Latest news with #MedicalAssistanceProgram
Yahoo
21-05-2025
- Health
- Yahoo
Let's separate Medicaid myth from fact
A pro-Medicaid message lights up the Capitol grounds, May 7, 2025 in Washington, D.C. (Photo byfor Caring Across Generations) During my 14 years in the Kentucky House of Representatives, I was deeply involved in overseeing Kentucky's Medical Assistance Program better known as Medicaid. I co-chaired a committee that made an in-depth study of Medicaid that resulted in legislation that I sponsored to address waste, fraud and abuse. Recently, Medicaid and its recipients have been misrepresented, resulting in divisive and misleading rhetoric. It is crucial that we examine the facts carefully and address the misinformation stemming from recent news reporting and pending legislative actions. Medicaid funds do not go directly to recipients. Medicaid services prepay for medical care, such as doctor visits, procedures and medications to aid low-income families, children, parents, caregivers, pregnant women, seniors and people with disabilities. The proposal in Congress to cut Medicaid by $625 billion over 10 years, leaving an estimated 7.6 million people without health insurance by 2034, along with the impending work requirements, suggests a lack of sensitivity or understanding regarding the nature of this program and the demographics of Medicaid recipients in Kentucky and nationwide. Let's begin with a quick overview: Medicaid, established in 1965, is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. It is funded jointly by the federal government and the states. Funds allocated for Medicaid do not go directly to recipients but are used to pay health care providers on a fee-for-service basis or through prepayment arrangements for medical care. This includes doctor visits, medical procedures, medications and more. In Kentucky, the federal government pays about 70% and the state 30% of traditional Medicaid reimbursements while the match is 90% federal-10% state for expanded Medicaid, allowing Kentucky to provide 'significant health care services' at a good value. Now let's look at the myth surrounding work requirements for Medicaid care. As the chair of the 1993 Program Review and Investigations Committee and principal sponsor of House Bill 127, an act relating to waste, fraud and abuse, I have consistently kept up with the Kentucky Medicaid Program over the years. It appears a long-standing misconception has produced an effort to create a solution for a problem that does not exist. Full-time and part-time workers must rely on Medicaid and SNAP, a nutrition assistance program, because they do not earn a living wage to support their families. Maybe addressing this issue would help find a solution to the real, underlying problem we are currently facing. Between 2015 and 2017, over 60% of Kentucky Medicaid recipients consistently held full-time or part-time employment. According to 2023 data from the Kaiser Foundation, Kentucky currently ranks 10th in the nation for the number of 'working Medicaid recipients.' There are 56.4% with full-time employment and 14.6% with part-time employment. Subsequently, 70.7% of Medicaid recipients are currently working, while 29.3% are not employed. The non-working group comprises elderly individuals, people with disabilities, children and caregivers who together account for approximately 19.8%. These individuals do not meet any of the work requirements currently being proposed. Consequently, the legislative proposals being considered would only affect 9.5% of the remaining Medicaid population here in Kentucky — undoubtedly, a solution for a problem that does not exist. Work requirements put up barriers to Medicaid coverage. Changes to work and reporting requirements and eligibility criteria have been shown to cause confusion among Medicaid enrollees, leading to substantial coverage loss, even for those who are eligible. A 2022 Kaiser Family Foundation report revealed that nearly 70% of people who had been dropped from Medicaid lost coverage due to procedural reasons. This is just the latest evidence of the harmful impact on peoples' access to health care caused by recent changes in Medicaid policy. During the time studied, Kentucky disenrolled 71,000 enrollees for missed paperwork and other procedural reasons. Of these, 74% (52,540) lost coverage attributed to barriers created by the beginnings of a state Medicaid work requirement that a court blocked from taking full effect, while 26% were found ineligible. As a result, 52,540 individuals lost access to health care services. Clearly, any barriers affecting Kentucky's Medicaid recipients warrant reevaluation. Our diligent Medicaid recipients merit equitable treatment and consideration. However, Houston, we do have a problem: Kentucky reported that in 2022, half of working Medicaid enrollees (50%) were employed by companies with over 100 employees and 42.8% worked in the agriculture/service sector. These full-time and part-time workers must rely on Medicaid and SNAP, a nutrition assistance program, because they do not earn a living wage to support their families. Maybe addressing this issue would help find a solution to the real, underlying problem we are currently facing. The Congressional Budget Office's analysis shows that this 'one big, beautiful bill' will reduce expansion reimbursements, add additional cost to Medicaid recipients, add work requirements, increase coverage barriers, cut Medicaid spending by $625 billion over 10 years, and leave at least 7.6 million more people without health insurance by 2034. True leadership involves building bridges, not barriers. Jack L. Coleman, a Democrat from Harrodsburg, represented Kentucky's 55th House District from 1991 to 2005. As co-chair of the legislature's Program Review and Investigations Committee, he helped lead a study of Medicaid that included findings and recommendations concerning financial accountability, recovery and drug utilization. In 1996, he sponsored House Bill 127, an act related to Medicaid waste, fraud and abuse, based on the results of the study. The bill served as a companion to Senate Bill 37, sponsored by then-Sen. Susan Johns, co-chair of the program review committee. Coleman is the father of Lt. Gov. Jacqueline Coleman. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
27-03-2025
- Health
- Yahoo
Central Health is creating a bridge in medical care with new clinic for homeless patients
Daniel Perez says he almost died three times a year ago because of an opioid overdose. One time he ended up in a hospital intensive care unit. After the hospital, Perez relapsed and was jailed before being sent to Integral Care's diversion program. Integral Care is the public mental health, substance use and intellectual disabilities services provider for Travis County. The diversion program brings people to mental health and substance abuse care centers instead of the hospital or jail. Integral Care has converted a former Ronald McDonald House into a 24-bed respite center that opened in October and where participants receive mental health and/or substance abuse care for up to 90 days. Beginning in February, the respite center also started receiving weekly medical care from Central Health's Bridge Clinic program. Central Health, which is the hospital district for Travis County and provides medical care for people making less than 200% of the federal poverty level by using property tax dollars, launched a physical Bridge Clinic in June at Central Health's Capital Plaza Specialty Clinic at 5339 N. Interstate 35. The Bridge Clinic's focus is on providing medical care to the unhoused population instead of sending them to a hospital emergency room for treatment that a primary care doctor should provide. The clinic is a partnership with Austin-Travis County Emergency Medical Services. Patients can either find their way there, or often EMS will bring them to the clinic instead of the emergency room. Central Health's 2024 demographics study, which came out in March, includes statistics on the unhoused population it serves, as well as populations based on U.S. Census tracts. That report collected data from July 2022 through June 2023, before Travis County and Integral Care formally created the diversion program and before Central Health started the Bridge Clinic. The data shows a huge gap between being admitted to the hospital and having a safe place afterward, said Jessie Patton Levine, the analytics quality manager with Central Health, during a March board meeting in which the demographics study was presented. In that study, behavioral health, cardiovascular disease, high blood pressure and substance use disorders were the most common chronic conditions treated in people experiencing homelessness. They had two to four times higher rates of behavioral health, substance use disorder and kidney failure compared with all enrollees in Central Health's Medical Assistance Program, which is similar to an insurance program through the hospital district. Chronic respiratory illnesses such as asthma and chronic obstructive pulmonary disease also were higher. The unhoused population also had a high reliance on going to the emergency room for their care vs. going to a primary or specialty care clinic. Trips to Dell Seton Medical Center, the safety net emergency department for Travis County, were twice as much as any of the other clinics or hospitals for these Central Health patients. The patients who are unhoused also had lower rates of cancer and diabetes care than other Central Health populations, which doesn't mean they didn't have those conditions. It just means they were not being diagnosed with them as often, in part because of a lack of continual care from a primary care doctor. The report states: "The data underscore persistent disparities, particularly among racial and ethnic groups, as well as the increased medical complexity of the unhoused population." The Bridge Clinic focuses on making it easy and less stressful to get medical help. Patients don't have to have an appointment or be an established patient with the clinic. They can come anytime from 8 a.m. to 5 p.m. Monday through Friday. There is a side entrance to avoid a traditional waiting room, which is another obstacle to seeking care. "We are meeting patients' needs without asking them to conform to traditional medical models or a traditional primary care model where they have to show up on time and there's a wait period and there are all these barriers," said Dr. Pheba Thomas, the physician lead for the clinic. Sometimes patients are exhausted by the time they arrive at the clinic, said Dr. Audrey Kuang, Central Health's co-director of high-risk populations and founder of the Bridge Program. It makes a difference that they can come to the clinic, take a rest and then see the doctor, she said. If the team comes at the patient right away about fixing their blood pressure, "we're not gonna accomplish anything and that patient's going to leave being like, 'I just got berated at this office and nobody's helpful,' versus if you say, 'take your time, have a snack, soak your feet, do what you need to do first, and then we'll talk about everything else later," said Dr. Jennifer Nunes, a physician at the clinic. The clinic has four patient rooms but is housed in the same building as the specialty care clinic, which means the clinic's doctors can consult with gastroenterology, hepatology, infectious disease, a dietician and palliative care, as well as having a pharmacy and an ultrasound available down the hall. CommUnity Care also has a substance abuse clinic in the same building. One of the things that makes Bridge Clinic doctors most happy is the over-the-counter medications and supplies they keep to give to patients. These include pain relievers, fungal cream, iron pills and antacids. "What's hard for us, it's not being able to give things to our patients we know they need. ... Knowing our patient needs it, deserves it, it would make them feel better, it's part of their treatment plan." Kuang said. "I think that's why we get so giddy with this." Once they have created a connection with patients, Kuang says they are seeing them return for follow-up visits or the next time that they have a health concern. The clinic can arrange rides for patients to get to the clinic if they know what area of town the patient will be in at what time. "There are so many people lost in the system," she said. "I feel like we're one family looking out for our neighbors and our community," she said. While patients can come to the physical Bridge Clinic any Monday through Friday, on certain days the clinic staff also brings care to the community: the Integral Care respite center on Mondays and the city of Austin's Eighth Street Shelter for Women on Wednesdays. A nurse and medical assistant pack up all the supplies they will need from the Central Health offices at 1400 N. Interstate 35, the site of the old Austin Children's Hospital, and drive it to the location. Then a doctor helps them unload and set up the clinic for the day, including a secure internet service for logging patient records. At the Integral Care respite center, one room becomes where patients arrive and get their vitals checked, as well as talk to the nurse and the medical assistant about any services they might need. Another room is the doctor's office. On a Monday in March, Jalen Reasonover, a medical assistant, is taking Perez' blood pressure and blood oxygen level, as well as taking some blood for basic lab work. Perez asks if there is any way they could get him some eyeglasses. Nurse Lana Sherrill tells him they will have a voucher for an eye checkup and a pair of glasses when they come back next Monday. Inside the doctor's office, Dr. Tim Mercer, Central Health's co-director of high-risk populations and an associate professor of Population Health at Dell Medical School, examines Perez with a stethoscope and feels Perez's ankles for any swelling. They talk about Perez's improved blood pressure and run through the other things Mercer has been working on with Perez: pain in his back, difficulty using one of his hands and wrist, and a boil from a stab wound in his knee that doesn't seem to want to go down. Mercer then looks at the boil, which will need an ultrasound and a follow-up appointment with a surgeon. The clinic will schedule those for Perez. Mercer also sends a prescription for a year's supply of blood pressure medicine as well as Narcan, should Perez choose to use opioids again, and talks to him about using fentanyl test strips and not using drugs alone. He advises against using Xanex on the street because most likely it has been laced with Fentanyl. Mercer talks without any judgement, making Perez feel more open to not hide his past drug use. Documents, interviews show how agencies responded to rash of deadly overdoses in Austin Perez's goal when he leaves the respite center is to work in construction, after he gets new copies of his Social Security card and his driver's license, which he lost. The clinic has its own social worker to help patients get what they need and connected to programs and resources they might want. This includes making sure they have medical care through either Medicaid or Central Health's MAP program. Housing is one of the biggest wants. In Kuang's ideal world, the Bridge Clinic staff would have housing vouchers they could hand out. Perez has been on wait lists for housing, he says, since 2022. Mercer's big picture goal is for Central Health to have the agencies providing the care work in partnership and continue to break down barriers to health care. "We have a lot of work to do," he said. Do you know how to use Narcan? Austin health officials demonstrate This article originally appeared on Austin American-Statesman: Central Health establishes Bridge Clinic for homeless patients
Yahoo
13-02-2025
- Yahoo
Care-dependent woman locked in York County basement dog pen; two charged
YORK COUNTY, Pa. (WHTM) — Two people in York County allegedly locked a care-dependent woman in a basement dog pen while they went on vacation without telling anyone, according to court documents. Brian and Ashlee Brady, both 26 and both from Hanover, are accused of neglecting the woman, who suffers from severe dementia, and stealing from her when they had control of her bank accounts, the charges filed Thursday by the Attorney General's Office shows. Close Thanks for signing up! Watch for us in your inbox. Subscribe Now The York County Area Agency on Aging made a referral to the AG's Office in March last year about the alleged neglect from Brian and Ashlee. According to the criminal complaint, Brian was a Direct Care Worker for the woman employed by Moravia Health, while Ashlee was involved with informal support. The victim required 24/7 supervision from professional providers or family members due to her condition. The woman was found on Feb. 5 last year in the basement, alone, behind a dog fence on the basement floor with a bowl full of hotdogs and two small cups of water after EMS arrived at the home after someone called 911, the complaint shows. Lancaster County man accused of raping unconscious teen on Susquehanna River island Investigators say Ashlee and Brian duo had left the victim on their own and took a vacation at Great Wolf Lodge, leaving the victim alone for 24 hours, according to the complaint. Text messages on Ashlee's phone showed that she invited a friend to come along with them on their trip, but nothing about asking for help looking after the woman while they were gone, according to the complaint. She claimed arrangements were made for someone to watch the woman, however, investigators say they found no evidence that she asked anyone. Arrangements, though, had been made for a neighbor to take care of her dogs. 'The neighbor said she would go over but I don't want her seeing mom on the floor can you just go step over the gate downstairs and put her in the chair she will be fine til I get home tomorrow,' Ashlee sent in a text to a family member, according to the complaint. Investigators say Brian admitted to investigators that he knew it 'wasn't the right thing' to leave the woman in the basement. Ashlee is quoted saying that she made a 'mistake' leaving the woman in the basement and that is the 'only (expletive) thing I'm guilty of,' the charges show. Close Thanks for signing up! Watch for us in your inbox. Subscribe Now Brian's employer and the victim's provider Moravia Health was also not told about the trip, and its policy states there must be a seven-day notice for vacations. The investigation also found Brian 'clocked' in for his care worker shifts during the hours he was working his other job, allegedly stealing at least more than $1,000 from the Medical Assistance Program. Investigators say Ashlee was also the woman's power of attorney from 2019 to 2024 and was using her money to buy alcohol, fast food, traffic citations and other personal expenses. She and Brian allegedly admitted to taking the money, which was noted to be at least over $10,000 stolen. Ashlee faces multiple charges that include felony counts of perjury, financial exploitation of an older adult or care-dependent person, and neglect of a care-dependent person. Brian faces multiple charges that include Medicaid fraud, financial exploitation of an older adult or care-dependent person, and theft by deception. The duo is currently out on unsecured bail set at $50,000 by Magisterial District Judge Jeffrey Sneeringer. They both have preliminary hearings scheduled for March 27. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
