Latest news with #Medicaid-eligible
The Hill
7 days ago
- Health
- The Hill
Rural New York's health care crisis deepens amid federal funding battle
ALBANY, N.Y. (NEXSTAR) — Comptroller Thomas DiNapoli released an audit on Aug. 7 detailing health care staffing shortages in 16 rural counties across New York. The report found the state lacking in primary care doctors, pediatricians, OB-GYNs, dentists and mental health professionals. According to DiNapoli's office, they conducted the system-wide analysis following roundtable discussions in the Hudson Valley and Finger Lakes, where health care access represents a major concern. Per the report, which you can read at the bottom of this story, several counties do not have access to a variety of specialty medical providers. On average, the 16 rural counties examined — Allegany, Cattaraugus, Chenango, Delaware, Essex, Franklin, Greene, Hamilton, Herkimer, Lewis, Schuyler, Steuben, Sullivan, Washington, Wyoming, and Yates — had just four primary care physicians for every 10,000 people. That's less than half the statewide ratio of 8.1 and further still below the national average of 8.4. And that disparity gets worse in designated 'primary care health professional shortage areas,' where nearly 173,000 New Yorkers live. In those regions, it's down to just 0.12 physicians per 10,000. The 16 rural counties have just 0.5 pediatricians for every 10,000 people, less than a fifth of the state ratio of 2.8. Chenango, Schuyler, and Yates Counties have no pediatricians at all, per the audit. The ratio of obstetrician-gynecologists is 0.4 per 10,000, translating to about one for every 23,000 people. Hamilton, Herkimer, Schuyler, and Yates Counties have no OB-GYNs. For dentists, these rural counties had 3.6 per 10,000 people, below half of the state's ratio of 8.3. Ten of the 16 counties have dental primary care health professional shortage areas for those eligible for Medicaid, which includes 134,248 people. And according to the comptroller, Hamilton County has no dentists at all. The audit determined a ratio of 6.9 mental health practitioners per 10,000 people in rural New York. The ratio for the entire state, meanwhile, is 16.1. All 16 counties are mental health primary care health professional shortage areas, either for the entire population or specific groups, like the Medicaid-eligible population. That means that almost 41 percent of the population in these counties — over 305,265 New Yorkers — are considered underserved in mental health care. The audit also reported a lack of physician assistants (PAs) and nurse practitioners, positions meant to address doctor shortages in the 1960s. These professionals now deliver as many as 25 percent of health visits in the U.S. The ratio of PAs per 10,000 people in the rural counties is 4.2, less than half of the state ratio, 9.2. NPs are also lower, at 10.5 per 10,000 compared to the state's 16.4. The comptroller audit, which built on a 2023 comptroller report about rural New York, found that many of these areas struggle with population loss, an aging population, and decreases in the labor force. Low population densities and limited public transportation mean that people have to spend to maintain personal vehicles to access health care. The report recommends creating mobile clinics and school-based health centers to increase access to care, alongside expanded transportation and telemedicine programs. It also suggests offering loan forgiveness and stipends to new healthcare professionals in rural areas and creating educational opportunities for nursing staff to advance their degrees and bolster the workforce. And it proposes that four-year SUNY schools offer satellite programs at local community colleges that blend online and in-person coursework. The federal government has a huge impact on rural hospitals. A new federal law — Public Law No. 119-21, or the One Big Beautiful Bill (OBBB) — earmarks $50 billion from 2026 to 2030 for a Rural Hospital Transformation Program, but it's not guaranteed to offer funding to all states. According to the American Hospital Association, the law would reduce federal Medicaid spending on New York's rural hospitals by $1.125 billion over 10 years. And that law also reduces eligibility for Medicaid and the Essential Plan, which is likely to worsen the situation for rural hospitals operating on narrow profit margins. That's because they need Medicaid funding to stay open. The law also enacts new student loan limits of $50,000 annually for professional students and an aggregate limit of $200,000. This would make it harder for proposed loan forgiveness programs to attract any new doctors to rural New York. An April 2025 analysis from the Center for American Progress found that federal funding cuts to Medicaid threaten these hospitals across the country. They determined that close to a third of those in New York would be at immediate risk of closing. The numbers from another April analysis, this from the Center for Healthcare Quality and Payment Reform, were broadly aligned in finding that close to 200 rural hospitals in 34 Medicaid expansion states were already at immediate risk of closing because of financial instability. In New York, they found that over a third of rural hospitals were at risk of immediate closure. They also counted three having closed since 2015, and 62 percent of the state's rural hospitals reported financial losses in 2023-2024, even with Medicaid funding intact. According to the U.S. Government Accountability Office (GAO), rural hospitals survive best in states that increase Medicaid enrollment and eligibility. New York has six rural hospitals in the top 10 percent nationwide for their Medicaid payer mix, and five more have had negative margins for three consecutive years. In the 16 rural counties examined, 27 percent of the population was on Medicaid as of May 2025. That's close to 205,000 people. The Healthcare Association of New York State (HANYS) and the Greater New York Hospital Association (GNYHA) have opposed the OBBB. In letters sent to New York's congressional delegation in May, both organizations warned of the bill's catastrophic impact on the state's healthcare infrastructure. HANYS stated that the bill would cost the Empire State almost $13.5 billion per year. GNYHA also argued that the bill's cuts would be unsustainable for the state and wreck its hospital system. A June analysis from the Fiscal Policy Institute found that hospitals at immediate risk for closure in New York get over 25 percent of their net patient revenue from Medicaid or other government appropriations. They also reported that 94 hospitals in the state would see their annual profits disappear altogether with just a 10 percent cut to Medicaid revenue, because the program already pays less than half of what commercial insurance pays for the same services. According to the Fiscal Policy Institute, two Republican lawmakers who voted for the bill, Reps. Nicholas Langworthy and Elise Stefanik, represent districts with some of the highest numbers of at-risk hospitals. Eight are in Langworthy's, and seven in Stefanik's. In fact, five Republican members of the state's congressional delegation— including Stefanik and Langworthy —even published a letter in June on the topic. While they said they support OBBB's 'intent to prioritize federal benefits for citizens and long-term residents,' they asked to delay the implementation of two sections. They argued that states and healthcare providers avoid 'drastically disruptive consequences' for the healthcare system with a less abrupt transition. Their letter asked for sections 112101 and 112102, modifying tax credit eligibility for certain lawful immigrants, to not take effect until January 2029. The law would force 500,000 immigrant New Yorkers who live here legally onto state-only Medicaid — because New York is constitutionally required to provide coverage—with state and county taxpayers footing the bill. This could cause 'unsustainable spikes in uncompensated costs' for local health services and destabilize the state's Essential Plan, they warned. Take a look at the comptroller's report below: rural-health-shortages Download
CNBC
26-06-2025
- Health
- CNBC
Supreme Court rules for South Carolina over bid to defund Planned Parenthood
WASHINGTON — The Supreme Court on Thursday ruled for South Carolina over its effort to defund Planned Parenthood, concluding that individual Medicaid patients cannot sue to enforce their right to pick a medical provider. The court held in a 6-3 ruling on ideological lines with the conservative justices in the majority that the federal law in question does not allow people who are enrolled in the Medicaid program to file such claims. The ruling authored by Justice Neil Gorsuch is a boost to the state's effort to prevented Planned Parenthood from receiving funding through Medicaid, a federal program for low-income people that is administered by the states, because it prevents individual patients to enforce their right to choose their preferred health care provider. Federal funding for abortion is already banned, but conservatives have long targeted Planned Parenthood, which provides reproductive health services including abortions where allowed, for any funding it receives even it is for other health care-related services. They argue that even non-abortion related funding that flows to Planned Parenthood would help it carry out its broader agenda that favors abortion rights. The state's efforts to defund Planned Parenthood came before the Supreme Court, which has a 6-3 conservative majority, overturned the landmark Roe v. Wade abortion rights ruling in 2022. South Carolina now has a six-week abortion ban, meaning abortions are rare in the state. Planned Parenthood has facilities in Charleston and Columbia that provide abortion care in compliance with the new law, as well as other health care services, including contraception, cancer screenings and pregnancy testing. In 2018, Gov. Henry McMaster issued an executive order that prohibited Planned Parenthood of South Atlantic, the local affiliate of the national group, from providing family planning services under Medicaid. Julie Edwards, a Medicaid-eligible patient who wants to use Planned Parenthood, joined a lawsuit filed by the group, saying that under federal civil rights law she could enforce her rights in court. A federal judge ruled in her favor, and after lengthy litigation, the Supreme Court agreed to weigh in.
NBC News
26-06-2025
- Health
- NBC News
Supreme Court rules for South Carolina over bid to defund Planned Parenthood
WASHINGTON — The Supreme Court on Thursday ruled for South Carolina over its effort to defund Planned Parenthood, concluding that individual Medicaid patients cannot sue to enforce their right to pick a medical provider. The court held in a 6-3 ruling on ideological lines with the conservative justices in the majority that the federal law in question does not allow people who are enrolled in the Medicaid program to file such claims. The ruling authored by Justice Neil Gorsuch is a boost to the state's effort to prevented Planned Parenthood from receiving funding through Medicaid, a federal program for low-income people that is administered by the states, because it prevents individual patients to enforce their right to choose their preferred health care provider. Federal funding for abortion is already banned, but conservatives have long targeted Planned Parenthood, which provides reproductive health services including abortions where allowed, for any funding it receives even it is for other health care-related services. They argue that even non-abortion related funding that flows to Planned Parenthood would help it carry out its broader agenda that favors abortion rights. The state's efforts to defund Planned Parenthood came before the Supreme Court, which has a 6-3 conservative majority, overturned the landmark Roe v. Wade abortion rights ruling in 2022. South Carolina now has a six-week abortion ban, meaning abortions are rare in the state. Planned Parenthood has facilities in Charleston and Columbia that provide abortion care in compliance with the new law, as well as other health care services, including contraception, cancer screenings and pregnancy testing. In 2018, Gov. Henry McMaster issued an executive order that prohibited Planned Parenthood of South Atlantic, the local affiliate of the national group, from providing family planning services under Medicaid. Julie Edwards, a Medicaid-eligible patient who wants to use Planned Parenthood, joined a lawsuit filed by the group, saying that under federal civil rights law she could enforce her rights in court. A federal judge ruled in her favor, and after lengthy litigation, the Supreme Court agreed to weigh in.
Yahoo
11-06-2025
- Health
- Yahoo
Legislature eyes changing Medicaid eligibility rules for people with intellectual disabilities
House Speaker Daniel Perez (R) with House budget chief Rep. Lawrence McClure (L). (Photo by Jay Waagmeester/Florida Phoenix) Florida could be poised to make it easier for people with developmental and intellectual disabilities (IDD) to maintain their Medicaid services. The latest round of budget negotiations between the House and Senate includes a proposal by the House to eliminate a requirement for people with IDD to annually be redetermined eligible for the health care safety net program for the poor, elderly, and disabled. If approved once, they would be presumptively eligible the rest of their lives unless they no longer qualify for Medicaid or their condition changes. The proposal, if accepted by the Florida Senate, would require approval from the U.S. Centers for Medicare & Medicaid Services to take effect. 'I'd call it a game changer for our population,' Florida Developmental Disabilities Council Executive Director Valerie Breen told the Florida Phoenix Wednesday. The council aims to increase the capacity of individuals with IDD to be included in their communities. The House health care budget conferees made the offer Tuesday. As of this publication, the budget negotiators had not met again. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX Breen said people with these disabilities face difficulties when they have to be re-determined Medicaid-eligible. She said people with IDD erroneously fell off the Medicaid rolls when, following the end of the public health emergency associated with Covid 19, people had to requalify for Medicaid. Breen guessed that as many as 1,000 people with IDD who were eligible for Medicaid erroneously lost their coverage. For people with IDD the redetermination process requires the Department of Children and Families (DCF), which determines eligibility, to communicate with the state Agency for Health Care Administration (AHCA), which administers the Medicaid program, and the Agency for Persons with Disabilities (APD), which is charged with oversight of programs that serve these populations. Sometimes, Breen said, redetermination also included interaction with the Social Security Administration. 'Those were the critical components, and the agencies did not communicate with each other,' she said. As a result people with IDD lost access to the home and community-based services that help them with the activities of daily living like eating and grooming. 'They were not able to access any of those services,' Breen said. The Legislature was forced to extend the 2025 Session after legislative leadership couldn't reach an agreement on how much state money to spend in state fiscal year 2025-26, which begins July 1, and how much tax relief to provide residents. House Speaker Daniel Perez and Senate President Ben Albritton ultimately agreed to extend the session until June 16 and to spend about $50 billion in general revenue, or state tax dollars, across various government agencies. Most of the money will go to two areas: education and health care, with the former receiving more than $22 billion and the latter about $17.5 billion. Budget negotiators have been meeting to try to hammer out the details of how the money should be spent. The state budget must be printed and distributed to legislators by June 15 in order to vote on it by June 18. That's because of a constitutional provision that requires the budget to cool off for 72 hours before legislators can vote on it. New law brings managed care to people with intellectual disabilities The move to allow people with IDD to remain on Medicaid after initially being determined eligible is one of several proposals relating to people with IDD that are being championed by the House. Perez vowed to make those issues a priority during his two year tenure. To that end, Perez championed HB 1103, a proposal to make a small managed care pilot program, available statewide for people with IDD. HB 1103 also requires APD to publicly publish reports regarding the number of people with IDD the state serves and the number of people on a wait list for the Medicaid services. Gov. Ron DeSantis has signed the legislation. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Miami Herald
05-06-2025
- Health
- Miami Herald
Millions of kids are caregivers for elders. Why their numbers might grow
High school senior Joshua Yang understands sacrifice. When he was midway through 10th grade, his mom survived a terrible car crash. But her body developed tremors, and she lost mobility. After countless appointments, doctors diagnosed her with Parkinson's disease, saying it was likely triggered by brain injuries sustained in the wreck. At 15, Yang, an aspiring baseball player and member of his school's debate team, took on a new role: his mother's caregiver. Researchers estimate that Yang, now 18, counted among at least 5.4 million U.S. children who provide care to an adult in their home. As state officials eye federal Medicaid funding cuts that could drastically reduce home care services for those who are disabled or have chronic health conditions, many predict that number will rise. That's bad news for kids: Studies show that when young people take on care for adults with medical conditions, their health and academic outcomes decline. At the same time, their loved ones receive untrained care. 'It all fell to me,' said Yang, whose sisters were 9 and 10 at the time of their mom's accident, and whose stepdad worked nights. His grades fell and he quit after-school activities, he said, unable to spare the time. Early on, Yang found reprieve from a personal care nurse who gave them supplies, such as adult diapers, and advice on items to purchase, such as a chair for the shower. And for about a year, Yang was able to work for a personal care agency and earn $1,000 a month caring for his mom — money that went toward her medication and family needs. But at the beginning of 11th grade, a change to his mom's insurance ended her personal care benefit, sending him into a runaround with his county's Medicaid office in Minnesota. 'For a solid month I was on my phone, on hold, in the back of the class, waiting for the 'hello,'' he said. 'I'd be in third period, saying, 'Mr. Stepan, can I step out?'' A report published in May by the U.S. Government Accountability Office reminded states that National Family Caregiver Support Program grants can be used to assist caregivers under 18. However, the future of those grants remains unclear: They are funded through the Older Americans Act, which is awaiting reauthorization; and the Administration for Community Living, which oversees the grants, was nearly halved in April as part of the reorganization of the Department of Health and Human Services under President Donald Trump. Additionally, if Congress approves proposed cuts to Medicaid, one of the first casualties likely will be states' home- and community-based service programs that provide critical financial relief to family caregivers, said Andrew Olenski, an economist at Lehigh University specializing in long-term health care. Such programs, which differ by state but are paid for with federal dollars, are designed to ensure that Medicaid-eligible people in need of long-term care can continue living at home by covering in-home personal and nursing care. In 2021, they served almost 5% of all Medicaid participants, costing about $158 billion. By law, Medicaid is required to cover necessary long-term care in a nursing home setting but not all home or community care programs. So, if states are forced to make cuts, those programs are vulnerable to being scaled back or eliminated. If an aide who makes daily home visits, for example, is no longer an option, family caregivers could step in, Olenski said. But he pointed out that not all patients have adult children to care for them, and not all adult children can afford to step away from the workforce. And that could put more pressure on any kids at home. 'These things tend to roll downhill,' Olenski said. Some studies show benefits to young people who step into caregiving roles, such as more self-confidence and improved family relationships. Yang said he feels more on top of things than his peers: 'I have friends worrying about how to land a job interview, while I've already applied to seven or eight other jobs.' But for many, the cost is steep. Young caregivers report more depression, anxiety, and stress than their peers. Their physical health tends to be worse, too, related to diet and lack of attention to their own care. And caregiving often becomes a significant drag on their education: A large study found that 15- to 18-year-old caregivers spent, on average, 42 fewer minutes per day on educational activities and 31 fewer minutes in class than their peers. Schools in several states are taking notice. In Colorado, a statewide survey recently included its first question about caregiving and found that more than 12% of high schoolers provide care for someone in their home who is chronically ill, elderly, or disabled. Rhode Island's education department now requires every middle and high school to craft a policy to support caregiving students after a study published in 2023 found 29% of middle and high school students report caring for a younger or older family member for part of the day, and 7% said the role takes up most of their day. Rates were higher for Hispanic, Asian, and Black students than their white peers. The results floored Lindsey Tavares, principal of Apprenticeship Exploration School, a charter high school in Cranston. Just under half her students identified as caregivers, she said. That awareness has changed conversations when students' grades slip or the kids stop showing up on time or at all. 'We know now that this is a question we should be asking directly,' she said. Students have shared stories of staying home to care for an ill sibling when a parent needs to work, missing school to translate doctors' appointments, or working nights to pitch in financially, she said. Tavares and her team see it as their job to find an approach to help students persist. That might look like connecting the student to resources outside the school, offering mental health support, or working with a teacher to keep a student caught up. 'We can't always solve their problem,' Tavares said. 'But we can be really realistic about how we can get that student to finish high school.' Rhode Island officials believe their state is the first to officially support caregiving students — work they're doing in partnership with the Florida-based American Association for Caregiving Youth. In 2006, the association formed the Caregiving Youth Project, which works with schools to provide eligible students with peer group support, medical care training, overnight summer camp, and specialists tuned in to each student's specific needs. This school year, more than 700 middle and high school students took part. 'For kids, it's important for them to know they're not alone,' said Julia Belkowitz, a pediatrician and an associate professor at the University of Miami who has studied student caregivers. 'And for the rest of us, it's important, as we consider policies, to know who's really doing this work.' In St. Paul, Joshua Yang had hoped to study civil engineering at the University of Minnesota, but decided instead to attend community college in the fall, where his schedule will make it simpler to continue living at home and caring for his mom. But he sees some respite on the horizon as his sisters, now 12 and 13, prepare to take on a greater share of the caregiving. They're 'actual people' now with personalities and a sense of responsibility, he said with a laugh. 'It's like, we all know that we're the most meaningful people in our mom's life, so let's all help out,' he said. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
