Medicaid, ACA Uncertainty Threaten Success Of Ex-Offenders’ Health Care Programs

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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.

Women's Health

Medicaid Offers Birth Control Right After Delivery

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Low-income women in Connecticut who have just given birth and know they don’t want to get pregnant again anytime soon are now offered a long-acting birth control option postpartum. Medical providers say the policy by the U.S. Department of Health and Human Services will reduce the number of unplanned pregnancies, as well as lead to better maternal health outcomes by ensuring pregnancies are spaced a healthy length of time apart. Connecticut’s HUSKY program is one of 26 state Medicaid programs nationwide that reimburses hospitals for administering long-acting reversible contraception (LARC)—namely, intrauterine devices (IUDs) and subdermal implants—to Medicaid patients. HUSKY started reimbursing for the devices last year. “It’s a great thing,” said Dr. Elizabeth Purcell, an obstetrician and gynecologist practicing in Hartford.

Women's Health

It’s Time To Stop Segregating Reproductive Rights

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Now is the time to repeal a 40-year-old law that perpetuates inequality among women. The Hyde Amendment, which bans the use of federal funds to pay for abortions except in certain circumstances, is unfair. The amendment targets women who rely on Medicaid for their health care coverage. According to the federal Centers for Medicare and Medicaid Services, roughly two out of three adult women enrolled in Medicaid are between the ages of 19 and 44—the reproductive years. Abortions can run upward of $1,000, which places the (legal) procedure out of reach for most women living in poverty.

health care

Alzheimer’s Care Puts Financial Strain On Family Members

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Connecticut has a high prevalence of Medicare beneficiaries living with Alzheimer’s disease or other dementias, often placing an enormous financial strain on caregivers who are spending thousands of dollars a year on care, reports show. “Alzheimer’s is the most expensive disease in America,” said Jennifer Walker, vice president of communications and advocacy for the Connecticut chapter of the Alzheimer’s Association. “The cost of care is very high.”

Medicare covers most fees for doctor visits, and some hospitalization, if needed; but other costs associated with care—including home health services, transportation, diapers for incontinence—are not covered. People with Alzheimer’s often suffer from other chronic illnesses such as diabetes, heart and hypertension, which add to the out-of-pocket costs for care. The financial burden is forcing families who rely on Medicare to tap into retirement savings, cutback on food and medical care for themselves, reduce work hours or quit work altogether to be caregivers, according to the Alzheimer’s Association report Alzheimer’s Disease Facts and Figures.

Primary Care

E-Consults Quickly Connect Patients With Specialists

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Medicaid will reimburse some health centers in the state for providing patients with access to medical specialist through electronic consultations, which some providers believe will increase low-income patients’ access to care. “The impact is potentially huge,” said Dr. Daren Anderson, director of the Weitzman Institute, which is the research and quality improvement arm of Community Health Center Inc. (CHC). CHC is a Middletown-based network of 13 health centers that includes facilities in New Britain, Stamford, Norwalk, Clinton, and Old Saybrook. An e-consult enables a primary care doctor to contact a specialist—for a second look at patient’s echocardiogram, for instance—and securely send part or all of a patient’s medical records electronically. The specialist then replies to the primary care doctor within a few days (but more typically within just a few hours), reducing the need for a patient visit to the specialist.

Health Insurance Coverage

Federal Waivers Could Make Health Insurance Accessible, Affordable

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Health insurance coverage might be more accessible and affordable in Connecticut if the state applied for certain Affordable Care Act and Medicaid waivers, according to advocates who say the options should be explored. Two waivers in particular—Affordable Care Act (ACA) Section 1332 and Medicaid Section 1115—would let the state disregard certain federal requirements, possibly lowering health care costs for some individuals, according to a policy brief commissioned by the Universal Health Care Foundation of Connecticut and the Connecticut Health Foundation. “What we need to do in Connecticut is really think about … how could we creatively, imaginatively, innovatively use waivers to expand coverage to quality care and really help improve health,” said Frances Padilla, president of Meriden-based Universal Health Care Foundation of Connecticut. “We haven’t had that conversation yet in Connecticut.”

The ACA waiver isn’t available until 2017 but the Medicaid waiver is already being used by dozens of other states to lower costs, she said. “It allows a state to get past some of the requirements of Medicaid and do some things that are innovative,” she said of the Medicaid waiver.

Disparities

As Smoking Rates Drop, Medicaid Recipients Twice As Likely To Smoke

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People who are uninsured or on Medicaid are more than twice as likely to smoke tobacco compared to those covered by other insurance, according to a national study by the Centers for Disease Control and Prevention. About 28 percent of uninsured adults and 29 percent of adults on Medicaid smoke nationwide, according to the Centers for Disease Control and Prevention (CDC), compared with just 13 percent of adults on private insurance plans and 12.5 percent on Medicare. The CDC, which examined data from the 2014 National Health Interview Survey, published the findings in November. The CDC found that cigarette-smoking rates were higher among people who live below the poverty level (26.3 percent) and people with a GED certificate (40 percent). Overall, the prevalence of cigarette smoking among adults declined from 20.9 percent to 16.8 percent from 2005 to 2014, according to the CDC.

Fines & Sanctions

Southington Dentist Will Pay Settlement In Medicaid Fraud Case

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A dentist will pay $55,000 to settle claims he defrauded the state’s Medicaid program, Attorney General George Jepsen announced Monday. Dr. Thomas DeRienzo, a licensed practicing dentist in Southington, will pay the money to settle civil healthcare fraud allegations that he submitted fake claims for Medicaid payments. Jepsen alleged that DeRienzo carried out a “long-term scheme” in which he submitted claims to the state Department of Social Services, which administers Connecticut’s Medicaid program, for dental services he did not provide to patients enrolled in the Connecticut Medical Assistance Program (CMAP).  CMAP, run by DSS, includes family, children’s and low-income Husky programs.

Jepsen accused DeRienzo of submitting claims to DSS for resin-based composite fillings that he never gave to CMAP patients. In addition to agreeing to pay $55,000 to resolve those allegations, DeRienzo has entered a separate agreement with DSS in which he is permanently barred from participating as a dentist in the CMAP, according to Jepsen.

Reached at his practice Monday, DeRienzo denied any wrongdoing.

Fines & Sanctions

Access Health Enrollment Starts Sunday; Uninsured To Face Steeper Fines

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Open enrollment for consumers to buy health insurance through the Access Health CT marketplace begins Sunday, and 2016 will bring considerably steeper fines for consumers who lack insurance. Access Health CT (AHCT), now in its third year, enrolled close to 100,000 individuals in private insurance plans in its first two years, according to Andrea Ravitz, director of marketing. About 500,000 enrolled in Medicaid through AHCT, during the first two years. The marketplace aims to enroll between 105,000 and 115,000 in private plans by the end of open enrollment, Ravitz said. AHCT concentrated on attracting new enrollees its first two years but this year it has been focusing on retaining enrollees, she added.

Fines & Sanctions

Podiatrist Pleads Guilty To Submitting False Medicare Claims

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A Stamford-based podiatrist faces hefty fines and prison time after she pleaded guilty this week to submitting fraudulent Medicare claims.

Amira Mantoura pleaded guilty Monday in Hartford federal court to one count of making a false statement to Medicare after she billed the government program for foot surgeries when she merely clipped patients’ toenails, according to Deirdre M. Daly, U.S. Attorney for the District of Connecticut. Mantoura, 53, lives in Greenwich and has a practice at 95 Morgan St., Stamford. In her guilty plea, she admitted that she submitted false claims to not only Medicare, but Medicaid and private insurance companies as well, Daly said. Reached by phone at her practice Tuesday, Mantoura declined to comment. According to court documents, between January 2009 and August 2013, Mantoura “knowingly submitted materially false claims” seeking payment for nail avulsions, which are surgical treatments for ingrown toenails.