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Millions of people could lose Medicaid from April



Due to pandemic-related continuous enrollment provisions, Medicaid lists have grown to over 90 million members. On April 1, for the first time in 3 years, states will begin to remove these provisions and exclude individuals who are no longer eligible for the program.

While most states have taken numerous steps to ensure those who are still eligible for coverage do not lose it due to procedural reasons such as renewal letters sent to the wrong address, experts and lawmakers who have spoken in discussions in America’s 2023 Health Plans Medicare, Medicaid, Duals and Commercial Markets Forum Thursday is still worried.

Arkansas State Rep. Deborah Ferguson (D-51), a dentist, said her biggest concern is people with chronic conditions who are “moving from Medicaid to Employer Insurance or the Affordable Care Act … pre-approval for treatment, whether they need to get more one pre-approval for medicines, will the formulary change… Will they have such a huge gap in care that it will really create problems?”

Generally, Medicaid processes renewals on an annual basis. Under the provisions of the Families First Coronavirus Response Act and the Coronavirus Relief, Relief, and Economic Security Act, states were required to maintain continuous enrollment for all Medicaid participants until the end of the Public Health Emergency (PHE) , and in return they were given 6.2 percentage points Percentage of federal medical care. (For every dollar a state spends on Medicaid, the federal government posts a compliance rate that varies from year to year.)

As a result of these provisions, Medicaid and the Children’s Health Insurance Program (CHIP) will increase by 30% or 23.3 million by March 31, according to estimates from the Kaiser Family Foundation (KFF).

Starting April 1, all 92 million registered members will be renewed and increased federal assistance will end.

This change came as a result of a provision in the Consolidated Appropriations Act passed in December 2022 that separated the continuous enrollment provision from PHE and named March 31 as the end of the continuous enrollment period.

While Ann Marie Costello, MD, Associate Director of the Center for Medicaid Services and CHIP CMS, said she was impressed by the states’ “massive investment” in enrollment, she noted that processing renewals for 92 million people over a period of 12 to 14 months is “an insurmountable task”.

And that’s the challenge government agencies face in trying to keep their workforce, like most other industries, she added.

Joan Alker, Ph.D., executive director and co-founder of the Center for Children and Families at Georgetown University in Washington, D.C., said she found some insights from KFF report based on a nationwide poll released on Thursday is “encouraging.”

However, “I don’t see any way we don’t lose millions of people,” she said, noting “the potential for hundreds of thousands, if not millions, of children to lose insurance when they are still eligible.”

In the survey, more than one-third of reporting states indicated that about 18% of Medicaid enrollees would be disenrolled at the end of the continuous enrollment period—predictions range from 7% to 33%.

More than half of the states plan to wait until April to begin implementing the “roll-up process,” while another 15 states have said they will start in March and eight more states plan to start in February.

In terms of the projected length of renewal, 43 states intend to use the full 12-14 months to complete the renewal process, five states plan to take 9 to 12 months, and one state intends to complete the process in less than 9 months. Two states declined to respond.

Stretching the workload over an extended period can help states balance renewals, but will also increase government spending, said Trisha Brooks, MBA, senior fellow at Georgetown University’s Center for Children and Families and lead author of the KFF report, and her co-authors.

Other findings from the report include:

  • About half of the states have flagged individuals they suspect are no longer eligible or have not responded to renewal requests.
  • In 16 of the 26 states that responded, the vacancy rate among eligible workers is over 10%, and in seven of the 16 states it is over 20%.
  • Forty-three states use unilaterally renewal process (which uses government wage or unemployment benefit data before the enrolled member is asked to fill out a form or provide information)
  • Approximately 34 states are seeking updates through the Supplemental Food Assistance Program (SNAP) and other programs; 33 states are asking Medicaid managed care organizations to contact members; and 13 states have launched an online change of address form.
  • Most states (40) will attempt to contact subscribers when mail is returned.

Brooks et al noted that all 50 states and the District of Columbia have taken steps to update enrollee contact information.

CMS released guidance for states in 2021 with detailed guidance on how to respond to returned mail. In addition, all states are required to “make good-faith attempts to contact an enrollee in at least two ways prior to refusing to register for return mail,” the authors write.

Alker said she is concerned that adults in non-Medicaid states (states that have not extended eligibility for all adults to 138% of the federal poverty level) will not be eligible for Medicaid because their income is being forfeited. their rights. These adults will fall into a “coverage gap,” meaning they don’t have an affordable insurance option.

This coverage gap has always been a major problem, but losing coverage for children is a new problem, Alker said. Mississippi today in a recent interview in front of the panel.

Between 15 million and 18 million people are still expected to lose coverage during the renewal process, and HHS estimates that around 6.8 million might still fit.

  • Shannon Firth has been covering health policy as a Washington correspondent for MedPage Today since 2014. She is also a member of the Enterprise & Investigative Reporting group. Follow

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California Covid Misinformation Law Confused by Lawsuits, Conflicting Ordinances



Gavin Newsom’s government may have been prudent when he acknowledged free speech concerns by signing the California Accord. covid disinformation bill Last failure. V appeal to deputiesThe governor warned of “the chilling effect of other potential laws” on doctors’ ability to speak frankly with patients, but expressed confidence that the one he signs does not cross that line.

However, a law meant to punish doctors who give patients false information about covid-19 is currently in limbo after two federal judges issued conflicting rulings in recent lawsuits that say it violates freedom of speech and too vague for doctors to know what he forbids. tell them to patients.

In two trials, Senior U.S. District Judge William Schubb in Sacramento ruled. temporary stop on the application of the law, but it applies only to plaintiffs in these cases. Schubb said the law was “unconstitutionally vague”, in part because it “fails to provide a person of ordinary intelligence with fair notice of what is prohibited”. His decision last month clashed with the Santa Ana decision in December; in this case, U.S. District Judge Fred Slaughter refused to obey the law and said it is “likely to promote the health and safety of covid-19 patients in California.”

The legal fight in the nation’s most populous state is, to some extent, a continuation of the pandemic-era struggle, in which supporters of public health guidelines are opposing groups and individuals who have resisted masking orders, school closures and vaccination bans.

California’s covid disinformation law, which went into effect Jan. 1, is being challenged by vaccine skeptics and civil liberties groups. Among those suing Get the Law Declared Unconstitutional is a group founded by Robert F. Kennedy Jr., who has been questioning the science and safety of vaccines for years.

But doubts about the law are not limited to those who have fought the scientific mainstream.

Dr. Leana Wen, Professor of Health Policy at George Washington University, who previously served as President of Planned Parenthood and Health Commissioner of Baltimore, wrote in a review weeks before Newsom signed into law that it would have “a chilling effect on medical practice, with wide-ranging implications that could paradoxically impair patient care.”

Northern California branch of the American Civil Liberties Union suspended against the law on the basis of freedom of speech, although the national organization confirmed constitutionality of covid vaccination mandates.

“If doctors are afraid of losing their licenses for giving advice they find helpful and relevant, but they don’t fully understand what the law means, they are less likely to speak openly and frankly with their patients,” said Hanna Kischnik. , an attorney for the ACLU of Northern California.

The law states that physicians who provide false information to patients about covid are acting in an unprofessional manner, which could result in disciplinary action from the California Medical Board or California Osteopathic Medical Board.

Supporters of the law tried to crack down about what they think is the most obvious: doctors advertising treatments such as ivermectin, an antiparasitic that has not been proven effective in treating covid and may be dangerous; who exaggerates the risk of vaccination compared to the risk of disease; or who spread unsubstantiated theories about vaccines, including that they can cause of infertility or damage DNA.

But there is no such specificity in the law, defining disinformation only as “false information that is contrary to modern scientific consensus that is contrary to the standard of medical care.”

Michelle Mello, professor of health law and policy at Stanford University, said the wording was confusing.

“On a subject like covid, science is changing all the time, so what does it mean to talk about scientific consensus?” she asked. “To me, there are many examples of statements that clearly, without any vagueness, meet the definition of the behavior that the legislature adheres to. The problem is that there are a lot of other hypothetical things that people can say that clearly don’t violate it.”

Dr. Christine Cassel, professor of medicine at the University of California, San Francisco, said she expects the law to be enforced only in the most egregious cases. “I trust scientists enough to know where there is a legitimate dispute,” she said.

Kassel’s opinion reflects Newsom’s rationale for signing the law, despite being aware of the potential problems with free speech. “I am confident,” he wrote in his message to legislators, “that the discussion of new ideas or treatments, including the subsequent risks and benefits, does not constitute disinformation or misinformation under the criteria of this bill.”

Plaintiffs in Santa Ana case, two physicians who have sometimes deviated from public health guidelines have appealed Slaughter’s decision allowing the law to remain in place. The case was joined in the 9th U.S. Circuit Court of Appeals with another case in which a San Diego judge declined to rule on a similar request for a temporary suspension of the law.

Newsom spokesman Brandon Richards said in early February that the administration would not appeal two Sacramento cases in which Shubb issued a narrow injunction. Lawyers for the plaintiffs expected the state to appeal the decision, believing that all four claims would then be decided by an appellate court, providing greater clarity for all parties.

Richard Jaffe, lead attorney in one of the Sacramento cases brought by Kennedy’s Children’s Health Physician and a group called Physicians for Informed Consent, said Newsom’s decision not to appeal “will just increase the level of chaos in terms of who the law applies to.” “.

But the Newsom administration has decided to wait for the appeals court to rule on the decisions of the other two judges, who have upheld the law for now.

Janine Younes, New Civil Liberties Alliance lawyer, lead counsel other Sacramento cases in which Schubb issued his injunction, Newsom said, perhaps calculating that “you’re in a stronger position to raise your winnings on a win than on a loss.”

Newsom’s victory in the appeals court could dampen the impact of the two Sacramento cases, according to Jaffe and others.

Opponents of California’s COVID Disinformation Act are wondering why it’s needed at all, given that medical boards already have the power to punish doctors for unprofessional behavior. However, only about 3% of the nearly 90,000 complaints received by the California Medical Board in a decade resulted in physician disciplinary action. 2021 investigation from Los Angeles Times.

This may be good news for physicians, who fear the new law could limit their ability to counsel patients.

“I don’t see medical boards being particularly active about the competence of physicians in general,” Stanford’s Mello said. “You have to be really bad to get their attention.”

This story was produced by KHN who publishes California Health Lineto an editorial independent service California Health Foundation.

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I am single, in my 30s, and it is very difficult for me to make new friends | Life and style



I am a man in my 30s who feels pretty lonely. Igraduated from university so I’m no longer around new faces and friends left for various reasons (left, children, etc.). Two of my closest friends live abroad, and although I love them very much, I really miss the personal contact, especially after the pandemic is virtual.

My partner and I do something from time to time, but in general we prefer to do different things: she likes to receive guests, I like to walk, she likes walks in nature, I am a city dweller. I work from home, organizing my companyses social activities that I refuse because they happen in large groups and myou are the biggest obstacle is an introvert, with social anxiety. I have always struggled to make and keep friends. The usual advice is to join a class, a club (or volunteer), but it all happens in a group setting, and as an introvert, I find even small groups. frightening; I am rarely a cheerful or interesting person in such an environment.

If getting out of my comfort zone led to some connections, I could at least say it was worth the initial discomfort, but the older I get, the less helpful it is to force myself to get through those situations. I don’t know where to start.

We are connected to real life and I think what you are saying about everything being virtual during (and after) the pandemic has had a real impact on many. But loneliness can also arise in the company, when we do not feel seen or heard. I notice you say you’ve always struggled, but I’m wondering if you’re feeling especially lonely right now? I have to ask: is your relationship fulfilling?

I went to a BACP registered psychotherapist, John-Paul Davis, who picked up on what you said about being an introvert. “For me, an introvert is someone who withdraws into himself to solve problems, and not an extrovert who tends to draw energy from other people. So I don’t think it’s an obstacle [to making friends] perhaps anxiety is more than that.”

Anxiety about how we might appear and worry about being disliked seems to underlie most social interactions. I wonder how different we would all feel if we could see what everyone else is thinking in situations like this. Most likely the same: more people feel like you than you can imagine. But if you have low self-esteem, then it’s hard to accept.

And, as Davis pointed out, self-esteem depends partly on knowing who we are and finding ourselves interesting, and partly on people around us responding positively to themselves—which is why positive social interaction is so important.

Davis’ advice was to “try to deepen existing relationships, especially those that you already feel comfortable with.” I know your friends don’t live nearby, but trying to enrich those connections can be a good first step: via video chat, email, or even letters. If you find video chats too intense, could you consider calling while you are doing something like cooking?

We also thought that perhaps the building blocks for friendship are closer than you think. You say that your partner loves to host, maybe this is an opportunity to meet new people in an environment in which you already feel comfortable? At home, you may have many excuses to leave the room if you need to regroup (you need to change the music, bring more drinks, etc.). Would your work meetings be more bearable if you set yourself a time limit of, say, 45 minutes?

I also wonder if you might, when meeting new people, think: will they not find you interesting, but will you find them? their interesting. This can take attention away from you and reduce anxiety. Instead of trying to find something to say, ask questions. Unless people are on the run, they tend to like to talk about themselves. (I left entire parties and no one knew anything about me).

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Friendship takes work and time. It’s also tempting to view every social situation as a way to make new friends, but that’s not realistic. So maybe if you could think of these occasions as ways to make connections, even short ones, rather than lifelong friendships, that could help relieve tension.

Every week Annalize Barbieri solves a personal problem submitted by a reader. If you would like advice from Annalize, please send your problem to Annalize regrets that she cannot conduct personal correspondence. Content is subject to our terms and conditions.

Comments on this article are pre-moderated to keep the discussion on the topics raised in the article. Please note that comments on the site may take a little time to appear.

Annalize’s latest podcast episode available Here.

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Scientists investigate bird flu outbreak in seals



Last summer, a highly contagious strain of avian influenza that was spreading among North American birds entered marine mammals, causing seal splash along the coast of Maine. In June and July, more than 150 dead or sick seals washed ashore.

Now the study provides a new insight into the outbreak. Scientists reported Wednesday in the journal Emerging Infectious Diseases that of 41 beached seals tested for the virus, nearly half were infected with it. The researchers concluded that it was likely that wild birds transmitted the virus to seals at least twice. In several seals, the virus had mutations associated with adaptation to mammals.

The risk to humans remains low and the seal outbreak has subsided rapidly, scientists said.

“As far as we can tell, it was a dead end,” said Caitlin Sawatsky, a research fellow at Tufts University’s Cummings School of Veterinary Medicine and author of the new paper. “The virus that entered these seals did not survive.”

But the report comes amid growing fears that the virus, which has already caused the largest avian flu outbreak in the country’s history, could adapt and spread more efficiently among mammals, potentially causing a new pandemic.

It remains unclear whether the seals transmitted the virus to each other or picked it up from birds in the first place. But the number of affected seals suggests that either the virus spreads easily among marine mammals or the barrier to bird-to-seal transmission is low.

“We really don’t know if it’s transmitted from bird to seal, bird to seal, bird to seal 100 times in a row, or if it’s passed on to a pair of seals and then spread,” said Wendy Puriar, a virologist at Tufts Veterinary School. and author of a new article. “Both are possible,” she added. “None of them are great.”

Either scenario calls for closer observation of the seals, said David Stalknecht, a wildlife disease and influenza expert at the University of Georgia who was not involved in the study.

“We just need to keep an eye on them,” he said. “The easiest way to find out if this persists in seals is to keep testing them.”

The current version of H5N1 has become unusually widespread in wild birds and has been repeatedly transmitted to mammals, including lynxes, raccoons and foxes. Scientists believe that most wild mammals contract the virus directly from birds.

But an outbreak of bird flu last fall on a Spanish mink farm showed that the virus can spread efficiently among some mammalian species. another mass death of sea lions in Peru raised concerns that marine mammals could also transmit the virus to each other.

Seals are known to be susceptible to avian flu, and other versions of the virus have previously caused outbreaks in animals.

The new study is the result of a collaboration between researchers from several academic institutions and wildlife organizations, including the Maine and New England Wildlife Centers, as well as federal scientists.

The researchers collected samples from 1,079 wild birds and 132 gray and harbor seals washed ashore in the North Atlantic from January 20 to July 31, 2022. “It gave us a really powerful opportunity to see what is happening with birds and seals. at the same time in the same region,” the doctor said. Purye said.

The researchers found that wild birds had two flu waves. The first, which peaked in March 2022, primarily affected birds of prey, while the second, which began in June, affected gulls and sea ducks known as eiders.

No seal tested positive for avian influenza during the first wave of avian infections. But during a summer stranding, 19 out of 41 seals tested positive.

The researchers found two slightly different versions of the virus in the seals. One matched what circulated in terns, and the other resembled what circulated in a wider range of birds, including gulls and eiders. The findings suggest that the virus has spread at least twice.

Since these seals do not normally eat birds, scientists suspect that the animals pick up the virus from the environment, possibly through contact with bird droppings.

Seal virus samples also had mutations that were rare or absent in birds. Mutations were found in three seal samples that have been shown to improve virus replication or increase virulence in mammals.

Such mutations are not unique. IN another recent studyA team of Canadian scientists found the same mutations in some virus samples taken from foxes infected with avian influenza. “When there is spread from birds to mammals, they seem to be acquired pretty quickly,” says the doctor. Savatsky said.

The presence of these mutations in itself is not a cause for alarm, the doctor notes. said the groom. But constant surveillance is needed not only to protect human health, but also to protect wild animals from a virus that has already proven its destructive power.

“These emerging diseases need to be considered on a larger scale than just ‘pandemic potential,'” he said, “because they affect so many other species around the globe.”

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