Health care is a perennial pain in every state legislature’s side – pardon the pun – and 2016 is shaping up to cause just as many headaches for statehouses and their budgets as usual.
As of October 19, the National Conference of State Legislatures had identified 325 newly enacted laws and resolutions in 45 states, D.C. and Puerto Rico related to health care. While they don’t publish totals for filed non-enacted bills, the organization says there are well over 1,000 across all 50 states and districts. That’s a lot of state legislation being slung around that state health care trackers need to keep tabs on.
A significant portion of states’ budgets are earmarked for health care related expenses, which is why it’s not surprising state legislatures introduce such a large number of bills a year related to health care spending and administration.
Top health care issues
So what are the top health care issues affecting the states for which legislation is being introduced? What are the health care issues you should be paying attention to?
Medicaid, a public health coverage program for low-income children, their parents, the elderly and people with disabilities, is a federal/state partnership with shared authority and financing. Medicaid pays for health and long-term care services for more than 55 million people. Although participation is optional, all 50 states participate.
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Eligibility requirements vary by state, but provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income is at or below 133% of federal poverty guidelines ($14,484 for an individual and $29,726 for a family of four in 2011.) States have the option to opt out of the expansion program.
Thus far, 29 states and the District of Columbia have agreed to expand Medicaid eligibility and four more states are considering it.
Alaska’s Gov. Bill Walker on July 16, 2015, announced he would use his executive power to expand Medicaid to about 40,000 additional residents. The governor sent a letter to Alaska’s Legislative Budget and Audit Committee, giving it the required 45-day notice that he planned to accept federal funding to expand the program and the state’s Medicaid expansion went into effect on Sept. 1, 2015.
The Florida Senate in 2015 approved a Medicaid expansion plan, but it was rejected by Gov. Rick Scott and the statehouse. State lawmakers expect to debate Medicaid expansion again in 2016.
Health care worker shortages
More than 17 million new Americans have become insured since the Affordable Care Act was fully implemented, but the number of health care providers, including primary care providers, is not anticipated to drastically increase. The health care workforce is strained and states are searching for ways to address the shortage.
Critical shortages remain in some health care professions and in certain geographic areas, according to Debra Miller, director of health policy for the Council of State Governments.
“Important areas of debate for state leaders include scope of practice laws, reimbursement rates, professional education standards, licensing requirements and telemedicine standards,” she said in a blog post earlier this year.
What a health professional can and cannot do to or for a patient is dependent on that health professional’s scope of practice, which is defined by state boards of medicine, boards of nursing, etc., oftentimes through state legislation.
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With evolving technology, many state legislatures are redefining the scope and standards of practice for several medical professions and telehealth services.
In March, Idaho’s governor signed into law the Idaho Telehealth Access Act, which defines the scope of practice for telehealth services, clarifies requirements for patient evaluation and treatment, relates to prescription drug orders, and requires providers to keep certain records and make them available to insurers, among other things.
Also in March, New York’s governor signed into law legislation that prohibits an insurer from excluding from coverage a service that is otherwise covered under a policy that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth. It also provides for the use of medical assistance funds for the delivery of telehealth services.
Health care delivery
States continue to look for ways to improve health care outcomes as a way to address rising health care costs, with many states focusing reform efforts on integrating health care with services typically considered human or social service efforts.
Several state legislatures in 2015 have introduced legislation aimed at reforming health care delivery in their state market and no doubt many more will do the same in 2016.
In June, Colorado enacted legislation to create the Cross System Response Pilot Program, which serves individuals with intellectual or developmental disabilities, provides crisis intervention, stabilization, and follow-up services to individuals who have both an intellectual or developmental disability and a mental health or behavioral disorder and who also require services not available through an existing home or community-based service.
In April, Mississippi’s governor signed into law legislation that authorizes the formation of provider-sponsored health plans, defines the term provider-sponsored health plan, and requires the Department of Insurance to establish a process for the certification of provider-sponsored health plans. The law also encourages the development of appropriate population or community health strategies, among other things.
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