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Failing Children’s Health: New Medicaid Program Aims for Coordinated Care

by Chief Editor
written by Chief Editor

The Future of Pediatric Care: Moving Beyond Silos with Integrated, Value-Based Models

For too long, the healthcare journey for children with complex medical and behavioral needs has been fragmented. Parents often find themselves as the sole coordinators of care, navigating a maze of specialists, therapies and school support systems. This unsustainable model not only burdens families but as well leads to poorer health outcomes and increased costs. A shift is underway, driven by initiatives like the Centers for Medicare and Medicaid Services’ (CMS) new ASPIRE program, to create a more integrated and effective system.

The Problem with Fee-for-Service

The traditional fee-for-service model incentivizes quantity over quality, leading to siloed care where providers operate independently. This lack of communication can have serious consequences. Children with autism, for example, benefit significantly from early interventions like speech therapy and behavioral treatment. But, if these services aren’t coordinated, children may miss critical windows of opportunity for optimal development. Research demonstrates that children receiving these interventions before their second birthday show improved social and communication skills later in life.

The consequences of this fragmented approach are stark. Children covered by Medicaid with high and rising health risks are 56% more likely to visit the emergency room and 53% more likely to be hospitalized compared to those with private insurance. In severe cases, children may require care in institutional settings or even be forced to abandon school.

ASPIRE: A New Path Forward

ASPIRE (Accelerating State Pediatric Innovation Readiness and Effectiveness) represents a significant step towards addressing these challenges. The $125 million pilot program will support up to five states in transforming how they utilize Medicaid and CHIP funds to treat children with complex conditions and those at risk of developing them. The core principle is a “whole-child” approach, connecting physical health, behavioral health, and community support services.

A key component of ASPIRE is a shift away from fee-for-service towards value-based care. This means providers will be incentivized not just for the volume of services they deliver, but for the quality of care and the outcomes they achieve. Incentive payments will reward care teams that effectively coordinate, prioritize prevention, and demonstrate improvements in efficiency and health outcomes.

The Rise of Integrated Care Models

ASPIRE builds upon the success of the Integrated Care for Kids (InCK) Model, which demonstrated the positive impact of coordinated care. Parents participating in InCK reported improvements in their children’s sociability, creativity, and engagement in activities. The program’s success highlights the potential of integrated care to reshape a child’s future and provide hope to families.

The future of pediatric care will likely see a wider adoption of similar integrated care models. These models will emphasize:

  • Care Coordination: A single point of contact for families to navigate the healthcare system.
  • Preventative Care: Focusing on early intervention to prevent chronic conditions from worsening.
  • Data Sharing: Securely sharing information between providers to ensure a comprehensive understanding of the child’s needs.
  • Family-Centered Care: Actively involving families in the decision-making process.

The Role of CHIP and Medicaid

The Children’s Health Insurance Program (CHIP) and Medicaid are central to this transformation. CHIP provides low-cost health coverage to children in families with incomes too high for Medicaid but too low to afford private insurance. Together, these programs cover half of all children with complex medical and behavioral needs. By embracing innovative models like ASPIRE, CHIP and Medicaid can play a crucial role in ensuring that all children have access to the care they necessitate to thrive.

States are increasingly recognizing the importance of these programs. As of 2018, 9.6 million children were enrolled in CHIP, demonstrating the significant reach of this vital program.

Looking Ahead: A More Holistic Future

The challenges facing pediatric healthcare are complex, but the solutions are becoming clearer. By prioritizing integration, prevention, and value-based care, we can create a system that truly meets the needs of children and families. ASPIRE is a promising step in this direction, and its success could pave the way for a more holistic and effective healthcare system for all.

Frequently Asked Questions

What is ASPIRE? ASPIRE (Accelerating State Pediatric Innovation Readiness and Effectiveness) is a CMS pilot program designed to transform how states use Medicaid and CHIP funds to treat children with complex health needs.

What is the goal of value-based care? Value-based care aims to incentivize providers to deliver high-quality care and achieve positive health outcomes, rather than simply providing more services.

Who is eligible for CHIP? Children in families with incomes too high to qualify for Medicaid but too low to afford private insurance may be eligible for CHIP. Eligibility requirements vary by state.

How can I apply for CHIP? You can apply for CHIP by calling 1-800-318-2596 or by filling out an application through the Healthcare.gov website.

What is the difference between Medicaid and CHIP? Medicaid provides health coverage to low-income individuals and families, whereas CHIP provides coverage to children in families with slightly higher incomes.

Did you know? Early intervention services can significantly improve outcomes for children with autism and other developmental conditions.

Pro Tip: Don’t hesitate to ask your child’s healthcare providers about care coordination services. A coordinated care team can make a significant difference in your family’s experience.

What are your thoughts on the future of pediatric care? Share your experiences and ideas in the comments below!

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Health

Why Kathy Hochul & NY Dems fear questions about Medicaid fraud

by Chief Editor
written by Chief Editor

New York Medicaid: A System Ripe for Reform and Why Albany Fights It

Gov. Kathy Hochul’s dismissal of federal Medicaid probes as politically motivated rings hollow when considering the systemic issues plaguing New York’s program. Experts like Bill Hammond of the Empire Center reveal a deeper truth: state Democrats have strong incentives to resist scrutiny, protecting a network of political support and campaign donations tied to Medicaid funding.

The Scale of the Problem: New York’s Outsized Spending

New York’s Medicaid program isn’t just large; it’s an outlier. In 2024, the state spent $4,492 per resident, a staggering 77% more than the national average and 24% higher than Kentucky, the second-highest spender. This massive outlay, exceeding $124 billion, attracts fraud and waste, creating a “big fat target” for those looking to exploit the system.

Who Benefits from the Status Quo?

A significant portion of Medicaid funds flows to politically connected entities. The state’s Consumer Directed Personal Assistance Program (CDPAP), funding home care aides, has ballooned to nearly $15 billion annually. Remarkably, these aides now outnumber retail clerks and prompt-food workers combined in New York. Hochul’s attempt to “reform” CDPAP through a contract with Public Partnerships LLC is itself under investigation for potential bid-rigging.

Beyond CDPAP, Medicaid dollars subsidize health insurance for SEIU 1199 members and fund lobbying efforts for increased Medicaid spending. Groups like Somos Community Care, receiving tens of millions in Medicaid funds for back-office services, have funneled substantial “consulting fees” – $51 million – to individuals with no prior healthcare experience, such as a former Democratic National Committee vice chair.

A Lack of Oversight and Accountability

Despite the enormous sums involved, New York’s efforts to detect and prevent Medicaid fraud are remarkably weak. The state’s Medical Fraud Control Unit completed an average of only eight probes per billion dollars spent between 2020 and 2024 – the third-lowest rate in the nation and 63% below the US average. Adding to the problem, the state Senate is pushing “reforms” that could “hamstring” the Office of the Medicaid Inspector General, limiting its ability to audit healthcare providers.

This lack of oversight allows questionable practices to flourish. Nursing homes, seemingly operating on thin margins, simultaneously pay millions for services and rent to companies with overlapping ownership, raising concerns about hidden profits and fraudulent billing.

The Stakes of Dr. Oz’s Investigation

The federal investigation led by Dr. Mehmet Oz represents a significant threat to the existing power structure. For those who benefit from the current system, Oz’s scrutiny could “kill their golden goose.” The potential for uncovering widespread fraud and waste could disrupt the flow of funds to politically connected organizations and individuals.

Frequently Asked Questions

Q: Why is New York’s Medicaid spending so high?
A: New York offers Medicaid benefits to individuals with incomes far above the poverty line, contributing to its higher per-capita spending compared to other states.

Q: What is the CDPAP program?
A: The Consumer Directed Personal Assistance Program funds home care aides, and has seen significant growth in recent years.

Q: How effective is New York’s Medicaid fraud investigation unit?
A: New York’s Medical Fraud Control Unit conducts a relatively low number of investigations per billion dollars spent, ranking it among the least active in the country.

Q: What is Somos Community Care?
A: Somos Community Care is a Medicaid recipient that provides back-office services to physicians, but has been criticized for directing funds to individuals without healthcare backgrounds.

Pro Tip: Stay informed about Medicaid developments by following reports from non-partisan organizations like the Empire Center for Public Policy.

Did you know? New York’s home care aides now outnumber retail clerks and fast-food workers combined.

Want to learn more about New York’s Medicaid system and the ongoing investigations? Explore the Empire Center’s research and follow the latest updates from the New York Post.

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Health

High medical debt leads to significant delays in routine and preventive care

by Chief Editor
written by Chief Editor

Medical Debt’s Growing Shadow: How Delayed Care Impacts Americans

Medical debt is a pervasive issue in the United States, and a new study from the Johns Hopkins Bloomberg School of Public Health reveals a troubling connection: financial hardship directly leads to people delaying essential healthcare. This isn’t limited to major procedures; the research shows significant deferrals in dental, medical, and mental health services, even among those with health insurance.

The Scale of the Problem: A Nation Postponing Treatment

The study, published in the Journal of General Internal Medicine on March 10, analyzed data from the 2023 National Health Interview Survey, encompassing nearly 30,000 U.S. Adults. Over 10% of participants reported struggling with medical debt – defined as difficulty paying medical bills in the past year. But the numbers truly highlight the impact on access to care.

Individuals burdened by medical debt were found to be 2.4 times more likely to postpone dental care, 4.3 times more likely to delay medical care, and nearly three times more likely to put off mental healthcare compared to those without debt. Specifically, 42.3% with medical debt delayed dental care, 23.0% delayed medical care, and 14% delayed mental health care.

Dental Care: The Most Vulnerable Service

The research indicates that dental care is particularly susceptible to being deferred due to financial constraints. This may be since dental insurance is often separate from medical insurance, and typically offers more limited coverage. The consequences of delaying dental care extend beyond oral health, with links to heart disease and cognitive decline.

Pro Tip: Explore community dental clinics and dental schools for lower-cost options if you’re facing financial barriers to dental care.

Insurance Status Matters, But Doesn’t Eliminate the Risk

Whereas the impact of medical debt on deferred care was consistent across insurance types, the study found a significant difference between insured and uninsured adults. Uninsured individuals experiencing medical debt were considerably more likely to delay medical care than those with commercial insurance. Specifically, 32.5% of uninsured adults with medical debt deferred medical care, compared to 16.9% of those with commercial insurance.

The prevalence of medical debt itself varies by insurance status: 19.5% among the uninsured, 12.6% with Medicaid, 9.3% with commercial insurance, and 8.1% with Medicare.

The Ripple Effect: Worsening Health and Economic Strain

Delaying care doesn’t just impact individual health; it creates a cycle of worsening conditions and increased costs. As Catherine Ettman, PhD, a senior author of the study, explains, “Avoiding routine or preventative care can worsen patient health conditions, ultimately making them more costly to address—for patients, insurers, and taxpayers.”

Did you realize? Preventive care, like regular check-ups and screenings, can often identify and address health issues before they become serious and expensive to treat.

Policy Implications and Future Concerns

The study’s authors emphasize that recent policy changes, such as potential cuts to insurance coverage, could exacerbate the problem of medical debt and deferred care. They advocate for policies that address affordability and mitigate the financial burden of medical expenses.

FAQ: Medical Debt and Access to Care

  • What is considered medical debt? Medical debt is defined as experiencing problems paying or being unable to pay medical bills, including those for doctors, dentists, hospitals, and medication.
  • Does having health insurance protect me from medical debt? While insurance helps, it doesn’t eliminate the risk. The study shows that even insured individuals can experience medical debt and delay care.
  • Which type of care is most often delayed due to medical debt? Dental care is the most commonly deferred service, likely due to limited or separate dental insurance coverage.
  • What can be done to address this issue? Policies that improve affordability and reduce the financial burden of medical expenses are crucial.

This research underscores the urgent need for comprehensive solutions to address medical debt and ensure equitable access to healthcare for all Americans. Further investigation is needed to fully understand the long-term consequences of deferred care and to develop effective strategies for prevention and intervention.

Explore further: Read more about the financial burden of healthcare on The Roosevelt Institute’s analysis of the US medical debt crisis.

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Health

NC lawmakers turn critical eye toward spending on autism therapies, child care :: WRAL.com

by Chief Editor
written by Chief Editor

North Carolina’s Dual Crisis: Child Care and Medicaid Funding on a Collision Course

North Carolina lawmakers are grappling with a complex web of challenges as the 2026 legislative session approaches. Escalating Medicaid costs, particularly for autism therapies, are colliding with a severe child care shortage, creating a precarious situation for families, businesses, and the state’s economy.

The Child Care Crunch: A $5.65 Billion Problem

More than one in four modern parents in North Carolina have been forced to leave their jobs due to a lack of affordable and available child care. This isn’t just a personal hardship; it’s a significant economic drain. Insufficient child care coverage is costing the state an estimated $5.65 billion annually in lost economic activity, with $4.29 billion attributed to employee turnover and absenteeism. Businesses are feeling the impact, struggling to recruit and retain talent.

The problem extends beyond availability. The cost of child care is a major barrier, averaging over $11,000 per year per child. Child care workers themselves face low wages – around $14.20 an hour – contributing to staffing shortages and exacerbating the issue. This creates a difficult cycle: raising wages requires raising rates for parents, potentially forcing more to leave the workforce.

Candace Witherspoon, who leads early childhood programming for the state Department of Health and Human Services, emphasized the importance of affordable, quality child care for supporting working families and developing the future workforce.

Medicaid Under Pressure: Autism Therapy Costs Soar

Simultaneously, North Carolina’s Medicaid program is facing a financial strain, driven largely by a dramatic increase in spending on autism therapies. Costs have surged from $121 million in 2022 to $544 million last year, with projections reaching $1.1 billion by 2027. This rapid growth has raised concerns among lawmakers about potential fraud and the efficient use of funds.

Senator Benton Sawrey highlighted a 127% increase in referrals to the special investigative unit at the Department of Health and Human Services related to Medicaid payments for autism therapy. Questions have also been raised about the length and necessity of telehealth sessions, with some questioning whether services are actually being provided as billed.

A Budget Impasse and Political Friction

Governor Josh Stein has repeatedly urged lawmakers to fully fund Medicaid, warning that a shortfall could jeopardize health coverage for the 3 million North Carolinians who rely on the program. However, reaching a funding agreement has proven difficult, particularly in the absence of a new state budget passed last year.

Republican lawmakers acknowledge the need for Medicaid funding but have also expressed concerns about the Stein administration’s efforts to control costs and prevent fraud. A special session called by the governor late last year to address Medicaid funding was ignored by Republican legislators.

The state is attempting to find savings within the Medicaid system, identifying $48 million in potential savings through billing reviews. However, the program also faces a $124 million cut from federal funding, adding to the financial pressure.

Looking Ahead: Potential Solutions and Challenges

Lawmakers have discussed potential solutions to the child care shortage, including building facilities at state universities and expanding subsidies for low-income families. However, action has been limited. Currently, the state only covers 18% of children who qualify for subsidies, leaving over 15,000 children on a waitlist.

Addressing the Medicaid crisis will require a collaborative effort and a willingness to address concerns about both funding and program efficiency. The state faces a delicate balancing act: ensuring access to essential health care services while safeguarding taxpayer dollars.

Frequently Asked Questions

  • How much is North Carolina losing due to child care issues? North Carolina’s economy is losing an estimated $5.65 billion annually due to insufficient child care coverage.
  • What is driving up Medicaid costs? A significant increase in spending on autism therapies is the primary driver of rising Medicaid costs.
  • How many North Carolinians rely on Medicaid? Approximately 3 million North Carolinians are currently enrolled in Medicaid.
  • What is the average cost of child care in North Carolina? The average annual cost of child care in North Carolina is over $11,000 per child.

Pro Tip: Explore resources offered by NC Child (https://ncchild.org/) for information on child care advocacy and support.

What are your thoughts on these challenges facing North Carolina? Share your comments below and let us understand how these issues are impacting your community.

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Health

Philadelphia Planned Parenthood centers at risk after funding cuts

by Chief Editor
written by Chief Editor

Philadelphia’s Healthcare Safety Net Under Strain: Planned Parenthood Faces a Critical Crossroads

Philadelphia’s access to vital reproductive and sexual health services is facing a significant threat. Federal Medicaid cuts, stemming from the “One Big Beautiful Bill Act,” are placing immense pressure on Planned Parenthood affiliates, potentially leading to reduced services or even clinic closures. The situation is particularly concerning for the approximately 20,000 patients in Greater Philadelphia who rely on these centers, many of whom are Medicaid recipients.

The Impact of the “One Big Beautiful Bill Act”

The “One Big Beautiful Bill Act” restricts Medicaid payments for routine exams, cancer screenings, and other essential care provided at facilities that also offer abortion services. This has created a financial crisis for Planned Parenthood, forcing centers to absorb the costs of care that were previously covered. Signe Espinoza, vice president of public policy and advocacy at Planned Parenthood of Southeastern Pennsylvania, warned the Philadelphia City Council that the current situation is unsustainable.

“A Philadelphia without Planned Parenthood is no longer a hypothetical, it is a highly real possibility,” Espinoza stated during a recent public hearing. The potential loss of these services would disproportionately affect low-income individuals and those who depend on Medicaid for healthcare access.

A System Already at Capacity

The concern isn’t simply about access to abortion care; it’s about the broader impact on reproductive and sexual health services. Planned Parenthood provides critical preventative care, including gynecological exams, cancer screenings, and STI testing. Espinoza emphasized that Philadelphia’s existing healthcare infrastructure is unable to absorb 20,000 additional patients if Planned Parenthood centers were to significantly reduce services or close.

Did you know? Planned Parenthood centers often serve as the primary healthcare provider for many individuals, particularly those in underserved communities.

The Call for Local Funding and Potential Future Trends

Advocates are urging the city of Philadelphia to provide financial support to bridge the funding gap created by the federal cuts. Without local intervention, the future of reproductive healthcare access in the city remains uncertain. This situation highlights a growing trend: increasing restrictions on reproductive healthcare access at the federal level, coupled with a reliance on local governments to mitigate the impact.

This trend is not isolated to Philadelphia. Similar challenges are emerging across the country as states and the federal government grapple with healthcare funding and policy changes. The potential for further cuts to Medicaid, as discussed in recent news, could exacerbate these issues. The Pennsylvania Health Law Project has been tracking potential Medicaid cuts, signaling a broader concern about healthcare access in the state.

The Ripple Effect: Beyond Reproductive Health

The impact of reduced access to Planned Parenthood services extends beyond reproductive health. STI rates could rise, preventative cancer screenings could decrease, and the overall burden on the healthcare system could increase. This is particularly concerning given the existing strain on healthcare resources.

Pro Tip: Stay informed about changes to your healthcare coverage and advocate for policies that support access to affordable healthcare.

FAQ

Q: What is the “One Big Beautiful Bill Act”?
A: It’s a federal law that blocks Medicaid payments for routine exams, cancer screenings, and other care at facilities that also perform abortions.

Q: How many patients could be affected in Philadelphia?
A: Approximately 20,000 patients in Greater Philadelphia, many of whom have Medicaid, could be affected.

Q: What is being done to address the situation?
A: Advocates are calling on the city of Philadelphia to provide funding to support Planned Parenthood and preserve services.

Q: What other healthcare issues are impacting Pennsylvania?
A: Pennsylvania is also facing potential cuts to Medicaid and discussions around healthcare costs, including spending on anti-obesity drugs.

Wish to learn more about the challenges facing healthcare access in Philadelphia? Explore recent news and updates from the Pennsylvania Health Law Project.

Share your thoughts on this critical issue in the comments below!

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Health

Multimillion-dollar fraud probe targets California hospices

by Chief Editor
written by Chief Editor

California Hospice Fraud: A Looming Crisis and What’s Next

A sweeping investigation has revealed widespread alleged fraud within California’s hospice and home healthcare system, particularly in Los Angeles County. Hundreds of providers are under scrutiny by the Centers for Medicare & Medicaid Services (CMS), raising concerns about the misuse of taxpayer dollars and the potential compromise of patient care.

The Scale of the Problem: Los Angeles as Ground Zero

Los Angeles County is at the epicenter of this crisis, housing nearly half of America’s end-of-life care providers. Dr. Mehmet Oz, CMS Administrator, confirmed that “every single hospice in California is now under investigation,” citing a significant percentage of potentially illegitimate operations. The investigation was prompted by data from an industry insider detailing hundreds of suspicious hospices and home agencies across the state.

The alleged fraud isn’t limited to a few terrible actors. Investigators are finding multiple agencies registered at the same addresses, including vacant storefronts, auto parts shops and locations that don’t appear to exist at all. One building in North Hollywood reportedly houses 12 hospice and home health agencies, yet a recent visit revealed no signage indicating healthcare businesses.

From ‘Pay and Chase’ to ‘Stop and Clot’: CMS’s New Approach

Historically, CMS operated on a “pay and chase” system, reimbursing providers and then attempting to recover fraudulent funds. However, Dr. Oz announced a shift to a “stop and clot” approach, actively cutting off payments to suspicious clinics and requiring them to prove their legitimacy. This change is being facilitated by sophisticated fraud detection tools, including artificial intelligence, which analyze patient volume, scope of operations, and other key metrics.

For example, St. Rita’s Home Health, registered to a vacant strip mall in Van Nuys, has billed Medicare and Medicaid over $4 million since 2021. Despite being listed as active, the location is currently for rent, and the agency’s contact information leads to a Yahoo email address.

Industry Response and Calls for Action

Sheila Clark, president and CEO of the California Hospice and Palliative Care Association (CHAPCA), has been raising concerns about fraud in Los Angeles County since 2019. She emphasizes the illogical nature of many of these locations, noting the lack of proper signage and the presence of businesses unrelated to healthcare. Dr. Ira Byock, a leading palliative care physician, described the situation as a “crisis” that has “completely overwhelmed” state and federal authorities.

The 2022 California Hospice and Licensure and Oversight report highlighted “weak controls” that have created opportunities for large-scale fraud and abuse. While CMS takes over inspections once companies are certified, the California Department of Public Health (CDPH) confirmed that all companies identified by the California Post remain licensed.

Future Trends and Potential Solutions

The current investigation signals a likely increase in scrutiny of hospice and home healthcare providers nationwide. Several trends are expected to emerge:

  • Increased AI Integration: CMS will likely expand its use of AI and machine learning to proactively identify fraudulent activities.
  • Stricter Licensing Requirements: State and federal authorities may implement more rigorous licensing and oversight procedures.
  • Enhanced Data Sharing: Improved data sharing between CMS, CDPH, and law enforcement agencies could help detect and prevent fraud.
  • Focus on Patient Outcomes: A greater emphasis on patient outcomes and quality of care could help differentiate legitimate providers from fraudulent ones.

FAQ

What is Medicare’s role in this investigation? Medicare, administered by CMS, is the primary payer for hospice and home healthcare services. CMS is actively cutting off payments to suspicious providers and conducting investigations.

What is CHAPCA doing to address the issue? The California Hospice and Palliative Care Association is advocating for stronger regulations and increased oversight to combat fraud.

How can patients protect themselves? Patients should verify the legitimacy of their hospice or home healthcare provider and report any concerns to Medicare or the CDPH.

What happens to patients if a hospice is shut down due to fraud? CMS works to ensure continuity of care for patients affected by fraudulent closures, helping them transition to legitimate providers.

Did you realize? California has over 2,800 hospice programs, significantly more than any other state.

Pro Tip: Always verify a healthcare provider’s license and accreditation before receiving services.

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Health

Few doctors have seen it before

by Chief Editor
written by Chief Editor

Mission Hospital’s Measles Exposure: A Warning Sign for U.S. Healthcare?

A recent measles exposure at Mission Hospital in Asheville, North Carolina, has brought into sharp focus a growing concern: the increasing risk of encountering measles and a potential decline in healthcare professionals’ ability to quickly identify the virus. The incident, which led to the hospital receiving an “Immediate Jeopardy” designation from the Centers for Medicare & Medicaid Services (CMS), underscores a broader trend of declining vaccination rates and a potential weakening of public health infrastructure.

The Asheville Incident: A Timeline of Events

In January, twin brothers arrived at Mission Hospital exhibiting symptoms consistent with a common cold – fever, cough, rash, and pink eye. Despite training on identifying and isolating potential airborne illnesses, hospital staff took over two hours to isolate the children. Further delays meant the patients weren’t separated from others for another two hours. It was later determined the boys had measles, exposing at least 26 other individuals within the hospital.

Federal investigators found that Mission Hospital lacked a designated area for patients with respiratory symptoms, and patients were separated only by plastic partitions. CMS designated Mission in “Immediate Jeopardy,” threatening federal funding unless the issues were addressed. A hospital spokesperson stated staff were trained to manage airborne sickness and are following federal rules.

A Forgotten Disease? The Challenge of Recognition

The Asheville case highlights a troubling reality: many healthcare workers haven’t encountered measles in their careers. “There’s a word, ‘morbilliform’ — it means measles-like, and there are lots of viruses that can cause a rash that looks like a measles rash in children,” explained Theresa Flynn, a pediatrician in Raleigh. North Carolina has reported over 20 cases since mid-December, and more than 3,000 cases have been reported nationwide since the beginning of 2025.

The CDC advises looking for the “three C’s” – cough, coryza (cold symptoms), and conjunctivitis (pink eye) – as initial indicators. Mission Hospital staff had received training on these symptoms, yet the initial response was delayed.

The Role of Federal Policy and Public Trust

The resurgence of measles is occurring against a backdrop of declining public trust in vaccines. The article points to policies under the Trump administration, specifically the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, and subsequent changes to CDC vaccine recommendations. Kennedy publicly recommended unproven treatments for measles, including steroids and cod liver oil.

This shift in federal messaging has created a vacuum, leaving healthcare workers to rely on their own experience or guidance from state public health systems. Some clinics, like Asheville Children’s Medical Center, have implemented pre-screening procedures over the phone and in vehicles to mitigate risk.

Declining CDC Support and Communication

Health workers and infectious disease experts have reported a decrease in communication and support from the CDC regarding outbreak response. Brigette Fogleman, a pediatrician at Asheville Children’s Medical Center, stated, “We certainly do not feel the support or guidance from the CDC right now.” The CDC spokesperson responded that state and local health departments lead investigations, with the CDC providing support “as requested.”

The Threat to “Measles Elimination Status”

The U.S. Has maintained “measles elimination status” since 2000, but outbreaks in multiple states – Texas, Arizona, Utah, and South Carolina – threaten this designation. One county in South Carolina has already reported over 900 cases, exceeding Texas’s total for 2025. Measles is considered one of the most contagious diseases, remaining active for up to two hours after an infected person leaves a room, and can be lethal, with 1 to 3 deaths per 1,000 cases in children.

Preparing for a Future with More Measles

Experts emphasize the demand for increased vigilance and coordination among public health agencies. Jennifer Nuzzo, an epidemiologist at Brown University, stressed the importance of coordination. Patsy Stinchfield, a former president of the National Foundation for Infectious Diseases, called the CMS penalty for Mission “extreme,” but acknowledged the difficulty in identifying the virus. She attributed the spread to a lack of communication from CDC leaders and a lack of a widespread public information campaign.

In Buncombe County, North Carolina, health officials anticipate further cases and are preparing for a potential surge similar to South Carolina. Local efforts include public education campaigns and urging families to vaccinate their children.

FAQ: Measles and Current Concerns

Q: How contagious is measles?
A: Measles is extremely contagious. The virus can remain active for up to two hours in the air after an infected person leaves a room.

Q: What are the symptoms of measles?
A: Symptoms include fever, cough, a blotchy rash, and red, watery eyes. The “three C’s” – cough, coryza, and conjunctivitis – are often early indicators.

Q: How effective is the measles vaccine?
A: Two doses of the measles, mumps, and rubella (MMR) vaccine provide a 97% chance of protection against the virus.

Q: What is “Immediate Jeopardy” and what does it mean for Mission Hospital?
A: “Immediate Jeopardy” is a designation from CMS indicating a hospital poses an immediate threat to patient safety. It can result in loss of Medicare and Medicaid funding if the issues aren’t resolved.

Q: What is the current status of measles elimination in the U.S.?
A: The U.S. Is at risk of losing its “measles elimination status” due to recent outbreaks.

Pro Tip: If you suspect you or a family member has measles, contact your healthcare provider immediately. Do not go to the emergency room without calling first.

Did you know? Measles can have serious complications, including pneumonia, encephalitis (brain swelling), and even death.

Stay informed about measles outbreaks in your area and consider reviewing your family’s vaccination records. For more information, visit the Centers for Disease Control and Prevention website.

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Hochul is letting Medicaid costs soar — to buy political support from Big Health Care

by Rachel Morgan News Editor
written by Rachel Morgan News Editor

For the fourth consecutive year, Gov. Kathy Hochul has described her Medicaid budget as “unsustainable.” Despite this acknowledgement, concerns remain regarding fiscal management, as the state’s share of Medicaid costs has increased by 60% over the past four years – a rate roughly five times that of inflation.

Novel York’s Medicaid Spending

The governor’s latest proposal would add another 10% to Medicaid spending. Total Medicaid spending for the next fiscal year, including federal aid, is projected to be $28 billion higher than when Hochul took office, and this figure doesn’t account for potential additions from the Legislature.

Did You Know? New York State has 314 home health aides per 10,000 residents, which is three times the national average.

Despite the substantial financial investment, Medicaid enrollment is decreasing as the post-pandemic period continues. However, the quality of care in New York remains low, with hospitals averaging a 2.5 out of 5-star federal rating, placing the state 48th nationally.

The governor’s spending increases are, in part, attributed to securing political support from the health-care lobby and its allies in Albany. This approach, critics argue, prioritizes the interests of the health-care industrial complex, leading to higher fees, larger subsidies, and reduced accountability.

This year’s proposal includes $1.5 billion for hospital and nursing home fee boosts and another $1 billion for health-care capital grants. While Hochul claims these increases are necessary to offset potential cuts in federal funding, this argument is contested.

Changes enacted in President Donald Trump’s One Big Beautiful Bill Act merely slowed the growth of Medicaid spending, and some key provisions, including a work requirement, have not yet taken effect. Currently, New York’s federal Medicaid funding is expected to increase by $3 billion, or 5%, in the next fiscal year.

Expert Insight: Prioritizing the interests of the health-care industry over careful fiscal management could lead to continued increases in Medicaid spending without demonstrable improvements in patient care or outcomes.

Impact on the Essential Plan

The Essential Plan, which provides coverage to individuals just above the income threshold for Medicaid, is expected to be affected. The OBBBA imposed stricter rules regarding health subsidies for non-citizens, a demographic that comprises nearly half of the Essential Plan’s 1.7 million enrollees. State officials anticipate a loss of $7.6 billion in federal funding previously allocated to the program.

Instead of replenishing these funds, Hochul is seeking permission from Washington to tighten eligibility requirements and utilize unspent federal aid reserves, potentially avoiding any state financial contribution. If approved, total state and federal funding for combined health programs could still exceed $130 billion – an all-time high.

Since becoming governor, Hochul has directed more new funding to Medicaid than to all other programs combined. Despite this, health-care lobbyists are expected to continue advocating for increased funding, even as the health-care sector experiences significant job growth – adding 71,000 jobs in New York City alone last year.

A Commission on the Future of Health Care was appointed in 2023 to provide guidance on Medicaid budgets, but its first report has not been released.

Frequently Asked Questions

What has happened to Medicaid spending under Gov. Hochul?

Over the past four years, the state’s share of Medicaid costs has increased by 60%, or roughly five times the rate of inflation. Her latest proposal would add another 10%.

What is the Essential Plan?

The Essential Plan provides taxpayer-funded coverage to people just above the income cut-off for Medicaid. Approximately half of its 1.7 million enrollees are legally present immigrants.

What is the One Big Beautiful Bill Act (OBBBA)?

The OBBBA, enacted during President Donald Trump’s administration, slowed the growth of Medicaid spending and imposed stricter rules regarding health subsidies for non-citizens.

Considering the substantial and increasing investment in Medicaid, what steps could be taken to ensure greater transparency and accountability in how these funds are allocated and utilized?

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Health

Medicaid HCBS: Report shows what’s at stake if services are cut

by Chief Editor
written by Chief Editor

Medicaid Cuts Threaten Home Care Lifeline for Millions

A new KFF issue brief highlights the growing reliance on Medicaid to support older adults aging at home and the potential fallout from looming federal funding cuts. For millions of Americans, Medicaid Home and Community Based Services (HCBS) aren’t just a benefit – they’re the key to remaining independent and avoiding costly institutional care.

The Rising Demand for Home-Based Care

Medicaid now covers approximately two-thirds of all U.S. Spending on home- and community-based services, filling a critical gap left by Medicare’s limited coverage of long-term home care. In 2023, 5.1 million Medicaid enrollees used home care, with nearly 20% being adults 65 and older managing chronic illnesses or disabilities. This demand is fueled by a strong preference among seniors to age in place, supported by their families.

Federal Cuts and State Budget Pressures

The recently enacted “One Big Beautiful Bill Act” (H.R. 1) is projected to reduce federal Medicaid spending by $911 billion over the next decade. States, constitutionally required to balance their budgets, are facing difficult choices about how to respond. Optional benefits like HCBS are particularly vulnerable to cuts.

Alice Burns, Associate Director of KFF’s Program on Medicaid and the Uninsured, notes that the impact of these cuts remains uncertain. Still, reductions in payments and supports for family caregivers could force more older adults into institutional care or place an even greater burden on unpaid family members.

The Impact on Family Caregivers

Medicaid supports family caregivers in multiple ways, including direct payments for care exceeding typical family responsibilities, respite care to provide temporary relief, and even health insurance coverage for caregivers themselves. AARP estimates that over 8 million family caregivers – 13% of the total – rely on Medicaid for their own health coverage.

All responding states allow waiver payments to family and friends providing care, and 44 permit payments to “legally responsible relatives.” These payments are contingent on demonstrating a need, close supervision, and meeting provider requirements.

Workforce Shortages Exacerbate the Problem

The availability of paid home care workers is shrinking even as demand rises. Immigration policies are contributing to the problem, as nearly one in three home care workers are immigrants. Recent reports indicate that restrictive policies have led to some workers avoiding work, further straining the system.

Potential State Responses and What to Watch For

Advocates are concerned that states may respond to budget pressures by denying waivers for caregiver payments, reducing payment amounts, or cutting back on home-based and respite services. Local nonprofits and public-private partnerships may attempt to fill these gaps, but their capacity is limited.

Reporters and concerned citizens can monitor state budgets and line items for aging services to identify potential cuts. Key questions to investigate include whether states are denying waivers, reducing payment amounts, or scaling back essential services.

New Work Requirements and Caregiver Exemptions

New Medicaid work requirements are going into effect in 41 states that have expanded Medicaid eligibility. While family caregivers are supposed to be exempt, the details of how this exemption will be documented and enforced remain unclear.

FAQ

Q: What are Medicaid HCBS?
A: Medicaid Home and Community Based Services are programs that help older adults and people with disabilities receive care in their homes or communities, rather than in institutions like nursing homes.

Q: Why are Medicaid HCBS important?
A: They allow millions to age in place, maintain independence, and avoid costly institutional care.

Q: What is the biggest threat to Medicaid HCBS right now?
A: Federal funding cuts are forcing states to create difficult budget decisions, potentially leading to reductions in HCBS.

Q: How can I discover out what’s happening with Medicaid HCBS in my state?
A: Check your state’s budget and line items for aging services, and contact your state representatives.

Did you know? Approximately 1 in 5 Medicaid home care recipients are adults 65 and older with chronic illnesses or disabilities.

Pro Tip: Stay informed about proposed legislation impacting Medicaid at the state and federal levels. Advocate for policies that support home- and community-based services.

Learn more about Medicaid and HCBS programs by visiting the KFF website.

Have questions or concerns about Medicaid HCBS in your area? Share your thoughts in the comments below!

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Health

Denver Public Schools moves to drop Kaiser Permanente after 50 years

by Chief Editor
written by Chief Editor

Denver Public Schools and Kaiser Permanente: A Healthcare Breakup and the Future of Employee Benefits

A decades-long partnership between Denver Public Schools (DPS) and Kaiser Permanente Colorado is facing a potential end, sparking concerns among educators and raising questions about the future of employee health benefits. The dispute, which has already led to a district administrator being placed on leave, highlights a growing trend of school districts grappling with rising healthcare costs and complex contract negotiations.

The Core of the Conflict: Cost vs. Continuity of Care

DPS leaders are seeking to replace Kaiser Permanente with MotivHealth Insurance Company or UnitedHealthcare, citing cost concerns. According to documents reviewed by The Denver Post, Kaiser received the lowest score during the bidding process, primarily due to cost considerations. Although, the Denver Classroom Teachers Association (DCTA) argues that switching providers will disrupt care for approximately 5,800 DPS employees and their families, many of whom value their existing relationships with Kaiser doctors.

“This is a significant disruption in the system,” said Rob Gould, president of the DCTA. “I’m not really sure why they want to get rid of it other than cost and trying to push us to a lower cost system.”

A Bidding Process Under Scrutiny

The situation escalated after Kaiser Permanente alerted DPS employees in December that their coverage would end in July – a notification DPS officials claimed was premature. This led to an outside investigation into the bidding process and the placement of DPS Chief of Talent Edwin Hudson on administrative leave. While the investigation reportedly found no wrongdoing by Hudson, the incident underscores the sensitivity and complexity of these negotiations.

DPS officials allege Kaiser violated the proposal process by contacting a third-party consultant and submitting an additional proposal after the bidding period had closed. Kaiser disputes these claims, stating they were contacted by the consultant and responded to a request for a revised proposal.

Rising Healthcare Costs and Budgetary Pressures

The DPS-Kaiser dispute is not isolated. School districts across Colorado, and nationwide, are facing increasing financial constraints due to declining enrollment and uncertainty surrounding state and federal funding. Simultaneously, healthcare costs are on the rise. DPS’s budget for employee health insurance has increased by 20% – approximately $12 million – since the 2023-24 fiscal year.

This pressure to control costs is forcing districts to make challenging decisions, including reducing budgets, delaying raises, and exploring alternative insurance options. The situation is exacerbated by a projected deficit for DPS starting in the 2027-28 fiscal year, and potential cuts to federal K-12 funding.

The Impact on Educators and Families

The potential switch in providers has caused significant anxiety among DPS employees. Educators shared stories with the school board about the potential disruption to their families’ healthcare, including the need to find modern doctors for chronic conditions and the impact on mental health services for students and staff following incidents at East High School.

“Canceling Kaiser would force educators to change providers mid-care, disrupt prescriptions and delay critical services,” East High School educator Tyler Knauer told the school board. “That’s not a little inconvenience. It’s a real health risk.”

Looking Ahead: Trends in School District Healthcare

The DPS-Kaiser situation foreshadows several key trends in school district healthcare:

  • Increased Scrutiny of Healthcare Contracts: Districts will likely become more rigorous in their evaluation of insurance proposals, prioritizing cost-effectiveness alongside quality of care.
  • Direct Negotiation with Providers: Some districts may explore direct negotiation with healthcare providers to cut out intermediaries and reduce administrative costs.
  • Employee Wellness Programs: A greater emphasis on preventative care and employee wellness programs to reduce long-term healthcare costs.
  • Transparency and Communication: The need for clear and transparent communication with employees throughout the healthcare selection process to build trust and minimize disruption.

FAQ

Q: When will the DPS Board of Education vote on the health insurance plan?
A: The board is scheduled to vote next week, but could too choose to extend current contracts and restart the bidding process.

Q: How many DPS employees are currently covered by Kaiser Permanente?
A: Approximately 5,800 DPS employees and their family members receive their healthcare through Kaiser.

Q: What are the alternative insurance providers being considered by DPS?
A: MotivHealth Insurance Company and UnitedHealthcare are the two alternative providers.

Q: What caused the district administrator to be placed on leave?
A: Edwin Hudson, the chief human resources officer, was placed on administrative leave following questions raised about the health insurance proposal process.

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