The Department of Healthcare and Family Services will extend its current contracts with Medicaid managed care organizations in the HealthChoice Illinois program for an additional year as new leadership settles in, Director Elizabeth Whitehorn said Friday. [Health News Illinois]

Whitehorn, who began the role in January, told members of the Medicaid Advisory Committee that the decision to postpone the procurement process by a year would give them the “appropriate time to ensure the process is designed to drive healthcare transformation.”

“We really value input from our stakeholders and our customers and believe that incorporating the feedback at the front end will lead to a better final procurement,” Whitehorn said.

The contracts are currently in the sixth year of an eight-year deal, she said. HealthChoice Illinois covers roughly 80 percent of all the state's Medicaid enrollees.

The focus for future contracts will include prioritizing behavioral health, maternal and child health, health equity and “accountability," Whitehorn said. 

That will include higher standards for performance metrics, financial withholds for both pay-for-performance and pay-for-reporting elements, and standardizing quarterly reviews of individual plan performances.

“We'll continue to grow the team and have some fresh perspective on how we work with our MCOs,” Whitehorn said. “I really hope this additional time will ensure the success of procurement for the agency, for the state and — most importantly — for our customers.”

The department is working on requests for proposals for a new fully integrated dual-eligible special needs plan, she said. That comes after the Centers for Medicare and Medicaid Services notified the state that it will not extend the Medicare-Medicaid Alignment Initiative demonstration program past 2025.

The program covers about 90,000 consumers who are dually eligible for Medicaid and Medicare.

The requests for proposals are expected to be released later this spring.

###

The Department of Public Health said Thursday it has updated a standing order that allows school officials to administer naloxone and other opioid antagonists. [Health News Illinois]

The order allows schools to obtain a supply of medications that can reverse the effects of an opioid overdose without a prescription. Additionally, a school nurse or other person trained in their use may administer them on school property. 

The revision also adds nalmefene as an approved opioid antagonist.

“This updated standing order will ensure Illinois schools have the authority to use this treatment to prevent tragedies,” said agency Director Dr. Sameer Vohra. “While we continue to work vigilantly to steer young people away from misuse of opioids and other substances, a public health approach requires us to do everything in our power to reduce harm — preventing the most tragic and permanent consequences of these substances.”

A state law that went into effect this year requires public and private schools to keep a supply of opioid antagonists on hand.

Last school year saw 10 reported instances where school personnel administered an opioid antagonist to a student with signs of an overdose, according to data from the Illinois State Board of Education.

###

Gov. JB Pritzker unveiled a nearly $53 billion spending plan Wednesday that addresses medical debt for over 300,000 Illinoisans, Black maternal health outcomes and care for asylum seekers. [Health News Illinois]

Additionally, Pritzker announced a sweeping proposal on how insurers handle network adequacy and prior authorization that he said would put “power back into the hands of patients and their doctors.”

Under the governor's proposed budget, Illinois would provide $10 million for a program to relieve an estimated $1 billion in medical debt for more than 300,000 Illinois households. The plan mimics an initiative from Cook County, which announced last fall it has erased more than $280 million of medical debt for over 158,000 residents.

“Let’s make this a reality for all of Illinois,” Pritzker said during his State of the State and Budget Address in Springfield. 

The proposal also pledged $23 million to expand maternal healthcare, with just over half of that for a child tax credit intended to help reduce child poverty in low- and middle-income families with children under 3 years old. 

The Department of Public Health would receive $4.4 million to assess Illinois’ maternal mortality rate and create an action plan centered on reproductive care. The Department of Human Services would receive $5 million for a program to connect new moms and babies with resources.

“In Illinois, a serious effort to reduce maternal mortality rates is long overdue,” said Pritzker, noting a state report last fall found Black women are three times more likely to die from pregnancy-related causes than white women. “It’s imperative that we act now, ensuring that as we do, we also reduce and eliminate racial disparities.”

The proposal would also allocate $629 million for programs that provides Medicaid-like coverage for undocumented individuals ages 42 and older. Of the funds, the state would cover an estimated $440 million. About $100 million would come from a federal emergency services match, $50 million from drug rebate payments and $40 million from managed care organization taxes.

Pritzker also called on lawmakers to approve $181.7 million for shelter, healthcare and other services related to asylum seekers coming to the state.

“I won’t pretend any of this is easy, but it would be irresponsible to do anything but come here, lay out the scope of the challenge, tell you what I think we need to do and then work with you to make it happen,” he said.

Recent discussions between the state, Cook County and the city of Chicago estimate the cost to maintain shelters and services for the population will total $321 million for the calendar year. Cook County Board President Toni Preckwinkle has pledged around $70 million to address the shortfall. Chicago officials have not made their intentions known about the city’s financial commitment.

The spending plan also calls for $35 million to continue funding and implementing recommendations from the Children’s Behavioral Health Transformation Initiative. Of that, $31.3 million would go to expand a program that offers services like assessments, crisis stabilization and housing to youth who are at risk of involvement in the child welfare system or the juvenile justice system.

And Pritzker is proposing $23.8 million to establish a state-based Affordable Care Act marketplace, which is set to go live for plan year 2026.

Other parts of Pritzker’s plan include:

• More than $181 million to support unhoused populations seeking shelter and services.
• A $104.4 million increase for a program that supports seniors who receive in-home and community-based services to accommodate caseload growth and utilization, as well as to annualize a rate increase that went into effect this year.
• $50 million for a Medicaid tiered safety-net hospital add-on. 
• Maintaining $18 million to support existing reproductive health initiatives, including a navigation hotline and a learning and training collaborative for providers. 
• $6 million for the Department of Public Health to hire 100 additional staff for licensing, inspecting and certifying that healthcare facilities are compliant with state and federal regulations.

Pritzker used Wednesday’s speech to introduce a plan to implement further regulations on the insurance industry.

The proposal would ban “step therapy,” or the practice of an insurer asking a patient to try a less costly treatment before authorizing the more expensive alternative. It would also bar short-term, limited duration health plans and prior authorization for inpatient adult and children’s mental healthcare.

He said the proposal would also require insurance companies to update their in-network directories of doctors “to reflect the actual availability of healthcare.” It would also prevent insurers from “unfairly increasing rates on consumers," he said.

“I know how hard the insurance industry will fight me on this,” Pritzker said. “But let me be perfectly clear: I am willing to spend serious political capital and put my shoulder to the wheel to get this done. It will save lives and lower healthcare costs for millions of Illinoisans.”

Laura Minzer, president of the Illinois Life and Health Insurance Council, said they look forward to learning more about the governor’s plan and how it will “build on all of the existing insurance reform laws we have negotiated in good faith over the last decade.”

###

Health systems are increasingly prioritizing the development of artificial intelligence (AI) oversight efforts as they continue to navigate the potential promise and pitfalls of these tools in healthcare, according to a report published today and shared with HealthITAnalytics by the Center for Connected Medicine (CCM) at the University of Pittsburgh Medical Center (UPMC). [Health IT Analytics]

The report, “How Health Systems are Navigating the Complexities of AI,” surveyed executives from almost three dozen health systems on their approaches to overseeing the technology.

As AI rapidly advances, healthcare organizations continue to investigate how these tools can help automate administrative tasks and reduce clinical documentation burdens, among other use cases. However, this increased interest and swift development makes the pros and cons of AI in healthcare challenging to balance, as stakeholders have raised a plethora of concerns around data privacy, clinician over-reliance, patient trust, and more.

More> 

###

Some health systems have decided that providing hospital-at-home care "might not be worth it," NBC News reported. [Becker's]

While "hospital at home" has exploded in popularity in recent years, particularly since CMS started reimbursing for it, some systems have been reluctant to partake in the trend because the CMS waiver expires at the end of 2024, according to the Feb. 7 story.

"For many hospitals, it seems like it might not be worth it," Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, told the news outlet. Some commercial payers are also waiting on the government's next move before deciding whether to reimburse for the care model.

Hospital-at-home leaders told Becker's for a December story that the uncertainty is causing some health systems to take a wait-and-see approach, but most of them expect Congress to extend the waiver or make it permanent.

More>

###

Illinois and Cook County have pledged a combined $250 million to help support shelters and healthcare services for asylum seekers coming to the region, Gov. JB Pritzker and county board President Toni Preckwinkle said Thursday. [Health News Illinois]

The funds are intended to address the $321 million cost to maintain shelters and services this calendar year, according to estimates from recent discussions between the state, county and city of Chicago.

"With thousands of asylum seekers continuing to come to Chicago in desperate need of support and with Congress continuing to refuse to act — it is clear the state, county and city will have to do more to keep people safe," Pritzker said in a joint statement. "I'm thankful to President Preckwinkle for working with us to help close this budget gap and maintain critical services in the year ahead."

The city of Chicago was not included in the release. A spokeswoman for Pritzker directed questions on how it plans to cover the remaining shortfall to Mayor Brandon Johnson’s office.

Johnson told reporters Thursday there is "no disconnect" between him and the state and county. 

When pressed about the city's financial commitment to asylum seekers, Johnson said that additional details need to be clarified, but they are "committed to the mission."

"It's not just simply about finding financial resources, it's about building an entire operation," he said. "For the first time in the history of the world, a local municipality has been asked to establish, build, maintain and operate a migrant resettlement."

The city's current budget allocates more than $150 million to support temporary shelter, food and other necessities for asylum seekers — an amount officials have acknowledged is well short of the actual expected cost.

Of the state and county funding announced Thursday, $182 million will come from Pritzker’s proposed budget for the coming fiscal year. The rest will come through the Cook County Board of Commissioners.

Preckwinkle said the funds will maintain shelter capacity, as well as the continuation of wraparound and healthcare services.

“As critical funding for this ongoing humanitarian crisis stalls in Congress, Cook County stands committed to the well-being of the region," she said.

The joint statement noted that Cook County Health has been the primary healthcare provider for new arrivals, having served more than 25,000 patients and provided for nearly 70,000 visits.

Illinois previously pledged a total of $638 million to help address the asylum seeker response, while Cook County pledged more than $100 million in its current fiscal year budget.

###

Does exposure to mRNA COVID-19 vaccination during pregnancy increase the risk of adverse events in newborn infants? 

Findings  In this population-based cohort study from Sweden and Norway that included 94 303 infants exposed to COVID-19 vaccination during pregnancy and 102 167 control infants born between June 2021 and January 2023, vaccination during pregnancy was associated with lower odds of neonatal intracranial hemorrhage, cerebral ischemia and hypoxic-ischemic encephalopathy, and neonatal mortality. [JAMA]

Meaning  In this large population-based study, vaccination of pregnant individuals with mRNA COVID-19 vaccines was not associated with increased risks of neonatal adverse events in their infants.

Abstract

Importance  Better knowledge about neonatal adverse events after COVID-19 vaccination during pregnancy could help address concerns about vaccine safety.

More> 

###

Millions of people deal with Covid-19 symptoms long after their initial infections. Two new studies – one looking at pregnant people and the other on children – give a better look at the burden from this health problem that doctors say often goes under the radar. [CNN Health]

The first study says that 1 in 10 people who had Covid when they were pregnant will develop long-term symptoms. The results were shared Monday at the Society for Maternal-Fetal Medicine’s annual meeting in National Harbor, Maryland.

The researchers used data from the National Institutes of Health’s Recover Initiative, a project created to determine the long-term effects of Covid in adults and children. Of the 1,503 people who were pregnant in the dataset, 9.3% reported having symptoms six months or more after they were infected. The most common symptom was a feeling of being tired after light physical or mental activity. Some also reported dizziness.

More>

###

Has COVID replaced syphilis as the great imitator? At the turn of the 20th century, Sir William Osler was quoted as saying, "He who knows syphilis knows medicine." [Medscape]

If you have any doubts about the "imitator" analogy, simply use any broad search engine or AI portal and enter "what is the differential diagnosis of primary syphilis, or secondary syphilis, or tertiary syphilis?" A plethora of diseases across many body systems appears.

Another Great Pretender?

Did you or do you now have long COVID? How do you know? Do you even know what long COVID is? How would you diagnosis it?

More>

###

People who experience food insecurity are at greater risk of dying prematurely and living a shorter life after age 50, researchers say, underscoring how a fairly prevalent problem can impact individual health.[US News]

READ: 

Millions More Americans Were Food Insecure in 2022 Than 2021

The federal government says food insecurity refers to “limited or uncertain access to adequate food” – an economic and social condition that can lead to hunger. In an analysis published Monday in JAMA Internal Medicine, researchers found 78.4% of more than 57,400 U.S. adults included in the study were fully food secure, compared with 8.5% who had marginal food security, 7.4% who had low levels of food security and 5.6% who experienced very low food security.

Researchers also found estimated life expectancy at age 50 was 32.5 years among individuals with full food security, compared with 29.9 years among adults with marginal food security, 30 years among those with low food security and 28 years among individuals with very low food security.

More> 

###