Tagged Medicaid

5 Things to Know About Health Care Changes in Montana

HELENA, Mont. — The 2021 Montana legislative session will be remembered as one of the state’s most consequential as a Republican-led legislature and governor’s office passed new laws restricting abortions, lowering taxes and regulating marijuana.

But the debate over those and other highly publicized issues may have caused other meaningful legislation related to health care to slip off the public’s radar. Here are five substantial health-related policies that emerged from the recently ended session. They include bills that Gov. Greg Gianforte has signed or is expected to sign into law.

1. The permanent expansion of telehealth

One byproduct of the covid-19 pandemic has been the widespread use of computers, tablets and smartphones for medical and behavioral health appointments instead of in-person office visits. Telehealth has particularly benefited Montana’s large rural population during the pandemic.

“A lot of Montanans are in very rural areas and often need to take extended time off work, drive long distances, find child care just so they can attend a routine health care appointment,” said state Sen. Jen Gross (D-Billings).

Gross sponsored one of two Montana bills that make permanent the expanded telehealth regulations set by emergency order at the start of the pandemic last year. The new laws redefine telehealth to include nonclinical health services, require private insurers and Medicaid to cover telehealth services and authorize state licensing boards to set rules regulating the practice.

The new laws also allow audio-only telehealth appointments, which supporters say are needed for rural areas without broadband internet coverage. An exception is that a doctor can’t certify a patient for the state’s medical marijuana program by phone without a previously established doctor-patient relationship. Telehealth by text messaging and fax alone is also still illegal.

The boom in virtual health care is being met with concern by local providers who worry that large out-of-state providers might poach patients and by regulators who see the potential for telehealth scams and fraud.

2. The weakened authority of local public health officials

Lawmakers fettered local public health officials with legislation after local health departments implemented and enforced state and federal recommendations to stop the spread of the coronavirus, such as mask mandates, limits on gathering and bans on indoor dining.

Many public health officials have faced threats and harassment over their work to enforce those covid restrictions, leading to high rates of turnover in health departments across the nation.

One measure passed by Republican-majority lawmakers ensures that any Montana public health order can be changed or repealed by elected officials, such as a county commission, and it bans officials from placing any restrictions on attending church services.

Another measure bars public health officials from issuing orders that restrict the ability of a private business to operate. There are some exceptions, such as restaurant health inspections. A third allows citizens to amend or reject public health orders by referendum, while a fourth overturned a law that penalized law enforcement officials who refused to enforce public health orders.

State lawmakers also added a provision in a bill on how to distribute the federal aid in the American Rescue Plan Act that would withhold 20% of any infrastructure grant made to a city, town or county if that local government enforces covid restrictions such as mask mandates and restaurant limits. Gianforte lifted those statewide restrictions after taking office, and the provision takes aim at local governments, like Gallatin County, that decided to keep their own restrictions.

“It’s time for us to make sure the state is open,” said Rep. Frank Garner (R-Kalispell), who backed the provision.

3. Making it more difficult to stay enrolled in Medicaid expansion

Lawmakers cut funding for the state Medicaid expansion program’s 12-month continuous eligibility provision, which has allowed people enrolled in the program to receive benefits for a full year, regardless of changes to their income.

Continuous eligibility is meant to reduce the churning of Medicaid expansion rolls as people are added and removed if their income fluctuates, such as with seasonal work.

Instead, those enrollees will be required to certify their eligibility more than once a year. Department of Public Health and Human Services spokesperson Jon Ebelt said in an email that the department has reached out to the federal Centers for Medicare & Medicaid Services for guidance on how to make the change after the pandemic emergency ends.

Nearly 98,000 Montana adults were enrolled in the Medicaid expansion program in March, according to the most recent data.

4. Anti-vaccinators make their mark

Riding a wave of opposition toward the covid vaccines, the Montana Legislature passed a bill that makes it more difficult to require workers to be vaccinated as a condition of employment. That measure received much publicity and several last-minute amendments in the session’s final days as hospitals and long-term care facilities warned it would force them to require face masks for employees and permanently ban visitors. The bill that passed “poses a significant threat to public safety,” Montana Hospital Association CEO Rich Rasmussen said.

Another consequential vaccination bill that received less attention will make it easier for parents to obtain medical exemptions for their children for vaccines required by schools. State law requires kids to be vaccinated against illnesses such as measles and pertussis to go to school, but students can be exempted for religious or medical reasons.

Previously, a physician needed to sign off on a medical exemption. The new law allows a wide range of health professionals to do so, including nurses, pharmacists, massage therapists, chiropractors and nutritionists. It also makes it more difficult for schools to share exemption data with health officials.

Some parents who testified in support of the bill during legislative hearings said they wanted a medical exemption option because their children might need that medical documentation in the future to attend college or get a job that might not accept a religious exemption.

The state health department and the American Academy of Pediatrics opposed the legislation. “This bill has the effect of making medical exemptions extremely easy to obtain in cases where they might not be warranted,” said Dr. Lauren Wilson, a pediatrician and vice president of the Montana chapter of the American Academy of Pediatrics.

5. Hearing aids for kids

Lawmakers passed a bipartisan measure that will require private insurers and the state employee health plan to cover hearing amplification devices and services for children 18 and under.

The new law won’t affect a large number of people in the state, but supporters said it will make a difference in the lives of families who spend $6,000 every three to five years on hearing aids for their children.

Kiera Kirschner of Bozeman testified before lawmakers during the session that her 2½-year-old son was born with hearing loss and has had hearing aids since he was 2 months old.

“My son did not choose to have hearing loss,” Kirschner said. “He needs hearing aids so he can grow and develop. They’re medically necessary.”

Montana is the 26th state to require such insurance coverage, and insurers said they did not oppose the measure because the total cost would not be significant.

Covered California dice que el seguro de salud se ha vuelto demasiado barato como para ignorarlo

Una nueva ley federal podría hacer que sea mucho más barato comprar tu propio seguro si no tienes cobertura a través de un empleador o un programa del gobierno como Medicare o Medicaid.

La ley proporciona miles de millones de dólares federales para reducir las primas de las personas que compran cobertura a través de los mercados de seguros establecidos por la Ley de Cuidado de Salud a Bajo Precio (ACA).

Esta ayuda amplía un crédito fiscal federal creado por ACA que se puede recibir por adelantado como un descuento en tu prima, o como un reclamo en tus impuestos del año siguiente. Estos subsidios está disponible para quienes compran pólizas individuales o familiares en el mercado privado por fuera de los intercambios de ACA. Por lo tanto, si tienes un plan de salud por fuera de estos mercados, podrías ahorrar mucho dinero si cambias a uno que ofrezcan los mercados de ACA.

Si ya estás inscrito en un plan del mercado de seguros, podrías ver una cuenta más baja, en muchos casos mucho más baja, comenzando tan pronto como con tu prima de mayo.

Covered California, el mercado de seguros de salud de ACA del estado, abrió un período de inscripción especial el 12 de abril para las personas que quieran aprovechar la nueva ayuda al inscribirse o cambiar de cobertura. El período se extiende hasta diciembre. Los subsidios recientemente mejorados entran en vigencia con la cobertura que comienza el 1 de mayo. Para obtener cobertura el primer día de cualquier mes, solo necesitas inscribirte el día anterior.

Casi el 90% de los beneficiarios de Covered California ya reciben ayuda financiera, y muchos ahora recibirán más. Algunos afiliados que antes no calificaban para créditos fiscales ahora pueden ser elegibles.

Darci Gutiérrez, una agente de seguros en Dublin, California, dijo que un cliente con una familia numerosa ahorró $425 al mes en una PPO de Blue Shield en el nivel Plata, el segundo nivel más bajo de cobertura.

“Me sorprendió la cantidad de reducción de costos. Yo estaba como, ‘Santo cielo’”, dijo Gutiérrez.

Está previsto que la ayuda federal adicional se detenga después de 2022, lo que significa que tu seguro podría costarte más después.

La nueva ley también asigna dinero para brindar una cobertura prácticamente sin prima, solo en 2021, para cualquier persona que reciba beneficios por desempleo en cualquier momento durante el año.

Si ya estás inscrito en Covered California, puedes mantener tu plan y aprovechar los ahorros, o puedes comparar precios y ahorrar aún más, o cambiar a un nivel más alto de cobertura sin aumentar tu gasto mensual.

Si no cambias, Covered California calculará automáticamente tu prima más baja y verás un crédito de mayo en tu factura de junio. También obtendrás ese ahorro de manera retroactiva durante los primeros cuatro meses de 2021 en forma de una reducción adicional de la prima, en cuotas mensuales iguales, durante el resto del año.

Sin embargo, si no tienes seguro o tienes un plan de salud por fuera de los mercados de seguros de ACA, debes tomar medidas. Investiga tus opciones e inscríbete, o cambia de plan.

Para saber si reúnes los requisitos para recibir asistencia federal, inicia una sesión en el sitio www.coveredca.com/espanol.

Haz clic en el botón “busca y compara” para encontrar los planes de salud disponibles para tí en tu área, junto con la prima mensual que pagarás después que se descuento tu subsidio.

También puedes hacer clic en un botón para recibir una llamada de un agente de seguros de salud certificado que puede ayudarte a resolver todo, sin cobrarte. Si no tienes una computadora, llama a línea de Covered California en español, al 800-300-0213.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

Covered California Says Health Insurance Just Got Too Cheap to Ignore

If you are uninsured because health coverage seemed too expensive the last time you looked, it’s time to look again.

A new federal law could make it a whole lot cheaper to buy your own insurance if you don’t get coverage through an employer or a government insurance program such as Medicare or Medicaid.

The law, the American Rescue Plan, provides billions of federal dollars to reduce premiums for people who buy their coverage through the insurance exchanges established by the Affordable Care Act.

The aid expands a federal tax credit created by the ACA that you can take upfront as a discount on your premium or claim when you file your taxes the following year. It is not available for those who buy individual or family policies in the open market outside an ACA exchange. So, if you are in an off-exchange health plan, you might save a lot of money by switching to one inside the exchange.

Covered California, the state’s ACA exchange, opened a special enrollment period on April 12 for people who want to take advantage of the new aid by enrolling or switching coverage. The period runs through December — 4½ months later than the Aug. 15 special enrollment end date on the federally run exchanges.

Covered California estimates the new money will reduce its customers’ monthly premium bills by an average of $180 per household. Nearly 90% of Covered California enrollees already get financial aid, and many will now get more. Some enrollees who didn’t previously qualify for tax credits may now be eligible.

Darci Gutierrez, an insurance agent in Dublin, California, says a client with a large family saved $425 a month on a Blue Shield PPO at the silver tier — the second-lowest level in the ACA’s four-tier system of coverage.

“I was shocked at the amount of reduction in cost. I was like, ‘Holy cow,’” Gutierrez says.

The additional federal aid is slated to stop after 2022, which means your insurance could cost you more after that. But there is talk in Congress about extending the enhanced tax credits for longer.

The new law follows the lead of California, which provided groundbreaking state-funded tax credits starting last year to augment the ACA credits and push eligibility for aid well into the middle class. The new federal dollars will provide assistance even further up the income scale.

Covered California estimates 100,000 consumers with incomes too high to qualify for federal or state credits under prior law will now be eligible for subsidies averaging $500 a month per household.

The share of the new money going to California could be about four times as much as those state-funded subsidies and will completely replace them, saving the state about $761 million this fiscal year and next.

The newly enhanced federal tax credits take effect with coverage that starts May 1. To get coverage for the first of any month, you need only sign up by the day before.

If you are currently enrolled in Covered California, you can keep your plan and take the savings, or you could shop around and save even more — or switch to a higher level of coverage without increasing your monthly bill.

“It’s critical that anybody who buys coverage as an individual take a look, because they may be leaving hundreds if not thousands of dollars on the table,” says Anthony Wright, executive director of Health Access, a Sacramento-based consumer advocacy group.

The new law, signed by President Joe Biden in March, also allocates money to provide virtually premium-free coverage — in 2021 only — for anyone, regardless of income, who receives unemployment benefits at any point during the year.

California is projected to get about $3 billion of the new federal money. Officials at Covered California think the state can get even more, and the exchange is spending more than $20 million on a television, radio and social media advertising blitz to drum up business. It is targeting in particular the approximately 810,000 uninsured Californians who are eligible for federal support under the new law.

“We need to rattle uninsured people to look again and realize this is new and different,” says Peter Lee, Covered California’s executive director. “If they think it’s just the same old same old, they ain’t going to check.”

Covered California is also marketing itself to an additional 270,000 people who are enrolled in health plans outside the exchange and would qualify for subsidized coverage if they switched to Covered California.

In an example used by Covered California in its promotional campaign, an Oakland couple making $77,580 a year, both 45 years old, pay the full monthly premium of $1,271 for a silver plan outside the exchange. By switching to the same plan in Covered California, they would pay only $550 — a monthly saving of $721.

If you are a current enrollee, Covered California — unlike the federally run exchanges — will automatically calculate your lower premium, and you will see a credit for May on your June bill. You will also reap that saving retroactively for the first four months of 2021 in the form of an additional premium reduction, in equal monthly installments, over the rest of the year.

If you are uninsured or in an off-exchange health plan, however, you need to take action. The money won’t just come to you. Research your options and enroll.

To find out if you qualify for federal assistance, log on to www.coveredca.com.

Click the “shop and compare” button to find the health plans available to you in your area, along with the monthly premium you will pay after your tax credit.

You can also click a button to get a call from a licensed health insurance agent who can help you figure it all out — without charging you. If you don’t have a computer, call Covered California at 800-300-1506.

In contrast to the federally operated exchanges, Covered California requires that people switching from off-exchange health plans into exchange-based ones be allowed to apply any deductible paid so far this year against the new policy, as long as they don’t change insurance companies. That flexibility also applies if you are exchanging one Covered California plan for another, but with more restrictions, so ask your health plan before you make any changes.

If you are coming to Covered California from the open market, it should be easy to keep doctors you like, since most off-exchange plans mirror ones in Covered California and have the same networks. But there are cases in which you would not be able to keep your doctors, so be sure to ask your insurer about it before making a final decision.

Another notable feature of the new federal tax credits is that they no longer carry upper-income limits for eligibility. Instead, the amount people pay in premiums is limited to a fixed percentage of their income, ranging from zero for low-income consumers to 8.5% for the most affluent.

For the 2020 tax year, the new law overrides a requirement that consumers whose incomes exceeded their original estimate pay back any subsidy amounts to which they are not entitled.

Tom Freker, an insurance agent in Huntington Beach, California, says one of his clients made a big profit on a property sale last year, which raised his income to a level that would have required paying back the $10,000 subsidy he received in 2020.

“But the new American Rescue Plan waived that repayment,” Freker says. “That’s a big deal.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN’s ‘What the Health?’: 100 Days of Health Policy


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It’s been a busy 100 days for the Biden administration on health policy. The promise Joe Biden made as president-elect to get 100 million covid vaccinations in arms was doubled, healthcare.gov reopened to those without insurance, and steps were taken to undo a raft of health policies implemented by President Donald Trump. The covid relief bill passed by Congress in March also boosted subsidies for those who buy their own coverage and provided incentives for the 12 states that have yet to expand their Medicaid programs under the ACA.

But those actions may prove the high point for health policy this year. Administration officials initially promised that health would be a major part of the president’s $1.8 trillion American Families Plan, but major changes, particularly those addressing prescription drug costs, were nowhere to be seen when the plan was unveiled Wednesday.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet

Here are some takeaways from this week’s podcast:

  • Among the Trump administration health policies the Biden administration has moved to reverse are those on women’s reproductive health and Medicaid work requirements. Some experts suggest that Democratic officials pushed forward on this with good speed because the past administration’s health policies were easier to disentangle than its rules on environment, where Biden also wants to make changes.
  • Democratic lawmakers had seemed eager to use Biden’s family plan to expand Medicare or drive down prescription drug prices. It likely signals that while health care is a key issue for Democrats on Capitol Hill, it is not as big a priority in the White House. Biden, who did mention those policies favored by progressive lawmakers in his speech to Congress on Wednesday, seems to be putting his emphasis on strengthening the Affordable Care Act.
  • Right now, the pharmaceutical industry is scoring high with voters and politicians because of the successes of the covid vaccines. So, getting Senate approval of a bill to allow Medicare to negotiate drug prices is likely to be difficult. Those odds get even tougher without pressure from the White House.
  • Biden may also have shied away from the drug pricing initiative in his formal plan for helping families because he was concerned that it could divide the Democratic caucus and imperil the overall initiative.
  • The administration is gearing up to provide India with help to fight the pandemic. Public health officials point out that although the vaccination effort in the U.S. is going well, it is imperative to tamp down the virus in other countries so variants that could evade the vaccines don’t develop. However, there is already a debate about how much U.S. vaccine to ship abroad before authorities determine how to vaccinate children here.
  • Federal health officials have lifted the pause on using the Johnson & Johnson covid vaccine, but that decision has been controversial and some scientists question whether there was enough study or it was the right move.
  • The Centers for Disease Control and Prevention loosened its mask-wearing recommendations for people who have been vaccinated, but the new rules are confusing and even sparked some jokes among late-night TV comedians.
  • As the vaccination efforts in the U.S. gain steam, interest is growing among people with long-term cases of covid-19. A hearing on Capitol Hill this week looked at some of the issues, such as what sorts of disabilities these patients face and what workplace accommodations are necessary.
  • The National Institutes of Health is beginning major studies of “long covid” and its myriad symptoms. Although health officials do not yet have a clear definition of long covid, they are generally not dismissing patients’ complaints about the disorder. That differs from some mysterious ailments in the past.
  • The Biden administration has loosened the rules governing who can prescribe the drug buprenorphine, a controversial but effective treatment for opioid addiction. The policy eliminates a training requirement and seeks to allow medical professionals other than doctors to prescribe the drug. But hurdles to its use remain, leading some to question how much more widely the drug will be used as a result of the new policy.

Also this week, Rovner interviews KHN’s Julie Appleby, who reported the latest KHN-NPR “Bill of the Month” feature — about the intersection between car insurance and health insurance. If you have an outrageous medical bill you’d like to share with us, you can do it here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: This American Life’s “The Herd,” by Ira Glass, Anna Maria Barry-Jester and David Kestenbaum. Also, KHN’s “We’re Coming for You’: For Public Health Officials, a Year of Threats and Menace,” by Anna Maria Barry-Jester.

Joanne Kenen: The New Yorker’s “How Vaccine Hesitancy Is Driving Breakthrough Infections in Nursing Homes,” by Masha Gessen.

Mary Ellen McIntire: CQ Roll Call’s “FEMA’s Tasks Pit COVID-19 Vaccinations Against Hurricane Prep,” by Emily Kopp.

Sarah Karlin-Smith: The Pink Sheet’s “Conflicts Galore: Upcoming Accelerated Approval Cancer Panel Includes Many Industry Relationships,” by Sarah Karlin-Smith.


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