Center Works on Pilot to Improve Access to Critical Community Services in Newark, NJ

.The Greater Newark Healthcare Coalition is a new nonprofit comprising Newark’s hospitals, Federally Qualified Health Centers, primary physicians, and many community groups, as well as city and state government representatives, gathered to improve access to care for the region’s most vulnerable populations. Professor John Jacobi, Faculty Director of the Center for Health & Pharmaceutical Law & Policy and Dorothea Dix Professor of Health Law & Policy, serves as the Coalition’s board chair.  The Coalition has already spun off a Health Information Exchange, and is engaged in a number of exciting pilot projects.

One project will address the community care needs of very high utilizers of hospital emergency department services.  The Coalition plans to indentify an initial cohort of frequent users and provide them with intensive case management with the goal of matching them with appropriate, community-based services. This approach has been shown in other states to both improve the lives of frequent users and reduce unnecessary hospital visits.

Professor Jacobi and Research Fellow Kate Greenwood will analyze the role of existing laws and policies in either facilitating or frustrating the Coalition’s efforts. They hypothesize that while funding flows (relatively) freely to hospital emergency departments because of the legal entitlement to care in that setting, these funds will not readily follow frequent users as they seek community health and social services better suited to their needs.  They hope to assist state and regional policymakers and service providers in their efforts to reform the funding and delivery mechanisms to better meet the needs of this very vulnerable population.

Everybody in the Pool — High Risk That Is

By Labinot A. Berlajolli

Photo by wsuNate via Flickr

Individuals with pre-existing medical conditions may now begin applying for the Pre-Existing Condition Insurance Plan. Under the recently passed health care law (PPACA), the government set aside $5 billion to fund the plan from July 1, 2010 through Jan 1, 2014. Money is expected to be allocated based on each state’s population as well as its costs. Although, HHS officials said they might shift funding among states if the new $5 billion program to cover the uninsured runs out more quickly in some states than in others.

To qualify for coverage, individuals must be U.S. citizens or legal residents, have been denied coverage because of a preexisting medical condition, and have been uninsured for the past six months.  Administration officials said people who apply by July 15 will begin receiving coverage by Aug. 1.   States were required to let HHS know by April 30 whether they wanted to use federal grant money to set up a high-risk pool.  As of now, 21 states have chosen to join the federal run pools and 29 states and the District of Columbia have chosen to go it alone.  The 21 states that have chosen to opt into the federal plan are: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, and Wyoming.  Several of the largest states operating their own plans, including California, Illinois and New York, are not expected to begin enrollment until August. The administration expects that all states will begin enrolling people by the end of the summer.

Joining the plan will not be cheap. The Los Angeles Times reports that premiums, as well as benefits, are expected to vary greatly from state to state, with some plans charging as little as $140 a month and some as much as $900 a month. Independent experts, on the other hand, estimate premiums will average around $400 to $600 a month.

However, serious questions remain about the new risk pools.  Specifically, whether the $5 billion allocated will be enough. Many experts expect the $5 billion to run out well before 2014 because of high demand. The Centers for Medicare and Medicaid Services has estimated that the $5 billion will last for only two years. The Congressional Budget Office has estimated that the funding is not enough to cover all eligible participants, and that the administration will have to limit enrollment to only 200,000 people through 2013, though there are roughly 12.6 million with pre-existing conditions, according to the Miami Herald.   Others who advise Congress and the administration have warned the funds could be exhausted as early as the end of 2011.

Those interested in applying for the high-risk pools may visit the newly launched website, healthcare.gov, for more information and instructions on how to apply.