Personal Injury and Social Security Disability Blog

Texas - State Of Neglect, Part 2

I wrote recently about a continuing series in the Dallas Morning News, and how it reflected my loss of pride in my native state. The second of a four-part series is in the paper today, and continues to discuss in blunt terms the failing of Texas government to protect the weak, the needy, and the helpless. I encourage all Texans to read this fine series. Here is the introduction:

Texas has long been hard on the weak and vulnerable. It fares badly in national surveys of child poverty, food assistance and care for the mentally ill and disabled.

But it isn't only the poor and afflicted who need help; everyone relies on state government for some protection.

Not everyone receives it.

Business interests and lobbyists exert strong influence on the writing of laws and the workings of state government.

Who benefits from that? Frequently, not ordinary Texans.

Social Security Disability, Medicaid, And The Economy

Many of our clients who are granted disability by the Social Security Administration will qualify for Medicaid benefits. For those who are not disabled but rely on Medicaid because they qualify based on income, the worsening of the economy means more people may begin to rely on Medicaid alone for their health insurance. This situation was detailed in an Associated Press article recently. The full story is revealing. Here are excerpts:

Since the recession began a year ago, many states have seen increases in the Medicaid rolls just as tax revenues are falling below projections. Governors have lobbied President-elect Barack Obama and Congress to help them weather the downturn by increasing the federal government's share of Medicaid spending for at least two years.

The governors said the extra $40 billion would ease the service cuts or tax increases that legislatures need to balance state budgets.

The unemployment rate has jumped from about 4.7 percent last December, when the recession began, to 6.7 percent today. Economists estimated in a Kaiser Family Foundation report that each 1 percent gain in the unemployment rate adds 1 million people to the Midicaid and State Children's Health Insurance Program.

In Connecticut, a state faring better than many, enrollment in the Medicaid program has climbed from about 312,000 last December to about 329,500 in November - a 6 percent increase. Many who lost their jobs were eligible to continue group health insurance. But that is not an option in most cases because they no longer have an employer picking up a large share of their premiums.

Medicaid insures nearly one in six low-income people in the U.S. The program typically covers the very poor and about half of enrollees are children. Spending came to $333 billion in the budget year ending Sept. 30, 2007. Washington picks up about 57 percent of that; the states cover the remainder.

Medicaid Covering Unapproved Drugs

Our tax dollars at work - Medicaid is risking patients lives by authorizing potentially dangerous drugs. As reported in the Dallas Morning News, Medicaid has paid at least $200 million since  2004 for medicines that have never been reviewed by the government for safety and effectiveness but still are covered under Medicaid. Excerpts from the article:

The availability of unapproved prescription drugs to the public may create a dangerous false sense of security. Dozens of deaths have been linked to them, records show.

The medications date back decades, before the Food and Drug Administration tightened its review of drugs in the early 1960s. The FDA says it is trying to squeeze them from the market, but conflicting federal laws allow the Medicaid health program for low-income people to pay for them. The FDA says there may be thousands of such drugs on the market.

The FDA and Medicaid are part of the Health and Human Services Department, but the FDA has yet to compile a master list of unapproved drugs, and Medicaid – which may be the biggest purchaser – keeps paying.

Medicaid officials acknowledge the problem, but they say they need help from Congress to fix it, officials said.

BACKGROUND: FDA REVIEWS

•In 1962, Congress ordered the Food and Drug Administration to review all new medications for effectiveness. Thousands of drugs already on the market were also supposed to be evaluated.

•Some manufacturers claimed their medications were "grandfathered" under earlier laws, and even under the 1962 bill. However, the FDA is skeptical that any drugs on the market are entitled to grandfather status.

•In the early 1980s, an older medicine, E-Ferol, a high-potency vitamin E injection, was linked to serious reactions in some 100 premature babies, 40 of whom died. The FDA began a program to weed out such drugs.

•Last year, the FDA banned unapproved cough medicines containing hydrocodone, a potent narcotic. Some had directions for treating children as young as age 2, although no hydrocodone cough products have been shown to be safe and effective for children under 6.

 

Limits Placed On Medicaid Outpatient Services

I wrote a few days ago about the Bush administration's plan to push through a raft of new regulations loosening restrictions on such matters as pollution and consumer safety. Now the New York Times reports on another regulation change—this one affecting Medicaid reimbursements. Here are excerpts

In the first of an expected avalanche of post-election regulations, the Bush administration on Friday narrowed the scope of services that can be provided to poor people under Medicaid’s outpatient hospital benefit.

Public hospitals and state officials immediately protested the action, saying it would reduce Medicaid payments to many hospitals at a time of growing need.

The new rule conflicts with efforts by Congressional leaders and governors to increase federal aid to the states for Medicaid as part of a new economic action plan.

President-elect Barack Obama has endorsed those efforts. At a news conference on Friday, he said that legislation to stimulate the economy should include “assistance to state and local governments” so they would not have to lay off workers or increase taxes.

In a notice published Friday in the Federal Register, the Bush administration said it had to clarify the definition of outpatient hospital services because the current ambiguity had allowed states to claim excessive payments.

“This rule represents a new initiative to preserve the fiscal integrity of the Medicaid program,” the notice said.

But John W. Bluford III, the president of Truman Medical Centers in Kansas City, Mo., said: “This is a disaster for safety-net institutions like ours. The change in the outpatient rule will mean a $5 million hit to us. Medicaid accounts for about 55 percent of our business.”

Alan D. Aviles, the president of the New York City Health and Hospitals Corporation, the largest municipal health care system in the country, said: “The new rule forces us to consider reducing some outpatient services like dental and vision care. State and local government cannot pick up these costs. If anything, we expect to see additional cuts at the state level.”

The rule narrows the definition of outpatient hospital services to exclude those that could be provided and covered outside a hospital.

In May, the White House said it wanted to avoid the rush of “midnight regulations” that had occurred at the end of other administrations. But Bush administration officials said this week that they still intended to issue, or relax, many economic, environmental, health and safety rules before they leave office on Jan. 20.

Medicaid, financed jointly by the federal government and the states, provides health insurance to more than 50 million low-income people. Services can often be billed at a higher rate if they are performed in the outpatient department of a hospital rather than in a doctor’s office or a free-standing clinic. Hospitals generally have higher overhead costs.

Ann Clemency Kohler, the executive director of the National Association of State Medicaid Directors, said: “The new rule is a pretty sweeping change from longtime Medicaid policy. Since the beginning of the program, states have been allowed to define hospital outpatient services. We have to question why the rule is being issued now, three days after the election, with a new administration coming in.”

Computer Crash Hinders Texas Attorney General's Medicaid Fraud Case

According to the Dallas Morning News, the Texas Attorney General has hit a major speed bump in his investigation into Medicaid fraud in Texas, and all because of a computer crash and a failure to backup data. Let this be a lesson to all of us - back up your computer now!

A massive computer crash that destroyed hundreds of the state attorney general's confidential documents may prevent scores of Medicaid fraud prosecutions and has revealed serious problems with a newly expanded state outsourcing of computer services.

As much as 50 percent of the Tyler Medicaid fraud division's files were destroyed in July when a server being repaired by a state vendor wouldn't restart. The scope of the damage is in dispute.

In an apparent oversight, the documents lost were not backed up – meaning that evidence crucial to convicting dishonest health-care providers who ripped off the state's health insurance program for the poor may never be recovered. E-mails and other records obtained by The Dallas Morning News indicate some Tyler investigators lost up to 90 percent of their open case files.    

Link of the Day - Medicaid Information From Families USA

You will find quite a bit of helpful information about Medicaid and Children's Health at the Families USA Web site.