Health Affairs, 27, no. 2 (2008): 574-576 doi: 10.1377/hlthaff.27.2.574 © 2008 by Project HOPE	New Online   May/June Issue: Health Reform Revisited   Reform and '08 Election   Promoting off-label drug use information

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GrantWatch

EDITOR’S NOTE: Some parts of the GrantWatch section are published on the Web only. The online-only material usually includes selected coverage of both recently announced grants and publications about or funded by foundations. (Reporting of selected grant outcomes and key personnel changes at foundations, as well as GrantWatch essays, reports, and interviews, are published in both print and online form.)

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GrantWatch is funded in part by the Robert Wood Johnson Foundation.

Medicaid

Recent grant:

University of California, San Diego (UCSD), School of Medicine, La Jolla, CA. Rick Kronick and colleagues at UCSD will investigate small-area variations in use of Medicaid services and in Medicaid payments to providers and will explore the implications of these variations on quality of care and on Medicaid expenses. The study aims to provide policymakers with an understanding of the effect of policy choices regarding Medicaid benefit limits and payment rates on costs, use of services, and quality of care. The researchers “will compare the services received and cost of care for Medicaid beneficiaries across state Medicaid programs" and across regions within states and determine how much variation there is, said Kronick. They will also determine “the extent to which variation in expenditures per beneficiary” results from “variation in the rate of use of services” and how much of it can be attributed to “variation in the rate of payment per unit of service,” according to Robert Wood Johnson Foundation (RWJF) materials. Kronick also wants to see whether variations in the use of services and in expenses per Medicaid beneficiary relate to variations in the quality of care received or the outcomes of care. Kronick, who is a professor in the medical school’s Department of Family and Preventive Medicine, told Health Affairs that he and his colleagues also plan to produce a Medicaid Atlas of Health Care under this grant.

$336,513 over eighteen months. Funded by the Robert Wood Johnson Foundation.

Reports:

The Effects of Medicaid Reimbursement Rates on Access to Dental Care, Alison Borchgrevink (a Presidential Management Fellow) and Andrew Snyder and Shelly Gehshan of the National Academy for State Health Policy (NASHP), March 2008, 32 pp., including appendix, http://www.nashp.org/Files/CHCF_dental_rates.pdf. Funded by the California HealthCare Foundation. The report says that “state Medicaid programs are required by federal law to provide dental services to eligible children”; however, “in 2006, only one in three children [enrolled] in Medicaid received a dental service.” Private dentists provide most of that care in the United States. Dentists cite three main reasons for their low Medicaid participation rate: “low reimbursement rates, burdensome administrative requirements, and problematic patient behaviors.” Borchgrevink and coauthors compare the efforts of six states that used “a variety of approaches” in the late 1990s and early 2000s “to address access concerns,” with the experiences of California. This NASHP study aimed to answer the question: “What effect does raising Medicaid reimbursement rates [for dentists] have on access to dental care?” Among the report’s findings is that “rate increases are necessary—but not sufficient on their own” to improve access. Another finding is that “provider participation increased by at least one-third” after rate increases in the study states; subsequently, “patients’ access to care. . . increased.” What do the authors suggest for California, where dentists have “the same complaints”? The report says that although “reimbursement rate increases of the scale undertaken by study states like Alabama and Tennessee may not be possible” because of California’s “current fiscal situation,” the Golden State might consider the “lower-cost” ideas of “reducing administrative barriers or crafting a more targeted rate increase.” (Such increases are “for selected services or special populations,” the report explains.)

Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles—A Fifty-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2008, Donna Cohen Ross and Aleya Horn of the Center on Budget and Policy Priorities and Caryn Marks of the Henry J. Kaiser Family Foundation’s (KFF’s) Kaiser Commission on Medicaid and the Uninsured, January 2008, 68 pp., including tables, http://www.kff.org/medicaid/upload/7740.pdf. This Kaiser Commission report covers all states and the District of Columbia in the period July 2006–January 2008. As for increasing “access to health coverage for children and families in Medicaid and SCHIP [the State Children’s Health Insurance Program],” the authors report that 2007 saw “strong forward momentum.” However, some “federal developments,” such as the Deficit Reduction Act (DRA) of 2006’s requirement that those applying for Medicaid must document their citizenship and the fact that SCHIP was only temporarily extended, not reauthorized, are “dampening the prospects for making real progress.” Other flies-in-the-ointment are “emerging state budget deficits and potential pressure to cut state spending,” which are “placing the hard-won progress on children’s health coverage at further risk.” The report is based on a national survey. Among survey findings was that almost two-thirds of states acted “to increase access to health coverage for low-income children, pregnant women, and parents” (and “the most vigorous activity was focused on children”) during the study period. Also, “no state cut back income eligibility for children.” However, “income eligibility for parents still lags behind eligibility for children”—that is, it is harder for parents to qualify for Medicaid, based on income. Report coauthor Aleya Horner told Health Affairs on 23 April 2008 that since the report was released, “There has been a lot of activity regarding the ‘hurdles’” mentioned; “however, none of the federal policies mentioned have been rescinded.”

Long-Term Care in Balance: The Role of Medicaid Policy in Pennsylvania, Howard B. Degenholtz and Judith R. Lave of the Pennsylvania Medicaid Policy Center at the University of Pittsburgh, 21 December 2007, 28 pp., including appendices, http://pamedicaid.pitt.edu/documents/PA%20long%20term%20care%20rebalancing%20-%20final.pdf. In 2006 the Pew Charitable Trusts established this center “to help stakeholders in Pennsylvania understand the facts about Medical Assistance [Pennsylvania Medicaid],” according to the Pew Prospectus: 2008. The center’s mission includes being “independent” and “nonpartisan.” Major support for the center comes from Pew, with additional funding from the Jewish Healthcare, North Penn Community Health, Brandywine Health, and Pottstown Area Health and Wellness Foundations. The center’s Web site contains this helpful Frequently Asked Questions page about Pennsylvania Medicaid. The report explains that “in Pennsylvania, as in other states, there are major ongoing efforts to shift LTC [long-term care] spending away from nursing homes and toward home and community-based alternatives.” The report gives an overview of LTC programs in Pennsylvania. The authors also “discuss several policy options” having to do with “expanding community-based long-term care.” They make seven recommendations—for each of them, they explain the rationale and discuss “potential costs and benefits.” Among the recommendations is “Expand consumer directed home care for the elderly.” Here, the authors mention that Pennsylvania received a demonstration grant from the RWJF “to develop and implement” a Cash and Counseling model. The authors conclude that “Pennsylvania provides a substantial level of service in home and community-based settings” for the mentally retarded and developmentally disabled populations; however, “there is significant room for improvement” as to such services for the disabled elderly. Degenholtz commented to Health Affairs that “since the report came out, the state has been developing regulations to put [a recently] created assisted-living residence licensure category into effect.”

Medicaid Managed Care Reexamined, Michael Sparer of Columbia University, February 2008, 49 pp., http://www.uhfnyc.org/pubs-stories3220/pubs-stories_show.htm?doc_id=673869. Published by the Medicaid Institute at United Hospital Fund. (The United Hospital Fund is classified as a public charity: It can both award and receive grants. The Medicaid Institute receives most of its funding from the State of New York.) This report about New York State’s Medicaid program says that the state is forging ahead with efforts to urge the more than 1.6 million people still “in fee-for-service to enter some type of managed care system.” However, “there are still surprisingly few efforts to examine how well the [managed care] program is achieving its basic goals,” the report notes. Among the issues Sparer discusses are Medicaid client “churning”; benefit carve-outs—he maintains that, of the factors driving “the decision to carve services out of the managed care benefit package,” only one is in “the best interest of the beneficiary”; and health plans’ strategies to improve quality of care. In answer to the question, “Has Medicaid managed care been successful” in the state, the report says there have been “some impressive achievements”; on the other hand, New York does not seem to have “achieved its underlying goals,” and “there is ongoing uncertainty” as to whether the state is pursuing the correct managed care strategy. Sparer cites several concerns, including the following: “No independent evidence exists that the managed care initiative has lowered health care costs.” He says that managed care clearly has potential, but the challenge is to figure out “how to turn that promise into better care for all Medicaid beneficiaries.”

Related resources:

Bad Medicine: The President’s Medicaid Regulations Will Weaken State Economies, Families USA, series of short reports on twenty-four individual states, being released 15-29 April 2008, http://www.familiesusa.org/resources/publications/reports/bad-medicine.html. This advocacy group is looking at the effects on various states of seven Medicaid regulations, “taken together,” that were issued by the Bush administration in 2007. Specifically, the group’s “reports are based on taking a loss of federal dollars in a given state and calculating the corresponding economic impact on business activity, jobs, and wages in that state.”

Congress Should Support HHS [U.S. Department of Health and Human Services] Efforts to Curtail Medicaid Mismanagement,” Nina Owcharenko of the Heritage Foundation, 6 March 2008 WebMemo, 2 pp., http://www.heritage.org/Research/HealthCare/upload/wm_1837.pdf. Owcharenko, a senior policy analyst with Heritage (a think tank espousing such principles as free enterprise and limited government) focuses here on five of the Medicaid regulations mentioned above.

“Congressman Sarbanes Works to Protect Medicaid, Rep. John Sarbanes (D-MD), press release 24 April 2008, http://www.house.gov/apps/list/press/md03_sarbanes/042408.shtml. This release announces the U.S. House of Representatives’ passage of H.R. 5613, “Protecting the Medicaid Safety Net Act of 2008.” Sarbanes’ office explains that this bill “would place a moratorium. . . on seven Medicaid regulations issued by the [U.S.] Department of Health and Human Services” and details the regulations. Here is the Congressional Budget Office’s 22 April 2008 Cost Estimate of the legislation as it was reported by the House Committee on Energy and Commerce 16 April 2008; the bill passed the House 23 April 2008 and has been sent to the U.S. Senate. MaKeda Scott, press secretary for Rep. Sarbanes, explained to Health Affairs that this bill now “will need to be taken up and passed by the [U.S.] Senate” and that the Senate is expected to pass it. Go to THOMAS, the legislative information service of the Library of Congress, for the latest information on this bill.

Health Advocate, National Health Law Program (NHeLP) newsletter, Winter 2008, http://www.healthlaw.org/library/attachment.79663?print. The newsletter, which contains articles on Medicaid and other topics, is available by subscription only. NHeLP is a national public interest law firm.

“State Would Take Medicaid Hit in Bush Plan,” Lynn Bonner, Raleigh, North Carolina, News and Observer, 22 April 2008, http://www.newsobserver.com/news/story/1045934.html. This story reports on Families USA’s analysis of how North Carolina would fare under the Bush administration’s Medicaid regulations.

News of Foundations and Philanthropy

Announcements of changes at two foundations; a philanthropy center launched

The W.K. Kellogg Foundation announced a reaffirmation and refining of its mission statement in December 2007. The foundation “supports children, families, and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and society.” Kellogg is placing “a stronger focus on helping vulnerable children succeed,” according to its Web site. Kellogg recommends that grantseekers “delay sending unsolicited proposals for U.S.-based projects” and adds that “it is our hope that by summer 2008, we will be able to offer more details on our new strategic framework.” Meanwhile, here is the foundation’s proposed strategy for change. Among the funder’s “key approaches” will be a focus on “key policy issues.”

At the Grantmakers In Health annual meeting in February 2008 in Los Angeles, Kellogg Foundation president and chief executive officer, Sterling Speirn, told attendees about the funder’s five new program elements and other insights about the foundation’s plans. One element is “food, health, and well-being.” Speirn told attendees that children’s needs under that element include “high-quality food, physical activity, . . . and access to health care.”

Northwest Health Foundation (NWHF), which funds in Oregon and southwest Washington, has a new strategic plan, approved in December 2007. Its “core interest areas” are “access to [high-]quality health care, public health, and the nursing workforce,” according to Thomas D. Aschenbrener, in his President’s Message. The first two are new. Within the interest areas, the NWHF will focus on “strategies we believe will advance the social change that is necessary to eliminate health disparities and improve community health over the long term.” He noted that the funder’s “programs are becoming increasingly focused.” The NWHF is also gradually transitioning to a grant-making strategy “built on specific funding initiatives”; requests for proposals will be used more frequently. The foundation’s advocacy and policy priorities for 2009 will be announced in June 2008. Here are answers to some frequently asked questions about the foundation. Also, the foundation sponsors a blog called Talk Health Reform, “a public conversation about health policy in the State of Oregon.”

“Sillerman Center Draws Crowd for Inaugural Philanthropy Lecture (video),” Brandeis University, press release, 30 January 2008, http://www.brandeis.edu/news/2008/january/sillermanlecture.html. Read about the Heller School for Social Policy and Management’s recently opened Sillerman Center for the Advancement of Philanthropy. Joel Fleishman of Duke University was the speaker at the official opening. According to the release, alumnus Robert Sillerman and his wife, Laura, “established the Sillerman Center to promote activist philanthropy that leads to social, community, and policy change.” The Sillermans donated $10 million for the center through their Tomorrow Foundation. Andy Hahn, a Heller professor, directs the center. An article in the Summer 2007 Brandeis University Campaign Connections newsletter explained that the center “will serve as a powerful resource to strengthen the country’s 34,000 family foundations as they partner with non-profit organizations to deliver crucial health and social services.” The article also said that the center “will provide research-supported advice on effective grant-making strategies, develop best practices, and help successful ventures expand their reach.” Hahn told Health Affairs that the center began operations in September 2007.