V. Emerging Issues/Trends
Access to Care for Medicaid and Medicare Patients
Access to primary care affects all Trust beneficiary groups. Patients in some parts of Alaska report disturbing levels of difficulty in finding primary care providers willing to see Medicare patients. Many seniors have been terminated from care by their long-standing family physicians. Doctors say that Medicare’s reimbursements cover less than 50% of their costs of care.
Additionally, community mental health providers who serve people who are dually eligible for Medicare and Medicaid are reimbursed for clinic services at Medicare rates, which are lower than Medicaid rates. A number of community mental health centers, especially the urban centers that serve large numbers of adults with severe mental illness, experience financial hardship because of this federal billing requirement.
After a Congressional hearing held by Senator Lisa Murkowski in Anchorage in early 2007, a resolution (SJR 3) passed by the 2007 Legislature urged Congress to order a comprehensive rewrite of the Medicare reimbursement formulas. In summer 2008, Congress passed legislation which included an increase in the physician reimbursement rates for Alaska to begin in 2009.
Eligibility Disparity for Early Special Education Services
To meet state eligibility criteria for services under the Individuals with Disabilities Education Act (IDEA) Part C, children from birth to three years old must have a 50% delay in one or more developmental domains. This is a stricter requirement than for children ages 3-22, which requires only a 25% delay in at least one developmental domain to access special education services through Part B of this same Act.
This disparity means that for children birth to three with developmental delays between 25-50%, services are delayed until they are eligible for special education services from their school district no earlier than their third birthday.
According to DHSS Office of Children’s Services, this disparity is at odds with what we know about the importance of both early identification and early intervention, particularly for vulnerable children with multiple risk factors. Many of these children with moderate delays of 25-49% will continue to fall behind their peers while waiting to access these vital services, and this will increase needs and the costs when they enter services under Part B.
Returning Service Members with Brain Injury and Mental Health Conditions
According to the RAND Corporation, nearly 20 percent of military service members who have returned from Iraq and Afghanistan report symptoms of post-traumatic stress disorder or major depression. In addition, 19 percent report possible brain injury and 7 percent report both a probable brain injury and current PTSD and major depression. (See RAND Corporation News Release April 17, 2008. One in Five Iraq and Afghanistan Veterans Suffer from PTSD or Major Depression.)
Researchers found many treatment gaps exist for those with PTSD and depression. Just 53 percent of service members with PTSD or depression sought help from a provider over the past year, and of those who sought care, roughly half got minimally adequate treatment. (RAND Corporation, April 17, 2008).
According to the RAND Corporation project co-leader, if PTSD and depression go untreated or are under-treated, there is a cascading set of consequences including drug use, suicide, marital problems and unemployment. “There will be a bigger societal impact if these service members go untreated. The consequences are not good for the individuals or society in general."
The Alaska Brain Injury Network reports that the 3rd Medical Unit at Elmendorf Air Force Hospital has developed a Mild Traumatic Brain Injury clinic to address the brain injury needs of returning service members in addition to the programs for PTSD or major depression.