Dr. Veronica Maria Pimentel, who specializes in obstetrics and gynecology at Saint Francis Hospital in Hartford, recalls a patient who suffered a stroke soon after delivering her baby prematurely. The woman’s Medicaid eligibility ended just two months after she gave birth, despite the complications caused by her stroke and the baby’s premature birth. Although the woman’s medical coverage ended, Pimentel said, her needs didn’t. “She still needs physical therapy. She still needs occupational therapy.
In February, Lori Dingwell of Waterbury tested positive for COVID-19. She says she has yet to recover fully. The 53-year-old has seen her primary care physician, a neurologist, ophthalmologist, retinal specialist, infectious disease expert, and rheumatologist. After a host of scans, blood tests and “an abnormal spinal tap,” Dingwell—a member of the COVID long-hauler support group Survivor Corps—said physicians had no answers to help explain her malady. Adding to her woes, she racked up nearly $10,000 in medical debt.
When the pandemic began, LaVita King of Bridgeport worried about how she would continue to see her behavioral health therapist and primary care physician at Southwest Community Health Center. She lives close enough to walk to the federally qualified health center but didn’t feel comfortable leaving her home in those early days, let alone venturing into a medical office. But she’s been able to access care through phone and video chats. “For me, it’s been such a lifesaver, such a blessing,” said King, 69. “Otherwise, I would not have been able to talk to my behavioral health therapist for this whole entire time.
While the deadly coronavirus seems to be subsiding in Connecticut for now, its impact on nursing homes has not. More than 6,700 beds are empty, and it may take many months of financial struggle before occupancy climbs back to pre-pandemic levels. Of the approximately 200 nursing homes in Connecticut that receive payments from Medicaid, the government health insurance program for low-income people, only 15 were 70% or less occupied in January, according to the Connecticut Health Investigative Team’s analysis of state data. By August, almost five times as many facilities saw occupancy drop to that level or less. While the statewide average decline was 15%, the number of residents in 19 nursing homes has plummeted to 55% and below since January.
In states where Medicaid was expanded under the Affordable Care Act (ACA), women are more likely to receive breast cancer diagnoses at an early stage, compared with women in other states, new research shows. Among women younger than 50, the average rate of diagnosis at advanced stages lowered from 23% to 21% between 2012-13 (before most states expanded Medicaid) and 2015-16 (after expansion), according to a Yale Cancer Center study published today in JAMA Surgery. In states where Medicaid wasn’t expanded, the average rate of advanced-stage diagnoses stayed constant at 26% during those years. “It’s a small percentage change [in expansion states] but it was statistically significant,” said Dr. Tristen Park, senior author of the study and a breast cancer surgeon at the Yale Cancer Center and Smilow Cancer Hospital, especially since the drop was evident over just a few years. “It’s quite exciting.
Pharmacy benefit managers – the middlemen who negotiate drug purchases for insurers and large buyers – are coming under growing scrutiny and criticism both in Connecticut and nationwide for their role in the sharp rise of prescription drugs. The third-party companies, called PBMs for short, originally processed claims for pharmacies, but now are hired by Medicare, Medicaid and commercial health plans to manage pharmaceutical benefits. Their reach is broad: they choose what drugs are covered by insurance; negotiate purchasing deals with drug makers; determine co-pays for consumers; decide which pharmacies will be included in prescription plans; and decide how much pharmacies will be reimbursed for the drugs they sell. The growing legions of PBM critics, who include state Comptroller Kevin Lembo, pharmacists and their trade and service organizations, say that the industry is helping drive the unrelenting rise in prescription drug prices and insurance premiums.
PBMs, Lembo’s office and state pharmacists say, use a variety of tactics to capture cash from consumers, payers and pharmacies. One is spread pricing, where they pay the pharmacy less for a prescription than a payer gives them, sometimes even forcing the pharmacist to take a loss.
Betty Williams says giving up crack cocaine was easier than her ongoing struggle to quit cigarettes. “A cigarette is a friend,” said Williams, who lives with schizophrenia and chronic obstructive pulmonary disease. People with mental illness account for 44% of the cigarette purchases in the United States, and they are less likely to quit than other smokers. High smoking rates among people with mental illness contribute to poorer physical health and shorter lifespans, generally 13 to 30 years shorter than the population as a whole. About 37% of men and 30% of women with mental illness smoke.
When immigrant families bring their children to the Yale Children’s Hispanic Clinic, it’s just not about check-ups and vaccinations. Clinicians help them deal with everything from teething to nutrition to finding a place to live. But these days when front-line clinicians encourage families to use the many services offered through federal public programs, parents have questions—and misgivings. “They are hesitant because they are afraid,” said Patricia Nogelo, a clinical social worker at the Yale Children’s Hispanic Clinic. A proposed change in immigration law is making immigrants in Connecticut and nationally wary of utilizing federal programs that cover health, food and housing assistance.
Federally Qualified Community Health Centers (FQHCs) in Connecticut have expanded services, upped their staffing and renovated their facilities mostly due to increased revenue streams from the Affordable Care Act (ACA). Connecticut and the 30 other states that opted for the ACA Medicaid expansion program have benefitted from billions of dollars in additional core grant funding, with Connecticut receiving $150.7 million from 2011 to 2016, according to a January report by the Congressional Research Service. Health centers in Connecticut used some of that funding to hire professionals to enroll thousands of residents in health insurance—residents who were previously uninsured and used the centers for their health care. Now the centers are serving about 70,000 more insured patients, mostly covered by Husky Health plans. The cost of treating uninsured patients has declined by about $10 million since 2012, according to Deb Polun, director of government affairs and media relations at the Community Health Center Association of Connecticut.
Since 2011, Connecticut has issued more than 39,000 new Medicaid cards to prisoners returning to communities, connecting them to health care services with the goal of keeping them healthy and out of prison. This initiative, which gives ex-offenders the opportunity to see a primary care physician on a regular basis and access critical mental health and drug-abuse treatment programs, exists because of the Affordable Care Act (ACA), and Medicaid pays most of the costs. Recidivism data show that the initiative is working, state officials say. Yearly, the Court Support Services Division (CSSD) refers approximately 20,000 adults on probation to various behavioral health programs and tracks them for 12 months. In 2016, CSSD reported that 23.1 percent of adults who completed their referral program were rearrested, a five-year low since CSSD started tracking in 2012.