Renuka Rayasam, Author at KFF Health News https://kffhealthnews.org Thu, 17 Oct 2024 01:28:11 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.5 https://kffhealthnews.org/wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=32 Renuka Rayasam, Author at KFF Health News https://kffhealthnews.org 32 32 161476233 Extended-Stay Hotels, a Growing Option for Poor Families, Can Lead to Health Problems for Kids https://kffhealthnews.org/news/article/extended-stay-hotels-children-health-problems/ Fri, 11 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1924542 STONE MOUNTAIN, Ga. — As principal of Dunaire Elementary School, Sean Deas has seen firsthand the struggles faced by children living in extended-stay hotels. About 10% of students at his school, just east of Atlanta, live in one.

The children, Deas said, often have been exposed to violence on hotel properties, exhibit aggression or anxiety from living in a crowded single room, and face food insecurity because some hotel rooms don’t have kitchens.

“Social trauma is the biggest challenge” when students first arrive, Deas said. “We hear a lot about sleep problems.” To meet students’ needs, Deas developed a schoolwide program featuring counselors, a food pantry, and special protocols for handling those who may fall asleep in class.

“Beyond the teaching, there’s a social part,” he said. “We have to find ways to support the families as well.”

Extended-stay hotels are often a last resort for low-income families trying to find housing. Nationally, more than 100,000 students lived in extended-stay hotels in 2022, according to the Department of Education, though officials say that is likely an undercount. Children living in hotels are considered homeless under federal law, and in some Atlanta-area counties about 40% of homeless students live in this kind of housing, according to local officials.

And with rising rents and evictions, and decreased access to federal public housing, the use of extended-stay hotels as a long-term option is becoming more frequent. Like other forms of homelessness, hotel living can lead to — or exacerbate — physical and mental health problems for children, say advocates for families and researchers who study homelessness.

In the Atlanta area, inspections of extended-stay hotels have revealed ventilation issues, insect infestations, mold, and other health threats. Children living there also can experience or witness crime and gun violence. The increasing use of extended-stay hotels is a warning sign, observers said, a reflection of the lack of sufficient affordable housing policy in the U.S.

And the crisis is having “lifelong consequences,” said Sarah Saadian of the National Low Income Housing Coalition. “The only way that we can really address that shortage is if there are significant federal resources at scale. Build more housing and bridge the gap between rents and wages.”

Often, evictions force families into hotels — and can keep them trapped there. Many landlords refuse to rent to people with evictions in their credit history, even if the tenant isn’t responsible for the displacement, said Joy Monroe, founder and CEO of the Single Parent Alliance & Resource Center, or SPARC, a nonprofit group in metro Atlanta that has helped hundreds of families move from hotels to apartments or rental homes.

Black women and other women of color, often with kids, are evicted at much higher rates and are more likely to find themselves living in extended-stay hotels, advocates say.

Some residents are also families fleeing domestic violence, they say.

Hotels often don’t require security deposits, application fees, or background checks, thus providing immediate relief for families seeking shelter. While there are higher-end options, the average rate for an economy-class extended-stay room was $56.68 a night during the first three months of 2024, according to the Highland Group, a research firm that focuses on the hotel sector — which works out to more than $1,700 a month.

And while the rooms offer respite from other forms of homelessness — like sleeping in a car or in a tent — a hotel “is no place to raise children,” said Michael Bryant, CEO of New Life Community Alliance, which helps families in South Dekalb, a part of metro Atlanta, move from hotels to homes.

Children living in hotels are often behind on vaccinations, and they may end up in the emergency room because of delays in care, said Gary Kirkilas, a pediatrician in Phoenix who helps children, teens, and families who are presently homeless or at risk of homelessness. About 75% of children with unstable housing whom he sees have at least one developmental delay, and others experience significant emotional and behavioral issues.

Tanazia Scott, who has bounced between two extended-stay hotels for several months, said her three children “feel depressed and upset” over hotel life.

An eviction sent Kassandra Norman, 58, and her two daughters into a months-long journey of staying in Atlanta-area hotels. For three months, they slept in a car outside a convenience store. “It’s hard to do homework in a car and in the hotel,” said 19-year-old Kazuri Taylor, Norman’s younger daughter.

Some hotels prohibit kids from playing outside in their parking lots, leading to additional stress, advocates say. That was the reason Yvonne Thomas, 45, and her family were evicted from an extended-stay hotel in DeKalb County, she said: “They put us out for nothing.”

And there are other problems. More than a dozen students at Dunaire Elementary live on an extended-stay property called Haven Hotel. In August, DeKalb County’s code enforcement division said the hotel had “not maintained minimum life safety standards.” Roaches and spiders live in rooms and breezeways, according to state health inspection reports. Residents say they have been charged $1 for a roll of toilet paper.

The hotel’s owner and manager could not be reached for comment after multiple attempts.

“No one is talking about these families,” said Sue Sullivan, a community advocate and a volunteer with the Motel to Home coalition in Atlanta, who brings toys, bookbags, food, and toiletries on her hotel visits.

A February public health inspection at another DeKalb County hotel found several rooms with poor ventilation, insect infestation, and mold, among other potential health threats. In May, two people were fatally shot there.

Children who witness violence can develop anxiety, depression, and other disorders, said Charles Moore, director of the Urban Health Initiative at Emory University School of Medicine. “They can feel emotional aftershocks,” said Moore, who has visited Atlanta-area hotels.

Closing such hotels, however, can hurt families, given the shortage of affordable housing, the absence of national federal renter protections, and a dearth of places to go, said Terri Lewinson, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice. Extended-stay hotels do “offer a low-barrier option for families who have no other options,” she said.

To alleviate the housing problem, county officials and nonprofit organizations around the country have been creatively filling the gap. In the Seattle area, for example, King County officials purchased hotels and converted them into affordable housing, said Mark Skinner of the Highland Group.

In metro Atlanta, SPARC and the local United Way’s Motel to Home offer funding to help people transition into an apartment.

In DeKalb County, where Dunaire Elementary School is located, more than a third of the 1,300 homeless students live in hotels, according to Commissioner Ted Terry.

“I hope we can rescue the children,” he said. “It’s not a safe environment for them.”

Advocates who seek to help people living in hotels propose the construction of more affordable housing and stronger protections for renters against eviction. The federal government has failed to invest in repairs needed to maintain current public housing units, and 25-year-old legislation effectively prohibits the construction of new public housing.

It’s also “extremely fast, easy, and cheap” to evict tenants in Georgia, said Taylor Shelton, an associate professor of geosciences at Georgia State University, whose research focuses on social inequalities and urban spaces. “The playing field is tilted heavily toward landlords.”

Under such circumstances, the cycle of poverty is difficult to break, said Jamie Rush, a senior staff attorney at the Southern Poverty Law Center. “Most parents would want their kids in a safe, stable home,” Rush said. “You can’t budget your way out of poverty.”

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A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk. https://kffhealthnews.org/news/article/dangerous-roads-black-neighborhoods-sidewalks-racial-equity-child-death-durham-north-carolina/ Tue, 08 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1923442 DURHAM, N.C. — It’s been 35 years since John Parker died after a pickup collided with the bike he was riding on Cheek Road in east Durham before school. He was 6.

His mother, Deborah Melvin-Muse, doesn’t display photos of him, the second-youngest of six children. His brother’s birthday was the day after the crash — and he hasn’t celebrated it since. An older brother carries a deep sense of guilt because he was looking after John that morning.

And Cheek Road, in a predominantly Black neighborhood, still lacks sidewalks for children to safely make their way to the local elementary school.

This, despite the years community activists and academic researchers have spent pleading with city leaders for safety improvements along the busy thoroughfare with sloping shoulders where John died. Drivers zoom along Cheek Road in the Merrick-Moore neighborhood, which connects downtown Durham to industrial sites and newer suburban developments.

Melvin-Muse moved her family out of the neighborhood after John’s death. “Now when I go down there, I look and see, you know, nothing really changed,” she said. “It still looks the same.”

Cheek Road has been “identified as needing improvements” by a local metropolitan planning board, said Erin Convery, Durham’s transportation planning manager, in an email.

“The infrastructure that exists is not well implemented,” concluded a May preliminary report produced by University of North Carolina-Chapel Hill students who collected data on speeding, noise, and air quality along Cheek Road. “Poorly marked crosswalks and inadequately positioned bus stops show a need for safety and accessibility improvements,” the report said.

Data was difficult to collect because “there were areas we didn’t want to get out of our cars because of the dangerous conditions,” said Ari Schwartz, one of the researchers.

In the 1940s, Black military veterans returning from World War II helped establish the Merrick-Moore neighborhood. Since then, residents say they have endured everything from noisy industrial trucks and speeding cars to illegal tire dumping and air pollution that threaten their health and safety.

Pedestrian deaths are highest in formerly redlined areas, neighborhoods where Black people lived because of discriminatory federal mortgage lending practices, research shows. The lack of sidewalks, damaged walkways, and roads with high speed limits are concentrated in these neighborhoods, studies show, creating a little-recognized public health crisis.

Governments invest in roads for people driving through such neighborhoods, but not in safety measures — like sidewalks, crosswalks, traffic circles, and speed bumps — that protect people living in them, researchers and advocates say.

“People will talk about vulnerable communities as if there is a problem with these communities, when in fact it is our systems and policies that have created these failings,” said Darya Minovi, a senior analyst at the Union of Concerned Scientists who studies environmental health and justice.

While the share of Black residents in Merrick-Moore has dropped in recent decades, data shows the neighborhood remains more than 80% Black or Hispanic and households there are typically less well-off than in other parts of the city.

“Local government takes money from the neighborhood but does not invest in it,” said Bonita Green, head of the Merrick-Moore Community Development Corporation and a former City Council candidate.

Green said the community group had documented more than 100 auto crashes along Cheek Road during a recent four-year span and at least three pedestrian deaths before 2020. In this fast-growing city of roughly 300,000, students at Merrick-Moore Elementary and others at a nearby high school sometimes walk along the road — where traffic is heavy, drivers are known to disregard the 25-mph speed limit, and the shoulders slope steeply.

When longtime residents like Ponsella Brown see kids walking there or hear about another accident, they remember the death of John Parker, who was in first grade.

“I just cringe,” said Brown, who worked as an administrative assistant at Merrick-Moore Elementary when John died. “Every time it comes up, it’s like really vivid in my mind.”

On the day John died, someone rushed into the office and said a child had been hit by a car on Cheek Road, recalled Brown, who said she ran to the scene.

“I remember the way his head was turned. I remember the spot of blood on his face. Like one speck of blood,” said Brown, who also works for the Merrick-Moore Community Development Corporation and is now a counselor at another school.

Traffic on Cheek Road is expected to increase as the population grows in Durham and surrounding areas, according to a separate April report from UNC graduate students. It noted that during the morning school drop-off time, many cars driving on Cheek Road don’t observe the posted speed limits.

Under an equity program meant to reverse the harm done to communities of color, Convery said, Durham officials are considering traffic-calming measures, including traffic circles, speed cushions, and high-visibility crosswalks.

“We’re open to future conversations that will help us achieve zero traffic deaths and injuries,” Convery said.

Yet a 2017 plan that prioritized more than 600 sidewalk projects based on safety, equity, and demand did not include Merrick-Moore Elementary School on Cheek Road, she said.

A strike by Durham school bus drivers this year only heightened concerns about the lack of safe walking routes for the 650 students who attend the elementary school, according to the April report.

Melvin-Muse, now 67, was at work when she got a call that John had been struck by a truck in front of their house. Before she left home that late May morning in 1989, she put her older kids in charge of the younger ones. They passed the time before school riding bicycles near their house, a few blocks from Merrick-Moore Elementary School, when the accident occurred.

John died two months shy of his 7th birthday from “massive head injuries,” according to The (Raleigh) News & Observer, which wrote about his death on Cheek Road at the time. John was buried in Markham Memorial Gardens, according to his obituary in The (Durham) Herald-Sun.

Melvin-Muse said his death sent the family into a tailspin of grief, anger, and regret.

“It caused a big rip in the family,” Melvin-Muse said.

Melvin-Muse and John’s father later divorced. She said she paid for therapy for her other kids, but they still got in trouble at school and two of her children ended up living in a home for kids with behavioral health issues. “It was just a bad time,” she said.

Years after the accident, Melvin-Muse said, she worked up the courage to call the driver who had hit her son. When he answered, he didn’t recognize her name, or John’s, fueling her rage, she recalled.

“I wanted revenge. An eye-for-an-eye kind of thing,” she said. “And I plotted to take him out the same way my son was taken out.”

She went so far as to get a job where he worked, the Durham County tax department, only to find he had left a week before she started.

“God knows what was in my heart and what I planned on doing,” Melvin-Muse said. “God moved him out of that place before I got there.”

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The Public Health Consequences of Public Housing Failures https://kffhealthnews.org/news/article/health-brief-yamacraw-village-public-housing-health-consequences/ Mon, 23 Sep 2024 13:38:35 +0000 https://kffhealthnews.org/?p=1919963&post_type=article&preview_id=1919963 Every year more than 10,000 taxpayer-supported public housing units are lost to disrepair. But federal lawmakers routinely ignore the full amount, around $115 billion, needed to keep the units in “decent, safe and sanitary” condition.

One-time funds for public housing repairs were cut from the final version of the 2022 Inflation Reduction Act to appeal to centrist Senate Democrats who cited the cost.

The results have been disastrous for the more than 1 million people who rely on public housing — mostly low-income, Black and Hispanic tenants — especially as rental prices and eviction rates soar.

It’s not just a matter of housing affordability; it’s also a public health imperative. Research shows that living in derelict housing contributes to higher rates of heart disease, diabetes, asthma, violence and other life-threatening risks.

Exposure to mold, cockroach, mouse and dust mite allergens are major contributors to childhood asthma. Deteriorating conditions can send people to the ER with falls and injuries. And toxic pollutants contribute to cardiovascular health problems.

Earlier this year, my colleague Fred Clasen-Kelly and I traveled to Yamacraw Village, a public housing complex in downtown Savannah, Ga. We spoke with residents who told us about the mold, rats and roaches that make them sick, and gunshots that disrupt their sleep. One former resident said he takes an allergy pill daily, years after leaving, because of mold exposure in his Yamacraw unit.

Last year, a consultants’ report found a host of problems in Yamacraw, including water leaks and faulty wiring. They estimated the “remaining useful life” of the property was 0 years.

In a city where the average two-bedroom apartment rents for more than $1,600 monthly and the housing assistance waitlist has more than 3,000 families on it, records show most of the 315 apartments in Yamacraw sit empty because so many units are uninhabitable.

The local housing authority argues that without more federal funds, there isn’t much it can do.

Starting with the Nixon administration, lawmakers slowed investing in new public housing as more Black families and other people of color became tenants. And during the Clinton administration a moratorium passed that effectively prohibits the construction of additional public housing units, because lawmakers soured on public housing after years of their own disinvestment.

Now a handful of Democratic lawmakers are calling for Congress to take another look at public housing.

Rep. Alexandria Ocasio-Cortez (D-N.Y.), Sen. Tina Smith (D-Minn.) and others recently introduced a bill that would create a new social housing authority to support construction of more affordable housing. It would also lift a 25-year-old moratorium on public housing construction and commit extra funds for public housing repairs.

But many Republicans oppose federally supported public housing, as do centrist Democrats. It’s unclear whether either a Trump or Harris administration would prioritize additional public housing funds.

That’s no surprise to Detraya Gilliard, whose 15-year-old daughter Desaray was shot and killed when they lived at Yamacraw Village. Gilliard is suing the Housing Authority of Savannah, alleging the agency failed to take added security measures in its public housing complexes.

Gilliard left Yamacraw and returns only to maintain a memorial for her daughter. “Nothing has changed before, since or after” her daughter’s death, she said.

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‘What Happens Three Months From Now?’ Mental Health After Georgia High School Shooting https://kffhealthnews.org/news/article/apalachee-high-school-georgia-shooting-mental-health-aftermath-shortage/ Fri, 13 Sep 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1913402 WINDER, Ga. — About an hour after gunfire erupted at Apalachee High School, ambulances started arriving at nearby Northeast Georgia Medical Center Barrow with two students and two adults suffering from panic attacks and extreme anxiety, not bullet wounds.

A fifth patient with similar symptoms later arrived at another local facility, according to a health system spokesperson.

The day after the Sept. 4 school shooting that killed two students and two teachers, some 80 families showed up in a county office to receive counseling from volunteer therapists who converged from across the Atlanta metro area, according to one medical provider. That Sunday, nine people received free treatment at a local church for post-traumatic stress disorder from volunteering Atlanta-area providers. On Monday, the state opened a temporary recovery center to help locals find counseling, faith-based support, or other aid. The needs are still great.

“We don’t really … know how we’re doing,” Amanda McKee — whose son, Asa Deslonde, is a senior at Apalachee — said two days after the shooting. “It’s second by second. It’s minute by minute. The last couple days have been unimaginable.”

When shootings of any magnitude occur, they often leave the survivors with invisible injuries that can create life-changing symptoms that sometimes paralyze them.But such problems can take time to emerge. Panic attacks and anxiety can spike across a community after a shooting and can be most intense when people return to the scene, said Howard Liu, chair of the Council on Communications for the American Psychiatric Association.

So health providers worry that in the coming days, months, and years the community will struggle to find help for their mental health needs. Barrow County, along a highway that connects Atlanta to the college town of Athens, is a community where agriculture is steadily giving way to development.

Prior to the shooting, the area had one stand-alone inpatient mental health facility, located in Gainesville, about 30 miles away from where the shooting occurred in Barrow County, that was “constantly overwhelmed,” said Sean Couch, a spokesperson for Northeast Georgia Health System. And, the latest federal data shows, Barrow would need to add at least 13 full-time providers to no longer be considered a mental health workforce shortage area.

“We put a band-aid on a chronic situation and that band-aid isn’t going to last,” said Roland Behm, a co-founder of the Georgia Mental Health Policy Partnership, an advocacy group that represents mental health organizations in the state. “What happens three months from now?”

The scarcity of mental health providers in Barrow County is emblematic of the state as a whole. Georgia ranks nearly last among states in access to mental health care resources, according to Mental Health America, a nonprofit that advocates for increased mental health spending. More than 5 million Georgians live in mental health care professional shortage areas like Barrow County.

Paying for mental health care to treat such trauma is difficult nationwide. But Georgia is one of the 10 states that have not fully expanded eligibility for Medicaid, the nation’s safety net insurance for those with low incomes and also the largest payer for mental health services. The state has an uninsured rate of 13.6%, which is 4.1 percentage points higher than the country as a whole, according to 2022 data from the U.S Census Bureau.

Even people with private health plans have trouble finding affordable, in-network mental health care because of a lack of providers willing to accept low insurance reimbursement rates, Behm said.

Tamara Conlin, CEO of Advantage Behavioral Health Systems, said the people who came to the initial counseling sessions that her group helped arrange in a county office showed a lot of sadness and anxiety.

“Some of them are still in shock and trying to wrap their heads around what happened,” she said.

Even before the shooting, students at Apalachee High School reported significant mental health challenges.

Nearly 200 of 1,725 student respondents reported that they had seriously considered attempting suicide one or more times in the prior year, according to the latest Georgia Student Health Survey. Top motivators included problems with peers, friends, or family. About half of the students from the school who answered said they felt sad, depressed, or withdrawn at least once in the prior 30 days.

County residents complained about having to travel for psychiatric care and said the “shortage of psychologists and counseling services led to untreated high anxiety and depression rates,” during a 2019 focus group about health care access.

The lack of mental health care remained a top concern in the region during a follow-up assessment in 2022. That year, the opioid overdose death rate in Barrow County was among the highest in Georgia, according to state data, and the five-year suicide rate was above the state average.

The Barrow County School System, which includes Apalachee High School, received a $1.8 million federal grant to boost mental health resources in schools from 2023 through 2028.

But immediately following the shooting, mental health providers across the region still had to cobble together free resources for area residents. Three volunteers helped with last Wednesday’s response at Northeast Georgia Medical Center Barrow. Advantage Behavioral Health Systems kept its Barrow clinic open on Sunday and is providing counselors to community events and local schools as they reopen.

William Smith, who heads the Atlanta Center for EMDR, is planning sessions using eye movement desensitization and reprocessing therapy to address PTSD — at least one for first responders and another for residents.

Over the weekend, Lutheran Church Charities brought nine golden retrievers as “comfort dogs” to help the grieving. The group’s dogs have been deployed in the wake of other school shootings, including the Uvalde, Texas, massacre.

“We can’t fix what they’re feeling,” said volunteer Paul Soost, as people gathered around a campus flagpole where they delivered flowers and messages. “We can provide comfort.”

Many health care providers expect the community’s needs to spike when students return to Apalachee High School and as the national attention on the shooting recedes.

“That’s when people start experiencing the trauma,” said Conlin, with Advantage Behavioral Health Systems, who compared the current crisis to the surge of patients she saw after the immediate threat of the covid-19 pandemic passed.

Her clinic in Barrow County already had about 750 active clients before the shooting, with about 120 under the age of 18.

McKee said she knows healing will be a long process for her son, Asa. One of his football coaches, Richard Aspinwall, was among the four killed. A key step came the day after the shooting, she said, when the school’s head football coach convened the team to share how much he was hurting.

“The coach validated that they were hurt, and encouraged them to embrace that they were injured,” McKee said. “They’re not the physical injuries that were incurred by the senseless act, but they are injuries nonetheless.”

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The First Year of Georgia’s Medicaid Work Requirement Is Mired in Red Tape https://kffhealthnews.org/news/article/georgia-medicaid-work-requirement-red-tape/ Fri, 13 Sep 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1908630 ATLANTA — On a recent summer evening, Raymia Taylor wandered into a recreation center in a historical downtown neighborhood, the only enrollee to attend a nearly two-hour event for people who have signed up for Georgia’s experimental Medicaid expansion.

The state launched the program in July 2023, requiring participants to document that they’re working, studying, or doing other qualifying activities for 80 hours a month in exchange for health coverage. At the event, booths were set up to help people join the Marines or pursue a GED diploma.

Taylor, 20, already met the program’s requirements — she studies nursing and works at a fast-food restaurant. But she said it wasn’t clear what paperwork to submit or how to upload her documents. “I was struggling,” she said.

Georgia is the only state that requires certain Medicaid beneficiaries to work to get coverage. Republicans have long touted such programs, arguing they encourage participants to maintain employment. About 20 states have applied to enact Medicaid work requirements; 13 won approval under the Trump administration. The Biden administration has worked to block such initiatives.

The Georgia Pathways to Coverage program shows the hurdles ahead for states looking to follow its lead. Georgia’s GOP leaders have spent millions of dollars to launch Pathways. By July 29, nearly 4,500 people had enrolled, the state’s Medicaid agency told KFF Health News.

That’s well short of the state’s own goal of more than 25,000 in its first year, according to its application to the federal government, and a fraction of the 359,000 who might have been eligible had Georgia simply expanded Medicaid under the Affordable Care Act, as 40 other states did.

So far, the pricey endeavor has forced participants to navigate bureaucratic hurdles rather than support employment. The state would not confirm whether it could even verify if people in the program are working.

Research shows such red tape disproportionately affects Black and Hispanic people.

“The people that need access to health care coverage the most are going to struggle with that administrative burden because the process is so complicated,” said Leah Chan, director of health justice at the Georgia Budget and Policy Institute.

At an August press event, Georgia Republican Gov. Brian Kemp announced a $10.7 million ad campaign to boost enrollment in Pathways, one of his administration’s major health policy initiatives. The plan has cost more than $40 million in state and federal tax dollars through June, with nearly 80% going toward administration and consulting fees rather than paying for medical care, according to data the state Medicaid agency shared with KFF Health News.

Enrollment advisers, consumer advocates, and policy researchers largely blame a cumbersome enrollment process, complicated program design, and back-end technology flaws for Pathways’ flagging enrollment. They say that the online application is challenging to navigate and understand and lacks a way for people to receive immediate support, and that state staffers don’t respond to applicants in a timely manner.

“It’s just an administrative nightmare,” said Cynthia Gibson, director of the Georgia Legal Services Program’s Health Law Unit, who helps Pathways applicants appeal denials.

Administrative challenges have also undermined a key part of the program’s philosophy: that people maintain employment to keep coverage. As of July, the state was not removing enrollees for not meeting Pathways’ work requirement, according to Fiona Roberts, a spokesperson for Georgia’s Medicaid agency.

“We understand that people need to be held accountable to those 80 hours for the spirit of the program, and we intend to do that,” said Russel Carlson, the agency’s commissioner.

Pathways is set to expire Sept. 30, 2025, unless the state asks the Centers for Medicare & Medicaid Services for an extension. Georgia officials say they won’t have to make that request until next spring, well after November’s election. So the state could be asking for an extension from the Trump administration, which approved the program in the first place.

Georgia officials sued the Biden administration this year to keep Pathways running without going through the official extension process, which requires the state to conduct public comment sessions, gather extensive financial data, and prove that Pathways has met its goals. A federal judge ruled against Georgia.

A CMS spokesperson said the agency wouldn’t comment on the program.

During the August press event, Kemp said the Biden administration’s attempt to stop the program in 2021 delayed its rollout and stymied enrollment. A federal court blocked the administration and allowed Georgia to proceed.

People familiar with the enrollment process said Pathways has been mired in design flaws and system failures. As of the end of May, 13,702 applications were waiting to be processed, according to state documents.

The program’s lengthy questionnaires and technical language are confusing, guidance is opaque, and tools to upload documents are tricky to navigate, according to interviews with health insurance enrollment specialists conducted for the Georgia Budget and Policy Institute.

“It’s not an easy, ‘Oh, I want to apply for Pathways,’” said Deanna Williams, who helps people enroll in insurance plans at Georgians for a Healthy Future, a consumer advocacy group. People generally learn about the program after being denied other Medicaid coverage, she said.

In the online application, people click through pages of questions before they’re shown a screen with information about Pathways, Williams said. Then they must check a box and sign a form saying they understand the program’s requirements.

Sometimes the Pathways application doesn’t pop up, and she must start over. The process to apply is “not smooth,” she said.

Data shows that people who don’t earn enough to qualify for free ACA plans but also make too much for Medicaid are disproportionately people of color. Pathways offers Medicaid coverage to adults earning up to the federal poverty level: $15,060 for an individual or $31,200 for a family of four.

Some people eligible for Pathways who work in retail or restaurants with fluctuating hours are nervous they can’t meet requirements every month, Williams said.

Many current enrollees don’t know how to upload documents, and the website sometimes stops working, said Jahan Becham, an employment specialist for Pathways at Amerigroup Community Care. Or people just forget.

Every month Becham gets a list of 200 to 300 enrollees who haven’t submitted their hours. “It is something new, and not many people are used to this,” Becham said.

“I would get reminders,” said Taylor, who attended the event for enrollees in August. “I just didn’t know how.”

In a June 2023 meeting with Georgia Medicaid staffers weeks before the program launched, federal officials questioned why the state wasn’t automatically verifying eligibility with existing data sources, according to meeting minutes KFF Health News obtained through a state open-records request. Georgia officials said they were unsure when they’d be able to simplify the verification process.

Many potential participants face improper denials, advocates said. Gibson, at the Georgia Legal Services Program, said not enough workers are trained to properly evaluate applications.

Fewer than 1 in 5 people who have their Pathways applications processed had been accepted into the program as of May, according to a KFF Health News analysis of state data. Roberts, with the state, said people were denied because they earned too much, didn’t meet requirements, or didn’t complete the paperwork.

A full-time graduate student was wrongly blocked from the program, and in February a state administrative judge ordered her case be reconsidered. In another case, a different judge ruled a 64-year-old woman who couldn’t work because she was her disabled husband’s full-time caregiver would not qualify for Pathways.

Despite the challenges, state records from May show no individuals were removed from the program since it launched for failing to meet work requirements.

Georgia’s experiment comes after a 2018 effort in Arkansas to implement work requirements on an existing Medicaid expansion population led to 18,000 people losing coverage, many of whom either met requirements or would have been exempted.

Taylor found out about Pathways when she applied for food stamps last year. It wasn’t until August that she learned she could submit her school schedule to meet the qualifying hours requirement. With a full Medicaid expansion, Taylor would have been eligible for health coverage without the extra effort. But, for her, it’s still worth it.

“It’s important to have health insurance,” said Taylor, who has been to the dentist several times and plans to visit a doctor. “I’m glad I have it.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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A Teen’s Murder, Mold in the Walls: Unfulfilled Promises Haunt Public Housing https://kffhealthnews.org/news/article/public-housing-unhealthy-conditions-yamacraw-village-georgia-hud-funding-backlog/ Thu, 22 Aug 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1892755 SAVANNAH, Ga. — Blocks from where tourists stroll along the cobblestoned riverfront in this racially divided city, Detraya Gilliard made her way down the dark, ruptured sidewalks of Yamacraw Village, looking for her missing 15-year-old daughter.

Like most other people living in one of the nation’s oldest public housing projects, Gilliard endured the boarded-up buildings and mold-filled apartments because it was the only place she could afford.

Without working streetlights in parts of Yamacraw, Gilliard relied on the crescent moon’s glow to search for her daughter Desaray in May 2022. She passed yards dotted with clotheslines and power lines, and a broken-down playground littered with juice boxes and red Solo cups.

“I happened to look down, and I knew it was her by her feet, by the shoes she had on,” Gilliard said. She was “barely hanging on and she was covered in blood.”

The year before Desaray died, President Joe Biden called for the federal government to spend tens of billions of dollars to fix dilapidated public housing that he said posed “critical life-safety concerns.” The repairs, Biden said, would mostly help people of color, single mothers like Gilliard who work in low-income jobs, and people with disabilities.

The federal Department of Housing and Urban Development estimates that $115 billion is needed to fund a backlog of public housing repairs. But, two years ago, money to fund those repairs became a casualty of negotiations between the Biden administration and congressional lawmakers over the Inflation Reduction Act. Republicans also have blocked efforts to lift 25-year-old legislation that effectively prohibits the construction of additional public housing, despite the catastrophic public health consequences.

Tenants living in derelict housing face conditions that contribute to higher rates of heart disease, diabetes, asthma, violence, and other life-threatening risks.

The federal government has a long history of discriminatory practices in public housing. In cities across the country after World War II, Black families were barred from many public housing complexes even as the government induced white people to leave them by offering single-family homes in the suburbs subsidized by the Federal Housing Administration. Starting with the Nixon administration, lawmakers slowed investing in new public housing as more Black families and other people of color became tenants.

Today “residents are facing really terrible choices, or terrible options about their future,” said Sarah Saadian, senior vice president of policy for the National Low Income Housing Coalition. “We got here from Congress really failing to live up to its responsibilities of ensuring that people have access to an affordable, stable home.”

In 2022, an art deco luxury apartment building opened down the street. But little has changed in Yamacraw, which is filled with Black families.

Current and former tenants say the Housing Authority of Savannah, the agency that oversees Yamacraw, has ignored the mold, rats, and roaches that infest the units and sicken residents, and the bullet holes in windows and gunshots that ring through the night. Now they fear the city is using the poor state of Yamacraw as justification to push residents out.

In April, an inspection of Yamacraw apartments conducted by HUD, which oversees taxpayer-supported public housing nationwide, found 29 “life-threatening” deficiencies that pose a high risk of death to residents, according to a preliminary report.

The inspection cited 28 deficiencies it called “severe,” meaning they present a high risk of permanent disability, serious injury, or illness. An additional 195 deficiencies were cited as “moderate” because they could cause temporary harm or prompt a visit to a doctor.

Research links structural racism and disinvestment to chronic gun violence, which has taken a heavy toll on Black neighborhoods and kids such as Desaray. A study of gun injuries in four large cities at the height of the covid-19 pandemic found that Black children were 100 times as likely as white youths to suffer a firearm assault.

Study co-author Jonathan Jay, an assistant professor of community health sciences at Boston University, said most of the country’s gun violence stems from disputes in neighborhoods that lack investment in housing and other public services

“This is about white privilege,” Jay said. “The result is driven by racist policymaking.”

Desaray Gilliard was a high school freshman when she was killed. She loved clothes, music, dancing, and the color pink, her mother said. She planned to go to Italy with her art class. She was excited about learning to drive and getting a job. Desaray had her sights set on attending Ohio State University.

They’d lived in Yamacraw for seven years. The teen’s shooting death remains unsolved.

Gilliard has struggled with thoughts of self-harm, she said. She maintains a memorial with pictures, stuffed animals, and flowers near the spot where she found Desaray’s body.

“I have to remember this is for her,” she said of her middle child’s death, “because nobody else is doing these things for her to keep her memory alive.”

A Broken Promise?

Federally funded public housing must be kept in “decent, safe and sanitary” condition, according to HUD. In 2013, the agency’s then secretary, Shaun Donovan, visited Savannah to announce a program that could give the local housing authority millions of dollars to rehab four public housing complexes, including Yamacraw, which has been among the lowest-rated public housing complexes in Georgia.

The Rental Assistance Demonstration program touted by Donovan did not provide new public money. Instead, it loosened rules to allow local officials to work with private lenders and developers to pay for repairs, transforming public housing complexes into mixed-income developments with Section 8 project-based rental assistance.

Last year, a consultants’ report found a host of problems in Yamacraw, including water leaks and faulty wiring. “The Remaining Useful Life of the Property is estimated to be 0 years,” the consultants wrote. The housing authority wants to demolish Yamacraw and replace it with homes that are “healthier, more energy efficient and accessible,” the report said.

Yamacraw never saw the windfall Donovan promised, current and former tenants said. Even with a housing assistance waitlist of more than 3,000 families in Savannah, records show most of the 315 apartments in Yamacraw sit empty, many with boarded-up doors and windows. Some other public housing developments in the area have been repaired or rebuilt, but except for new roofing added in 2019, Yamacraw has not had a significant renovation in years, according to the consultants’ report.

Rather than repair the units, local officials started a process to tear down the complex, threatening to displace residents who have nowhere else to go in a city where the average two-bedroom apartment rents for more than $1,600 monthly.

Congress has provided less money than was needed over the past 20 years to fix Yamacraw and other public housing complexes nationwide, leaving local agencies in a tough spot, said Earline Davis, executive director of the Housing Authority of Savannah.

The housing authority still plans to demolish Yamacraw and redevelop the property with new affordable housing, she said. Residents fear that they will be pushed out, and that because of its prime location, the redevelopment plans would prioritize apartments that attract people who can afford higher rents.

“Anytime you want to do something to make money — go destroy the historic Black community,” said Georgia Benton, who grew up in Yamacraw. “But ain’t nobody hollerin’ ‘Stop.’”

She and her son LaRay Benton have been fighting the housing authority’s redevelopment plans, which they say could also disrupt the two-century-old First Bryan Baptist Church. Rev. Andrew Bryan, a former enslaved person and ordained minister, founded the church in 1788. He later bought his freedom.

The Bentons and three City Council members went door to door observing the condition of residents’ units. They said plumbing issues caused sewage overflows and leaky faucets, mold tracked across the ceilings, and there were insect and rodent infestations.

Many families said they developed respiratory problems, such as bronchitis and asthma, after they moved in. “It is an unhealthy situation,” LaRay Benton said.

About seven years ago, after his previous Savannah landlord raised the rent, Paris Snead, his wife, and two children found themselves homeless. A nonprofit helped them get into Yamacraw, where rent was $750 a month.

It’s been years since they left. Snead said he still takes a daily allergy pill because he believes he was exposed to mold in his unit, which caused allergy-like symptoms.

“The walls sweat like working men,” Snead said of his former apartment. “The walls will, literally, from the top to the bottom, leak water.”

“When you’re homeless, and you want to be able to have a place for your kids, I mean, you’ll make a home wherever you can,” he said.

Snead said he showed Yamacraw’s management the leaking walls, but they didn’t act.

“The management team there did more to evict people and cause problems than they did to help families and ensure they had a place to stay,” Snead said.

HUD, which conducts periodic inspections at public housing complexes, declined an interview request. The agency referred questions to the Housing Authority of Savannah.

The housing authority’s redevelopment plans have been delayed by HUD’s lengthy approval process, said Savannah Mayor Van R. Johnson II, who appoints people to a five-member board of commissioners that helps oversee the city’s public housing.

He said he met with HUD acting Secretary Adrianne Todman and other HUD officials about housing issues in Savannah.

“People don’t deserve to live like that,” Johnson said.

If Yamacraw is demolished and rebuilt, he said, current tenants will have a chance to return because the homes will be affordable to people with low incomes.

Nobody else is doing these things for her to keep her memory alive.

Detraya Gilliard

‘The Worst Experience of My Life’

Yamacraw’s struggles are rooted in century-old policies that have made it difficult for many Black neighborhoods to thrive.

In the 1930s, the federal government’s Home Owners’ Loan Corp. made color-coded maps for Savannah and 238 other cities and labeled redlined areas — usually places where Black people, Jews, immigrants, and Catholics lived — as undesirable for investment.

“The houses are occupied by the lowest class negro tenants,” a government surveyor wrote.

Yamacraw was opened in 1941 as segregated public housing for Black people. Today a health clinic occupies the original administrative building, designed to look like a plantation house.

Despite its problems, Johnson said, some of the city’s most prominent doctors, lawyers, and ministers grew up in Yamacraw.

Former and current tenants said the apartments slowly descended into disrepair.

Each year more than 10,000 public housing apartments across the U.S. become uninhabitable.

Some lawmakers have used the poor state of public housing as justification to refuse lifting a moratorium passed during the Clinton administration that prohibits the construction of additional units, even as the nation’s rental prices — and evictions — soar.

The argument that public housing “doesn’t work” is disingenuous, said Saadian, with the National Low Income Housing Coalition.

“The federal government really failed to invest in public housing, to keep it in good condition, and to keep those communities thriving,” Saadian said, “and in many cases, actively contributed to those communities declining.”

Instead of repairing public housing and building more high-quality units, federal lawmakers promised to provide housing vouchers, commonly known as Section 8, which helps people with low incomes rent privately owned homes. But most people who qualify for vouchers never receive them. Those who do often struggle to find landlords who will accept them, rendering them sometimes worthless.

Three years ago, LaTonya Atterbury was living in hotels north of Atlanta when she was offered a unit in Yamacraw for $511 a month. In August 2021, she moved in with her niece, now 29, and her niece’s son, now 8, relieved to have more stable housing.

But within the first week, she said, a neighbor’s son broke her window and the housing authority charged her $60 to fix it. She said her bathroom is covered in mold and mildew. One day, months after she moved in, Atterbury noticed a hole in her second-story window and saw a bullet on the floor, and realized there had been a shooting overnight. No one was injured, she said, but the bullet hole was only recently fixed — about 2½ years after the incident.

“It’s been the worst experience of my life,” Atterbury said. “Sitting here will make you very depressed.”

Atterbury said she and other residents remain in Yamacraw at least in part because the housing authority has promised vouchers to move elsewhere. Three years later, she is still waiting.

Demolishing and rebuilding Yamacraw could take years.

Davis, the housing authority’s executive director, said her agency has repeatedly told tenants they would be relocated to other public housing complexes or given a Section 8 voucher during construction if they have no lease violations. But residents say they routinely receive lease violations for harmless acts such as broken blinds. LaRay Benton said one resident was cited and fined $75 for leaving a stroller on her front porch while she took her baby inside.

A Mother’s Search

Researchers said that the presence of abandoned buildings can contribute to violent crime by making people feel unsafe and creating a sense of disorder. Studies suggest that razing abandoned buildings and improving green space can reduce it.

“No gun policy is going to work if we don’t fix social infrastructure,” said Jonathan Metzl, director of the Department of Medicine, Health, and Society at Vanderbilt University. “We need investments to make sure communities feel safe. This is not just a public health problem. This is a race problem. This is a democracy problem.”

In recent years, shooting victims or their relatives, including Desaray’s mother, have filed at least three lawsuits against the Housing Authority of Savannah. Those ongoing lawsuits allege the agency failed to take added security measures in its public housing complexes — some of which had fallen into disrepair — despite gun violence and other crimes.

“I don’t know how we can prevent shootings,” Davis said.

Davis declined to comment on the lawsuits. She would say only that her agency has installed cameras in Yamacraw, worked with police, and asked residents to report crime. The actions came after Desaray’s death.

Johnson, Savannah’s mayor, said police have investigated the Desaray Gilliard case, but there are people “who know what happened” and will not talk to officers.

Around 9 p.m. on a Friday night two years ago, Gilliard went looking for her daughter for the second time that night. Desaray missed an 8 p.m. curfew and wasn’t answering her phone.

Gilliard waited for about 30 minutes at a bench near a park in the middle of the complex, hoping Desaray would find her. Then she started to retrace her steps.

Gilliard called 911 after she saw her daughter’s body.

When the police arrived, they made their way through the darkened complex with flashlights, Gilliard said. An officer pulled up Desaray’s shirt and saw a bullet hole in her chest. Gilliard said she later learned from a funeral director that her daughter had been shot three times. She has yet to receive an autopsy report from the police.

Gilliard said “nothing has changed before, since, or after” her daughter’s death.

“It’s been very difficult,” she said. “Sometimes I wanted to give up. I even thought about committing suicide.”

About a month after Desaray died, Gilliard said someone tried to break into her apartment. A couple of weeks later, her request to move to a new complex was finally granted and Gilliard left Yamacraw.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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It’s Called an Urgent Care Emergency Center — But Which Is It? https://kffhealthnews.org/news/article/urgent-care-vs-emergency-room-confusion-bill-of-the-month/ Mon, 24 Jun 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1870449 One evening last December, Tieqiao Zhang felt severe stomach pain.

After it subsided later that night, he thought it might be food poisoning. When the pain returned the next morning, Zhang realized the source of his pain might not be as “simple as bad food.”

He didn’t want to wait for an appointment with his regular doctor, but he also wasn’t sure if the pain warranted emergency care, he said.

Zhang, 50, opted to visit Parkland Health’s Urgent Care Emergency Center, a clinic near his home in Dallas where he’d been treated in the past. It’s on the campus of Parkland, the city’s largest public hospital, which has a separate emergency room.

He believed the clinic was an urgent care center, he said.

A CT scan revealed that Zhang had a kidney stone. A physician told him it would pass naturally within a few days, and Zhang was sent home with a prescription for painkillers, he said.

Five days later, Zhang’s stomach pain worsened. Worried and unable to get an immediate appointment with a urologist, Zhang once again visited the Urgent Care Emergency Center and again was advised to wait and see, he said.

Two weeks later, Zhang passed the kidney stone.

Then the bills came.

The Patient: Tieqiao Zhang, 50, who is insured by BlueCross and BlueShield of Texas through his employer.

Medical Services: Two diagnostic visits, including lab tests and CT scans.

Service Provider: Parkland Health & Hospital System. The hospital is part of the Dallas County Hospital District.

Total Bills: The in-network hospital charged $19,543 for the two visits. BlueCross and BlueShield of Texas paid $13,070.96. Zhang owed $1,000 to Parkland — a $500 emergency room copay for each of his two visits.

What Gives: Parkland’s Urgent Care Emergency Center is what’s called a freestanding emergency department.

The number of freestanding emergency rooms in the United States grew tenfold from 2001 to 2016, drawing attention for sending patients eye-popping bills. Most states allow them to operate, either by regulation or lack thereof. Some states, including Texas, have taken steps to regulate the centers, such as requiring posted notices identifying the facility as a freestanding emergency department.

Urgent care centers are a more familiar option for many patients. Research shows that, on average, urgent care visits can be about 10 times cheaper than a low-acuity — or less severe — visit to an ER.

But the difference between an urgent care clinic and a freestanding emergency room can be tough to discern.

Generally, to bill as an emergency department, facilities must meet specific requirements, such as maintaining certain staff, not refusing patients, and remaining open around the clock.

The freestanding emergency department at Parkland is 40 yards away from its main emergency room and operates under the same license, according to Michael Malaise, the spokesperson for Parkland Health. It is closed on nights and Sundays.

(Parkland’s president and chief executive officer, Frederick Cerise, is a member of KFF’s board of trustees. KFF Health News is an editorially independent program of KFF.) The hospital is “very transparent” about the center’s status as an emergency room, Malaise told KFF Health News in a statement.

Malaise provided photographs of posted notices stating, “This facility is a freestanding emergency medical care facility,” and warning that patients would be charged emergency room fees and could also be charged a facility fee. He said the notices were posted in the exam rooms, lobby, and halls at the time of Zhang’s visits.

Zhang’s health plan required a $500 emergency room copay for each of the two visits for his kidney stone.

When Zhang visited the center in 2021 for a different health issue, he was charged only $30, his plan’s copay for urgent care, he said. (A review of his insurance documents showed Parkland also used emergency department billing codes then. BCBS of Texas did not respond to questions about that visit.)

One reason “I went to the urgent care instead of emergency room, although they are just next door, is the copayment,” he said.

The list of services that Parkland’s freestanding emergency room offers resembles that of urgent care centers — including, for some centers, diagnosing a kidney stone, said Ateev Mehrotra, a health care policy professor at Harvard Medical School.

Having choices leaves patients on their own to decipher not only the severity of their ailment, but also what type of facility they are visiting all while dealing with a health concern. Self-triage is “a very difficult thing,” Mehrotra said.

Zhang said he did not recall seeing posted notices identifying the center as a freestanding emergency department during his visits, nor did the front desk staff mention a $500 copay. Plus, he knew Parkland also had an emergency room, and that was not the building he visited, he said.

The name is “misleading,” Zhang said. “It’s like being tricked.”

Parkland opened the center in 2015 to reduce the number of patients in its main emergency room, which is the busiest in the country, Malaise said. He added that the Urgent Care Emergency Center, which is staffed with emergency room providers, is “an extension of our main emergency room and is clearly marked in multiple places as such.”

Malaise first told KFF Health News that the facility isn’t a freestanding ER, noting that it is located in a hospital building on the campus. Days later, he said the center is “held out to the public as a freestanding emergency medical care facility within the definition provided by Texas law.”

The Urgent Care Emergency Center name is intended to prevent first responders and others facing life-threatening emergencies from visiting the center rather than the main emergency room, Malaise said.

“If you have ideas for a better name, certainly you can send that along for us to consider,” he said.

Putting the term “urgent” in the clinic’s name while charging emergency room prices is “disingenuous,” said Benjamin Ukert, an assistant professor of health economics and policy at Texas A&M University.

When Ukert reviewed Zhang’s bills at the request of KFF Health News, he said his first reaction was, “Wow, I am glad that he only got charged $500; it could have been way worse” — for instance, if the facility had been out-of-network.

The Resolution: Zhang said he paid $400 of the $1,000 he owes in total to avoid collections while he continues to dispute the amount.

Zhang said he first reached out to his insurer, thinking his bills were wrong, before he reached out to Parkland several times by phone and email. He said customer service representatives told him that, for billing purposes, Parkland doesn’t differentiate its Urgent Care Emergency Clinic from its emergency department.

More from Bill of the Month

More from the series

BlueCross and BlueShield of Texas did not respond to KFF Health News when asked for comment.

Zhang said he also reached out to a county commissioner’s office in Dallas, which never responded, and to the Texas Department of Health, which said it doesn’t have jurisdiction over billing matters. He said the staff for his state representative, Morgan Meyer, contacted the hospital on his behalf, but later told him the hospital would not change his bill.

As of mid-May, his balance stood at $600, or $300 for each visit.

The Takeaway: Lawmakers in Texas and around the country have tried to increase price transparency at freestanding emergency rooms, including by requiring them to hand out disclosures about billing practices.

But experts said the burden still falls disproportionately on patients to navigate the growing menu of options for care.

It’s up to the patient to walk into the right building, said Mehrotra, the Harvard professor. It doesn’t help that most providers are opaque about their billing practices, he said.

Mehrotra said that some freestanding emergency departments in Texas use confusing names like “complete care,” which mask the facilities’ capabilities and billing structure.

Ukert said states could do more to untangle the confusion patients face at such centers, like banning the use of the term “urgent care” to describe facilities that bill like emergency departments.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Emily Siner reported the audio story.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Weight-Loss Drugs Are So Popular They’re Headed for Medicare Negotiations https://kffhealthnews.org/news/article/health-brief-weight-loss-drugs-headed-for-medicare/ Fri, 07 Jun 2024 13:49:50 +0000 https://kffhealthnews.org/?p=1865169&post_type=article&preview_id=1865169 The steep prices — and popularity — of Ozempic and similar weight-loss and diabetes drugs could soon make them a priority for Medicare drug price negotiations. List prices for a month’s supply of the drugs range from $936 to $1,349, according to the Peterson-KFF Health System Tracker.

The Inflation Reduction Act President Biden signed in 2022 paved the way for the federal program to negotiate prices directly with drugmakers for the first time. But for now, the high price of Ozempic, Trulicity and other drugs in the class known as GLP-1 agonists have put them out of reach for many low-income patients.

Novo Nordisk’s Ozempic and Wegovy could be eligible for negotiation as early as 2025, said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF. Lilly’s Trulicity may follow the next year.

Medicare shelled out $5.7 billion in 2022 for three popular GLP-1 drugs, up from $57 million in 2018, according to research by KFF. The “outrageously high” prices have “the potential to bankrupt Medicare, Medicaid, and our entire health care system,” Sen. Bernie Sanders (I-Vt.), who chairs the Senate Committee on Health, Education, Labor and Pensions, wrote in a letter to Novo Nordisk in April.

That spending will continue to skyrocket as the benefits of these drugs pile up. Medicare can’t cover the drugs for weight loss alone, but the program does cover them when prescribed to treat diabetes. Wegovy, a version of Ozempic, has also been approved to treat heart disease and the compound has shown promise in treating kidney disease.

The drugs are likely choices for Medicare haggling, according to the Congressional Budget Office.

But just how much will prices come down?

We’ll learn whether Medicare is a good bargainer in September, when the negotiated prices of the first 10 drugs selected for the process are published, Cubanski said.

While the negotiations will initially help only Medicare beneficiaries, other patients could see a benefit once prices are made public and drugmakers start feeling pressure. That’s what happened after the Inflation Reduction Act capped insulin prices for Medicare enrollees at $35 a month.

Another wild card? The winner of the November election. Biden’s been touting Medicare drug price negotiations on the campaign trail.

Trump talked a lot about driving down drug prices in his first term, but he eventually backed off letting Medicare negotiate. It’s unclear whether Trump would take on drugmakers — or his own party — during a second term.

Congressional Republicans voted against the IRA and some have put forward proposals to repeal it.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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High Price of Popular Diabetes Drugs Deprives Low-Income People of Effective Treatment https://kffhealthnews.org/news/article/high-prices-ozempic-mounjaro-wegovy-glp1s/ Tue, 21 May 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1851630 For the past year and a half, Tandra Cooper Harris and her husband, Marcus, who both have diabetes, have struggled to fill their prescriptions for the medications they need to control their blood sugar.

Without Ozempic or a similar drug, Cooper Harris suffers blackouts, becomes too tired to watch her grandchildren, and struggles to earn extra money braiding hair. Marcus Harris, who works as a Waffle House cook, needs Trulicity to keep his legs and feet from swelling and bruising.

The couple’s doctor has tried prescribing similar drugs, which mimic a hormone that suppresses appetite and controls blood sugar by boosting insulin production. But those, too, are often out of stock. Other times, their insurance through the Affordable Care Act marketplace burdens the couple with a lengthy approval process or an out-of-pocket cost they can’t afford.

“It’s like, I’m having to jump through hoops to live,” said Cooper Harris, 46, a resident of Covington, Georgia, east of Atlanta.

Supply shortages and insurance hurdles for this powerful class of drugs, called GLP-1 agonists, have left many people who are suffering from diabetes and obesity without the medicines they need to stay healthy.

One root of the problem is the very high prices set by drugmakers. About 54% of adults who had taken a GLP-1 drug, including those with insurance, said the cost was “difficult” to afford, according to KFF poll results released this month. But it is patients with the lowest disposable incomes who are being hit the hardest. These are people with few resources who struggle to see doctors and buy healthy foods.

In the United States, Novo Nordisk charges about $1,000 for a month’s supply of Ozempic, and Eli Lilly charges a similar amount for Mounjaro. Prices for a month’s supply of different GLP-1 drugs range from $936 to $1,349 before insurance coverage, according to the Peterson-KFF Health System Tracker. Medicare spending for three popular diabetes and weight loss drugs — Ozempic, Rybelsus, and Mounjaro — reached $5.7 billion in 2022, up from $57 million in 2018, according to research by KFF.

The “outrageously high” price has “the potential to bankrupt Medicare, Medicaid, and our entire health care system,” Sen. Bernie Sanders (I-Vt.), who chairs the U.S. Senate Committee on Health, Education, Labor and Pensions, wrote in a letter to Novo Nordisk in April.

The high prices also mean that not everyone who needs the drugs can get them. “They’re kind of disadvantaged in multiple ways already and this is just one more way,” said Wedad Rahman, an endocrinologist with Piedmont Healthcare in Conyers, Georgia. Many of Rahman’s patients, including Cooper Harris, are underserved, have high-deductible health plans, or are on public assistance programs like Medicaid or Medicare.

Many drugmakers have programs that help patients get started and stay on medicines for little or no cost. But those programs have not been reliable for medicines like Ozempic and Trulicity because of the supply shortages. And many insurers’ requirements that patients receive prior authorization or first try less expensive drugs add to delays in care.

By the time many of Rahman’s patients see her, their diabetes has gone unmanaged for years and they’re suffering from severe complications like foot wounds or blindness. “And that’s the end of the road,” Rahman said. “I have to pick something else that’s more affordable and isn’t as good for them.”

GLP-1 agonists — the category of drugs that includes Ozempic, Trulicity, and Mounjaro — were first approved to treat diabetes. In the last three years, the Food and Drug Administration has approved rebranded versions of Mounjaro and Ozempic for weight loss, leading demand to skyrocket. And demand is only growing as more of the drugs’ benefits become apparent.

In March, the FDA approved the weight loss drug Wegovy, a version of Ozempic, to treat heart problems, which will likely increase demand, and spending. Up to 30 million Americans, or 9% of the U.S. population, are expected to be on a GLP-1 agonist by 2030, the financial services company J.P. Morgan estimated.

As more patients try to get prescriptions for GLP-1 agonists, drugmakers struggle to make enough doses.

Eli Lilly is urging people to avoid using its drug Mounjaro for cosmetic weight loss to ensure enough supplies for people with medical conditions. But the drugs’ popularity continues to grow despite side effects such as nausea and constipation, driven by their effectiveness and celebrity endorsements. In March, Oprah Winfrey released an hourlong special on the medicines’ ability to help with weight loss.

It can seem like everyone in the world is taking this class of medication, said Jody Dushay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But it’s kind of not as many people as you think,” she said. “There just isn’t any.”

Even when the drugs are in stock, insurers are clamping down, leaving patients and health care providers to navigate a thicket of ever-changing coverage rules. State Medicaid plans vary in their coverage of the drugs for weight loss. Medicare won’t cover the drugs if they are prescribed for obesity. And commercial insurers are tightening access due to the drugs’ cost.

Health care providers are cobbling together care plans based on what’s available and what patients can afford. For example, Cooper Harris’ insurer covers Trulicity but not Ozempic, which she said she prefers because it has fewer side effects. When her pharmacy was out of Trulicity, she had to rely more on insulin instead of switching to Ozempic, Rahman said.

One day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to adjust the prescriptions for all 18 of the patients she saw because of issues with drug availability and cost, she said. One patient, insured through a teacher retirement health plan with a high deductible, couldn’t afford to be on a GLP-1 agonist, Addison said.

“Until she reaches that deductible, that’s just not a medication she can use,” Addison said. Instead, she put her patient on insulin, whose price is capped at a fraction of the cost of Ozempic, but which doesn’t have the same benefits.

“Those patients who have a fixed income are going to be our more vulnerable patients,” Addison said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Personas de bajos ingresos no pueden recibir terapias efectivas contra la diabetes por el alto costo https://kffhealthnews.org/news/article/personas-de-bajos-ingresos-no-pueden-recibir-terapias-efectivas-contra-la-diabetes-por-el-alto-costo/ Tue, 21 May 2024 08:59:00 +0000 https://kffhealthnews.org/?post_type=article&p=1854443 Durante el último año y medio, Tandra Cooper Harris y su esposo, Marcus, ambos viven con diabetes, han luchado para volver a llenar sus recetas de los medicamentos que necesitan para controlar su azúcar en sangre.

Sin Ozempic o un medicamento similar, Cooper Harris sufre desmayos, se cansa demasiado para cuidar a sus nietos y lucha por ganar dinero extra haciendo trenzas. Marcus Harris, que es cocinero en Waffle House, necesita Trulicity para evitar que sus piernas y pies se hinchen y se hagan moretones.

La médica de la pareja ha intentado recetarles medicamentos similares, que imitan una hormona que suprime el apetito y controla el azúcar en sangre al aumentar la producción de insulina. Pero no suele haber stock de estas drogas. Otras veces, el plan médico que tienen a través del mercado de la Ley de Cuidado de Salud a Bajo Precio (ACA) les impone un largo proceso de aprobación o un costo de bolsillo que no pueden pagar.

“Es como si tuviera que saltar obstáculos para vivir”, dijo Cooper Harris, de 46 años, residente de Covington, Georgia, al este de Atlanta.

La escasez de suministros y las barreras que ponen las aseguradoras para obtener esta poderosa clase de medicamentos, llamados agonistas de GLP-1, han dejado a muchas personas que viven con diabetes y obesidad sin los medicamentos que necesitan para mantenerse saludables.

Una de las raíces del problema es el precio muy establecido por las farmacéuticas que fabrican estos medicamentos. Alrededor del 54% de los adultos que habían tomado un medicamento GLP-1, incluidos aquellos con seguro, dijeron que el costo era “difícil” de pagar, según los resultados de una encuesta de KFF publicada este mes.

Pero los más afectados son los pacientes con ingresos más bajos: personas con pocos recursos que luchan por ver a los médicos y comprar alimentos saludables.

En Estados Unidos, Novo Nordisk cobra alrededor de $1,000 por un suministro mensual de Ozempic, y Eli Lilly cobra una cantidad similar por Mounjaro. Los precios de un suministro mensual de diferentes medicamentos GLP-1 varían de $936 a $1,349 antes de la cobertura de la aseguradora, según el Peterson-KFF Health System Tracker.

El gasto de Medicare en tres populares medicamentos para la diabetes y la pérdida de peso —Ozempic, Rybelsus y Mounjaro— alcanzó los $5.7 mil millones en 2022, frente a los $57 millones en 2018, según una investigación de KFF.

El precio “escandalosamente alto” tiene “el potencial de llevar a la quiebra a Medicare, Medicaid y todo nuestro sistema de salud”, escribió el senador Bernie Sanders (independiente de Vermont), presidente del Comité de Salud, Educación, Trabajo y Pensiones del Senado de EE.UU., en una carta a Novo Nordisk en abril.

Los precios altos también significan que no todos los que necesitan los medicamentos pueden obtenerlos. “Ya están en desventaja de múltiples maneras y esta es solo una más”, dijo Wedad Rahman, endocrinóloga de Piedmont Healthcare en Conyers, en Georgia. Muchos de los pacientes de Rahman, incluidos los Cooper Harris, están desatendidos, tienen planes de salud con deducibles altos o están en programas de asistencia pública como Medicaid o Medicare.

Muchos fabricantes de medicamentos tienen programas que ayudan a los pacientes a comenzar y mantenerse en tratamientos con medicamentos por poco o ningún costo. Pero esos programas no han sido confiables para drogas como Ozempic y Trulicity debido a la escasez de suministros. Y los requisitos de muchos aseguradoras, que los pacientes reciban autorización previa o primero intenten con medicamentos menos costosos, suman demoras en la atención.

Para cuando muchos de los pacientes de Rahman la ven, su diabetes no ha sido controlada durante años y están sufriendo complicaciones graves como heridas en los pies o ceguera. “Y ese es el final del camino”, dijo Rahman. “Tengo que elegir algo más que sea más asequible y que no sea tan bueno para ellos”.

Los agonistas de GLP-1, la categoría de medicamentos que incluye Ozempic, Trulicity y Mounjaro, fueron aprobados por primera vez para tratar la diabetes. En los últimos tres años, la Administración de Alimentos y Medicamentos (FDA) ha aprobado versiones con nuevas etiquetas comerciales de Mounjaro y Ozempic para la pérdida de peso, lo que ha llevado a que la demanda se dispare.

Y la demanda solo está creciendo a medida que se hacen más evidentes los beneficios de los medicamentos.

En marzo, la FDA aprobó el medicamento para la pérdida de peso Wegovy, una versión de Ozempic, para tratar problemas cardíacos, lo que probablemente aumentará la demanda y el gasto. Hasta 30 millones de estadounidenses, o el 9% de la población, se espera que estén usando un agonista de GLP-1 para 2030, según estimó la consultora financiera J.P. Morgan.

A medida que más pacientes intentan obtener recetas de agonistas de GLP-1, los fabricantes se esfuerzan por producir suficientes dosis.

Eli Lilly está instando a las personas a evitar usar su medicamento Mounjaro para la pérdida de peso cosmética, para asegurar suficientes suministros para personas con afecciones médicas. Pero la popularidad de los medicamentos sigue creciendo a pesar de efectos secundarios como náuseas y constipación, impulsada por su efectividad y el respaldo de celebridades. En marzo, Oprah Winfrey lanzó un especial de una hora sobre la capacidad de los medicamentos para ayudar con la pérdida de peso.

Puede parecer que todo el mundo está tomando estos medicamentos, dijo Jody Dushay, profesor asistente de medicina en la Escuela de Medicina de Harvard y endocrinólogo en el Centro Médico Beth Israel Deaconess. “Pero no son tantas personas como piensas”, dijo. “Simplemente no hay suficientes”.

Incluso cuando los medicamentos están en stock, las aseguradoras están tomando medidas, dejando a los pacientes y proveedores de atención médica navegando por una maraña de reglas que cambian constantemente.

Los planes de Medicaid estatales varían en su cobertura de los medicamentos para la pérdida de peso. Medicare no cubrirá los medicamentos si se recetan para la obesidad. Y las aseguradoras comerciales están restringiendo el acceso debido su costo.

Los proveedores de atención médica están diseñando planes de atención en base a lo que está disponible y lo que los pacientes pueden pagar.

Por ejemplo, la aseguradora de Cooper Harris cubre Trulicity pero no Ozempic, que ella prefiere porque tiene menos efectos secundarios. Cuando su farmacia se quedó sin Trulicity, tuvo que depender más de la insulina en lugar de cambiar a Ozempic, dijo Rahman.

Un día en marzo, Brandi Addison, endocrinóloga en Corpus Christi, Texas, tuvo que ajustar las recetas de los 18 pacientes que vio debido a problemas de disponibilidad y costo de los medicamentos, dijo. Una paciente, con cobertura a través de un plan de salud para maestros jubilados con deducible alto, no podía permitirse un tratamiento con un agonista de GLP-1, dijo Addison.

“Hasta que alcance ese deducible, simplemente no es un medicamento que pueda usar”, dijo Addison. En cambio, puso a su paciente bajo tratamiento con insulina, cuyo precio está limitado a una fracción del costo de Ozempic, pero que no tiene los mismos beneficios.

“Esos pacientes que tienen un ingreso fijo serán nuestros pacientes más vulnerables”, concluyó Addison.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

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