Thursday, April 18, 2019

Medicaid audits include important findings but should be kept in context

By JEANIE DONOVAN | Policy Director, Louisiana Department of Health

Medicaid is arguably the most impactful public program in the state, and that’s why the Louisiana Department of Health (LDH) has a steadfast commitment to maintaining the program’s integrity. Medicaid promotes the health and wellbeing of 1.7 million low-income Louisianans. While recent audit findings released by the Louisiana Legislative Auditor are used by some as evidence that improper enrollment and fraud are pervasive in Louisiana’s Medicaid program, that is far from reality.

Improper enrollment and recipient fraud in Medicaid are the exceptions rather than the rule. Also, it is important to distinguish that recent legislative audits primarily identified cases of human error or neglect rather than actual fraud, which is defined by the federal government as the intentional provision of false information to get Medicaid. One audit by the Legislative Auditor estimated about 3% of all Medicaid expansion enrollees had wages above the eligibility limit after enrolling in the program and did not self-report their excess wages to the Department, as required by the state’s eligibility policy. Another audit identified five Medicaid expansion cases in which a caseworker’s error or failure to follow established protocol resulted in individuals who earned above the income limit being improperly enrolled in Medicaid.


It is important to remember that Medicaid expansion enrollees who had incomes above the eligibility limit did not receive any direct payments. Instead, the funding went to health insurers and healthcare providers responsible for delivering services to those individuals. What’s more, between federal Medicaid funding and premium taxes paid by health insurers to fund Medicaid expansion in Louisiana, no state general fund dollars are used for Medicaid expansion.

Still, any funding spent on an ineligible person is funding that could have been spent on another important purpose.  That’s why LDH, over the past two years, has greatly enhanced its investment in program integrity functions. Through our new eligibility and enrollment system, LDH is able to reduce caseworker error and more rigorously and regularly verify Medicaid recipients’ eligibility. Our new eligibility system has enhanced functionality that currently checks wage data and will soon check tax data to ensure that all recipients are earning below the eligibility limit, as recommended by the Legislative Auditor.

The department’s new Medicaid Recipient Fraud Investigations Unit is investigating cases and collaborating with the Louisiana Attorney General’s office to prosecute cases of Medicaid fraud. Recently, the Trump administration’s Centers for Medicare and Medicaid Services shared several of LDH’s Medicaid program integrity efforts for others states to consider.

LDH staff take the audit findings very seriously and have worked diligently to incorporate the recommendations of the Legislative Auditor into the Medicaid program. It is important, however, that the magnitude of the audit findings not be overstated or misrepresented. The vast majority of Medicaid recipients are eligible for the program and use their Medicaid health coverage to access needed medical care. The program is improving and saving lives in every town, city and parish across the state of Louisiana — a fact that is often overlooked or diminished in the ongoing conversations about program integrity.

Friday, April 12, 2019

Is your baby up to date on vaccinations?

By STACY HALL, RN, MSN | Immunization Program Director, LDH Office of Public Health

Vaccines are safe, effective and prevent disease, yet only 72% of infants in Louisiana are up to date with immunizations. Vaccination protects the child and entire communities by preventing and reducing the spread of serious infectious diseases. Please join me in celebrating National Infant Immunization Week to highlight the importance of protecting infants from vaccine-preventable diseases and promoting healthy communities in Louisiana and throughout the United States. This year, National Infant Immunization Week will be April 27 to May 4.


Because of the success of vaccines in preventing disease in the U.S., parents may not have heard of some of today’s vaccines — including the inactivated polio vaccine and DTaP vaccine — or the serious diseases they prevent. These diseases can be especially severe for infants and young children. Protection begins before a baby is even born. Learn more about the importance of maternal vaccination at www.cdc.gov/vaccines/pregnancy and follow the recommended immunization schedule to protect infants before they encounter potentially life-threatening diseases.

Vaccine-preventable diseases such as measles and whooping cough still circulate in the United States and around the world, so continued vaccination is necessary to protect everyone from potential outbreaks. The Centers for Disease Control and Prevention declared measles eliminated from the United States in 2000, but the disease has made a comeback because of mistrust regarding the safety of vaccination. The second-greatest measles outbreak since elimination is ongoing, with over 450 cases in 19 states since January 1, 2019. Information on this measles outbreak, vaccination recommendations and resources are available at www.cdc.gov/measles.

2019 marks the 25th anniversary of the Vaccines For Children (VFC) program. VFC is a federally-funded program that provides vaccines at no cost to children who might not be able to afford the shot. The VCF program helps children get their vaccines according to the recommended immunization schedule. It has helped increase childhood immunization coverage levels, making a significant contribution toward making coverage more equal among young children.

Healthcare professionals remain parents’ most trusted source of information about vaccines for their children. They play a critical role in supporting parents in understanding and choosing vaccinations, and will help keep children up to date on vaccinations and work with parents to get their child caught up if they fall behind. The Louisiana Department of Health’s Healthy Babies Don’t Wait, Vaccinate webpage can help you find a VFC provider in Louisiana.

National Infant Immunization Week is a reminder of the importance of keeping up to date with vaccinations. Louisiana can do better than not protecting more than a quarter of our babies with timely immunizations. See how the infants in your parish are doing here.

Friday, April 5, 2019

STD conversations don’t have to stay in the dark

Number one for case rates of newborns born with syphilis.

Number two for chlamydia case rates.

Number three for primary and secondary syphilis case rates.

Number three for gonorrhea case rates.

These statistics belong to Louisiana, and they’re sobering. The rates of sexually transmitted diseases — syphilis, chlamydia, gonorrhea and more — in our state make it vital that we have conversations about STDs: what they are, how they are spread, how they can be treated and how they can be prevented.

April is Louisiana STD Awareness Month. Like many other states around the U.S., Louisiana is participating in efforts to draw attention to STD awareness. And, because sexually transmitted diseases are often talked about in hushed whispers or not at all, that makes this year’s theme all the more important: “Start the Conversation — About STDs.” The slogan for this year’s campaign is, “It doesn’t matter how, it just matters that you do. Start the conversation!”


Three simple rules

The federal Centers for Disease Control’s Talk. Test. Treat. campaign encourages these three simple actions to protect yourself and others from STDs.

TALK
  • Talk openly and honestly to your partner(s) and your healthcare provider about sexual health and STDs.
  • Talk with your partner(s) BEFORE having sex. Not sure how? We have tips to help you start the conversation. Make sure your discussion covers several important ways to make sex safer:
    • Talk about when you were last tested and suggest getting tested together.
    • If you have an STD (like herpes or HIV), tell your partner.
    • Agree to only have sex with each other.
    • Use latex condoms from start to finish every time you have sex.
  • Talk with your healthcare provider about your sex life, and ask what STD tests you should be getting and how often.
    • Not all medical checkups include STD testing, so don’t assume that you’ve been tested unless you discuss it with your provider.
    • Ask your doctor whether certain vaccines, like the hepatitis B vaccine or the HPV vaccine, are right for you.
TEST
  • Get tested. It’s the only way to know for sure if you have an STD.
  • Many STDs don’t cause any symptoms, so you could have one and not know. If you’re having sex, getting tested is one of the most important things you can do to protect your health.
  • Find out which STD tests CDC recommends for you. Even if you’re pregnant, you can still get an STD. If you’re having sex, you’re still at risk.
  • If you’re not comfortable talking with your regular healthcare provider about STDs, find a clinic near you that provides confidential testing that’s free or low cost. (The Louisiana Department of Health’s STD/HIV Program administers statewide and regional programs. Learn more here.)
TREAT
  • If you test positive for an STD, work with your doctor to get the correct treatment.
  • Some STDs can be cured with the right medicine from your doctor, and all STDs are treatable. Make sure your treatment works by doing these things:
    • Take all of the medication your doctor prescribes, even if you start feeling better or your symptoms go away.
    • Don’t share your medicine with anyone.
  • Avoid having sex again until you and your sex partner(s) have all completed treatment.
  • Your doctor can talk with you about which medications are right for you.
Don’t be afraid to have the conversation. Talk about it, get tested and if needed, get treated. Take care of yourself and those around you.

Friday, March 29, 2019

Spring illnesses and allergies are in bloom

The sun is bright, the air is warm and the bees are buzzing … so why are so many people miserable?

While the spring warmth, rain showers and blooming plants may be a welcome change to many after the chill of winter, others are hounded by spring allergies and illnesses, including the common cold.

Let’s take a look at these unwelcome spring conditions.


Allergies and asthma

Seasonal allergies affect more than 50 million Americans, according to the American College of Allergy, Asthma and Immunology. An allergy is an overreaction of the immune system to substances, or allergens, that typically don’t affect other people. They may cause sneezing, coughing and itching and may be mild to life-threatening.

More than 25 million Americans have asthma — a disease of the lungs that causes repeated episodes of wheezing, breathlessness, chest tightness and nighttime or early morning coughing.
Both conditions are often triggered by soaring pollen counts encountered by people spending more time outdoors in the warm weather, as well as the growth of mold indoors and outdoors prompted by spring showers.

If you have seasonal allergies, it’s important to take your medication. If possible, start your medication two weeks before your symptoms typically show up or before your local newscast reports a streak of warm weather on the horizon. Also, check with your doctor to make sure you have the right kind of medication. People with asthma should keep their peak flow meters and rescue inhalers handy. You will also want to keep an eye on pollen counts if you already know what kind of pollen sets off your condition.

To find an allergy and asthma screening location in your area, click here.
Rhinovirus
The cause of roughly half of all common colds, rhinoviruses spread easily during spring, a peak time for these illnesses. Rhinoviruses are viral infections, as their name implies, and typically cause upper respiratory infections but sometimes affect the lower respiratory system as well. To avoid spreading or catching a rhinovirus, practice preventive measures like coughing or sneezing into your elbow or a tissue, washing your hands regularly and avoiding touching the eyes, nose and mouth.
Influenza
Just because winter is behind us doesn’t mean that the flu has also taken a hike. Flu activity in Louisiana has declined recently but is still elevated, and higher than our peak last season. This flu season, there have been about 7,000 hospitalizations and 700 deaths in Louisiana from flu and flu-related illnesses. Like rhinoviruses, preventive measures are key, including avoiding people who are sick and staying home from work or school if you have the flu. The best preventive measure is the flu shot, which can reduce the duration of illness, doctors’ visits and missed school and work, as well as flu-related hospitalizations. Learn more about how you can Fight the Flu.
Conjunctivitis
Known more commonly as pink eye, conjunctivitis is common during the spring months and is often confused with allergy symptoms. It’s a highly contagious condition that is easily spread, particularly among young children. Keep conjunctivitis at bay with regular and frequent hand washing and avoiding touching the eyes. This condition can be bacterial, viral or allergic, and treatment varies depending on type. Viral is treated for symptoms only, bacterial requires antibiotics, and allergic can be treated with antihistamines taken by mouth and/or in the eye.
Norovirus and rotavirus
Norovirus and rotavirus come with stomach pain, cramping, nausea, diarrhea and vomiting, and sometimes low-grade fever, chills, headache, muscle aches and fatigue. These symptoms are very unpleasant and typically last one to two days, but norovirus and rotavirus can be spread for several days after the symptoms clear up. Again, wash your hands frequently and stay home from work or school if needed. You will also want to wash your bedding and disinfect any household items that you may have touched.
Lyme disease
Spring weather, with its warmth and rain showers, is the perfect breeding ground for deer ticks, which transmit Lyme disease. Fortunately, Lyme disease is relatively rare in Louisiana, with just a handful of cases every year. Protect yourself when spending time outdoors by avoiding walking in tall grasses and other vegetation and using tick repellant. Watch your skin for a bull’s-eye rash, which is a sign of Lyme disease. The disease can be treated with antibiotics.
Don't let spring allergies and illnesses get you down. Take preventive measures and talk to your doctor if you're sick or concerned that you may become sick. Enjoy these warm days before the heat and oppressive humidity of summer take over!

Friday, March 22, 2019

It's OK to talk about colorectal cancer

Some cancers are more difficult for people to talk about, due to the sensitive nature of their location and worries about embarrassment. Colorectal cancer, sometimes simply called colon cancer, is one of them.
Since March is Colorectal Cancer Awareness Month, let’s talk about it and dispel the embarrassment. 
Colorectal cancer occurs in the colon, also called the large intestine or large bowel, or the rectum, the passageway linking the colon to the anus. Polyps, or abnormal growths, sometimes develop in the colon or rectum and may eventually become cancerous. 
Signs and symptoms of colorectal cancer include bloody stool; stomach pain, aches or cramps that don’t go away; and unexplained weight loss. Talk with your doctor or healthcare provider if you are having any of these symptoms, since they may be caused by something other than cancer. Your doctor may order diagnostic tests to discover the cause of your symptoms.

Screening
People with polyps or undiagnosed cancer may not always have symptoms, especially at first, which makes regular screening especially important. Several options are available, and each has its pros and cons:
  • STOOL TESTS: There are three kinds of tests, which check your stool for blood and test it for cancerous cells.
  • FLEXIBLE SIGMOIDOSCOPY: The doctor inserts a short, thin, flexible, lighted tube into your rectum to look for polyps or cancer inside the rectum and lower third of the colon.
  • COLONOSCOPY: This test is nearly identical to flexible sigmoidoscopy, with the difference being that the doctor checks the rectum and the entire colon. Most polyps and some cancers can be removed during a colonoscopy. It can also be used as a follow-up test for any of the other screening tests.
  • CT COLONOGRAPHY: Also called virtual colonoscopy, it uses X-rays and computers to produce images of the entire colon. The images are displayed on a computer screen for the doctor to analyze.

Screening is recommended for anyone ages 50 to 75, since about 90 percent of new colorectal cancer cases are found in people ages 50 and older. It’s also recommended for people younger than 50 if they or a close relative have had colorectal polyps or cancer, if they have an inflammatory bowel disease such as Crohn’s or ulcerative colitis, or if they have a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome).
Talk with your doctor to determine whether you need screening, what kind of screening is right for you and how often you should be screened. Your doctor will explain the procedure, any preparations you may need to make in advance of the test and potential risks.
Colon cancer statistics from the Healthy Louisiana dashboard show how many Louisianans have received colon cancer screening, diagnosis and polyps removed as a result of the 2016 Louisiana Medicaid expansion.





Tackling cancer in Louisiana
In Louisiana, colorectal cancer is the fourth most common cancer and the second leading cause of cancer death from 2010 to 2014. For those years, Louisiana also had the third highest incidence and death rates in the United States.
To address this and other cancers, Gov. John Bel Edwards and Louisiana Department of Health Secretary Dr. Rebekah Gee launched the statewide Taking Aim at Cancer in Louisiana (TACL) initiative in May 2018. This collaborative effort brings together leaders from healthcare, business, government, community, advocacy, philanthropy and other sectors, all with one common goal: improving cancer outcomes in our state.
To improve cancer outcomes, TACL seeks to improve early detection, improve patient care and treatment, and ultimately improve patient outcomes. Statewide partners, including doctors who treat cancer patients, also are called upon through TACL to help coordinate policies, programs and practices related to cancer diagnoses and treatments.
TACL was established as a 501(c)(3) nonprofit corporation in February, helping us tackle cancer in Louisiana one step at a time.
Learn more about TACL here. You can learn more about colorectal cancer here and here.