Advocates say there were several victories for health care in this year’s General Assembly session, but they worry that some much-needed changes won’t ultimately get funding from the governor.
The final fiscal 2016 budget passed by lawmakers April 13 included an increase in the Medicaid reimbursement rates for doctors, but those funds are part of the disputed $202 million dollars that Republican Gov. Larry Hogan has said he may not spend.
While the issue may not get as much attention as a disputed pay increase for state employees, it’s arguably more important, said Gene Ransom, CEO of MedChi, The Maryland State Medical Society.
Outgoing Democratic Gov. Martin O’Malley reduced Medicaid reimbursement by 13 percent in January to help balance the fiscal 2015 budget, and Hogan proposed keeping that rate at its reduced level.
Lawmakers ultimately raised the rate to 92 percent of its previous level, but it’s not clear whether Hogan will enact the change.
The issue is crucial because when Medicaid reimbursement increases, so does the volume of Medicaid patients accepted by doctors, said Vincent DeMarco, president of the Maryland Citizens’ Health Initiative.
A 2013 MedChi survey of 251 Maryland physicians found that about 57 percent of those who already accepted Medicaid were likely to take more Medicaid patients after a rate increase that year, and about 46 percent of those who didn’t accept Medicaid were likely to start.
“We are hopeful that the governor will spend the money as allocated to make sure people have the health care they need,” Demarco said.
Lawmakers also tried to restore $4.8 million to fund Medicaid coverage for pregnant women within 250 percent of the federal poverty level and a Medicaid family planning program, but that money, too, is at Hogan’s discretion to spend.
Without that funding, more than 1,000 pregnant women per year could find themselves without health coverage, in part because becoming pregnant is not a “qualifying life event” that would allow a women to enroll a plan through the state’s health exchange, according to Planned Parenthood of Maryland.
Ransom said that if Hogan decides to spend the allocated money, he will consider the 2015 legislative session a great one; but if not, it will still have been a good one.
Another of MedChi’s top priorities this session was a bill to repeal a regulation on sterile compounding – the custom preparation of medicine for patients – which also restricted the routine mixing of medicines in a doctor’s office. That bill was signed by Hogan Wednesday.
Maryland’s hospitals had successful session overall, with one victory coming in the form of a reduction in the Medicaid assessment that tacks 3 percent onto every patient’s hospital bill, said Carmela Coyle, president and CEO of the Maryland Hospital Association.
The assessment, which Coyle called a tax on the sick, generates about $400 million annually and will now be reduced by $25 million per year starting in 2017, she said.
DeMarco said he was pleased with the passage of a bill preventing insurers who offer stop-loss coverage to small employers – which protects the employer from catastrophic losses relating to the health insurance provided to employees – from charging higher rates, reducing coverage or denying coverage for a specific person on the employer’s health plan.
The bill will help make sure people can buy insurance on the small-group market, DeMarco said.
The legislative session also saw the passage of several bills aimed at reducing heroin and opioid abuse. One bill requires insurers to cover abuse-deterrent opioid drugs, which are more difficult to crush or dissolve and therefore harder to inject or snort; another gives doctors and nurses more latitude to prescribe Naloxone, a drug that can counteract the effects of a heroin overdose.
Lawmakers also approved the creation of a Joint Committee on Behavioral Health and Opioid Use, a standing committee of senators and delegates that will oversee issues related to prescription drug monitoring and programs to treat behavioral health disorders and addiction.
MedChi praised the creation of the task force, and Coyle said it was a crucial step to improving the state’s safety net.
Hospitals frequently encounter patients with these issues when they are having acute episodes , but there aren’t enough resources to which doctors can refer those patients for help managing their conditions in the long-term, Coyle said.