AzPHA Public Health Policy Update- December 6

Newborn Screening Policy Success Story

In 2014 a bipartisan group of AZ lawmakers passed a bill charging the ADHS with expanding their newborn screening program to include newborn pulse oximetry screening in hospitals. The test gives the baby’s doctors quick information about whether the newborn might have a congenital heart abnormality. Quick info like that gives them a chance to do early interventions that can save lives and improve outcomes. The agency and hospitals collaborated to implement the new testing and reporting procedures in 2015.

A new study this week in the Journal of the American Medical Association found that states that had our kind of congenital heart disease screening program (based on pulse oximetry) had 33% fewer infant deaths from critical congenital heart disease compared to states without screening policies.

Kudos to our public health partners at the American Heart Association in AZ for raising awareness with our legislators and for that body to recognize and pass this important evidence-based intervention.  This new study demonstrates that it's saving lives.

 

Medicaid Work Requirements & 5 Year Limit on Horizon

An AZ law (from 2015) requires AHCCCS to annually ask the Centers for Medicare and Medicaid Services (CMS) for permission to require work (or work training) and monthly income reporting for “able bodied adults” as well as a 5-year lifetime limit on AHCCCS eligibility. 

The work requirement and 5 year limit requests that were turned in during the Obama Administration were denied, but the new administrator CMS has publicly said (and written) that she’s receptive to proposals from states to require work or community engagement for people who want to receive Medicaid.

We’re getting closer to having these requirements become part of AZ’s Medicaid program with a transmission of a concept letter from AHCCCS to CMS about the upcoming 2017 request.

A few months ago, AHCCCS floated a draft waiver for public comment that outlined the following requirements for “able-bodied adults” receiving Medicaid services:

  • A requirement for all able-bodied adults to become employed or actively seeking employment or attend school or a job training program;
  • A requirement for able-bodied adults to monthly verify compliance with the work requirements and any changes in family income;
  • The authority to ban people from enrollment for 1 year if they fail to report a change in family income or lie about compliance with the work requirements; and
  • Limit lifetime coverage for all “able-bodied” adults to 5 years (except for certain circumstances). 

Hundreds of comments were turned in urging AHCCCS to change the initial waiver request.  AzPHA submitted a response letter back in February.  Several hundred people and organizations turned also in comments.  

While AHCCCS hasn't released the content of their final waiver request, they did issue a letter last week outlining what they intend to include in the Waiver (after considering the public comments).  

It's a lengthy letter and I can't summarize it all here - but interestingly - it includes a wider list of persons that would be exempt from the eligibility restrictions and the 5 year benefit limit (which already included folks with disabilities) including:

  • People over age 55
  • Women for three months after a pregnancy
  • Former foster youth up to age 26
  • People diagnosed with a serious mental illness
  • People receiving temporary or permanent long-term disability benefits
  • Full-time high school students over age 18
  • Full-time college or graduate students
  • Victims of domestic violence
  • Homeless individuals
  • People impacted by a death of family members in their immediate household
  • A parent or caregiver of a child under age 13
  • A caregiver of a family member in the Arizona Long Term Care System
  • People considered medically frail under state law
  • American Indians

There are other areas covered in the letter that go beyond the requirements of the 2015 law including:

  • Freezing the current base payment rates for community health centers and choosing an alternative inflation factor for future payments; and

  • Limits on paying for emergency medical transportation.

If some (or all) of the items in the waiver are approved (which appears likely) how AHCCCS implements the reporting requirements, coordinates with other agencies like ADES, and determines compliance with the eligibility requirements will have a profound impact on access to care for this population.

We'll continue to track this when the actual waiver request is turned in.

 

Community Health Worker Training Program Accredited

The Arizona Community Health Worker Association (AzCHOW) approved Central Arizona College’s CHW curriculum and training program last week, a key milestone toward building a robust CHW workforce in Arizona.

Their CHW program is approved for 5 years, at which time the program will be reviewed for renewal. The CHW curriculum provides the core competencies and skills students need for employment opportunities. Students are introduced to community and public health topics like chronic disease management, health communication, health literacy, counseling and motivational interviewing, wellness and health advocacy. 

The program can be completed in 1 year through distance learning and includes a 90- hour internship which can be completed.

The CHW training program was implemented in August of 2016 and the first cohort of students graduated in August of this year.  The second cohort of students is working towards the CHW certificate, and will graduate in August of 2018. 

For more information on the Community Health Worker Certificate Program and application form, please visit www.centralaz.edu/CPH or call Kim Bentley at 480-677-7780.  

 

Tax Bill Could Have Public Health Implications

The Senate approved their version of tax reform by a 51-49 vote last week. Last month, the House approved their version by a 227-205 vote. In the next couple of months, they’ll resolve differences between the two bills and produce a conference bill.

The Senate version repeals the individual mandate for people to have health insurance or pay a fine.  The Congressional Budget Office estimates that repealing of the individual mandate could increase the number of uninsured by 4 million by 2019 and 13 million in 2027. They also estimate that the repeal will increase health insurance premiums by 10% per year but also save the federal government $338 billion (e.g. fewer advance premium tax credits).

The Pay-As-You-Go Act of 2010 (PAYGO) requirement could threaten the Prevention and Public Health Fund and other public health programs. Congress will need to waive the PAYGO requirements separately to prevent these cuts from moving forward. Senator McConnell reportedly assured Senator Collins that the PAYGO waiver will happen, but waiving it will take 60 votes in the Senate.

 

Affordable Care Act – too big to fail and too big to ignore

By: Jana Granillo in the November 30, 2017 AZ Capitol Times 

How does the Affordable Care Act affect me and my community? Well, that is a big question with a big answer. ACA is big, it is more than the marketplace and mandates – which, by the way, is still the law. It is a whole system of care and infrastructure and problem solving intended to make us healthier as a nation.

When I think of the ACA, what churns to the top of my thoughts are vulnerable populations, my neighbors, my own insurance, and where I live.

When I hear students playing in the schoolyard, I know many are economically disadvantaged. We have a shockingly large percentage of students on Free and Reduced Lunch. How many of those children are on AHCCCS/Medicaid or participate in the ACA Marketplace?

When I commute, I drive by community health centers, also known as Federally Qualified Health Centers. ACA funding impacts these clinics.

When I grocery shop, I see seniors counting their pennies with clipped coupons. Which seniors will endure a fall or become victim to MRSA, a staph infection?  How many of them are Medicare and Medicaid dual eligible?

When I hear a first-responder siren, I think about behavioral health.  According a recent report on the opioid crisis, my community is on a data map and it is colored red. Does the siren tell of another victim? Does that victim have behavioral health options or even a treatment bed for evaluation?

When I choose doctors, I wonder if they were part of the National Service Corp.

What about treatment options? Is there a new medication on the horizon for a chronic condition or disease by the National Institute of Health? Will my elderly relative have to travel to Phoenix to get treatment that is not available in the rural areas?

Will the county hospital financially be in the “green” this year or do we take a hit on our property taxes to support the district? Will they receive Disproportionate Share Payments  for serving the underserved? What funding will be available?

What about all those medically served by the fire department, especially those who don’t have a point of care – who pays for that?

Finally, I ponder, will our family (employer) insurance be there tomorrow? I can’t afford a premium without help.

So, does ACA affect me, my family and my community? Answer: BIG yes!

How do we go forward? The answer is to include experts from multiple health disciplines to define reform around a common goal: affordable quality health care systems that are responsible, provide short-term stabilization and long-term solutions that protect all us.

— Jana Lynn Granillo is a AZPHA member and community health