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Question: What are states doing to regulate pharmacy benefit managers (PBMs)?

by Laura Kliewer ~ January 2021 ~ Question of the Month »
In a December 2020 decision, the U.S. Supreme Court unanimously affirmed that states can regulate pharmacy benefit managers (often abbreviated as PBMs), the “middlemen” between health insurance plans and pharmacies, to curb rising prescription drug prices. More »


State policies help spur rise in school-based mental health

by Tim Anderson ~ January 2021 ~ Stateline Midwest »
Increasingly, states are looking for ways to bring these services to students, and encourage partnerships with local providers who can deliver specialized care. More »


Some states look to expand postpartum Medicaid coverage in efforts to reduce maternal mortality

by Jon Davis~ January 2021 ~ Stateline Midwest »
A new Kaiser Family Foundation report recommends that states seeking to reduce maternal mortality should expand their Medicaid programs’ postpartum coverage to from the federally mandated 60 days to a full year from the date of birth. More »


On the frontlines of vaccination: From public awareness campaigns, to storage and distribution, to funding, states will play a leading role in efforts to control COVID-19 in 2021

by Jon Davis ~ December 2020 ~ Stateline Midwest »
States have at least two critical jobs in the months ahead regarding the COVID-19 vaccines. First, execute their role on the frontlines of distribution. Second, convince leery citizens to get vaccinated. “That is, at this point, the most critical [element],” Michael Osterholm, a leading national voice on COVID-19 policy, says of public education and persuasion. More »


Wisconsin alters Medicaid rules to improve services for individuals released from prison and jail

by Jon Davis ~ December 2020 ~ Stateline Midwest »
In late October, Wisconsin became the latest Midwestern state to suspend, rather than terminate, Medicaid coverage for people who are incarcerated, a policy step designed to ease a released person’s re-entry into society and reduce recidivism. More »


12-state network in Midwest has states working together to connect farmers with mental health services

by Carolyn Orr ~ December 2020 ~ Stateline Midwest »
Two years ago, in a resolution passed at the Midwestern Legislative Conference Annual Meeting, the region’s state legislators urged their federal counterparts to support an initiative that connects farmers and ranchers to mental health services. That policy wish was granted in the 2018 farm bill, which included funding for the Farm and Ranch Stress Assistance Network. Now the Midwest is poised to work together on delivering these services through a new 12-state initiative devoted to the mental wellness of agricultural producers in the region. More »


Indiana hits record-low rate for infant mortality, policies in place aim to continue this trend

by Jon Davis ~ December 2020 ~ Stateline Midwest »
Indiana’s infant mortality rate fell last year to the state’s lowest level ever since 1900, when records began to be kept, state officials announced this fall. Preliminary data released by the Indiana Department of Health also show the mortality rate for Black infants fell from 13.0 in 2018 to 11.0 in 2019. This marks the third year of decline in the state’s rate of infant mortality, which is defined as the death of a baby before his or her first birthday. Gov. Eric Holcomb said the data show that the state’s various initiatives to reduce infant mortality are working.
Improving birth outcomes has been a priority of Holcomb and state legislators for several years now. In 2019, for example, lawmakers passed HB 1007, which created the My Healthy Baby program. It connects expectant or new mothers to the health, social and other services that they need via a “navigator” — a home visitor who provides personalized guidance and support. My Healthy Baby targets state supports for pregnant women who are covered by Medicaid and reside in areas of the state with high infant mortality rates. The legislature committed $6.6 million toward the program over two years. The program launched in January with a goal of serving 20 counties by the end of 2020. Another 25 counties are expected to be added in 2021; the ultimate goal is to make these services available to all pregnant women who are insured through Medicaid.
In 2018, Holcomb also signed a law (SB 360) creating a perinatal “levels of care” rating system for hospitals and birthing centers. The Department of Health now has a six-level system classifying obstetrics and neonatal care in the state’s hospitals. These facilities are measured in six categories, ranging from organization to obstetric capabilities, personnel, equipment and medications. The goal is to give pregnant women (especially those experiencing high-risk pregnancies) and their doctors information to help them choose a facility that is best for them.



As recent data show big rise in youth suicide rates, states are launching, mulling new prevention strategies

by Jon Davis ~ November 2020 ~ Stateline Midwest

Newly released federal data on suicide rates among young people show a disturbing trend that many state lawmakers already know too well because of tragic stories in their own legislative districts. The number of deaths rose dramatically over the past decade — by 47.1 percent nationally — according to research from the U.S. Centers for Disease Control and Prevention, which compared suicides among people ages 10 to 24 between two time periods: 2007-2009 vs. 2016-2018. In the Midwest, rates were even higher in four states. More »


Nebraska bans ‘surprise billing’ for emergency medical care; other states may do so, too

by Jon Davis ~ September 2020 ~ Stateline Midwest »
Nebraska in July became the latest Midwestern state to regulate “surprise billing” when the “Out-of-Network Emergency Medical Care Act” (LB 997) was signed into law. More »


States taking steps to contain COVID-19 in nursing homes, other long-term-care facilities

by Jon Davis ~ September 2020 ~ Stateline Midwest »
As the COVID-19 pandemic grinds on, one trend has become clear and consistent: the virus is more deadly if introduced and spread in adult long-term-care facilities, which are accounting for a smaller percentage of cases, but almost half of all deaths nationwide since early May, according to an issue brief published in September by the Kaiser Family Foundation. More »


Michigan agrees to $600 million settlement in Flint water crisis, with most money going to children

by Tim Anderson ~ September 2020 ~ Stateline Midwest »
After 18 months of negotiations, the state of Michigan agreed in August to pay $600 million to individuals and businesses affected by the water crisis in the town of Flint, with close to two-thirds of the money going to children age 6 and under at the time of their first exposure. The crisis in Michigan's seventh-largest city began in 2014, when the town's supply of water was switched to the Flint River, leading to toxic levels of lead in drinking water. The consequences included an uptick in deaths from Legionnaires' disease and lead poisoning among children.
Most of the settlement money will be earmarked for young people: 64.5 percent for ages 6 and under, 10 percent for ages 7 to 11, and 5 percent for ages 12 to 17. Money also will go to local special-education services, as well as to pay the claims of adults and to compensate individuals for property damage and business losses.
Even prior to the August settlement, Michigan had spent more than $400 million on its response to the Flint water emergency. For example, it is helping the city replace all of its lead service lines and putting money toward nutrition programs, child health care services, early-childhood programs, and lead prevention and abatement. The state also has adopted the nation's strictest standards for lead and copper in drinking water.



Minnesota launches new housing assistance program as a regular part of its state Medicaid plan

by Jon Davis~ August 2020 ~ Stateline Midwest »
Though some states have used demonstration waivers to experiment with the use of federal Medicaid dollars for housing services, Minnesota is the first in the nation to take the idea a step further, making such services a basic benefit of the public health insurance program. More »


COVID-19 pandemic strained usual interstate resource sharing during emergencies, but also underscored value of cross-border cooperation

by Ilene Grossman ~ August 2020 ~ Stateline Midwest »
States are accustomed to working together and helping one another through times of crisis or natural disasters. Between 2016 and 2019 alone, via the congressionally authorized Emergency Management Assistance Compact, more than half of the U.S. states requested assistance from others. Every state but one provided help to another state during this time. In all, more than 29,000 personnel were deployed to states in need of help. But the COVID-19 pandemic of 2020 has brought challenges to states that they have not previously faced. That includes how to facilitate interstate cooperation and support. More »


Lessons from COVID-19 pandemic include investing more in public health, addressing prevalence of chronic and preventable conditions

by Tim Anderson and Ilene Grossman ~ August 2020 ~ Stateline Midwest »
Reduced federal and state investments in public health over the past decade. Fewer workers in state and local health departments. Growing numbers of people with diabetes, obesity, heart disease, high blood pressure and other underlying conditions. Inequities in the types of services and health infrastructure needed to keep individuals and whole communities well. They all added up to a country vulnerable to being hit hard by a transmissible disease such as COVID-19, two public health experts said to legislators during a July webinar of The Council of State Governments’ Midwestern Legislative Conference. More »


States provide limited immunity for health care workers, facilities, other companies in COVID-19 pandemic

by Jon Davis ~ July 2020 ~ Stateline Midwest »
As the Midwest’s policymakers have wrestled this year with the COVID-19 pandemic’s health and economic impacts, many have given health care (and other) businesses limited immunity from civil lawsuits, as long as they have made good-faith efforts to comply with public health guidelines during the crisis. More »


Utility shutoff moratoria serve a public health need in pandemic, but what will happen when they expire?

by Jon Davis ~ June 2020 ~ Stateline Midwest »
As the COVID-19 pandemic took hold and states and provinces began shutting down in March, many either required or called for halts on utility shutoffs due to non-payment of bills for the duration of the public health emergency. But as economies reopen, questions arise: When should these state-imposed moratoria be lifted? What happens then? More »


COVID-19 contact tracing has states in Midwest launching new apps, hiring new workers and addressing privacy concerns

by Jon Davis June 2020 Stateline Midwest »
To keep people safe, stay ahead of COVID-19 infection rates, and allow for the continued loosening of “stay at home” restrictions, many states are trying to heed the advice of public health experts — ramp up contact tracing programs. More »


Indiana providing new assistance to individuals transitioning from Medicaid to private insurance

by Tim Anderson ~ June 2020 ~ Stateline Midwest »
Indiana has received federal approval of a first-of-its-kind program that helps individuals transition from Medicaid to employer-based health coverage or a plan in the individual marketplace. The new “workforce bridge” builds on the Healthy Indiana Plan (HIP), which is used by the state to expand Medicaid to cover low-income adults. More »


Saskatchewan partners with government of Canada to boost wages of COVID-19 essential workers

by Tim Anderson June 2020 Stateline Midwest »
Workers in Saskatchewan caring for some of the province’s most vulnerable citizens were eligible for a 16-week boost in pay this spring as the result of a program largely financed by the Government of Canada and administered by the Saskatchewan Ministry of Finance. The Temporary Wage Supplement Program was established in response to the COVID-19 pandemic.
During the program’s first phase, a wage supplement of $400 per month was made available to home health care workers as well as individuals employed at long-term-care facilities, child care centers, emergency and transition shelters, and community-based group homes. To be eligible, workers had to have monthly earnings of less than $2,500. In early June, the province expanded the program by waiving the income threshold for workers at certain long-term-care facilities (those under public health orders to restrict visitations due to COVID-19).
According to the Regina Leader-Post, the cost of the program is $56 million, with about $3 million coming from the province. Under individual agreements with the provinces and territories, the Government of Canada is providing up to $3 billion in support to temporarily increase the wages of low-income essential workers. Saskatchewan’s program is running for 16 weeks, March 15 to July 4.



As COVID-19 burns through the Midwest, legislators brace for effects on states’ Medicaid budgets

by Jon Davis ~ May 2020 ~ Stateline Midwest »
Having been hit once by the onset of COVID-19, states should now be bracing for another punch ­— a surge in Medicaid enrollment, and spending, as their economies absorb the pandemic’s shock. More »


States at center of nation’s response to COVID-19 pandemic, and work has just begun

by Jon Davis ~ April 2020 ~ Stateline Midwest »
The scale and scope of the COVID-19 pandemic has turned a spotlight on the role of states in responding to a new public health emergency in a manner quite unlike a tornado, flood or even recent viral concerns such as H1N1 or Ebola. By April, all states and provinces in the CSG Midwest region had declared either states of emergency or public health emergencies. In many, governors or premiers had enacted “stay-at-home” or “shelter-in-place” orders for the first time in living memory. For state legislatures, the early response centered on working with their governors (oversight, consultation, etc.) and providing emergency funding where it was needed most. More »


Question: What have state legislatures in the Midwest done to improve access to diagnostic mammograms and other screenings?

by Mitch Arvidson ~ April 2020 ~ Question of the Month »
Screening mammograms are used to check for breast cancer in women who have not yet shown any signs or symptoms of the disease. Diagnostic mammograms, on the other hand, are used when additional images are needed after the screening mammogram discovers possible indicators of breast cancer. These indicators include lumps and dense breast tissue; the latter is an important indicator because women with extremely dense breasts are four to six times more likely to develop cancer than women with fatty breasts, according to Densebreast-info, Inc., an online educational resource. Additionally, it is often hard to detect cancer via routine screening mammograms in higher-density breasts, thus necessitating further tests. More »


Wisconsin expanding use of peer coaches to help individuals recover from addiction

by Jon Davis ~ April 2020 ~ Stateline Midwest »
Wisconsin Gov. Tony Evers in early March signed a quartet of bills aimed at further combating the state’s opioid abuse problems. Among the new laws is AB 650; it requires state Medicaid reimbursement of a treatment model known as “peer recovery coaching,” which connects individuals to a mentor with a personal history of addiction and recovery. A trained mental health professional must guide and oversee the work of the peer recovery coach.
Also under the new law, the state Department of Health Services will establish a program to facilitate overdose treatment. This program will include evaluating outcomes data on patients who receive various continuation-of-care services offered by treatment providers, including the use of peer recovery coaches.
Other recently enacted bills in Wisconsin include AB 645, allowing county jails to get naloxone (which circumvents overdose reactions if administered in time) and training in its use; AB 646, preventing state employees from being disciplined for using or possessing a controlled substance that is prescribed or recommended as part of a medication-assisted treatment for addiction recovery; and AB 647, extending the sunset date for the state’s prescription drug monitoring program to 2025.
In early 2020, the U.S. Centers for Disease Control and Prevention released data showing that the number of U.S. drug overdose deaths had fallen by 4.6 percent between 2017 and 2018. However, there continues to be a national rise in deaths involving synthetic opioids such as fentanyl, fentanyl analogs and tramadol — a 10 percent increase between 2017 and 2018.


Measures in Illinois, Minnesota seek to contain costs for patients needing insulin

by Jon Davis ~ April 2020 ~ Stateline Midwest »
In mid-April, Minnesota became the second Midwestern state with a new law that aims to curb the costs of insulin for patients who need it to control their blood sugar levels. Under the Senate version of HF 3100, drug manufacturers would fund patient assistance programs in order to cap what qualified Minnesotans must pay for insulin. The various legislative proposals in Minnesota this year have been dubbed the “Alec Smith Insulin Affordability Act,” named for a resident who died after rationing insulin once he aged off his parents’ health insurance coverage.
In December 2019, Illinois became the first Midwestern state to cap the monthly health insurance co-payment for insulin. Under SB 667, signed into law in January, the cap is no more than $100 for a 30-day supply. The law also requires the Illinois departments of Insurance, Human Services, and Healthcare and Family Services to investigate insulin prices and report their findings by November.
Recent legislative proposals in the Midwest to cap co-payments include Iowa‘s HF 2138, Kansas ‘ HB 2557 and SB 376, Michigan’s HB 4701 and 4702, Nebraska’s LB 949 and LB 970, and Wisconsin’s AB 411.
In Indiana this year, lawmakers approved a bill (SB 255) that allows people to get insulin without a prescription. (Indiana had been the only state with such a prescription requirement in place.) According to the American Diabetes Association, more than 30 million Americans live with diabetes, and approximately 7.4 million of them must take insulin every day.


States take lead on PFAS problem: ‘Forever chemicals’ persist in environment and are linked to health problems; options include drinking water standards, legal remedies to help fund cleanup efforts

by Jon Davis ~ March 2020 ~ Stateline Midwest »
Michigan and Minnesota are leading the charge to corral compounds known by an alphabet soup of acronyms that have become the source of widespread concerns about the safety of drinking water across the Midwest. More »


New restrictions on vaping sales, advertising take effect in Saskatchewan

by Tim Anderson ~ March 2020 ~ Stateline Midwest »
Under a Saskatchewan law that took effect in February, the province is restricting how vaping and e-cigarette devices are sold, displayed and marketed. Sales to people under the age of 18 are banned, and vaping-related products cannot be used in and around public buildings, including schools. In many ways,
The Tobacco and Vapour Products Control Act builds on the restrictions already in place in Saskatchewan for tobacco products. Vaping and e-cigarette products cannot be advertised in areas where young people can enter, and they cannot be sold at amusement parks, arcades and theaters. The province is allowing the regulated sale of flavored tobacco and vapor products to adults.
Provincial health officials say many Canadian jurisdictions have similar restrictions in place. In the 11-state Midwest, the minimum legal sales age for e-cigarettes is 21 in Illinois and Ohio; 19 in Nebraska; and 18 in Indiana, Iowa, Kansas, Michigan, Minnesota, South Dakota and Wisconsin, according to the Public Health Law Center at Mitchell Hamline School of Law.


State laws treat mother’s substance use during pregnancy as child abuse, but should they?

by Jon Davis ~ January/February 2020~ Stateline Midwest »
Twenty-two years after South Carolina became the first state to criminally convict a woman for child abuse for using crack cocaine during her pregnancy, only Alabama and Tennessee have joined it in criminalizing that behavior. But almost half of all states — including every Midwestern state except Kansas, Michigan and Nebraska — consider a mother’s drug use during pregnancy to be child abuse under civil child-welfare law, according to a December 2019 survey by the Guttmacher Institute, a New York City-based organization researching sexual and reproductive health rights policies worldwide. More »


Future of Medicaid being shaped by state expansions, work requirements and new ideas to contain costs

by Jon Davis ~ December 2019 ~ Stateline Midwest »
Medicaid expansion, new Medicaid work rules, and attempts to rein in prescription drug costs are among some of the major trends among Midwestern states' Medicaid programs in fiscal years 2019 and 2020, identified by the Kaiser Family Foundation's 19th annual survey of all 50 states. More »


Illinois becomes first Midwest state to cap monthly insurance co-payments for insulin

by Jon Davis ~ December 2019 ~ Stateline Midwest »
Illinois is the first Midwestern state — and the second nationwide — to cap insurance co-payments for insulin. Legislators in mid-November approved SB 667, under which most health insurance policies could charge insured individuals no more than $100 for a 30-day supply of what for diabetic patients is a life-saving medication. More »


New Wisconsin law enshrines Medicaid telehealth parity

by Jon Davis ~ December 2019 ~ Stateline Midwest »
Wisconsin became the latest Midwestern state to enact Medicaid telehealth payment parity legislation when Gov. Tony Evers signed SB 380 in November. Under the new law, the Department of Health Services must treat and pay telehealth services — including remote patient treatment, care and monitoring, consultation and diagnosis — delivered via an audio/video connection the same as in-person services. This includes the electronic collection and sharing of clinical information, more commonly known as “store and forward.”
The law ensures that Medicaid reimburses for the same telehealth services as Medicare, and allows patients to get telehealth care in non-clinical locations such as homes or schools. It also eliminates requirements for telehealth providers to get extra certifications or meet extra requirements just because a service is provided via telehealth.
According to the Center for Connected Health Policy, all Midwestern states reimburse for live video services while Wisconsin and Minnesota are now the only ones reimbursing for “store-and-forward.” Five states — Iowa, Michigan, North Dakota, Ohio and South Dakota — don’t reimburse for remote patient monitoring, according to the center.


Pharmacy benefit managers coming under increasing state scrutiny, regulation

by Jon Davis~ November 2019 ~ Stateline Midwest »
In their quest to bring prescription drug prices under control, many Midwestern states are looking at the role played by pharmacy benefit managers, the third-party administrators of many health plans’ prescription drug programs. The position (often abbreviated as PBM) is designed to leverage the aggregate purchasing power of health insurance policyholders by negotiating price discounts with pharmacies or prescription home-delivery services, and rebates from pharmaceutical manufacturers. More »


Rural hospitals straining, closing under increasing financial stress

by Carolyn Orr ~ November 2019 ~ Stateline Midwest »
Rural hospitals are a critical component of communities across rural America, but they’re in trouble: 16 in the Midwest have closed since 2010 and a recent study by Navigant suggests 139 more are at financial risk of closure. The National Rural Health Association says that 42 percent of rural hospitals in the Midwest are operating in the
red. More »


Wisconsin to provide health insurance to fallen officers' families

by Jon Davis ~ November 2019 ~ Stateline Midwest »
Wisconsin will now allow families of police officers killed in the line of duty to continue health insurance coverage rather than switching to federal COBRA coverage.
Under SB 266, which passed unanimously and was signed by Gov. Tony Evers in October, families of municipal, Marquette University or University of Wisconsin police, and state police are covered. So, too, are Capitol police, Department of Revenue special agents and Department of Natural Resources conservation wardens.
Coverage will not apply to spouses who remarry or reach 65 years of age, or to children once they turn 26. The state will reimburse local jurisdictions for this coverage, according to a Wisconsin Legislative Council memo.
Firefighters’ families have been covered by such provisions since 2009, the Milwaukee Journal Sentinel reports.
According to Concerns of Police Survivors, an advocacy organization of and for surviving family members, similar continuing coverage is available for the spouses of state and county officers in Illinois, Indiana, Iowa, Kansas, Minnesota, North Dakota, Ohio and South Dakota. Michigan covers spouses of state police officers for life, and dependent children until age 18.


Containing vaping: Midwestern states act to keep e-cigarettes away from teenagers as deaths and lung injuries proliferate

by Jon Davis ~ October 2019 ~ Stateline Midwest »
Vaping burst into the national consciousness this summer when hundreds of people reported lung damage and at least 12 people died from what the U.S. Centers for Disease Control and Prevention calls “vaping-associated pulmonary injury.” As of October, the CDC had reported at least 805 cases of vaping-related injuries from 46 states and the U.S. Virgin Islands, as well as 12 vaping-related deaths, including from Illinois (the first to be reported), Indiana, Kansas and Minnesota. More »


Five takeaways for Midwest from new Census Bureau data on health coverage, poverty and income

by Tim Anderson ~ October 2019 ~ Stateline Midwest »
Uninsured rates have dropped sharply since 2010, and poverty rates are down as well. During this decade, income has been distributed less equally among households across the Midwest; still, income inequality is less pronounced in most states in this region compared to the rest of the nation. More »


New Illinois law aims to protect students with diabetes

by Tim Anderson ~ October 2019 ~ Stateline Midwest »
Illinois has a new law to ensure that children with diabetes have access to the medical care they need. Under HB 822, which received unanimous approval in the state General Assembly, schools are given the authority to store an undesignated supply of glucagon.
This medication, used to treat low-blood-sugar emergencies, will have to be stored in a secure location that is immediately accessible to a school nurse. The nurse can then administer the glucagon if he or she has such authority under the student’s diabetes care plan. Parents must be notified immediately after the medication has been administered.
According to the Quad Cities Times, Illinois’ glucagon law is believed to be the first of its kind in the nation. It is the result of an incident that occurred at an Illinois middle school in 2018: A seventh-grader collapsed due to dangerously low blood sugar levels, and a nurse administered glucagon. In that incident, though, the student didn’t have a prescription at school, and the school didn’t have the authority at the time to carry an undesignated supply. The nurse used another student’s prescription. With the new law in place, every Illinois school can have an undesignated supply on hand.


Question: In the 11-state Midwest, what groups are required to report cases of child abuse and neglect?

by Tim Anderson ~ October 2019 ~ Question of the Month »
Nearly every state in this region identifies certain professions and workers that must report known or suspected cases of neglect. Earlier this year in Ohio, for example, police officers joined the state’s list of mandatory reporters, the result of legislation signed into law in late 2018 (HB 137). The Ohio statute already was fairly extensive, covering professions ranging from attorneys and podiatrists, to animal control officers and speech pathologists. More »


Illinois requires health insurance policies to cover maternal mental health, postpartum depression

by Jon Davis ~ September 2019 ~ Stateline Midwest »
Health insurance policies in Illinois must cover maternal mental health issues, including postpartum depression, under a new law signed by Gov. J.B. Pritzker in August. While Illinois’ existing health insurance law talks about mental health coverage, it “didn’t specify clearly enough for me” that pregnancy-related issues and postpartum depression should be included, says Rep. Mary Flowers, who sponsored HB 2438. More »


MLC Health & Human Services Committee: Lawmakers hear why vaccination rates decline, and how states can respond to disease outbreaks

by Jon Davis ~ August 2019 ~ Stateline Midwest »
A national measles outbreak this year, following closely after one in Minnesota in 2017, prompted the Midwestern Legislative Conference’s Health & Human Services Committee to look at “The Science of Vaccinations” in July at the MLC Annual Meeting in Chicago. More »


Wisconsin is the latest Midwest state to regulate 'step therapy'

by Jon Davis ~ August 2019 ~ Stateline Midwest »
Insurance companies may no longer dictate which medications patients in Wisconsin are allowed under protocols known as “step therapy” (or “fail first”).
Wisconsin becomes the sixth Midwestern state — joining Illinois, Indiana, Minnesota, North Dakota and Ohio — to regulate step therapy, which typically requires patients to begin treatment with the most cost-effective drug therapy, progressing to more expensive or risky treatments only if necessary.
SB 26, signed by Gov. Tony Evers in July, requires exceptions to step therapy regimens under limited circumstances, including when a drug is contraindicated (deemed medically inadvisable) for a patient or will cause an adverse reaction; if it’s expected to be ineffective; if it is ineffective or has been previously tried with adverse results; if the drug is not in the patient’s best interest or if the patient is already stable on a different drug under his or her current or past plan.
The new law also mandates that if a patient appeals a denial of a step therapy protocol exception, the insurance company must grant or deny that request within 72 hours (or 24 hours under emergency circumstances); any request for exception not answered by that deadline is considered granted.


Indiana law is first in the Midwest to let patients sue for ‘fertility fraud’

by Jon Davis~ June/July 2019 ~ Stateline Midwest »
Indiana has become the first Midwestern state to allow patients to sue doctors for “fertility fraud” — including instances when a woman being treated for infertility is given the health care provider’s own sperm or ova without permission.
Under SB 174, signed by Gov. Eric Holcomb in May, “civil fertility fraud” is classified as a Class 6 felony. The new law sets the statute of limitations at either 10 years after the child’s 18th birthday or 20 years after the procedure was performed; or within five years of discovering the fraud via DNA tests. Successful plaintiffs will be entitled to the costs of fertility treatment, as well as compensatory and punitive damages.
The case of an Indianapolis fertility specialist using his own sperm to impregnate more than 50 women without their consent has received national attention, and helped lead to lawmakers’ actions this year.
In 1995, California became the first state to make fertility fraud a crime, and Texas Gov. Greg Abbott signed SB 1259 in early June. It classifies fertility fraud as sexual assault punishable by between 180 days and two years in a state jail (and an optional fine up of up to $10,000).


Minnesota hikes license fees for opioid makers to raise more money for treatment programs

by Jon Davis~ June/July 2019 ~ Stateline Midwest »
Some states grappling with their ongoing opioid crises have tried to make manufacturers pay for treatment and prevention programs by levying a per pill fee or an excise tax based on an opioid’s potency.
Minnesota, which in May became the first Midwestern state to levy a fee on opioid manufacturers, took a different approach. HF 400 creates a new license category for makers of “opiate-containing controlled substances” and sets the fee to get one at between $55,000 and $250,000. More »


With new law, Iowa has new system devoted to children’s mental health

by Tim Anderson ~ May 2019 ~ Stateline Midwest »
Iowa legislators have created a first-of-its-kind system to better meet the mental health needs of children. As part of HF 690, signed into law in May, an appointed state board will be created to oversee this new comprehensive, coordinated system.
Members of the board will include a mix of state executive branch leaders (in health and education), experts in child welfare and mental health, local school leaders, pediatricians and law enforcement. Legislators will serve on the board as non-voting members. Iowa’s new law also spells out the types of “core services” that the system must deliver to children. That list of services includes: early intervention, medication management, outpatient therapy, access to a 24-hour crisis helpline, mobile response teams, and the availability of community-based and residential services to stabilize behavioral health crises in children.
Finding a sustainable, adequate supply of funding to provide these services remains the biggest legislative challenge ahead, mental-health advocates told the Sioux City Journal. Iowa Gov. Kim Reynolds initially called for state spending of $3 million on this new children’s mental health system, but legislators ultimately included a $2.1 million appropriation.


Changes coming to foster care: Midwest states move to revamp and reform their foster care systems as a new federal law emphasizes families, prevention

by Jon Davis ~ May 2019 ~ Stateline Midwest »
A federal law enacted in 2018 is going to revamp how the states approach their foster care systems by placing a greater emphasis on preventing children from entering foster care at all and, if they do, on placing them with relatives. In many cases, however, the Family First Prevention Services Act will accelerate trends already under way as states have been stepping up efforts to reform foster care programs by trending away from group homes, streamlining their legal processes regarding foster care, and providing more support for older youth as they “age out” of foster
care. More »


Question: Do any states have laws in place to protect health consumers from getting “surprise bills” from health providers?

by Tim Anderson ~ May 2019 ~ Question of the Month »
When a health consumer receives care outside of an insurer’s network of providers, he or she may receive a surprisingly high medical bill, and face the prospects of paying unexpectedly high out-of-pocket costs.
These situations are not uncommon, and often not the fault of the health consumer — for example, he or she requires immediate emergency care, or an out-of-network provider is part of a larger team of physicians providing complex medical treatment. More »


Changes coming to foster care: Midwest states move to revamp and reform their foster care systems as a new federal law emphasizes families, prevention

by Jon Davis ~ May 2019 ~ Stateline Midwest
A federal law enacted in 2018 is going to revamp how the states approach their foster care systems by placing a greater emphasis on preventing children from entering foster care at all and, if they do, on placing them with relatives. In many cases, however, the Family First Prevention Services Act will accelerate trends already under way as states have been stepping up efforts to reform foster care programs by trending away from group homes, streamlining their legal processes regarding foster care, and providing more support for older youth as they “age out” of foster care. More »


‘Tobacco 21’ bills beginning to find fertile ground in Midwest state legislatures

by Jon Davis~ April 2019 ~ Stateline Midwest
In early April, Illinois became the first Midwestern state — and the latest nationwide — to raise the minimum legal sales age for tobacco products from 18 to 21. The logic is straightforward: The U.S. surgeon general reported in 2012 and 2014 that the younger someone is when they begin using nicotine, the more likely they are to become addicted to it. So, proponents say, raise the age. More »


Overwhelmed by overdoses: The rise in drug-related deaths has states still searching for a mix of strategies to properly address the public health crisis

by Laura Kliewer ~ March 2019 ~ Stateline Midwest »
Few if any U.S. states have been hit harder than Ohio by the crushing rise in drug use, abuse and overdose deaths. That state’s rate of overdose deaths was second in the nation in 2017: 46.5 per 100,000. Behind those numbers, too, are tragic stories that have personally touched many Ohio legislators — and helped lead their ongoing search for policy solutions. More »


Minnesota study shows costs and benefits of lead pipe removal

by Jon Davis ~ March 2019 ~ Stateline Midwest »

A February study from the Minnesota Department of Health says removing lead from the state’s drinking water infrastructure would cost between $1.52 billion and $4.12 billion over 20 years — an investment that would yield benefits of between $4.24 billion and $8.47 billion.
Done with the University of Minnesota, the report, “Lead in Minnesota Water,” resulted from legislative action in 2017 ordering the department to determine the scope of lead exposure in water and the cost to eliminate it. It recommends a statewide inventory of lead pipes and a 20-year plan to remove them, along with public awareness campaigns and technical assistance to local communities.
In other Midwestern states, Michigan regulators are requiring water utilities to replace all lead pipes within 20 years at their expense starting in 2021. A Wisconsin law (SB 48 from 2017) lets municipalities and private utilities give financial assistance to private property owners to pay for lead pipe removal. An Illinois law (SB 550) requires lead testing in all elementary schools, licensed day care centers, and in home and group care settings. Illinois and Ohio also require community water systems to comprehensively inventory lead service lines, including privately owned ones.


States regulating insurers’ use of ‘step therapy’ to ensure patients get access to the drugs they need

by Jon Davis ~ March 2019 ~ Stateline Midwest »
Can health insurance companies dictate what medications you use? Yes, if they use a “step therapy” protocol. Step therapy (also known as “fail first”) requires a patient to begin treatment with the most cost-effective drug therapy, progressing to more expensive or risky treatments only if necessary. The idea, as with other kinds of prior authorizations — pre-approval to prescribe a specific drug or treatment — is cost control. More »


Access to oral health care: Midwest states expand telemedicine, allow dental therapists as part of strategies to open wider access to dental services

by Jon Davis ~ February 2019 ~ Stateline Midwest »

More than 56.7 million people in the United States live in areas with shortages of dentists, and only about one-third of dentists accept public insurance, which limits access for the 72 million children and adults on Medicaid or the Children’s Health Insurance Program (CHIP). In the Midwest has 1,448, or one-quarter, of the nation’s 5,834 designated Health Professional Shortage Areas. More »


Ohio intensifies efforts to help rising number of children in foster care

by Tim Anderson ~ February 2019 ~ Stateline Midwest »

The opioid crisis in Ohio has made the need for foster care families greater than ever, and the state launched a new website and public awareness campaign in January to get more children placed in safe, loving homes. Ohio has nearly 16,000 children in the custody of county children services agencies. Since 2013, the number of children entering the state’s foster care system has risen 24 percent. Many of these individuals are quite young —17 percent of the foster care population is under 12 months of age and 35 percent is 3 years old and younger.
Two years ago, with passage of HB 49, Ohio legislators created a Foster Care Advisory Group. That group, in turn, recommended the new statewide awareness campaign and website. Its other ideas include establishing formal rights for foster caregivers (in state statute or administrative code), providing bonuses to families with years of proven service, and increasing mentoring and training opportunities.
Nationwide, substance abuse-related problems have caused a spike in foster care caseloads — a rise of 10 percent between 2012 and 2016. During this time period, foster care populations rose by more than 50 percent in six U.S. states, including Indiana and Minnesota, according to the U.S. Department of Health and Human Services.


Protecting nurse safety is goal of new laws in Illinois, South Dakota

by Tim Anderson ~ January 2019 ~ Stateline Midwest »
Two states in the Midwest have new laws in place that aim to improve the safety of nurses and other health care professionals. The Illinois General Assembly passed HB 4100 in response to two high-profile incidents. In one case, the Chicago Tribune reports, two nurses were taken hostage after an inmate being treated at their hospital got hold of a corrections officer’s gun. One of the nurses was sexually assaulted before police fatally shot the inmate. A month later, a nursing assistant and corrections officer were taken hostage at another hospital.
The new law requires Illinois medical facilities to develop workplace violence-prevention programs (Minnesota has this type of requirement as well), establishes whistleblower protections for nurses, and creates new safety guidelines for facilities to follow when caring for an inmate.
South Dakota’s HB 1293, meanwhile, increases penalties for assaults committed against first-responders and medical-care workers. The American Nurses Association lists Illinois, Iowa, Kansas, Michigan, Nebraska and Ohio as among the other U.S. states with specific penalties for assaults against nurses. According to the U.S. Government Accountability Office, rates of assault against health care workers are up to 12 times higher than they are for the overall workforce.


States react to, push back against new federal rules on ‘skinny’ health insurance policies

by Jon Davis~ January 2019 ~ Stateline Midwest »
In October, the Trump Administration adopted new rules for short-term (or “skinny”) health insurance plans. Since then, some states have weighed in by adopting new rules of their own, while also reminding insurers that they must still comply with state-level regulations. More »


Telemedicine is on rise, and reducing barriers to care, in Minnesota

by Tim Anderson ~ January 2019 ~ Stateline Midwest »
A first-of-its-kind study in Minnesota details a dramatic rise in the use of telemedicine in that state. Between 2010 and 2015, the state’s number of “virtual visits” jumped from 11,113 to 86,238. These new findings, the result of research conducted by the state Department of Health and University of Minnesota School of Public Health, show that telemedicine “may be emerging as an option to overcome some of the geographical barriers of accessing specialty care,” state Commissioner of Health Jan Malcolm says.
In Minnesota’s nonmetropolitan areas, telemedicine was more commonly used by general practitioners to connect patients with specialists — for example, a primary care provider refers someone to a psychiatrist, or an emergency room doctor initiates a virtual visit with a neurologist to discuss caring for a stroke patient. Conversely, the majority of telemedicine services in metro areas involved non-emergency conditions, such as the common cold or strep throat, with consumers of commercial insurance visiting online with nurse practitioners.
According to Malcolm, this rise in telemedicine will require the state to look more closely at issues such as quality of care, broadband access, and new investments in telemedicine equipment.


Increase in meth use causing health, other problems in region

by Tim Anderson ~ December 2018 ~ Stateline Midwest »
The problem of methamphetamine availability and use is on the rise, with parts of the Midwest being hit harder than most other regions of the country. Iowa health officials announced in November that between 2014 and 2017, the number of admissions for methamphetamine treatment increased by 38 percent.
That same month, the U.S. Drug Enforcement Administration’s Omaha Division released data showing that methamphetamine seizures had risen by 3 percent over the past year in a five-state region: Iowa, Minnesota, Nebraska, North Dakota and South Dakota. According to the DEA, most of the methamphetamine available in the United States comes from Mexico. (Domestic methamphetamine production is at its lowest level since 2000.)
In 2017, South Dakota Gov. Dennis Daugaard called the methamphetamine problem in his state an “epidemic.” One year later, lawmakers in that state passed two bills (SB 63 and SB 65) strengthening state enforcement of illegal distribution and manufacture of the drug. In Nebraska, during the first seven months of 2017, parental use of methamphetamine was a factor in one of every three removals of children from their home.


Getting the lead out after Flint: How states reacted to the crisis

by Jon Davis ~ December 2018 ~ Stateline Midwest »
After the water crisis in Flint, Mich., burst onto the national scene in late 2015 and early 2016, many states took a closer look at their laws regarding lead pipes and water service lines. A new report from the Washington, D.C.-based Northeast-Midwest Institute details post-Flint lead laws and regulations passed since 2015 in those
regions. More »


Wisconsin is second state in region with Medicaid work requirement

by Tim Anderson ~ November 2018 ~ Stateline Midwest »
Wisconsin has received federal approval of changes to its Medicaid program that include requiring work for some enrollees and charging higher premiums based on the results of a health risk assessment. The approved waiver centers on childless adults applying for and receiving coverage through the public health insurance program. According to The Washington Post, Wisconsin also had originally sought to become the first state in the nation to impose drug tests on some of its Medicaid population. This requirement did not receive federal approval.
The state, however, can compel applicants to fill out a health-and-wellness questionnaire. The premiums charged to childless adults will vary depending on responses to questions such as whether they wear a seat belt, smoke cigarettes or use illegal drugs.
Wisconsin also joins Indiana and three other U.S. states with some type of Medicaid work requirement in place. (Kentucky’s law has been blocked by a federal judge.) According to the Kaiser Family Foundation, Kansas, Michigan, Ohio and South Dakota have similar proposals being considered by the U.S. Centers for Medicare & Medicaid Services.



To address the opioid epidemic, Wisconsin launches pre-booking diversion pilot program in select areas

by Jon Davis ~ November 2018 ~ Stateline Midwest »
Three Wisconsin law enforcement agencies are beginning a statewide experiment in gettingpeople who commit nonviolent crimes because they’re addicted to drugs into treatment rather than prison. The “Pre-Booking Diversion Pilot Program,” a key recommendation in a 2016 report of the Governor’s Task Force on Opioid Abuse, will split $267,000 in state funding annually over two years between a sheriff’s office and two city police departments. More »



Michigan adopts law — for now — ensuring workers paid sick time

by Tim Anderson ~ October 2018 ~ Stateline Midwest »

Michigan is the first state in the Midwest with a law requiring employers to offer paid sick time to their workers. But after the legislative vote, it was unclear how long the new measure would stay on the books. The Earned Sick Time Act began as an initiative petition and was scheduled to be on the November ballot. However, the Michigan Constitution gives the Legislature the opportunity to consider proposed ballot initiatives. Legislative approval of paid sick time came in early September — meaning no statewide vote on the measure.
According to The Detroit News, the Legislature could return later this year and “gut” the Earned Sick Time Act. Amending a voter-approved ballot measure, on the other hand, would have been much more difficult. For now, though, under the new law, an individual will receive one hour of paid sick time for every 30 hours worked. In a given year, a worker will be able to use up to 72 hours of sick time — paid at his or her normal hourly wage. This cap falls to 40 hours per year for workers at businesses with nine or fewer employees.
According to the National Partnership for Women & Families, 10 states outside the Midwest already have laws mandating paid sick days.


To increase farmers’ insurance options, two Midwest states try ‘coop,’ ‘association’ models

by Carolyn Orr ~ September 2018 ~ Stateline Midwest »
Residents living in more than half of the nation’s counties have only one insurer to choose from on their state’s Affordable Care Act health insurance exchange. This lack of options is most prevalent in rural areas: 41 percent of enrollees in non-metro counties vs. the overall rate of 21 percent, according to the Kaiser Family Foundation. Could the creation of agricultural cooperative health plans help fill insurance gaps, offer more choices for consumers and lower costs? More »


Indiana puts perinatal ‘levels of care’ standards into state law to reduce infant mortality

by Jon Davis ~ September 2018 ~ Stateline Midwest »
Earlier this year, Gov. Eric Holcomb signed SB 360, making Indiana the third Midwestern state to enshrine in state law a perinatal “levels of care” rating system for hospitals and birthing centers. SB 360 requires the Department of Health to create a program to certify levels-of-care designations for obstetrics and neonatal care for hospitals and facilities that provide birthing services. They will be measured in six categories ranging from organization to obstetric capabilities, personnel, equipment and medications. More »


Illinois expands legal use of medical cannabis to fight opioid crisis

by Tim Anderson ~ September 2018 ~ Stateline Midwest »
Illinois residents dealing with chronic pain have been given an alternative to opioids — medical marijuana.
SB 336 was signed into law in August. It provides certain individuals 21 and older with temporary access to the state’s existing medical cannabis program. This access is contingent on a licensed physician certifying that the individual has a condition for which opioids might be prescribed.
Participants must then register at a state-licensed dispensary. Dispensations are limited to 2.5 ounces every 14 days and cannot exceed 90 days per physician certification. The goal of the new law is to curb opioid addiction; according to the Illinois Department of Public Health, opioid deaths in the state increased 13 percent from 2016 to 2017.
Four other Midwestern states — Michigan, Minnesota, North Dakota and Ohio — have broad laws legalizing medical marijuana, Governing magazine reports. Earlier this year, the Minnesota Department of Health released a study showing that among patients using medical cannabis for “intractable pain,” the use of opioid medications fell by 38 percent. In June, Michigan added chronic pain to its list of debilitating medical conditions that qualify a person for the medical use of marijuana.


On measures of child well-being, 3 Midwest states rank near top

by Tim Anderson ~ August 2018 ~ Stateline Midwest »
In this year’s edition of a much-cited, comprehensive study of child well-being, Minnesota (fourth), Iowa (fifth) and Nebraska (ninth) ranked among the top-10 U.S. states. Results in the “2018 KIDS COUNT Data Book” (a project of the Annie E. Casey Foundation) are based on 16 indicators in four areas: economic well-being, education, health, and family and community. No Midwestern state ranked lower than 33rd (Michigan).
The region fared particularly well in the category of economic well-being, which is based on measures such as median family income and the percentages of children living in poverty, parents without secure employment, families receiving public assistance, and households with a high housingcost burden. North Dakota (first), Nebraska (second), Iowa (fourth), Minnesota (fifth), Kansas (eighth), South Dakota (ninth) and Wisconsin (tenth) all ranked in the top 10.
The data book’s national analysis points to positive trends since 2010 in areas tied to a child’s healthy development — for example, lower poverty rates, a slight increase in the percentage of young people with health insurance, and higher graduation rates. However, “KIDS COUNT” researchers also note that “troubling disparities persist among children of color and those from low-income and immigrant families.”



Dose of reality: How Canada's health care system really works

by Jon Davis ~ August 2018 ~ Stateline Midwest »
The reality of Canada’s health care system is different from the single-payer model sought by some U.S. liberals or the kind of government-controlled system often feared by U.S. conservatives, and different even from what many Canadians believe, Manitoba’s top health officials told lawmakers during a session at this year’s Midwestern Legislative Conference Annual Meeting. More »


School-based mental health care seen as way to better identify students in need, improve access

by Tim Anderson ~ August 2018 ~ Stateline Midwest »
For his first job out of college, psychologist Mark Weist went to work at a mental health center, splitting his time between providing services at the center and a local school. The differences in the two settings were dramatic. “At the mental health center, people weren’t showing up,” Weist, a professor of psychology at the University of South Carolina, said during a presentation at this year’s Midwestern Legislative Conference Annual Meeting. “We’d be scheduled to see six or seven families in a day, for example, and only somewhere between one and three showed up. “But in schools, there was this tremendous pent-up need for services.” More »


Midwest's legislators adopt resolution calling for greater mental-health supports for people living in rural areas

by Carolyn Orr ~ August 2018 ~ Stateline Midwest »
Myriad signs point to the need for better connecting farmers to services that help them deal with stress, depression and other mental health challenges. First, there is the history of the problem: In a study examining various industries between 1992 and 2010, The National Institute for Occupational Safety and Health found that farm operators and workers had the highest suicide rate. More »


Michigan will require lead service lines to be replaced starting in 2021

by Tim Anderson ~ August 2018 ~ Stateline Midwest »
As part of what state officials say is the strictest set of lead and copper standards in the nation, Michigan will require all of the state’s public water systems to replace their lead service lines. Starting in 2021, the Detroit Free Press reports, each public water system must replace, on average, 5 percent of its lead service pipes per year over a 20-year period, with water customers paying for most of the estimated $2.5 billion price tag.
The new state-level rules also create stricter “lead action levels,” the point at which a water system must take steps to control corrosion. The federal lead action level is 15 parts per billion; Michigan’s will be 12 ppb starting in 2025. In addition, the state will establish a new water system advisory council and mandate that two water samples be collected at sites served by lead service lines.
“The federal Lead and Copper Rule simply does not do enough to protect public health,” Michigan Gov. Rick Snyder said in June when announcing the new standards. The changes come four years after the start of a public health crisis in the Michigan town of Flint — the result of residents’ drinking water being contaminated with lead due to a switch in the town’s water source from Lake Huron to the Flint River.


Lawsuits as public health policy: North Dakota joins list of states suing opioid makers

by Jon Davis ~ June/July 2018 ~ Stateline Midwest »
North Dakota was one of six states to sue an opioid maker in May, alleging in part that it violated state consumer protection laws by falsely denying or downplaying the risk of addiction from opioids while overstating their benefits. More »



States are examining their mental and behavioral health systems with an eye on money- and life-saving reforms

by Jon Davis ~ May 2018 ~ Stateline Midwest »
A quiet health care revolution is under way as Midwestern states revamp their delivery of mental health services with an increasing focus on behavioral health, which integrates mental health and substance abuse treatments, and an expansion of mental health services to children. The changes reflect a growing realization that mental health and substance abuse disorders are interlinked; that effective treatment should run along a “continuum of care”; and that the earlier mental illnesses are recognized, diagnosed and treated in young people, the better for individuals and society. More »


Second state legislature in Midwest passes ‘fetal heartbeat’ bill

by Tim Anderson ~ May 2018 ~ Stateline Midwest »

Starting July 1, Iowa will have “the strictest abortion law in the country,” the Des Moines Register reports. SB 359 requires doctors to test for a fetal heartbeat; if one is detected, an abortion cannot be performed, except when required to preserve the life of the pregnant woman or protect her from “serious risk of substantial or irreversible impairment of a major bodily function.”
According to the American Pregnancy Association, a fetal heartbeat can be detected as early as between 5 1/2 and 6 1/2 weeks. North Dakota legislators passed a fetal heartbeat bill four years ago, but that measure was struck down in federal court. The constitutionality of Iowa’s SB 359 also will be challenged.
Forty-three states ban some abortions after a certain point in pregnancy, the Guttmacher Institute notes in its national review of laws. In the Midwest, these prohibitions apply at the point of “viability” in Illinois and Minnesota (exceptions made to protect the life or health of the woman) and Michigan (exception only in case of life endangerment). Bans in Indiana, Kansas, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin take effect at 20 weeks postfertilization, with exceptions for cases in which continuation of the pregnancy threatens the woman’s life or physical health.


In Iowa, schools across state will offer yearly training on suicide prevention, ‘postvention’

by Jon Davis ~ April 2018 ~ Stateline Midwest »
By next year, school districts across Iowa must begin to provide at least an hour of annual training on suicide prevention and “postvention” — the coordinated school response following a student’s suicide — for all licensed personnel who have regular contact with students. More »


Wisconsin is latest Midwest state to fund reinsurance plan

by Jon Davis ~ March 2018 ~ Stateline Midwest »

Wisconsin became the second Midwestern state to adopt reinsurance as a way to knock down health insurance premiums when Gov. Scott Walker signed SB 770 into law in February. The bill, which commits up to $200 million annually starting in 2019, received overwhelming bipartisan support in the state Senate and Assembly. As part of the new law, the state will now seek a federal waiver to launch a reinsurance program covering 50 percent to 80 percent of medical costs between $50,000 and $250,000 — the same range as Minnesota’s two-year, $542 million reinsurance program (approved by the Legislature in March 2017).
Under reinsurance programs, insurance companies reinsure portions of their coverage with other insurers so they won’t be on the hook for 100 percent of all costs in a given cost range. In an editorial earlier this year, the Minneapolis StarTribune credited Minnesota’s state-funded reinsurance program with holding 2018 health insurance premiums steady, or even decreasing them.
Proposals for reinsurance and subsidies are pending in the U.S. Congress, but no votes have been taken. Insurers could start issuing 2019 plan prices as early as April.


Work requirements for Medicaid approved by federal government, being pursued by some states in Midwest

by Jon Davis ~ February 2017 ~ Stateline Midwest »
The idea of requiring able-bodied adults to work or be actively seeking it as a condition for government assistance is certainly not new, but its application to Medicaid is as of January, when the Trump administration began approving some states’ applications to impose work rules as a condition of eligibility for this public health insurance
program. More »


New laws seek to end ‘doctor shopping,’ prevent opioid abuse

by Tim Anderson ~ January 2018 ~ Stateline Midwest »
Seeking to make greater use of their states’ prescription drug monitoring programs and to prevent opioid abuse, Illinois and Michigan lawmakers have established new requirements for prescribers. These measures were signed into law in December. Under Illinois’ SB 772, a patient’s prescription history must be checked, via the state-run program’s database, before he or she is prescribed Schedule II narcotics.
This is the federal classification for drugs that have a “high potential for abuse.” Michigan providers will have to review a patient’s history in the state-run electronic database before prescribing Schedule II, III, IV or V controlled substances (SB 166 and 167). One goal of these mandatory checks is to make it harder for individuals to obtain prescriptions from multiple doctors.
Every Midwestern state has a prescription monitoring program. Ohio and North Dakota require, under certain circumstances, prescribers and dispensers to check a patient’s history in the database, according to the Prescription Drug Monitoring Program Training and Technical Assistance Center. This mandate only applies to prescribers in Illinois, Indiana, Michigan, Minnesota and Wisconsin. Other states have no such requirements on prescribers or dispensers.


New CSG report focuses on efforts to combat diabetes

by Jon Davis ~ January 2018 ~ Stateline Midwest »
A new report from The Council of State Governments, “Diabetes in the United States: Examining Growth Trends, State Funding Sources and Economic Impact,” spotlights state-by-state spending and states’ efforts to fight diabetes. More »


Telemedicine, school-based clinics being used to improve students’ access to care in underserved areas

by Carolyn Orr ~ December 2017 ~ Stateline Midwest »
In the rural southern Indiana school district that Rep. Terry Goodin not only represents in the state Capitol but also leads as its superintendent, there is no pharmacy or hospital. The district, too, has no full-time school nurse. But because of last year’s passage of HB 1263, a new model of delivering care to young people has been opened — school-based clinics that connect students with a health provider via telecommunication technologies. Along with establishing new standards for telemedicine, that 2016 state law allows prescriptions to be dispensed remotely and for physician-patient relationships to be established without an in-office visit. More »


States move to enable direct primary care as a new approach to health care services

by Jon Davis ~ December 2017 ~ Stateline Midwest »
A trip to the doctor, and treatment, without a co-pay? It’s possible under “direct primary care,” a model whose growing popularity can be traced by the number of states (23) with “enabling” laws to clarify that direct primary care is an acceptable health care model and not to be confused with health insurance coverage or a health plan under federal law. More »


Minnesota gets waiver for plan to solidify insurance exchange

by Jon Davis ~ November 2017 ~ Stateline Midwest »

Minnesota has secured federal approval for its $542 million reinsurance program, which was created earlier this year via legislation (HF 5) and has been credited by officials with lowering premiums on the state’s health insurance exchange by 20 percent. Gov. Mark Dayton signed the “Section 1332” waiver (named for that section of the Affordable Care Act) in October. It is effective through 2022.
According to the U.S. Centers for Medicare & Medicaid Services, these waivers let states implement “innovative ways” of providing access to health care as long as they don’t increase the federal budget deficit and don’t compromise the availability of care.
Iowa had also applied for a Section 1332 waiver, but withdrew its application last month due to what Gov. Kim Reynolds says were inflexible rules. Illinois, however, addressed its 2018 premium hikes by requiring those eligible for ACA cost-sharing subsidies to use them only for “Silver” plans on its exchange or at healthcare.gov ­— and directing insurers to add a surcharge to those plans. According to Modern Healthcare, as those premiums increase, so do the federal tax credits for qualified consumers, thus forcing the federal government to pick up the tab.


Report spotlights how states are responding to opioid crisis via their Medicaid programs

by Jon Davis ~ November 2017 ~ Stateline Midwest »
An extensive new report from the Kaiser Family Foundation, “Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018,” provides an overview of states’ approaches to eligibility, premiums and managed care initiatives, emerging delivery system and payment reforms, long-term services and support reform, and provider rates and taxes. More »


MLC Chair's Initiative: Policies seek more screening of, treatment for maternal depression

by Tim Anderson ~ November 2017 ~ Stateline Midwest »
Four years ago, Northwestern University Medicine researchers completed the largest-scale study to date of depression among postpartum women. The findings were surprising to some (including the researchers), and disturbing to most everyone: 14 percent of women in the study screened positive for depression, a condition among new mothers that often isn’t treated or even screened in today’s U.S. health care system. More federal resources for states to help with this public health problem will soon be on the way. Under the U.S. 21st Century Cures Act, signed into law in late 2016, federal grants will be awarded to states to develop or strengthen programs that improve the availability of maternal depression screening and treatment. More »


Help wanted in health care: Student recruitment, telehealth expansion and changes in scope of practices among strategies pursued by Midwest's states

by Jon Davis ~ October 2017 ~ Stateline Midwest »
It seems a recipe for health care disaster: Combine population growth with an aging population, add expanded health insurance coverage, and … hope for the best? The growing need for health care workers of all disciplines is well recognized. Midwestern states have already moved to address the growing crisis with recruitment and retention strategies, as well as by redefining professionals’ scopes of work and expanding the use of new applications of technology such as telehealth. More »


In Midwest, positive trends seen in rates of poverty, uninsured

by Tim Anderson ~ October 2017 ~ Stateline Midwest »
Some notable trends in poverty, health insurance and household income in the Midwest were revealed in recently released U.S. Census Bureau data. For example:


Wisconsin invests in school-based mental health initiatives

by Tim Anderson ~ October 2017 ~ Stateline Midwest »
Wisconsin’s recently enacted state budget includes money for schools to improve students’ access to mental health services. Gov. Scott Walker signed the budget bill (AB 64) into law in September. For the first time, Superintendent of Public Instruction Tony Evers says, the state will provide funds for mental health training and partnerships between schools and community providers.
The state-funded training will provide school personnel with evidence-based strategies for addressing mental health issues in young people. Schools also will get more money to hire additional social workers. Lastly, a new state grant program will be available for schools that work with local mental-health professionals to improve student access to mental health services. Combined, these three initiatives will cost a total of $7 million, The (Appleton) Post-Crescent reports.
According to the National Alliance on Mental Illness, 20 percent of children between the ages of 13 and 18 have a serious mental illness. That includes anxiety, mood and behavior disorders, all of which often go untreated. Four years ago, the Wisconsin Legislature created an Office of Children’s Mental Health that focuses on policies to improve the delivery of mental health services among young people.


Eleven new Wisconsin laws take aim at state’s opioid epidemic

by Jon Davis ~ August 2017 ~ Stateline Midwest »

Wisconsin Gov. Scott Walker signed 11 bills into law in July that seek to address myriad facets of the state’s opioid crisis. The bills were the product of a special session held earlier in the year. According to the Milwaukee Journal Sentinel, school employees and volunteers, along with residence hall directors, will now be protected from lawsuits if they administer drugs designed to treat opioid overdoses (SB 1). These individuals must be properly trained and call 911 immediately after administering the drugs.
Other new laws in Wisconsin authorize:


MLC Chair's Initiative: At MLC meeting, legislators learn how states can help save babies’ and mothers’ lives from before birth through infancy

by Jon Davis ~ August 2017 ~ Stateline Midwest »
In pursuit of healthy birth outcomes, nothing grabs attention like a personal story. So when Lezlie Mestdagh, outreach coordinator for the Count the Kicks campaign — an educational effort founded by five Iowa mothers who suffered stillbirths and are determined to prevent that pain for other mothers — showed Midwestern legislators a “Good Morning America” video clip featuring an Iowa couple whose infant daughter was saved by Count the Kicks’ phone app, they applauded. That video illustrated the heart of Mestdagh’s message to the region’s lawmakers in July at the MLC Annual Meeting: Invest pennies in prevention to save dollars down the road, both in direct costs (stillbirths require greater resources than live births) and indirect costs such as funerals, ongoing counseling, lost income and reduced or delayed employment for parents, and more expensive medical care during subsequent
pregnancies. More »


Public health officials, law enforcement urge holistic approach to stem widespread opioid crisis

by Jon Davis ~ August 2017 ~ Stateline Midwest »
Strategies to deal with the rise of opioid abuse and drug overdoses were a focus of state legislators and policy experts who took part in this year’s MLC Health & Human Services Committee meeting. “We can’t prosecute our way out of the problem; there needs to be cooperation between law enforcement and public health,” Kevin Techau, a former U.S. attorney for the Northern District of Iowa, said to lawmakers at the July meeting. More »


MLC Chair's Initiative: Home visiting can improve outcomes for mothers and babies

by Tim Anderson ~ June/July 2017 ~ Stateline Midwest »
As the Midwest’s legislators look for ways to reduce infant mortality, prevent maternal deaths, and improve long-term outcomes for mothers and children, one policy option is to invest in home visiting. The idea of bringing preventive services and resources to the place where families live has captured more interest, and funding, during this decade. In 2010, the U.S. Congress created the Maternal, Infant and Early Childhood Home Visiting Program, and every year since then, states have received federal dollars to provide home services for vulnerable or at-risk
families. More »


Seeking to reduce maternal deaths, Michigan requires reporting by providers in order to improve medical practice, public policy

by Tim Anderson ~ May 2017 ~ Stateline Midwest »
Take a look at the longer-term trends in maternal mortality rates, and you see one of the great success stories in modern-day public health: In 1900, for every 1,000 live births, up to nine women were dying of pregnancy-related complications; a century later, that rate had declined by almost 99 percent. But the story told by more recent data is less clear, and more troubling. According to the U.S. Centers of Disease Control and Prevention, the number of reported pregnancy-related deaths increased between 1987 and 2013 — from 7.2 deaths per 100,000 live births to 17.3 in 2013. More »


Shoring up health exchanges: Premium hikes in 2017 led Minnesota to intervene with funding for subsidies, reinsurance; all states face uncertainty

by Jon Davis ~ May 2017 ~Stateline Midwest »
Last summer, as insurers filed their individual health insurance plan rate premiums for 2017, it became clear that something was wrong: Rates in 31 states shot up by double digits (triple digits for Arizona); overall, the average increase in premiums was 25 percent. In the Midwest, Minnesota was socked with a 59 percent increase that further roiled an already shaky individual health insurance market (or exchange). Legislators there responded earlier this year by first providing help to those not covered by federal subsidies and then creating a state-funded reinsurance program. More »


Wisconsin wants to be first state to require Medicaid drug screening

by Tim Anderson ~ May 2017 ~ Stateline Midwest »
Some Medicaid recipients in Wisconsin will have to submit to drug screenings and tests if federal officials give the OK to a demonstration waiver submitted by the state in April. This new requirement would apply to childless adults who are eligible for health insurance through the BadgerCare Plus program. As a condition of eligibility, individuals would have to complete a state-administered questionnaire. If the answers indicate possible abuse of a controlled substance, a drug test would be required. For anyone who tests positive, Medicaid eligibility would be contingent on completing a substance-abuse treatment program.
According to The Washington Post, Wisconsin would be the first U.S. state to mandate drug screening for Medicaid enrollees. Its waiver also calls for a 48-month time limit for childless adults who are not working or not in a job training program. In addition, Wisconsin wants to establish monthly premiums (between $0 and $10, based on income) and increase copayments for multiple trips to the emergency room.
For the state’s entire Medicaid population, Wisconsin is looking to fully cover residential treatment for substance abuse disorders.


Nebraska joins states requiring dense breast tissue notification

by Jon Davis ~ May 2017 ~ Stateline Midwest »
Nebraska Gov. Pete Ricketts in April signed LB 195, also known as “Cheri’s Law,” requiring that women be notified of breast tissue density following mammograms. It had passed the states’ Unicameral Legislature by a vote of 48-0.
The law requires that written notice be given to women if a mammogram reveals heterogeneous or extremely dense breast tissue. Such tissue can make breast cancer more difficult to detect. Under the new law, mammography patients must be told that a finding of dense breast tissue is normal, and that notice is being given to raise awareness and so patients can further discuss risk factors and detection methods with their doctor.
According to the Nebraska Radio Network, the law was named for Cheri Rauth, an Omaha, resident who died of breast cancer within 18 months of a mammogram due, her family believes, to dense breast tissue. Nebraska is now among 32 states with breast density reporting laws, including Michigan, Minnesota, North Dakota and Ohio. Illinois and Indiana have public education efforts, but do not require reporting, according to DenseBreast-info.org.
Breast cancer is the second leading cause of cancer death among women.

Kansas law bars DNR orders for children without parents’ OK

by Jon Davis ~ April 2017 ~ Stateline Midwest »
A new law in Kansas will bar “do not resuscitate” or similar physician’s orders for unemancipated minors unless at least one parent or guardian has been told of the intent to issue such an order. SB 85 requires that parental notice be given orally and in writing, and prohibits a DNR or similar orders if there is a refusal of consent. Also under this measure, the minor’s medical record must include information about the DNR order and the nature of efforts to contact both parents.
The law is named for Simon Crosier, born in September 2010 in a Missouri hospital to Kansas parents. He was diagnosed with a chromosomal disorder and died in December of that year. The Crosiers subsequently learned that a DNR order had been placed on Simon’s chart without their knowledge or consent.
The advocacy group Protecting Children by Empowering Parents lists Kansas and Michigan as among the 11 U.S. states with statutory language defining and protecting parental rights. In other states, these protections have come from the courts. Under Kansas’ existing statute (even prior to Simon’s Law), parents have a “fundamental right” to control the medical care of their minor children. The Michigan statute declares that parents have a “natural, fundamental right” to “direct the care, teaching, and education of their children.”


With new laws and enhanced tracking of drug use, states advance fight against opioid abuse

by Tim Anderson ~ April 2017 ~ Stateline Midwest »
Over the course of a two-week period in late March and early April, the rules for prescribing painkillers were tightened in Ohio, an improved drug-monitoring system was unveiled in Michigan, and nine bills to prevent opioid abuse won passage in the Wisconsin Assembly. The flurry of activity in those three states illustrates just how big the opioid problem continues to be in many parts of the Midwest, as well as how much of a priority legislative leaders have placed on finding new ways to address it. Near the top of that priority list is better controlling how prescription drugs are dispensed, prescribed and used. More »


Improving healthy birth outcomes in the Midwest is focus of 2017 MLC chair's initiative

by Jon Davis ~ March 2017 ~ Stateline Midwest »
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

by Jon Davis ~ February 2017 ~ Stateline Midwest »
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 »

Minnesota providing relief for those hit by high health premiums

by Tim Anderson ~ February 2017 ~ Stateline Midwest »
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

by Tim Anderson ~ February 2017 ~ Stateline Midwest »
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

by Tim Anderson ~ January 2017 ~ Stateline Midwest »
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

by Jon Davis ~ January 2017 ~ Stateline Midwest »
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

by Tim Anderson ~ December 2016 ~ Stateline Midwest »
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

by Jon Davis ~ December 2016 ~ Stateline Midwest »
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 ยป


Some states turning to provider taxes to pay their share of Medicaid expansions

by Tim Anderson ~ November 2016 ~ Stateline Midwest »
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

by Tim Anderson ~ October 2016 ~ Stateline Midwest »
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

by Tim Anderson ~ October 2016 ~ Stateline Midwest »
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

by Tim Anderson ~ September 2016 ~ Stateline Midwest »
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

by Tim Anderson ~ September 2016 ~ Stateline Midwest »
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

by Deb Miller ~ August 2016 ~ Stateline Midwest »
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

by Deb Miller ~ June/July 2016 ~ Stateline Midwest »
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

by Deb Miller ~ May 2016 ~ Stateline Midwest »
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

by Jon Davis ~ May 2016 ~ Stateline Midwest »
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

by Deb Miller ~ April 2016 ~ Stateline Midwest »
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

by Tim Anderson ~ March 2016 ~ Stateline Midwest »
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

by Jon Davis ~ March 2016 ~ Stateline Midwest »
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’

by Jon Davis ~ February 2016 ~ Stateline Midwest »
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?

by Katelyn Tye ~ February 2016 ~ Question of the Month »
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 »


In aging Midwest, more emphasis being placed on Alzheimer's policies and care

by Laura Kliewer ~ January 2016 ~ Stateline Midwest »
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

by Tim Anderson ~ January 2016 ~ Stateline Midwest »
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

by Tim Anderson ~ December 2015 ~ Stateline Midwest »
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 »


Deadly rise in drug overdoses has Midwest states searching for answers: Policy responses include greater oversight of prescription drug use, access to treatment

by Tim Anderson ~ October 2015 ~ Stateline Midwest »
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 »


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.


Illinois legislators OK wide-ranging plan to prevent drug overdoses

by Tim Anderson ~ June 2015 ~ Stateline Midwest »
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:
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.


Indiana authorizes local needle exchanges to deal with health emergencies, disease outbreaks

by Tim Anderson ~ May 2015 ~ Stateline Midwest »
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

by Kate Tormey ~ April 2015 ~ Stateline Midwest »
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

by Kate Tormey ~ March 2015 ~ Stateline Midwest »
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

by Tim Anderson ~ February 2015 ~ Stateline Midwest »
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 »


Ebola scare sparks discussion on quarantine, other policies to keep infectious diseases in check

by Kate Tormey ~ December 2014 ~ Stateline Midwest »
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?

by Laura Kliewer ~ December 2014 ~ Question of the Month »
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

by Kate Tormey ~ November 2014 ~ PDF of Stateline Midwest article »
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 »


What policies are states adopting to encourage people to seek assistance during drug and alcohol overdoses?

by Kate Tormey ~ October 2014 ~ Question of the Month »
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

by Kate Tormey ~ September 2014 ~ Stateline Midwest »
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 »


Debate over safety of triclosan sparks new bills in region; Minnesota first state to ban it

by Kate Tormey ~ July/August 2014 ~ Stateline Midwest »
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 »


Hidden, lifetime scars: States address the needs of children who have experienced trauma, aim to stem the cycle of negative outcomes

by Kate Tormey ~ May 2014 ~ Stateline Midwest »
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 autism coverage

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

by Kate Tormey ~ April 2014 ~ Stateline Midwest »
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 »


Indiana bill reflects concerns about rise in drug-addicted newborns

by Tim Anderson ~ March 2014 ~ Stateline Midwest »
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?

by Kate Tormey and Deb Miller ~ February 2014 ~ Question of the Month »
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

by Tim Anderson ~ February 2014 ~ Stateline Midwest »
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.


Glut of improper payments has states searching for new ways to weed out Medicaid fraud, abuse

by Kate Tormey ~ October 2013 ~ Stateline Midwest »
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

by Kate Tormey ~ September 2013 ~ Stateline Midwest »
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 »


Rural lawmakers fear loss of Critical Access Hospitals in Midwest

by Carolyn Orr ~ September 2013 ~ Stateline 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 »



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 »


Fragmented mental health system target of reform: Focus is on cost-effective,
evidence-based care

by Kate Tormey ~ February 2013 ~ PDF of Stateline Midwest article »

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 »


States cultivate healthy options in food deserts: Policies focus on improving access to fresh food

by Kate Tormey ~ November 2012 ~ Stateline Midwest »
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 »


What states in the Midwest have freedom-of-conscience language in their constitutions or statutes?

by Tim Anderson ~ June 2012 ~ Question of the Month »
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 »


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 »


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 »


Reworking workers’ comp: On 100th anniversary of system, states focusing on changes that cut business costs, remove uncertainties

by Laura A. Tomaka ~ November 2011 ~ PDF of Stateline Midwest article »
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 lawsuits.
But have the systems themselves become too costly for business and inefficient? More »