Community health in good shape all over; local Medicaid, behavioral health issues remain

State and federal governments must juggle many different responsibilities in their efforts to legislate and oversee health care concerns. Even as one area sees great strides, others clamor for attention. Although underserved areas will receive new health care centers through new funding made available from the community health program, many issues remain in North Dakota’s behavioral health and North Carolina’s Medicaid programs. These states’ legislators will have to work diligently in the coming months to ensure that their residents obtain proper care.

Community health centers, already doing well, get a boost

On August 11, 2015, HHS announced that more Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) funding would be available to create 266 community health centers (CHCs). These centers, which will be located in 46 states, D.C., and Puerto Rico, will receive a total of $169 million to enable them to offer care to the neediest communities. This follows a $101 million award announced in May 2015 for 164 new health centers.

The CHC program started under President Lyndon Johnson and grew at a slow pace over the next several years. President George W. Bush decided to double federal financing for the centers and created or expanded almost 1,300 clinics. The Obama Administration has already funded over 700 new health center sites through the ACA. In all, the national community health program serves nearly 23 million people. The program claims to save over $24 billion each year in health care costs due to early treatment of diseases and preventive care. The centers target low-income communities such as poor urban neighborhoods as well as isolated rural areas. The availability of these centers helps keep costs low, as patients would otherwise seek care in more expensive settings.

North Dakota’s behavioral health care has a long way to go

In contrast to the successful outreach of the community health program, states are struggling to properly meet their residents’ mental health needs. North Dakota is no exception. Although lawmakers have turned their focus to the matter and have been making strides to improve behavioral health services, the interim Human Services Committee said that the state still faces numerous hurdles. A final report from a consulting firm hired after the 2013 legislative session recommended changes in six areas: service shortages, workforce expansion, insurance coverage, communication, data collection, and the structure of the state agency.

Representative Kathy Hogan (D-Fargo) has been tasked with leading the interim committee. She feels that legislators are taking the problem more seriously, as 20 have asked for updates from the committee. The committee will study behavioral health needs and the best way to meet them. The members will develop recommendations and bill drafts for implementing the solutions, which Hogan admits is going to be a difficult process.

Last year, the legislature passed several behavioral health-related bills. One gave the Department of Human Services (DHS) $750,000 to address underserved areas as well as offer more addiction treatment services. Elizabeth Faust, Blue Cross Blue Shield of North Dakota’s senior medical director for behavioral health, said that throwing more money at the problem is not the answer. In her mind, the resources need to be spent more wisely. She told the committee that evidence-based, high-quality care must be consistently provided. Nancy Vogeltanz-Holm, director of the University of North Dakota School of Medicine’s Center for Health Promotion and Prevention Research, was encouraged to hear about the legislature’s awareness of  the workforce shortage. In 2013, North Dakota was ranked 43rd in mental health workforce availability.

North Carolina Medicaid reform forecast is stormy

The North Carolina House unanimously rejected the Senate’s Medicaid plan. The Senate bill would have changed the fee-for-service system and instead offered a per-member monthly allotment for in-state providers and commercial insurance. It also would have created a cabinet-level department of Medicaid. Following the rejection, the matter moved on to a committee of negotiators who already believe that a deal is in sight. House Republicans have tentatively agreed to a hybrid model that would involve both managed care companies and provider-led organizations. Patients would have the freedom to choose if their care will go through a large insurer or handled by a local provider-insurer combination.