July 2006

In this Issue:

New Resources

• Families USA: "The Burden of Proof: New Regulations Worsen Citizenship Documentation Requirement in Medicaid"
• The Campaign for Children’s Health Care
• The Health Resources and Services Administration: Web site on cultural competence
• New England Journal of Medicine: “Language Barriers to Health Care in the United States” 
• Health Affairs: “What Accounts For Differences in the Use of Hospital Emergency Departments across U.S. Communities?”
• Kaiser Family Foundation: Paths to Success: A Forum on Young African-American Men
• Lake Research Partners: "Experiences with Medicare Part D: Stories from Low-Income, Ethnically Diverse and Medically Needy Californians"

Activities in the Field

Policy Updates  
   
     Medicare Part D
     Medicaid

Upcoming Events

New Resources

Families USA published a new report entitled "The Burden of Proof: New Regulations Worsen Citizenship Documentation Requirement in Medicaid." This report analyzes the interim regulations that were released for the citizenship documentation requirement in Medicaid. 

The Campaign for Children’s Health Care officially launched on July 11, 2006. This campaign is dedicated to making high-quality, comprehensive, affordable health insurance coverage for all of America’s children a top national priority. To learn more about this campaign and to sign the petition, please visit http://www.childrenshealthcampaign.org/.   

The Health Resources and Services Administration (HRSA) launched a new web page on cultural competence. This user-friendly site highlights approximately 40 HRSA-supported projects on the critical subject of cross-cultural health care.

The New England Journal of Medicine published a new editorial entitled "Language Barriers to Health Care in the United States." This editorial examines the detrimental effects on access to care that are caused by a lack of medical interpreters.

Health Affairs published the study "What Accounts for Differences in the Use of Hospital Emergency Departments across U.S. Communities?”. In this study, the authors analyzed emergency room use in 12 communities around the country and found that the areas with the greatest numbers of uninsured, Latino, and immigrant residents actually had the lowest rates of emergency room use.

The Kaiser Family Foundation hosted a forum, Paths to Success: A Forum on Young African-American Men, featuring Bill Cosby and a panel of national leaders who examined the experiences of young black men in America.

Lake Research Partners released the report, "Experiences with Medicare Part D: Stories from Low-Income, Ethnically Diverse and Medically Needy Californians." The authors conducted in-depth interviews with 35 “medically needy” Medicare beneficiaries in California. They plan to follow these beneficiaries for one year and track their experiences under Part D.

The New York City Department of Health and Human Hygiene released "The Health of Immigrants in New York." This report reveals that foreign-born immigrants are less likely than U.S.-born New Yorkers to have a regular primary care provider and to receive preventive services, such as blood pressure and cholesterol checks, and colon and cervical cancer screenings. While foreign-born New Yorkers arrive in the city in better health than U.S.-born New Yorkers, immigrants who have been living in the United States for four or more years report worse health and are more likely to be obese.

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Activities in the Field

Developing Families Center

Established in 1998, the Developing Families Center’s (DFC) mission is to meet the primary health care, social service, and child development needs of underserved individuals and childbearing and childrearing families through a collaborative that builds on their strengths and promotes their empowerment. It is an “umbrella” organization and the physical home to three partner organizations:

• The Healthy Babies Project (HBP) - Social services and supports partner
• The Family Health and Birth Center (FHBC) - Health partner
• The Nation’s Capital Child and Family Development (NCCFD) - Early childhood education partner

All four entities are separate 501(c)(3) organizations that have come together in this facility and model to provide a continuum of care and support. Currently, the DFC is the only entity of its kind in the nation.

After five years of operation, DFC’s birth outcome data show substantial lowering of preterm birth, low birth weight, and cesarean section rates. The Family Health and Birth Center (FHBC) serves families, many of whom are African American and experience some of the country’s worst health outcomes. Both birth center births and hospital births are provided according to the mother’s needs and wishes, as well as primary pediatric care and immunizations to all age groups in collaboration with the DC Department of Health.
     
There are over 20 cities and/or jurisdictions that are interested in replicating DFC’s model. DFC welcomes everyone to visit their Web site at www.developingfamilies.org and also to come tour and see them in action. For more information on the Developing Families Center, please contact Linda A. Randolph, MD, MPH, President and CEO and/or Ruth W. Lubic, CNM, EdD, Founder and Chair, Family Health and Birth Center at 202-398-2007.

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Policy Updates

Medicare Part D

More than six months into Medicare’s new prescription drug program, Medicare Part D, many elderly and disabled Americans continue to face prescription drug costs that impose an enormous burden on their limited incomes. Some Medicare beneficiaries have begun to hit the so-called “doughnut hole,” or coverage gap, that leaves them entirely vulnerable to drug costs—even as they continue to pay premiums. Other beneficiaries are facing higher copayments or greater restrictions on the drugs they need to take. For example, about half of all low-income beneficiaries who receive both Medicare and Medicaid now must pay more out of their own pockets than when Medicaid covered their prescription drug costs.

Many of these problems can be fixed if Congress chooses to take appropriate action. First, Medicare could be allowed to negotiate deeper discounts directly with pharmaceutical companies in order to keep drug costs down. Families USA recently released a report showing that drug prices in the majority of Part D plans have increased substantially during the first six months of the program. The burden of these higher costs then falls on seniors and taxpayers. In fact, a comparison with the Department of Veterans Affairs (VA) reveals that the government has been able to negotiate better prices for almost every drug when compared to the prices paid for the same drugs under Part D plans.

Second, the savings achieved from discounted prices could be used to close the doughnut hole. This gap in coverage poses a severe financial burden for many beneficiaries and could lead some people to cut back on necessary medications. Legislation has been introduced in the House that would solve this enormous problem: The Medicare Prescription Drug Savings and Choice Act (H.R. 752) would shrink the doughnut hole and allow seniors in Medicare to get their drug benefit directly through Medicare.

Medicare Part D is still in its infancy, but the program’s rocky beginnings suggest that change is needed immediately. You can find out more about Part D by visiting our Medicare Drug Coverage Center or reading our most recent report, "Big Dollars, Little Sense: Rising Medicare Prescription Drug Costs."

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Medicaid

The citizenship documentation requirement for Medicaid officially began on July 1, 2006. This new requirement, which was passed as part of the Deficit Reduction Act of 2005 (DRA), forces millions of low-income Americans to come up with a passport, birth certificate, or other proof of U.S. citizenship to receive health care coverage. Shortly after the law took effect, the Centers for Medicare and Medicaid Services (CMS) issued “interim final” regulations that describe the implementation of the requirement. These regulations resolve some of the most pressing concerns surrounding the requirement, but they fall far short of their potential to ameliorate the harm that the requirement will cause. In fact, the regulations make the situation worse in several key ways by going further than the federal statute requires.

The good news is that the regulations exempt some 8 million of the most vulnerable beneficiaries from the requirement. According to the regulations, elderly and disabled individuals who qualify for Medicare or Social Security Income benefits now will not need to prove their citizenship status to receive Medicaid. This is an especially important victory for the more than 1 million African Americans in Medicare who depend on Medicaid to cover their health care costs, since many of them might lack a birth certificate or other citizenship documentation due to discriminatory hospital admission practices.

The new regulations, however, discriminate against children born to immigrant mothers and could cause newborns to lose access to vital health care. Although any child born in the United States is a U.S. citizen by virtue of being born in this country, the regulations distinguish between children born to citizen mothers and those born to immigrant mothers. Babies born to mothers who were on Medicaid or who qualified for Medicaid at the time of their birth can be “deemed” eligible for Medicaid and receive it for a year. For babies born to women who are undocumented immigrants (or legal immigrants who have not been in the U.S. long enough to qualify for ongoing Medicaid coverage), the regulations require a new Medicaid application with proof of citizenship and identity in order for those babies to get any Medicaid coverage at all—even if Medicaid paid for their births.

These regulations unfairly single out citizen children of immigrant parents by making it more difficult for them to receive health coverage as soon as they are born. This requirement will cause babies who are U.S. citizens by birth, and who are often in need of immediate care, to go without coverage until their Medicaid application is completed and the citizenship documentation requirement has been completed. This discriminatory policy is entirely unnecessary and creates two categories of American children—those born to immigrants and those born to citizens.

To get the latest updates about the citizenship documentation requirement, go to our Medicaid Alert page. There you can find our analysis of the regulations from CMS, including ways you can comment on them before August 10, and also an updated overview of the requirement, "The Burden of Proof: New Regulations Worsen Citizenship Documentation Requirement in Medicaid."

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Upcoming Events

• Utah Issues is sponsoring the Multicultural Health Network’s 3rd Annual Health Summit: Eliminating Inequalities in Utah. The event will explore various local health models to foster innovative solutions for facilitating better health care for all Utah’s residents. If you are interested in attending this Summit, please RSVP by August 4, 2006, to Greg Jaboin via e-mail at Greg@utahissues.org or by phone at 801-521-2035 ext. 120.
• The National Health Policy Training Alliance for Communities of Color is hosting a health policy journalism training event during the National Association of Black Journalists Annual Convention: August 18, 2006, Indianapolis, Indiana.
• The Regional Patient Advocacy Leaders Summit (PALS) is hosting “A Community Approach to Health Disparities” on August 18, 2006. This summit is an interactive session designed to identify and address the health disparities affecting California’s ethnic communities. For more information, please contact: Nancy Limón at 916-658-0144 or by e-mail at nancy@perrycom.com.
• The Congressional Black Caucus Health Braintrust is hosting its Fall Brainstrust, entitled African American Health – In Need of Intensive Care: Renewing and Expanding the Call for a State of Emergency at the Annual Legislative Conference: September 8, 2006, Washington Convention Center, Room 202 B, Washington, DC. For more information on this event, please contact Britt Weinstock at britt.weinstock@mail.house.gov.
• The Congressional Black Caucus, in preparation for their forthcoming trip to New Orleans, Louisiana on August 9-10, 2006, will be collecting school supplies to deliver to some of the most poorly resourced schools in the hurricane-affected areas. The dates of the donation drive are July 31-August 4, 2006. If you are traveling to the Hill to visit offices, please pass by any of the following CBC offices to donate schools supplies or other items: Rep. Artur Davis (208 CHOB), Rep. Cynthia McKinney (320 CHOB), Rep. Kendrick Meek (1039 LHOB), Rep. Donna Christensen (1510 LHOB), Rep. Carolyn Kilpatrick (1610 LHOB), Rep. Barbara Lee (1724 LHOB), Rep. William Jefferson (2113 RHOB), Rep. Mel Watt (2236 RHOB), Rep. Maxine Waters (2344 RHOB), or Rep. Bennie Thompson (2432 RHOB). For more information on the donation drive, please contact Britt Weinstock at britt.weinstock@mail.house.gov.
  

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