Managed Care - November 2008 - (Page 6)

NEWS AND COMMENTARY Spending on Medicaid Outpaces Economic Growth edicaid spending is expected to substantially outpace the rate of growth of the United States economy over the next decade, with actuaries at the Centers for Medicare & Medicaid Services (CMS) projecting the bill to reach $4.9 trillion over 10 years. From 2007 to 2008, Medicaid spending will increase 7.3 percent, reaching $339 billion; the annual average rate of growth projected over the next 10 years is 7.9 percent. In comparison, the projected growth rate for the economy over that period is 4.8 percent. Medicaid is a federal/state partnership program that provides health care to certain low-income people. For both federal and state governments, Medicaid accounts for the largest source of general revenue spending on health services. The federal government matches state expenditures based on a formula that yields subsidies ranging from 50 percent to 83 percent. The average is 57 percent. However, even with federal support, states report they are struggling to meet their share of expanding Medicaid costs. State spending on Medicaid has remained relatively stable as a share of states’ budgets, averaging about 20 percent from 1995 to 2007. These projections were presented in a report to the Medicare Board of Trustees. when they take a medically necessary leave of absence, under a law signed by President Bush last month. Called Michelle’s Law, after a New Hampshire student who died from cancer in 2005, Public Law 110-381 requires health plans and insurers to alert student beneficiaries about their rights under the law. The law is effective for plan years that begin on or after Oct. 9, 2009. The law will only apply if a group health plan provides coverage to a dependent child who is a student at a postsecondary institution. It covers full time and part time students. In general, federal law does not require that group health plans cover dependents. The law goes into effect when a medically necessary leave of absence or other change in enrollment causes the child to lose student status under the terms of the plan. Plans that do not require student status for older children do not have to comply with the law. Benefits the child receives during the required extension must be the same as if the child had continued coverage as a student not on leave. If the plan sponsor changes the design (e.g., changes insurers or moves from insured to self-insured coverage) and the new plan provides coverage for dependent children, the child would continue coverage under the new plan until the one-year period runs out. M Uninsured Don’t Jam Up the ED Despite the popular notion that crowded emergency departments (EDs) are filled with the uninsured, a recent study in the Journal of the American Medical Association suggests that perception is unsupported. A literature review by Manya F. Newton, MD, MPH, a Robert Wood Johnson Clinical Scholar candidate at the University of Michigan, and colleagues spotlights assumptions that the uninsured use the ED for nonurgent or nonemergent care or primary caretype, that uninsured patients are a common cause of ED crowding, or that the uninsured are high users of the ED. They say these assumptions are not supported by current data. The reviewers identified six common assumptions, which reflected “conventional wisdom” about uninsured patients in the ED, and found that three were not clearly supported and the remaining three were true for all patients — insured and uninsured alike. Policies intended to address ED crowding by blocking or creating barriers to ED access for uninsured patients are unlikely to be effective because, according to the researchers, “little evidence exists that uninsured patients are a large proportion of the problem.” Policies that redirect patients who require nonurgent care to primary care sources are unlikely to be successful unless those sites are readily accessible. The researchers concluded that privately insured, publicly insured, and uninsured patients will continue to go to the ED if they are unable to find ‘Michelle’s Law’ Mandates Coverage Group health plans and health insurers must provide coverage for up to one year to college students who would otherwise lose health coverage 6 MANAGED CARE / NOVEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.