Since a significant portion of states' health budgets go towards paying for Medicaid, public employees and public retirees, states are keenly aware of health policy and the need for innovation and reform to hold down costs while improving care.
In 2014, states are focused on a number of health policy areas. Debra Miller, director of health policy for the Council of State Governments, which recently published a report about state legislators' overriding issues, talked to Healthcare Finance News about the top five health policy issues states are focused on this year.
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1. Medicaid. More states may revisit their decision not to expand Medicaid. The lure of federal funding is a driver for this re-evaluation. "Medicaid spending growth, whether related to increased enrollment or increased per capita costs, continues to absorb almost all of states' annual revenue growth, crowding out other state priorities," Miller said.
2. Health insurance exchanges. The 14 states and District of Columbia established their own exchanges and have encountered fewer problems overall than the federal exchange. States without established state-based exchanges can move to a state-based exchange, but soon "the large amount of establishment grants available to states will be drying up," Miller said. The number of people who sign up and the mix of those who enroll and "what we might know of their experience" will be important to states contemplating a potential move to state-based exchanges, she said.
3. Mental health. The adequacy of state mental health systems and parity with physical healthcare are emerging as issues for states. Mental health became a piece of the formula for states in deciding whether it was in their interest to expand Medicaid, which has expanded the opportunity for treatment of behavioral health and substance abuse.
4. Health workforce adequacy. The shortage of healthcare providers will be intensified as more individuals gain health coverage and seek access to services. State policymakers will continue to debate scope of practice and increased professional training. More states are beginning to recognize stand-alone practices for nurse practitioners and to allow expanded prescription authority as well as expanded scope of practice for dentists and dental hygienists. "More and more I'm hearing the phrase that it is important to assure practice to the top of the license, whether you are a nurse, nurse practitioner or physician," Miller said. "But there are various views on expanding those licenses."
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5. Aging population. There is increased pressure for states to have community-based residential services for seniors instead of putting them in nursing homes. Additionally, states are girding for a large population of older seniors with Alzheimer's disease and other dementias, which will increase demand on state and private services.