April 6, 2023
Payers | Tea Leaves
  • Medicaid covers one-fifth of Americans who seek behavioral health services, but what the program pays psychiatrists varies widely across the country, according to a new study. Additionally, psychiatrists received 81 percent of the pay that they’d get from Medicare for treating the same conditions in Medicaid beneficiaries. The study’s lead author said that “Medicaid programs continue to lag behind Medicare on payment for mental health services, but what was surprising was the degree to which this varies across states. It is important to understand what’s happening in the states that are consistently underpaying in the context of the current workforce crisis—maybe they are implementing other policies or programs that work—or maybe not.” (Article here)
  • California will continue its Medicaid contract with Walgreens Boots Alliance Inc. despite Gov. Gavin Newsom tweeting that the state would cut ties with the pharmacy chain after the company’s decision to not offer the abortion pill mifepristone in 21 states where Republicans threatened legal action. California is legally bound to continue doing business with Walgreens through the state’s massive Medicaid program, health law experts said. And according to a public records request, the state paid Walgreens $1.5 billion last year. A spokesperson for the California Department of Health Care Services said in a statement that the state “has no intention of taking any action that would violate federal Medicaid requirements, or that could undermine access for low-income individuals.” (Article here)
  • Between 21 percent and 61 percent of patients are charged same-day costs while receiving preventive care that is required to be free under the Affordable Care Act, according to a study published in Health Affairs. Researchers found that mean out-of-pocket expenses for services like laboratory work or follow-up visits are highest for bronze plan enrollees, the lowest tier of coverage. The ACA preventative care mandate requires compliant plans to fully cover certain first-line preventative services with no patient cost sharing; however, researchers in the Health Affairs study found that preventative services like colonoscopies could generate between $329 and $941 in out-of-pocket expenses for patients. They also pointed to studies that found that cost sharing for mammograms and colonoscopies did not change significantly after the implementation of the ACA and that out-of-pocket expenses persisted almost a decade after the legislation’s 2010 passage. (Article here)