them. Instead, access can depend on where his or her family happens to live. But Iowa appears to be taking some important first steps to improving care, thanks to the recommendations of a work group formed by the Legislature in 2015 and actions taken by lawmakers during their 2016 session. More »
Girl’s allergy death spurs Illinois lawmakers to push for improved access to lifesaving medicines
A new law will in Illinois will allow police to carry and administer epinephrine autoinjectors, which are used to prevent death from serious allergic reactions. More »
States adopting practical ‘harm reduction’ approach in effort to stem tide of overdose deaths
Drug overdose deaths are becoming all too familiar, even if the epidemic hasn’t spread yet to the state in which you live.
In 2014, the last year for which the U.S. Centers for Disease Control and Prevention has compiled data, 47,055 individuals died of a drug overdose. Opioid-related overdose deaths — from prescription pain killers or heroin — accounted for 61 percent of the total that year. In the Midwest, opioid death rates in 2014 were higher than the national rate in three states: Michigan, Ohio and Wisconsin. Besides law enforcement strategies, many states are adopting a public health approach known as “harm reduction.” More »
Minnesota results show cost-cutting promise of patient-centered health care homes
Minnesota was an early adopter of the use of health care homes, and a five-year study of their impact shows promising results for any state looking to reduce health costs and improve patient outcomes. More »
Illinois aiming to ‘make every pregnancy planned’ by increasing access to improved long-acting reversible contraception
Illinois is leading the way in adopting Medicaid payment reforms to increase access to long-acting reversible contraception, known as LARCs.
LARCs — intrauterine devices, or IUDs, and subdermal contraceptive implants — are highly effective forms of birth control, with a pregnancy rate of less than 1 percent within the first year, according to the Centers for Disease Control and Prevention. More »
Michigan considering tougher copper, lead pipe regulations
Michigan Gov. Rick Snyder has proposed tightening the state’s lead level guidelines to 10 parts per billion by 2020, stricter than the current federal mark of 15 ppb.
The proposed change, announced at a meeting of the Flint Water Interagency Coordinating Committee, is part of a package of proposals that also includes annual water testing at day care centers and schools as well as a requirement that local governments create inventories of lead water pipes and then develop plans to replace them.
Critics of both Snyder’s plan and the federal Lead and Copper Rule say neither addresses the true lead danger level of 5 ppb.
The U.S. Environmental Protection Agency is in the process of updating the Lead and Copper Rule, a process that began in 2010. Proposed changes are expected to be submitted to the U.S. Congress in 2017. The rule applies to about 68,000 water utilities nationwide. It requires them to take remedial action to improve pipe corrosion controls or eventually replace lead pipes if 10 percent of sites tested for lead or copper exceed the “action level” of 15 ppb.
The Michigan proposals require approval by the state Legislature.
Iowa becomes latest Midwest state to move to managed care for Medicaid enrollees
After some bumps along the way, the Iowa Medicaid program — and some 560,000 Iowans — transitioned to a managed-care model of care in April.
Iowa now joins the majority of U.S. states nationally, and within the Midwest, that depend on private entities called managed-care organizations — or MCOs — to deliver Medicaid services to most enrollees in their public insurance programs for low-income families and individuals. More »
Minnesota, Wisconsin hail savings from new health care programs
Eight years ago, Minnesota lawmakers established a new way of paying for health care that they said should lead to lower costs and higher-quality care.
The hopes for this “health care home” model appear to have been realized. A five-year evaluation found that this model saved Medicaid and Medicare $1 billion. In addition, participating health clinics outperformed others on various quality measures, University of Minnesota investigators found.
Under this model, clinics voluntarily apply to be certified as a “health home”: This patient-centered approach to care involves coordination among a team of doctors, nurses and other providers. These clinics receive a per-patient payment for coordinating care. A central goal of this model is to improve how patients and their providers prevent and manage disease. The Minnesota study was released in February.
A month later, Wisconsin Gov. Scott Walker unveiled results of his state’s ramped-up efforts to prevent Medicaid fraud and overpayment. Five years ago, he created the office of inspector general within the state’s Department of Health Services. Between 2011 and 2015, the office recovered nearly $40 million in overpayments to Medicaid providers.
Aging infrastructure, lead pipes, nitrate runoff and funding among challenges vexing Midwest’s drinking water systems
The crisis in Flint, Mich., has pushed drinking water quality into the forefront of national conversation, but problems with the Midwest’s aging drinking water infrastructure are not new.
Plenty of lead pipes nearing the end of their service lives remain, and nonpoint source pollution from agricultural runoff besets watersheds and municipal water systems before ultimately afflicting the Great Lakes, Mississippi River and Gulf of Mexico. More »
As Michigan water crisis boils, legislators mull ‘right to water’
As the realization that a generation of children in Flint, Mich., has been exposed to lead poisoning by their own water sets in, some Michigan lawmakers are pushing to enshrine access to clean, safe water in state law as a basic human right. More »
Do states have statutory provisions allowing paramedics to provide non-emergency health services?
Community paramedicine programs — sometimes known as field emergency medical services (EMS) or mobile integrated health care — expand the role of certified paramedics and allow them to provide non-emergency, preventative health care services to patients in their communities. More »
Plan for U.S. to pay tribal health costs could help fund Medicaid
expansion in South Dakota
Twice in recent history, South Dakota governors tried and failed to fix what they saw as an unfair shift in health care costs from the federal government to their state.
But as of early 2016, Gov. Dennis Daugaard appeared close to making the third time a charm.
An agreement being worked out by state and federal officials would change how some health care services for Native Americans are funded, while also freeing up state dollars to expand Medicaid.
The governor’s plan, if approved by the federal government and state Legislature, would make South Dakota the eighth Midwestern state to approve a Medicaid expansion under the Affordable Care Act. No other state, though, has taken a path quite like South Dakota’s — the state with the region’s highest percentage of Native American residents. More »
In aging Midwest, more emphasis being placed on Alzheimer's policies and care
In most Midwestern states, the number of people with Alzheimer’s disease is expected to increase by close to 20 percent or more between now and 2025. The heavy toll that Alzheimer’s takes on individuals and families is well known, but the disease also has high costs for state health care systems and will require lawmakers to consider policies that help meet the greater demand for quality services. More »
Illinois allows residents of nursing homes to install room cameras
by Tim Anderson ~ January 2016 ~ Stateline Midwest »
In response to concerns raised by family members about the care and safety of their loved ones in nursing homes, Illinois has become one of the first U.S. states to allow the use of cameras in resident rooms.
HB 2462, signed into law in 2015, took effect in January.
Under the measure, recordings from these cameras can be admitted as evidence in administrative, civil and criminal proceedings. Criminal penalties have also been established for any person who intentionally tampers with or destroys a recording. The cameras must be paid for and maintained by nursing home residents or their representatives.
According to the Illinois attorney general's office, the state receives more than 21,000 calls annually and responds to approximately 5,000 complaints related to suspected neglect or negligence in nursing homes. In 2013, the Department of Public Health found 106 allegations of abuse, neglect or misappropriation of property against residents by facility staff to be valid.
In 2014, the Pew Charitable Trusts reported that four other states (none in the Midwest) had laws permitting nursing home residents to install cameras in their rooms.
More states in Midwest enacting 'right to try' laws
A nationwide legislative push to give terminally ill patients easier access to experimental medications has succeeded in changing the laws of six Midwestern states over the past two years.
In this region, the trend began in late 2014 in Michigan, with bipartisan passage and the governor’s signing of SB 991 and HB 5649. More »
State programs aim to prevent
premature births as part of strategy to reduce rates of infant mortality
Three years ago, wanting to know the story behind the troubling data about infant mortality in Ohio, Sen. Shannon Jones decided to take a tour of her home state.
Along with a colleague, Sen. Charleta Tavares, Jones organized visits to local hospitals and met with health care practitioners and social service providers.
Legislators didn’t come back from the statewide tour with any easy answers or magical fixes, but they did return with a resolve to do more to address the problem. More »
Rates of uninsured falling, but still at or near double digits
in some Midwestern states
While contributing to a rise in insurance coverage across the Midwest, The Affordable Care Act has not yet been a cure-all. In fact, in some states, the percentage of people without coverage still hovers around the double digits, federal data for 2014 show. More »
Deadly rise in drug overdoses has Midwest states searching for answers: Policy responses include greater oversight of prescription drug use, access to treatment
Across the country, communities are dealing with an epidemic of drug abuse and overdoses.
And nowhere is this health crisis more pronounced than in the Midwest: Between 2008 and 2013, the number of heroin-related overdose deaths in this region increased sixfold. States in the Midwest are adopting a number of strategies to address this health problem — for example, greater access to naloxone, more oversight of prescription drug use, and an expanded use of drug courts. More »
South Dakota mulls Medicaid expansion; federal waiver possible
by Tim Anderson ~ October 2015 ~ Stateline Midwest »
South Dakota leaders are taking steps this fall to become the Midwest’s eighth state to expand Medicaid access under the Affordable Care Act.
According to the Sioux Falls Argus Leader, the planned expansion would add 48,500 residents to the public health insurance program.
Though details of South Dakota’s plan had not been released as of early October, it will likely require a federal waiver. To date, Illinois, Indiana, Iowa, Michigan, Minnesota, North Dakota and Ohio have expanded Medicaid, the Kaiser Family Foundation reports. Of those states, three have received federal waivers:
• Indiana — Enrollees contribute monthly to personal savings accounts, which they use to pay for care until their deductible is met.
• Iowa — Individuals eligible via the expansion receive insurance from private health plans. Medicaid pays the premium, but the member may be charged $10 a month if certain healthy behaviors are not followed.
• Michigan — Newly eligible adults are enrolled in private health plans and have co-payments. Preventive services, though, are completely covered, and members can receive reductions in co-pays if they follow certain healthy behaviors.
States tighten rules on vaccinations to bolster immunization rates
by Tim Anderson ~ September 2015 ~ Stateline Midwest »
New policies in three Midwestern states have the goals of boosting immunization rates among young people and preventing the spread of disease.
In Illinois, a health care provider will have to sign a “certificate of exemption” in order for children not to be vaccinated on religious grounds. SB 1410 was signed into law in August. Before signing the certificate, a health care provider must provide education to parents about the benefits of immunizations and the health risks of not vaccinating students.
Every state in the Midwest allows for religious and medical exemptions to the vaccine mandate. Some states (Michigan, Minnesota, North Dakota, Ohio and Wisconsin in this region) also allow opt-outs based on philosophical beliefs, according to the U.S. Centers for Disease Control and Prevention.
Michigan, though, has tightened some of its rules this year, mlive.com reports. Prior to opting out, parents must be educated by a local health worker and sign a form acknowledging that they may be putting their children and others at risk.
A new law in Ohio, meanwhile, requires children attending day care or preschool to be vaccinated (with exemptions). According to The Columbus Dispatch, Ohio had been the only state without this vaccine-coverage law.
Some states ramping up efforts to enroll inmates in Medicaid
As Indiana Rep. Charlie Brown sees it, a new plan to enroll eligible inmates in Medicaid has the chance to be a win-win for his state and its taxpayers: Reduce recidivism by giving more people the health services they need, and cut long-term costs in the criminal justice system. Signed into law earlier this year, HB 1269 (of which Brown was a co-sponsor) received overwhelming legislative approval, and it is part of a broader trend that has states looking for new ways to improve outcomes for state and local inmates, who have disproportionately high rates of mental illness and substance abuse. More »
Illinois legislators OK wide-ranging plan to prevent drug overdoses
Last summer, lawmakers in the Illinois House declared a “heroin emergency” in the state. This year, the legislature overwhelmingly approved a comprehensive plan (HB 1) to deal with it.
According to The State Journal-Register (Springfield), the state's new fight against drug abuse will cost between $25 million and $58 million. The bill’s components include:
requiring that first-responders in Illinois have in their possession naloxone, which is used to treat drug overdoses;
allowing a pharmacist to dispense naloxone to prevent heroin overdoses,
establishing a heroin and opioid drug prevention program for schools,
covering rehabilitative services in Medicaid,
creating a statewide “take-back” program to help people safely and conveniently dispose of prescription drugs, and expanding the use of drug courts and the availability of drug treatment programs.
States across the country have been experiencing a rise in heroin overdose deaths. Between 2010 and 2013, the number of these deaths increased from 3,036 to 8,257.
Conflicts over guardianship, visitation rights spark passage of first-of-kind law in Iowa
When they were unable to visit their brother due to opposition from his legal guardian, family members in the Iowa town of Cedar Rapids turned to their local state senator for help.
And as Iowa Sen. Rob Hogg soon learned, that local family’s story was far from an isolated one; conflicts over visitation and guardianship rights were occurring across the state. His response was to introduce SF 306, a bill that ultimately received unanimous approval in the legislature and was signed into law in April. More »
Indiana authorizes local needle exchanges to deal with health emergencies, disease outbreaks
In the early part of 2015, an outbreak of HIV began spreading quickly in the small, southeast Indiana town of
Austin. By the end of April, the number of confirmed cases had reached nearly 150, with many of them linked to
use of the opioid painkiller Opana via needle injection. Gov. Mike Pence declared a public health emergency in Scott County to deal with the outbreak and to allow for a temporary needle-exchange program, but Sen. Patricia Miller says it was important for the legislature to act as well. And on the last day of session, lawmakers passed
SB 461. More »
Rethinking health policy:
State strategies look beyond access to care, focus on other factors that lead to poor outcomes and higher costs
When it comes to improving health outcomes, many policymakers look first to strategies that can provide better care for people who are ill.
But some experts argue that medical care itself accounts only for a small part of positive health outcomes.
The vast majority of interventions that can make people healthier, and reduce spending on health care, need to happen long before someone enters a doctor’s office. More »
State vaccination, exemption policies scrutinized after measles outbreak
Last month, a contagious disease that was once thought eradicated in the United States saw one of its largest outbreaks in recent years.
The resurgence of the measles has sparked a nationwide discussion about vaccination policy. Each state has different requirements for vaccines that children must have in order to attend school. Likewise, each state has its own set of exceptions. Across the country, exemptions are provided for health reasons, but state policies vary when it comes to allowing parents to opt out of vaccines for other reasons. More »
Michigan joins two other Midwestern states tying public benefits to drug-testing
Michigan has become the third state in the Midwest to require certain recipients of public benefits to undergo drug testing.
Signed into law in late December, HB 4118 and SB 275 will operate as a one-year pilot program in three counties. In those counties, some recipients of cash assistance will be drug-tested based on an “empirically validated substance abuse screening tool.”
Individuals who test positive will lose assistance if they don’t participate in a treatment program or if they fail to submit to periodic testing.
Since 1996, states have had the authority under federal law to require welfare recipients to undergo drug testing. Minnesota and Kansas are among the other U.S. states with drug-testing laws in place.
Kansas’ “suspicion-based” program was established by the Legislature in 2013 (SB 149) and began in July 2014. During the first four months of the program, The Kansas City Star reported late last year, 20 individuals had been tested. Four of the 20 failed the test and five refused to take it. In Minnesota, counties must conduct random tests of welfare recipients who have been convicted of a drug-related felony in the past 10 years.
States are not only expanding Medicaid; they're reshaping the health insurance program as well
by Kate Tormey ~ February 2015 ~Stateline Midwest »
The federal government has been granting unprecedented leeway to states in shaping Medicaid expansions. Some of the provisions recently approved have never been seen in the 50-year history of the program. More »
27 states, CSG weigh in on U.S. Supreme Court case on Medicaid reimbursement rates
The U.S. Supreme Court began to hear arguments in January in a case that will decide whether providers have the right to sue states over Medicaid reimbursement rates. Given the potential implications for disputes between states and the federal government, The Council of State Governments has weighed in by filing an amicus
brief. More »
Ebola scare sparks discussion on quarantine, other policies to keep infectious diseases in check
As the Ebola virus continues to affect tens of thousands of people halfway across the world in Africa, it is also spurring policy discussions in the United States about how governments can and should control the spread of serious infectious diseases. More »
What guidelines and regulations exist regarding human donor milk for infants whose mothers cannot provide breast milk?
Breast milk contains important nutrients, immune-system antibodies and growth factors that all contribute to a baby’s health, particularly babies who are vulnerable because they are premature or underweight. But a number of circumstances — including maternal illness, death, surgery, use of drugs or medications, and certain chronic conditions — can prevent a mother from being able to breastfeed. One potential alternative for some babies, then, is the use of human donor milk.
Indiana, Iowa, Michigan and Ohio are among the states with nonprofit human-milk banks that have been certified by the Human Milk Banking Association of North America. More »
Be ready for anything: Recent infectious-disease outbreaks serve as a reminder that state public-health systems need to be strong before disaster hits
When emergencies strike — whether a disease outbreak or a natural disaster — it can feel like everything is out of the ordinary. But public-health experts say that during an emergency, the response should feel as familiar and routine as possible. That’s because in order to successfully handle a disaster, the preparation and practice should happen before trouble is on the horizon. More »
Laws in Midwest put new limits on minors’ use of tanning beds
Minnesota has become the second state in the Midwest to prohibit anyone under the age of 18 from using indoor tanning beds. Under HF 2402, tanning-bed owners and operators will be charged with a misdemeanor for violating the state statute. Illinois’ under-18 ban (HB 188) was signed into law last year.
According to the Melanoma Research Alliance, 10 other U.S. states have under-18 prohibitions in place. Earlier this year, with passage of SB 50, Indiana joined Wisconsin in banning the use of tanning beds for anyone 15 and under.
Other Midwestern states have chosen to allow teenagers to use tanning beds, but require some kind of parental consent. Nebraska lawmakers passed a bill this year requiring parents to accompany a child under the age of 16 to a tanning bed. LB 132 also requires parents to sign a consent form and the tanning-bed owner or operator to post a sign warning about the danger of overexposure to ultraviolet radiation.
New Michigan law gives patients ‘right to try’ experimental drugs
Michigan has become the fourth U.S. state — and first in the Midwest — to pass a law giving terminally ill patients the right to try experimental medications.
SB 991 applies to drugs that have not yet been approved by the U.S. Federal Drug Administration, but have successfully completed Phase I of an FDA-approved clinical trial. The bill provides liability protections to drug manufacturers, and under a separate measure (HB 5649), health care providers cannot be sanctioned by the state for giving patients access to the drugs.
According to The Detroit News, insurance companies will not be required to cover the experimental treatments. And unlike clinical trials, manufacturers may not cover the costs.
The two bills were signed into law in October after received overwhelming bipartisan support in the Legislature. Some critics, though, warn that the law will provide “false hope” to patients and their families, and that the drugs — because they are not fully tested — could cause adverse reactions in the patients who use them.
As of October, Colorado, Louisiana and Missouri were the other states with “right to try” laws, according to the Goldwater Institute.
Potential power of technology seen in new Illinois, Michigan partnership to improve Medicaid management
States are consistently improving their use of technology to better serve their citizens, according to a recent nationwide analysis by the Center for Digital Government.
Every two years, the organization looks at state governments’ ability to be more efficient and provide better service — and Midwestern states fared well in the most recent rankings compared with other regions. Michigan and Ohio had among the highest grades in the “Digital States Survey.” More »
What policies are states adopting to encourage people to seek assistance during drug and alcohol overdoses?
In the United States, 113 people die each day from a drug overdose, the leading cause of injury death. Among people age 25 to 64, drug overdoses kill more people than do motor vehicle accidents, the U.S. Centers for Disease Control and Prevention reports.
Between 2010 and 2012, federal data show, deaths from heroin overdoses doubled. Partly in response, state policymakers have looked for new ways to help prevent these tragic incidents. One idea has been to create new immunity laws: protecting a person who seeks medical attention for someone believed to be in danger of overdosing. More »
Paying for value, not volume, in health care: States are experimenting with delivery and payment reforms focused on more-efficient, high-quality care
In most industries, consumers pay more for receiving more goods and services. But in health care, more isn’t necessarily better — sometimes it’s just more expensive, some policy experts say. That’s why states around the country are currently testing new ways to deliver and pay for health care, with the goal of fostering quality, cost-effective services. More »
Federal court case spurs proposals on contraception access
In June, the U.S. Supreme Court ruled in favor of the retailer Hobby Lobby, which sought an exemption on religious grounds from the federal mandate to cover contraception in employee health plans. Some state policymakers have expressed concern about the legal precedent of eliminating coverage for what they consider a basic preventive health need for women.
Minnesota and Ohio are among the states in which lawmakers have since announced or introduced legislation regarding contraceptive coverage. The proposals would require employer plans that offer prescription coverage to include all federally approved contraceptive medications and devices. (Minnesota policymakers would provide an exception to this mandate for nonprofit religious institutions, the St. Paul Pioneer Press reports.)
According to the Guttmacher Institute, 28 states (Including Illinois, Iowa, Michigan and Wisconsin) already have similar requirements.
Of those states, however, 20 — including Illinois — allow certain insurance companies and employers to request an exemption. This year in Illinois, lawmakers approved a non-binding question for November’s ballot; it will ask voters whether insurers that offer prescription coverage should be required to include birth control.
Debate over safety of triclosan sparks new bills in region; Minnesota first state to ban it
As federal regulators take a closer look at the safety of triclosan, a substance found in many personal-care products, lawmakers in at least two Midwestern states are making moves to keep the substance out of homes and waterways. More »
Medical marijuana law expanded in Illinois, adopted in Minnesota
A year after it joined the growing list of states that allow for the medical use of marijuana, Illinois has modified its law to provide relief for children who suffer from seizures.
SB 2636 will take effect at the start of next year. It permits children under 18, with a parent’s consent, to be treated with non-smokable forms of medical marijuana. The state’s original law did not include seizures, including those characteristic of epilepsy, among the list of debilitating medical conditions that could legally be treated with medical marijuana.
Earlier in the year, Minnesota joined Illinois and Michigan as the third Midwestern state to allow for the use of medical marijuana. Under Minnesota’s new law (SF 2470), the cannabis will be made by two in-state manufacturers and distributed at eight different facilities. Unlike Illinois and Minnesota, which rely on state-regulated manufacturers and dispensaries, Michigan allows patients to grow their own marijuana or to purchase it from regulated caregivers.
In all, close to half the U.S. states have legalized medical marijuana, but those laws vary on who should cultivate and dispense it, what the limits on possession should be, and what medical conditions should qualify.
Growing use of e-cigarettes raises public health, policy concerns
While widespread efforts to reduce tobacco use in the United States have successfully reduced smoking rates, policymakers are now facing the implications of a new type of nicotine use: e-cigarettes. And although the technology is new, “electronic nicotine delivery systems” pose many of the same policy questions as traditional cigarettes. More »
Early intervention is key to treating youth with mental illness
More than 20 percent of people ages 13 to 18 face a mental illness serious enough to cause significant impairment in their day-to-day lives. Yet in our country, just one-fifth of young people with a mental illness receive treatment. How best to address the mental health needs of young people was the topic of a roundtable discussion at the Midwestern Legislative Conference Annual Meeting. More »
New data track performance of state health systems, offer tools for setting goals and crafting policy
Which states have the highest rates of avoiding preventable deaths? How does the Midwest compare to the nation in providing equitable access to health care? The most recent edition of a Commonwealth Fund report aims to provide policymakers with the tools to start answering these questions — and look for the best policies for maximizing health system performance. More »
Hidden, lifetime scars: States address the needs of children who have experienced trauma, aim to stem the cycle of negative outcomes
Imagine being a young boy waking up one morning to the sound of your parents arguing and your mother being abused. You don’t get breakfast and you miss the bus — so you’re late for school. You get in trouble for being tardy, and by mid-morning, you’re hungry and frustrated, so you lash out at another student. You’re back in the principal’s office instead of learning in the classroom — and the vicious cycle continues. More »
New laws in Kansas, Nebraska require
by Tim Anderson ~ May 2014 ~ Stateline Midwest »
The number of Midwestern states requiring insurers to cover the diagnosis and treatment of autism continued to rise in 2014, as the result of legislative measures in Nebraska and Kansas that passed with overwhelming support.
The advocacy organization Autism Speaks now lists Ohio, North Dakota and South Dakota as the only states in the region that have not adopted autism insurance reform.
Under Nebraska’s LB 254, a wide range of services must now be covered, including up to 25 hours per week for behavioral health treatment, such as applied behavior analysis. The new mandate covers individuals up to the age of 21. Kansas’ HB 2744 covers children up to the age of 12. Like the Nebraska bill, too, it includes applied behavior analysis among the covered services. Other common treatments for children with autism include speech and occupational therapy. In both Kansas and Nebraska, some health plans will be exempt from the new mandates.
Earlier this year, the U.S. Centers for Disease Control and Prevention estimated that 1 in 68 children (and 1 in 42 boys) have been identified with autism spectrum disorder. The findings were based on results from sites in 11 different states, including Wisconsin.
States consider testing welfare recipients for drugs; Kansas and Minnesota have laws on books
Since 1996, states have had the authority under federal law to require welfare recipients to undergo drug testing. In recent years, more and more legislatures have given serious consideration to using this authority, including a handful of states in the Midwest. More »
Question of the Month: What laws have states passed regarding sports-related concussion prevention and treatment?
by Laura Kliewer ~ April 2014 ~ Question of the Month »
In the span of just two years (during the 2011 and 2012 legislative sessions), every Midwestern state adopted laws to better protect young people from concussion-related injuries. These so-called “return-to-play” laws had three key components. More »
Illinois close to joining Michigan as second Midwest state to allow use of medical marijuana
Illinois is in the process of becoming the latest U.S. state — and the second in the Midwest — to allow residents to purchase and use marijuana for medical purposes. Earlier this year, the state Department of Public Health issued proposed rules to implement legislation signed into law in 2013. More »
Indiana bill reflects concerns about rise in drug-addicted newborns
Concerned about the rise in drug-related health problems among newborns, Indiana lawmakers unanimously approved a measure in February that takes a first step in trying to address Neonatal Abstinence Syndrome.
Under SB 408, hospitals would be required to report cases of the syndrome to the Department of Public Health, which will develop a set of best practices on how to identify and document such cases. The bill also calls for the state to study treatment services for pregnant women addicted to drugs.
The abuse of illegal or prescription drugs during pregnancy can cause Neonatal Abstinence Syndrome. Symptoms among newborns include seizures, slow weight gain, and trouble sleeping or breathing.
As of early March, differences in the House and Senate versions of Indiana’s SB 408 had to be worked out in conference committee.
More than 13,000 infants were born with Neonatal Abstinence Syndrome in 2009, a nearly threefold increase since 2000, according to a study published two years ago in the Journal of the American Medical Association. A recent Ohio Department of Public Health study found that hospitalization rates for the syndrome in that state grew sixfold between 2004 and 2011.
Can states require a photo ID on the electronic benefit transfer (EBT) cards used by individuals who receive food stamps?
Under federal law, states can require that EBT cards for the Supplemental Nutrition Assistance Program (SNAP) include photos of the beneficiaries or that customers show photo ID to use the cards. Massachusetts is the only state that currently has such a law. More »
Wisconsin OKs package of bills to strengthen mental health system
Wisconsin legislators agreed in January to invest $4 million over the next two years on a plan to improve the state’s mental health system, the Milwaukee Journal Sentinel reports.
Passage of the multi-bill package culminated months of legislative work that began in early 2013 with formation of the Speaker’s Task Force on Mental Health. The new measures will:
• create crisis-intervention teams made up of law enforcement officers who have undergone specialized mental health training;
• offer new incentives for physicians and psychiatrists (up to $60,000) to serve in underserved areas of Wisconsin;
• establish a hotline that connects mental health professionals with children who need help and live in underserved areas; and
• invest in job training for people with severe mental illnesses and in-home treatment for children.
Michigan legislators and other state leaders, meanwhile, have issued a set of recommendations calling for improvements to their state’s mental health system. They focus on three areas: independent living for people with mental illnesses; better access to high-quality, coordinated care; and new metrics that evaluate the effectiveness of different mental health services.
Midwest’s states, poor families having to make due with lower levels of federal food benefits
Beneficiaries and state officials alike are adjusting to recent changes in how much financial assistance low-income families receive to purchase food. The Supplemental Nutrition Assistance Program, formerly known as food stamps, provides nutritional aid to about 47 million — or one in seven — Americans. More »
Legalized medical marijuana spreads to second Midwest state, with Illinois joining Michigan
The start of the new year marked the beginning of a four-year pilot project in Illinois that permits the use of marijuana for medical purposes.
Illinois is the second state in the Midwest with such a law and the first in the region where it was initiated by the legislature. Medical marijuana was legalized in Michigan six years ago via a ballot proposal.
Under Illinois HB 1, 22 regulated “cultivation centers” and up to 60 licensed dispensaries can now open in the state. Unlike some states, including Michigan, Illinois will not allow patients or their caregivers to grow marijuana.
As of late last year, Michigan law did not specifically authorize medical marijuana dispensaries. And in early 2013, the Michigan Supreme Court ruled that local prosecutors could use the state’s public nuisance law to shut these operations down.
A bill approved late in 2013 by the Michigan House (HB 4271) would allow local governments to decide whether or not to permit the opening of “provisioning centers.” These centers are needed to dispense the drug, legislative supporters say, because the number of medical marijuana patients far exceeds the number of caregivers able to provide for them.
Glut of improper payments has states searching for new ways to weed out Medicaid fraud, abuse
In fiscal year 2010, 9 percent of state Medicaid payments — totaling $11 billion — were considered “improper” by federal standards. Many of these payments were due to clerical mistakes or flagged because of insufficient documentation, and were not necessarily payments that shouldn’t have been made. More »
Small group, big health care bills: ‘Super utilizers’ of health care system are major drivers of Medicaid — and state — spending
Picture an elderly man who is constantly visiting the emergency room with out-of-control blood sugar levels. His doctors can’t figure out why his insulin is failing to control his diabetes and why he keeps ending up in the hospital.
Enter a patient-centered team that starts asking the man questions about his daily life. The team finds out that the man doesn’t have a refrigerator to keep his insulin cool; by the second half of the month, his medication isn’t working properly. After the man receives a small fridge to store his insulin, his visits to the hospital stop. More »
States split on Medicaid expansion; Michigan will require co-pays
After narrow legislative passage of a Medicaid expansion bill in August, Michigan became the Midwest’s fifth state to expand coverage under the federal Affordable Care Act.
Illinois, Iowa, Minnesota and North Dakota had already approved expansion plans earlier in the year. According to the Kaiser Family Foundation, one other Midwestern state, Ohio, may extend coverage by the end of the year.
The enacted bill in Michigan (HB 4714) includes two provisions that will require federal waivers, the Detroit Free Press reports.
First, the state wants to create health savings accounts for Medicaid recipients in the expansion population. Second, the expansion population will be broken into two groups. During the first four years on the program, a Medicaid recipient will have a 5 percent co-payment for medical costs. After four years, individuals must make a choice — take on a co-pay of 7 percent, or purchase private coverage via the new health care insurance exchange. Exemptions to this higher co-pay are included for “medically frail” individuals.
States that expand Medicaid will cover individuals with incomes of up to 133 percent of the federal poverty level. The federal government provides a 100 percent match through 2017; this rate then gradually falls to 90 percent by 2020.
Rural lawmakers fear loss of Critical Access Hospitals in Midwest
In Sen. Jean Leising’s eastern Indiana district, many of her residents — and communities — have long relied on their local “Critical Access Hospitals.” And like rural lawmakers across the Midwest, Leising has new reason to worry about the future of these hospitals, which rely in part on enhanced Medicare funding to keep their doors open. The specter of many of these hospitals losing their “critical access” status was raised in a recent report by the U.S. Department of Health and Human Services. More »
States shape use of ‘navigators’ to help consumers with new health insurance exchanges
As states prepare for enrollment in the new health insurance exchanges this fall, policymakers are working on a program that will help consumers use the new marketplaces.The federal Affordable Care Act will require everyone to have health insurance beginning in 2014, and it provides for several different types of consumer assistance to help Americans enroll. More »
Iowa reforms of mental health system now under way
by Kate Tormey ~ 2013 MLC Annual Meeting Edition ~ Stateline Midwest »
Before Iowa’s mental health reform several years ago, people in the state were having trouble getting access to services.
Waiting lists were increasing, financing was inconsistent in the county-based system, and there was a discrepancy in the number of providers available in rural and urban areas. More »
States experiment with using Medicaid funds to help people buy private health coverage
Earlier this year, policymakers in Arkansas gained national attention when they sought clearance from the federal government to buy private insurance plans for Medicaid enrollees. More »
Medicaid: Change is on the horizon; states prepare for a turning point in health program
Since its inception in 1965, Medicaid has been a critical part of our nation’s safety net. And as both enrollment and spending have been steadily increasing — and a new federal health law is poised to take full effect — the strength of that net is being tested. More »
New abortion laws in Kansas, North Dakota attract nationwide attention
New abortion laws and restrictions adopted by legislatures in the Midwest have once again attracted national interest. This year, the focus has been on bills signed into law in North Dakota and Kansas.
North Dakota’s new restrictions are the toughest in the nation, the New York Times reports. HB 1456 forbids abortions after detection of a fetal heartbeat, a period in pregnancy many weeks before the “viability standard” set by the U.S. Supreme Court. Gov. Jack Dalrymple says the measure is “a legitimate attempt by a state legislature to discover the boundaries of Roe v. Wade.” A second bill, HB 1305, bans abortions performed solely for the purpose of gender selection or due to the discovery of genetic disorders such as Down syndrome. SB 2305 requires any physician who performs abortions to have admitting and staff privileges at a nearby hospital. Lastly, North Dakota legislators are sending to voters a constitutional amendment that defines life as beginning at conception.
Kansas’ HB 2253 declares that the life of each human being begins at fertilization and prohibits selective-sex abortions. Midwestern state legislatures have adopted several abortion laws in recent years that garnered national attention, including a 2010 Nebraska measure (LB 1103) that prohibits the procedure at or after 20 weeks’ gestation.
Wider use of nurse practitioners seen as potential remedy to predicted shortage of doctors
In response to an ongoing shortage of primary-care providers — coupled with the fact that millions of Americans will be added to Medicaid and private insurance rolls under the federal Affordable Care Act next year — state policymakers are considering how to better train and deploy their health care workforces. More »
What have Midwestern states done to address childhood obesity?
by Laura Kliewer ~ April 2013 ~ Question of the Month »
A. Childhood obesity rates have tripled over the past three decades, leading to a rise in state efforts to combat the trend. And since children spend much of their day in school, new state laws and regulations have focused on the types of foods and levels of physical activity offered at school. More »
Midwestern states split on crucial decision of whether to expand Medicaid programs
States in the Midwest appear to be split on whether to expand their Medicaid programs, and a leading national expert says it’s the most consequential decision for policymakers since states were first given the chance to opt into the state-federal partnership 48 years ago. The topic of Medicaid expansion was explored at a special briefing held last month in South Dakota. More »
Fragmented mental health system target of reform: Focus is on cost-effective,
State efforts to improve mental health systems: Innovations in the Midwest »
Roughly one in four American adults is struggling with a mental illness, according to the National Institute on Mental Health, and half of them are dealing with more than one disorder at the same time. About 20 percent of American children already have had a mental illness at some point in their lives. More »
What is an “essential health benefit” package, and how have states implemented this new federal requirement?
by Kate Tormey ~ February 2013 ~ Question of the Month »
A. Under the federal Affordable Care Act, all individual and small-group plans available in state health care exchanges must cover certain services, or “essential health benefits.” More »
More than half of states miss first deadline for setting up Affordable Care Act health exchanges
Less than half of the states met the first major deadline for setting up health care exchanges under the federal Affordable Care Act. And it’s likely that most states in the Midwest will opt not to have a role in setting up their health exchanges at all.
States that plan to operate their own state-based exchange had to submit blueprints by Dec. 14, 2012.
Though they will follow the federal guidelines set out in the 2010 Affordable Care Act, the state-based exchanges will be run entirely by the states themselves. More »
States cultivate healthy options in food deserts: Policies focus on improving access to fresh food
Illinois Sen. Jacqueline Collins remembers when her legislative district on Chicago’s South Side had plenty of grocery stores and family restaurants.
But today, she sees a very different picture. She says she counts “too many” fast-food outlets. And in the Auburn-Gresham neighborhood, for example, she counts just two full-service, sit-down restaurants.
Residents also have few option in terms of grocery stores; many of the stores left with the demographic shift that occurred in the 1970s, when large numbers of residents fled the city for the suburbs.
This landscape is part of the reason why Collins has helped support recent legislation in her state to lure those grocers back with grants and loans. More »
States look for ways to control high cost of care for Medicaid-Medicare ‘dual eligibles’
Six Midwestern states have submitted plans to the federal government that aim to control the costs of caring for a relatively small — but expensive — population in the Medicaid program.
The goal is to better integrate care for so-called “dual eligibles”: the more than 9 million seniors and people with disabilities who receive benefits under both the federal Medicare and state-federal Medicaid programs.
Dual eligibles account for 15 percent of Medicaid’s beneficiaries, but 38 percent of program spending, according to the Kaiser Family Foundation. That is largely due to Medicaid paying for long-term-care services. More »
Across Midwest, new laws in place to improve concussion awareness
By year’s end, all 11 Midwestern states will likely have new laws on the books to help protect young people from serious or long-term health problems due to concussions.
The flurry of state activity began in 2011, when eight states in the region passed concussion-related bills. Legislation was also passed earlier this year in Michigan and Wisconsin. As of late October, Ohio was the lone state in the region where a bill had not been passed. The Ohio House approved a measure this summer, and key lawmakers in the state Senate told The Columbus Dispatch in October they were readying a bill for passage in November.
According to Education Week, all of the new laws in the Midwest require student-athletes suspected of having a concussion to be removed from the game. To return to action, they must first receive medical clearance from a health professional. In Ohio, lawmakers have been trying to decide who should have the authority to clear student-athletes for play — only licensed physicians, or other health care professionals as well.
Most states in the Midwest also now require parents to sign a concussion information form. Michigan, Minnesota, North Dakota and Wisconsin are among the states that now require coaches to undergo training on concussion awareness.
U.S. data on teen immunizations show most coverage rising, but little change in HPV vaccination
More of the nation’s teenagers are getting immunized against diseases such as meningitis and diphtheria, but U.S. vaccination rates also show wide variances among the states. In addition, federal data show little progress in the percentage of girls receiving the human papillomavirus (HPV) vaccine. “We are very concerned about plateauing in HPV vaccination rates,” says Dr. Melinda Wharton of the U.S. Centers for Disease Control and Prevention. More »
Access to medical care down since 2000 in most states, study finds
Nearly every state underwent declines in access to health care in the last decade, according to data released earlier this year by two leading health care organizations. And researchers believe that this deteriorating access has consequences not only for individuals’ well-being, but also for the health of states’ finances. More »
Illinois creates fund for sexual assault services with ‘strip club tax’
Over the past five years, state funding for Illinois’ 32 rape crisis centers has declined by 28 percent.
State lawmakers took actions in 2012 to reverse that trend, by creating a new revenue source that will be dedicated to funding these centers. The “skin tax,” as it is sometimes called, imposes a $3 per patron surcharge on strip clubs that serve alcohol or a flat fee based on a club’s taxable receipts.
Under HB 1645, signed into law in August, money from the tax will go toward a new Sexual Assault Services and Prevention Fund. Dedicating revenue from the tax to rape crisis centers is appropriate, proponents of the bill say, because alcohol consumption at strip clubs has been linked to sexual assault, sexual harassment and prostitution.
Lt. Gov. Sheila Simon noted in a March press release that Illinois is following the lead of Texas, which passed a similar law in 2007. The Texas measure has since withstood a legal challenge that it was an unconstitutional violation of free speech. According to the Chicago Sun-Times, Illinois’ new tax is expected to raise up to $1 million a year.
Removing barriers to coordinated care seen as key to better patient outcomes, lower health costs
At July’s annual meeting of the MLC Health and Human Services Committee, legislators discussed options for building health care systems that are more efficient — with the goals of trimming costs and improving patient outcomes.
One of the themes discussed by policymakers was “integrated delivery systems” — medical groups made up of hospitals, labs, pharmacies and other facilities. More »
Policymakers share ideas on how to reduce recidivism by better addressing mental health issues of offenders
While 5 percent of the general U.S. population is affected by a serious mental illness, the rate in state prisons is much higher: 24 percent among females and 16 percent among males.
More than half the time, these illnesses occur in conjunction with substance abuse — a combination that, when left untreated, can lead to an increased risk of recidivism, according to Hallie Fader-Towe, a program director at The Council of State Governments’ Justice Center. More »
Health care in states' hands: Questions about costs, covering uninsured will drive decisions about Medicaid, health exchanges
In the weeks leading up to the U.S. Supreme Court’s decision on the federal Affordable Care Act, policymakers, commentators and experts mulled over the many possibilities that could come out of the landmark case. But virtually no one could have predicted the complicated outcome — or the unexpected lineup of justices in the 5-4 decision. More »
Cases of physician discipline rise in some states,
fall in others
While the number of physicians being punished for
professional misconduct grew slightly last year, there is debate about whether
that’s a positive or negative trend. More »
What states in the Midwest have freedom-of-conscience language in their constitutions or statutes?
Every state constitution in the Midwest has language guaranteeing freedom of religion; in addition to these constitutional protections, many states have inserted statutory language often referred to as “conscience” or “refusal” clauses. More »
Legislatures in Midwest have taken little action thus far on health insurance exchanges
While state policymakers prepare for and analyze the outcome of the Supreme
Court case surrounding the U.S. Affordable Care Act, the federal government is
moving forward with regulations to implement the law. More »
Iowa moving ahead with major reform of mental health system
“If you do not have a system, you cannot have system reform.”
Those were the words used by authors of a 2011 report describing the structural problems with how care was being delivered in Iowa to individuals in need of disability or mental health services. Iowa has had 99 different systems in place — with each of its counties given the responsibility of administering and funding services. The same 2011 report, done by the Iowa Department of Human Services, says this structure has resulted in uneven care across the state, an absence of coordination and accountability, and a lack of alternatives to costly institutional care.
Lawmakers expect all of that to change with the passage of SF 2315, a bipartisan bill that redesigns Iowa’s mental health system. According to The Des Moines Register, the measure creates regional partnerships (replacing the county-by-county approach) and establishes core services that must be delivered everywhere in the state, including housing and job assistance and crisis intervention. Funding for these services will continue to come from local property taxes. Under the bill, though, the amount collected for mental health services will be more consistent from county to county — with the state providing money in areas of the state where the amount is not sufficient.
Costly Medicaid errors spark state efforts to improve programs
by Kate Tormey ~ May 2012 ~ Stateline Midwest »
According to data released by the U.S. Centers for Medicare and Medicaid Services, 8.1 percent of Medicaid payments were considered “improper” in fiscal year 2011.
And while this error rate has caused some concern about the program that covers more than 50 million people, it’s the fiscal tally that has turned
heads: $21.9 billion. More »
New Nebraska laws aim to remake child-welfare system
by Tim Anderson ~ May 2012 ~ Stateline
Tackling an issue that many of them viewed as the most important policy priority of 2012, Nebraska lawmakers have adopted a series of reforms to a child-welfare system mired in controversy and turmoil.
According to the Omaha World-Herald, the changes will, in part, upend an effort undertaken in 2009 to privatize child-welfare services. In most parts of Nebraska, cases will now be handled by the state itself.
The Legislature’s actions took place amid concerns about costs, how caseloads were being managed, and the outcomes for abused or neglected children in the system.
Other components of the five-bill package, signed into law in April, include:
• reducing caseloads for child-welfare workers to the standard set by the Child Welfare League of America;
• requiring more data and reporting on the system’s performance;
• creating the new position of inspector general for child welfare and establishing a statewide Children’s Commission to develop a child-welfare plan for the state; and
• boosting payments for foster care parents.
Michigan becomes 5th state in Midwest to require autism coverage
Michigan will soon join four other Midwestern states in requiring insurers to cover therapies for children diagnosed with autism spectrum disorder.
The package of bills (SB 414, 415 and 981) was passed by the Legislature in late March.
The new mandate takes effect in October, the Detroit Free Press reports. Coverage for autism treatment will be capped at different dollar amounts depending on the child’s age: $50,000 annually for children under 6; $40,000 for individuals between the ages 7 and 12; and $30,000 for 13- to 17-year-olds. Lawmakers have set up a fund to reimburse insurers for some of the costs related to autism treatment. It was not yet known how much money would be appropriated to the fund.
Michigan is also planning to provide similar coverage to publicly insured children.
According to the advocacy program Autism Votes, Illinois, Indiana, Iowa, Kansas and Wisconsin have previously adopted laws requiring coverage of autism-related treatment. Kansas’ law is considered the weakest because it applies only to state employees; a bill proposed this year (HB 2764) would extend the mandate to all state-regulated group insurance plans. The other four states already require coverage by some or all private plans, with maximum yearly benefit levels usually set between $25,000 and $50,000. (Indiana’s law does not establish such caps.)
What requirements do Midwestern states have for health education in K-12 public schools?
by Laura A. Tomaka ~ March 2012 ~ Question of the Month »
A. Over the last few years, the number of Midwestern states including health education as a requirement for high school graduation has increased — a policy move that reflects growing recognition of the link between healthy kids and academic achievement, and between public health and safer, healthier communities. More »
Court rules Minnesota cannot keep newborns’ blood samples
Minnesota health officials must begin destroying blood samples collected from newborns over the past 15 years, due to a state Supreme Court ruling issued in November.
Every state in the nation conducts a newborn screening program, which tests babies shortly after birth for a range of congenital diseases. Since 1997, Minnesota has kept the samples in an anonymous database and used them for research purposes after testing is complete, reports the Minneapolis Star Tribune.
But late last year, the Minnesota Supreme Court sided with nine families who sued the state on grounds that keeping the samples violates the state’s 2006 Genetic Information Act.
The state will still test babies after birth, but under the ruling, samples must be destroyed 71 days after collection. The state will soon begin destroying samples collected since the date of the Supreme Court ruling, Nov. 16.
But still in question are about 1 million other samples, which were collected between 1997 and the date of the court ruling. The District Court must decide whether the families involved in the lawsuit are entitled to damages,
a process which state officials say could take up to a year.
Health premiums continue to consume more and more of family budgets
by Tim Anderson ~ January 2012 ~ Stateline Midwest »
The cost of health insurance premiums continues to consume a rising share of household budgets, reaching more than 20 percent of median family incomes in 2010 in some Midwestern states. More »
Michigan ends health benefit for legislators now only available in 2 Midwestern states: Ohio and Illinois
by Tim Anderson ~ December 2011 ~ Stateline Midwest »
Michigan Rep. Joel Johnson says he entered elective office this year looking to save taxpayers money whenever and wherever he could.
Within weeks, he found one of his first targets: a health care benefit for him and his legislative colleagues. More »
With new laws and technologies, states strengthening review of rate increases by insurers
by Kate Tormey ~ December 2011 ~ Stateline Midwest »
Earlier this year, the federal government issued its first request for a health insurer to justify a premium increase.
Under the 2010 Affordable Care Act, insurance companies must explain premium hikes of 10 percent or more. The goal of this provision is to make sure insurance companies are basing their rates on sound data and that they are being fair to the consumer. But how proposed increases are handled varies widely from state to state. More »
Reworking workers’ comp: On 100th anniversary of system, states focusing on
changes that cut business costs, remove uncertainties
For 100 years, employees injured on the job have been provided guarantees
through state workers’ compensation systems that cover the cost of medical and
rehabilitation services, as well as lost wages.
In return for carrying this
mandatory insurance, employers are protected from potentially costly
But have the systems themselves become too costly for business and
inefficient? More »
Adult adoptees soon to get better access to birth records in Illinois
by Tim Anderson ~ October 2011 ~ Stateline
Beginning in November, adults in Illinois who were adopted as children will be given greater access to their birth records, including the names of their birth parents.
The change in state law (the result of passage of HB 5428 in 2010) seeks to strike the right balance between two competing interests: the desire of adoptees to know their personal history, and the wish of some birth parents to remain anonymous. Previous state law allowed birth records to be open only upon the request of the parent, the Chicago Tribune reports. In advance of the new law taking effect, birth parents were given the chance to keep their identifying information confidential by submitting a form to the state.
A 2009 federal study summarizes state policies on adoptees’ access to birth records and information on their birth parents. In general, states have been opening up access; for example, Minnesota, Nebraska and Ohio now release original birth certificates unless the birth parents have filed an affidavit. (In each state, laws on access vary depending on when the adoption was finalized.) In the past, states generally required a court order before an original birth certificate could be released. As of 2009, such a requirement was still on the books in 26 states, including Iowa, Kansas, North Dakota and South Dakota.
Midwest in middle of political, legal fight over abortion
by Tim Anderson ~ September 2011 ~ Stateline Midwest »
According to the Guttmacher Institute, 80 new restrictions on abortion have been enacted nationwide thus far in 2011 — a total that dwarfs activity in any other previous year. And much of the activity has been occurring here in the Midwest. More »
Michigan ‘deduction’ for retiree health care rejected by court
A Michigan law that reduced the pay of current state workers to offset the state’s retiree health care costs has been ruled unconstitutional.
If the decision stands, lawmakers will have to find a way of making up for the annual loss of $75 million — the amount estimated to come from the 3 percent paycheck “deduction,” the Detroit Free Press reports. (A similar measure affecting teachers is also being challenged.)
The Michigan Appeals Court ruled that the Legislature had wrongly encroached on the constitutional authority of the state’s Civil Service Commission. Only a two-thirds vote of the Legislature can override a wage increase, as set by the commission via the collective bargaining agreement reached with state employees. The 3 percent deduction, or “contribution,” was passed by a simple legislative majority and amounted to a pay cut, the judges ruled, noting the money would go toward paying the health care costs of retired, rather than current, workers.
Three Midwestern states (Michigan, along with Illinois and Ohio) cover most or all of the health care premiums of retired state workers. The other eight states in the region require workers to take on much of this cost burden, though retirees in states such as Wisconsin and Iowa can “cash in” their unused sick leave to pay for their premiums.
Eyeing 2014 federal deadline, states begin working to set up health insurance exchanges
On the calendar, 2014 seems like a long way off. But when it comes to preparing for health care reform, it’s just around the corner for state policymakers.
Right now, states are working to set up health insurance exchanges, which are required under the federal Affordable Care Act. This topic was the subject of a workshop held at the annual meeting of the Midwestern Legislative Conference Health and Human Services Committee in July. More »
Debate over Medicaid’s future raises possibility of shift to
state-run block-grant program
A debate about how to fund Medicaid, the public health insurance program that now covers 16 percent of Americans, is under consideration by state and federal policymakers alike.
And one idea that has received particular attention of late is shifting Medicaid to a block-grant program. More »
New federal incentives encourage states to shift long-term care spending away from institutions
The federal government has launched a new initiative designed to change how states deliver services in one of the most costly areas of Medicaid: long-term care.
Under the State Balancing Incentive Payment Program, which was included in the federal Affordable Care Act of 2010, states will have the chance to receive enhanced Medicaid matching funds in exchange for increasing their commitment to home and community-based care. More »
Ohio takes on problem of prescription-drug abuse with new law
June 2011 ~ Stateline Midwest »
Last month, Ohio lawmakers approved legislation aimed at cracking down on “pill mills” that illegally provide prescription medications to patients.
Under Ohio’s HB 93, pain-management clinics— and the physicians who work in them — will be more heavily regulated under special licenses from the state Board of Pharmacy. The state Medical Board will establish rules for physicians who operate these facilities and standards for doctors who provide care.
The bill also limits the amount of controlled substances that physicians can personally provide to their patients, and these prescriptions will be tracked in the state’s existing drug database. In addition, a program will be created to collect unused medication.
Ohio legislators took on the issue this year due to continuing concerns about prescription-drug addiction and related deaths in the state and across the nation. According to the White House Office of National Drug Control Policy, rates of deaths due to drug overdose have doubled since the early 1990s. Prescription painkillers were implicated in nearly 40 percent of these deaths.
Policymakers in 43 states have set up or are in the process of creating prescription-drug monitoring programs, which track patients and prescribers to identify troubling patterns.
CSG, RAND detail estimated impact of federal health reform on states' health insurance rates, costs in years ahead
by Tim Anderson ~ May 2011 ~ Stateline Midwest »
Over the next decade and beyond, the federal health care law passed in 2010 will have myriad effects on states and their health care systems.
For legislators, the law’s impact in two areas is perhaps most important of all. How many more people will have insurance under the Patient Protection and Affordable Care Act, and what are the fiscal consequences of the law?
An analysis done by the RAND Corporation and The Council of State Governments seeks answers to those questions. More »
CSG study details Medicaid funding cliff ahead for Midwestern states
by Kate Tormey ~ April 2011 ~ Stateline Midwest »
As enhanced federal matching rates for the Medicaid program expire later this year, there will be major changes in the federal funding that states receive for the health program.
Trends in Medicaid matching funds are detailed in a report released in March by The Council of State Governments. More »
Medicaid makeover: Premium on quality care, cost savings as states prepare for loss of federal funds and expansion of health program
by Kate Tormey ~ February 2011 ~ PDF of Stateline Midwest article »
Last month, lawmakers in Illinois approved what many are calling landmark reforms to public health programs in the state.
Among the reforms were significant changes to the state’s health program for children, All Kids, and the general Medicaid program.
Sen. Heather Steans says the main goal of the legislature’s recent actions was simple: address the rising cost of Medicaid at a time when the state faces a $16 billion budget shortfall. More »
New federal rules mandate how much insurers must spend on medical care
Regulations issued in November by the U.S. Department of Health and Human Services define how much insurance companies must spend on health care. These new “medical loss ratio” (MLR) rules pre-empt some Midwestern states’ laws and require all states to follow similar guidelines regarding the spending of health insurance companies. More »
Signs of success from Ohio's revamp of long-term care
Changes in state policy are helping Ohio rebalance its long-term-care system in a way that expands choices for consumers and results in cost savings, The Columbus Dispatch reports.
Compared to other states, Ohio has historically been more reliant on nursing homes to provide long-term-care services. However, the state is now placing more and more people into home- and community-based services — an option that state officials say costs about one-third as much as similar care in an institutional setting. The state’s rebalancing strategy has included:
combining different home- and community-based services into a single budget line item, thus better ensuring consumer access to the level of care they need;
strengthening the relationship with hospitals to make consumers aware of alternatives to institutional care; and
allowing the cost of care for an individual in home- and community-based care to rise as his or her needs increase.
According to the Kaiser Family Foundation, the distribution of long-term-care spending (which accounts for 34 percent of Medicaid costs) can vary widely from state to state. For example, home health and personal care accounts for 65 percent of spending in Minnesota (highest in the Midwest) and 29.6 percent in Illinois (lowest in the region).
The health care workforce: To ease shortages, states consider roles of nurses, midwives
Nearly 11 percent of the Midwest’s population is medically underserved, according to data provided by the U.S. Health Resources and Services Administration. In other words, about 6.4 million people in this region live in an area designated as having a shortage of health professionals.
In order to bring the region to the desired patient-to-provider ratio of 2,000-to-1, about 2,800 additional primary-care workers are needed in the Midwest. In response to this workforce shortage, federal and state policymakers have been working on ways to better train current workers and to encourage more people to choose professions in the health care field. More »
Federal assistance, cost-cutting measures helping curb fiscal impact of Medicaid on states
Due in part to higher-than-expected growth in Medicaid expenditures in fiscal year 2010, states have taken a number of actions to control program spending during the current fiscal year and beyond.
According to a report released this fall by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates, states reported an average increase in total Medicaid spending of 8.8 percent in FY 2010. In the annual survey, Medicaid directors attributed the spending increase to the effects of the recession and resulting increases in enrollment, which averaged 8.5 percent. More »
Indiana health workers may get background checks
Health care providers in Indiana would be subject to more-stringent background screenings under a proposal released this fall by the chair of the Senate Health Committee.
Sen. Patricia Miller, a Republican from Indianapolis, is calling for all of the state’s 263,000 health professionals, as well as new licensees, to undergo a criminal background check by the FBI. The process, which costs $18, would be paid for by licensees, reports The Times of Northwest Indiana.
Results would be forwarded to the state’s 24 medical licensing boards, which would then decide whether to take action. Under the current proposal, county prosecutors would also be required to alert the state attorney general’s office if someone who is arrested is found in a statewide database of licensed professionals.
Miller, a registered nurse, says the measure would increase patient safety; she will introduce legislation when the session begins in January.
Indiana is one of 14 states (Minnesota and South Dakota are among the others) that do not allow state medical boards to perform background checks, according to the Federation of State Medical Boards. However, many medical facilities already require such checks as a condition of employment.
Illinois changes rules for inhalers in school
November 2010 ~ Stateline Midwest »
Illinois students and parents can breathe a little easier this school year, thanks to a new law that makes it less difficult for students to keep lifesaving asthma medication with them.
It is estimated that 9.4 percent, or about 7 million, of American children have asthma. The condition can be potentially life-threatening without immediate access to inhalers.
HB 5836 stems from a 2001 law in Illinois that gave students the ability to keep asthma inhalers with them at all times (prior to the law, they might have to had keep inhalers in the nurse’s office).
Under the law, students had to obtain a yearly doctor’s note. Parents and advocates say that requirement was a barrier because it would sometimes require a separate doctor’s visit or a phone call to the child’s physician.
Under HB 5836, a student needs only a copy of the prescription and a note from his or her guardian. State officials believe the law is the first of its kind in the nation, according to the Chicago Tribune.
With passage this year of a law in South Dakota, all Midwestern states now allow children to carry and self-administer asthma medication, according to the Allergy and Asthma Network Mothers of Asthmatics.
Wisconsin sex-ed law spurs local challenges
A new sexual-education law is sparking controversy in Wisconsin, where two school districts are challenging whether students should automatically be taught sensitive topics.
The Healthy Youth Act (AB 458), signed into law earlier this year, requires school districts that teach human growth and development to cover both abstinence and contraception.
But the Cedarburg School Board has adopted a new “opt-in” policy that requires parents to specifically consent for their children to learn about those issues, reports the Milwaukee Journal Sentinel.
Board members say the district is in compliance with the state law — and is trying to involve parents. But supporters of this year’s state legislation say the board isn’t following the letter of the law.
In April, a local district attorney in Wisconsin warned school districts not to teach the new courses, citing concerns that teachers could be charged with contributing to the delinquency of minors.
Three Midwestern states (Iowa, Kansas and Minnesota) mandate sexual education. Three others — Illinois, Indiana and Michigan — require schools that do teach it to stress abstinence, according to the Guttmacher Institute.