NC Budget and Tax Center, public health

This health program transforms children’s lives — so why aren’t more in NC using it?

If you are a parent or guardian of a child who receives North Carolina Health Check, or you provide medical services to children with NC Health Check, chances are you have interacted with EPSDT. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT, for short) is a mandated guideline that works to ensure children receive the care they need when they need it.

EPSDT requires states to cover a broad array of medically necessary and rehabilitative services for children under the age of 21.

Successful implementation of EPSDT is a component of a robust preventative care model that recognizes how to address child health priorities and social determinants of health. However, parents and caregivers, as well as medical providers need more information about how to take full advantage of EPSDT.

Unfortunately, this lack of information translates into low utilization rates. In 2016, only 57 percent of children eligible for EPSDT in North Carolina received at least one initial or periodic screening. What’s more, utilization of EPSDT greatly decreases as children age. By the time children reach adolescence (ages 15-20 years), less than one-third of eligible children are receiving some kind of EPSDT related screening.

A recent report from the Budget and Tax Center and the Health Advocacy Project provides an overview of North Carolina’s EPSDT program and examines the effectiveness of the program as it relates to identified child health priorities and social determinants of health. By highlighting best practices at both the state and national level, the report offers practice and policy models for how EPSDT delivery can be improved or modified to address social determinants of health and ultimately improve child health outcomes.

North Carolina has several child health priorities including asthma, physical activity and nutrition, and depression, anxiety, and toxic stress. These health priorities are discussed within the context social determinants of health such as housing, neighborhood characteristics, and adverse childhood experiences. When used correctly, EPSDT is well-equipped to manage and improve child health and well being. EPSDT also allows for community-based treatment and care coordination, which greatly improves continuity of care and health literacy.

Currently, EPSDT delivery can be improved so that a higher level of preventative care is delivered to North Carolina Children. Looking forward, North Carolina faces a unique opportunity with plans to transform health care and social service delivery. State leadership is working to transition North Carolina’s Medicaid system to a Managed Care model. This allows for an opportunity to establish a health care delivery process that is preventative, cost-effective, and patient- and community-centered. Furthermore, North Carolina’s Section 1115 Waiver Application includes language to address social determinants of health such as housing, transportation, food insecurity, and toxic stress.

Read the full report here.

 

NC Budget and Tax Center

Rates of deep poverty are rising in NC and and across the nation

Just over seven percent of North Carolina households live in deep poverty, according to the 2015 American Community Survey. Deep poverty is defined as households living with incomes at or below 50 percent of the Federal Poverty Level, or less than $12,300 per year for a family of four. This amounts to a little more than $8 per person per day to survive on. Watauga County and Scotland County experience the highest rates of deep poverty in North Carolina, where nearly a fifth of households live in deep poverty. However, these numbers are likely an inadequate representation of the actual need because income is substantially underreported in the survey.

Since 1996 and the Personal Responsibility and Work Opportunity Reconciliation Act, also known as “welfare reform,” the nation has seen a rise in the number of families living in deep poverty. This trend can largely be attributed to the disappearance of cash-based benefits to families with low incomes such as Aid to Families with Dependent Children and the state Earned Income Tax Credit. As a result, a stable source of cash flow has become virtually nonexistent for those living in deep poverty, and many households live off less than $2 per person per day. Children are typically hit the hardest by poverty. In North Carolina 1 in 5 children live in households with incomes below the Federal Poverty Line. Children of color are more than twice as likely to live in poverty than white children.

Families living in deep poverty survive off of support from the Supplemental Nutrition Assistance Program (SNAP) and the informal economy. While cash assistance programs, such as Temporary Aid to Needy Families (TANF) are available, they are not adequate to meet the need of those living in extreme poverty and many families to do not apply because they do not think they will meet the program’s eligibility guidelines. In 2015, only seven percent of North Carolina families in poverty received TANF, falling far below the national average of 23 percent.

Commentary, Trump Administration

Senate to vote today on mystery health care bill

President Trump and Senate Majority Leader Mitch McConnell aren’t giving up on passing damaging legislation to repeal and (maybe) replace the Affordable Care Act and Medicaid. Despite McConnell delaying the Senate’s August recess to give his caucus more time for deliberations, the GOP has not been able to agree on a health care bill.

Now, McConnell is pushing a last ditch effort to move GOP healthcare plans forward against the wishes of the American public and nearly all provider and patient groups. Senators are expected to vote Tuesday on a “motion to proceed,” which, if passed, would allow the Senate to debate the future of the Affordable Care Act and Medicare and vote on amendments. However, many Senators are concerned because they have been left in the dark about which bill they will actually be voting on. There’s no shortage of bills that could possibly make up the motion to proceed, including: the Better Care Reconciliation Act, the Obamacare Repeal Reconciliation Act, or the House-passed American Health Care Act.

The fact is, each of the proposed health care plans would do irreversible harm to millions of Americans. What’s more, each proposed bill would wreak havoc on health insurance markets nationwide.

Here’s what we know about the proposals on the table:

  • Over 20 million Americans risk losing health care coverage altogether.
  • Medicaid funding—which covers 1.4 million North Carolina children, as well as people with disabilities and seniors in long-term care—would be slashed by 26 percent over ten years.
  • Protections for individuals with pre-existing conditions would be weakened, if not outright eliminated.
  • Plans may no longer be required to cover essential health benefits, such as hospitalization, maternity care, mental health, and medication.
  • Premiums would increase, especially for people with low-incomes and older adults.
  • Health insurance marketplaces would be destabilized as healthy consumers leave the risk pool.

The mystery bill needs to get past the motion to proceed before it can be discussed and signed into law. If the vote is unsuccessful the bill is considered dead…for now. That doesn’t mean the GOP will give up on repealing and replacing the Affordable Care Act and Medicaid. Since the ACA was passed in 2009, the House has held more than 50 votes to repeal former-President Obama’s signature legislation. Prior to May of this year, none of the bills were considered by the Senate. In the last month, however, the Senate had attempted to vote on a health care bill four times. Both the public and legislators are becoming impatient with the incessant focus on repealing and replacing the Affordable Care Act. A recent report from Axios states that many Trump supporters do not view repealing the Affordable Care Act a priority. Another report shows that 71% of the public favor a bipartisan effort to improve-not repeal- the Affordable Care Act.

We will see later today whether voters will get their wish.

Sydney Idzikowski is an MSW intern at the NC Justice Center

public health, Trump Administration

The silent killer of the Affordable Care Act

Screen grab from one of the HHS videos used as part of a multi-pronged social media campaign against the ACA.

A new report from the Daily Beast found that the Trump Administration is quietly using taxpayer money to undermine the Affordable Care Act, which remains law despite the Senate’s best efforts.  Tom Price, the Secretary of Health and Human Services, released a series of 23 testimonials videos featuring individuals describing how they have been burdened by the Affordable Care Act (ACA). The videos appeared on YouTube last month and have only accumulated a few hundred views each.

While this may seem like a small spiteful action, the money to produce these videos came from the “consumer information and outreach budget” which is intended to be used for informing the public about the ACA and encouraging enrollment.

In addition to the videos, HHS has pushed a multi-pronged social media campaign against the ACA. Not to mention, one of Trump’s first actions as President was to effectively kill ACA commercials with just 5 days left in Open Enrollment. This resulted in 424,000 less people enrolling in health insurance when compared to enrollments during the same time in the previous year.

This all seems relatively inexpensive, but the Trump Administration requested  $574 million for this specific budget item, though HHS declined to detail how much it has devoted to specific line items.

The true silent killer of the ACA has been reconstruction of the HHS.gov website. The website refuses to refer to the Affordable Care Act by name, replacing it with “the current law.” All info-graphs outlining the benefits of the ACA and key information, such as links to HealthCare.gov and critical enrollment dates, have been removed altogether. The website encourages consumers to use “private sector alternatives” instead of the Health Insurance Marketplaces established under the law.

HHS has also altered the HealthCare.gov website, removing the “Cost and Savings” tab where consumers can find information about where to find prices, if they have to pay penalties, or if they qualify for savings.

Needless to say, the Trump Administration is disregarding its responsibility to administer the Affordable Care Act and is putting significant resources into sabotaging the law through all means necessary. By quietly publishing anti-Affordable Care Act propaganda and removing vital information about the law from government websites, the Trump Administration continues to strip citizens of their rights under the ACA.

Andy Slavitt, former director of the Center for Medicare and Medicaid Services, puts it this way: “you’re not hired into the administration to decide whether you agree with the law you’re asked to execute. That’s not your job… Congress appropriates funds for you to carry out laws that they passed, not to spend those funds on activities that counteract those laws.”

Sydney Idzikowski is an MSW inter at the NC Justice Center

 

Commentary, Trump Administration

Trump’s budget would sink SHIIP counseling and leave seniors struggling to stay afloat

The ongoing effort in Congress repeal the Affordable Care Act is far from the only bad news from Washington of late when it comes securing health care for vulnerable people. Both of the budgets proposed by the Trump administration and the U.S. Senate would completely eliminate funding for State Health Insurance Assistance Programs. This would affect North Carolina’s assistance program, NC Seniors Health Insurance Information Program (NC SHIIP), which relies heavily on federal funds to provide valuable services to North Carolina’s Medicare beneficiaries.

NC SHIIP offers free, unbiased, accurate, and highly personalized one-on-one counseling to residents in all 100 North Carolina counties. In 2016 alone, NC SHIIP counseled more than 105,000 Medicare beneficiaries. NC SHIIP operates under a cost-effective and innovative model, utilizing a small paid staff and a network of approximately 1,000 trained volunteer counselors to meet the needs of North Carolina’s Medicare recipients. The counselors meet with Medicare beneficiaries, many of whom are elderly, retired, or disabled, to explain the increasingly complex Medicare program and to ensure consumers are taking full advantage of their benefits. Last year, NC SHIIP helped North Carolinians save more than $44.3 million on Medicare coverage and prescription drug costs. These cost savings are especially pertinent, given that 1 in 4 beneficiaries who rely on NC SHIIP have incomes below 150% of the Federal Poverty Level. This blatant disregard for the importance of consumer assistance programs puts the future of NC SHIIP at risk.

Mike Causey, North Carolina’s Commissioner of Insurance shared his support for NC SHIIP in a recent brief, stating, “Removing this program would eliminate the best and most reliable free and local resource that Medicare beneficiaries have in North Carolina.”

Without NC SHIIP, confused consumers will be forced to utilize a federal resource that is not equipped to handle the call volume or offer personalized assistance necessary to adequately explain Medicare benefits.

The proposed federal budgets are a direct attack on North Carolina’s most vulnerable. NC SHIIP protects the Medicare benefits of North Carolina residents who are elderly, disabled, and low-income. The program ensures access to affordable and comprehensive health care coverage. Without federal funding, NC SHIIP would be unable to provide these critical services. The House of Representatives is scheduled to debate the 100% funding cut for State Health Insurance Assistance Programs in the next few weeks.

Sydney Idzikowski is an MSW intern at the N.C. Justice Center.