Kaiser Health News
Anti-Fraud Efforts Meet Real-World Test During ACA Enrollment Period
SUMMARY: Unauthorized switching of Affordable Care Act (ACA) plans has decreased, with complaints dropping by a third, according to federal regulators. The Centers for Medicare & Medicaid Services (CMS) has implemented measures to combat fraud, such as requiring three-way calls for certain policy changes and suspending 850 agents involved in improper switching. Despite these efforts, concerns remain about increased complexity in the enrollment process, with potential delays for consumers. Some rogue agents are finding workarounds, and agent groups advocate for two-factor authentication to further prevent fraud. The CMS reports success in reducing unauthorized switches, but challenges remain.
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Kaiser Health News
Montana Eyes $30M Revamp of Mental Health, Developmental Disability Facilities
SUMMARY: Montana’s Republican Governor Greg Gianforte proposes significant changes to the state’s behavioral health system, which includes relocating a developmental disabilities facility, enhancing the Montana State Hospital, and establishing a new psychiatric unit in Helena. This initiative aims to improve service gaps and assist individuals transitioning back to their communities. A commission has allocated $300 million to enhance services for mental illness and disabilities, with about $100 million earmarked for various projects. Proposed plans include moving a 12-bed Intensive Behavior Center and creating a 16-bed “step-down” facility for patients ready to leave intensive care while addressing hospital infrastructure issues.
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Kaiser Health News
A Program To Close Insurance Gaps for Native Americans Has Gone Largely Unused
SUMMARY: Dale Rice, 62, lost a toe to infection and accrued over $20,000 in hospital debt while uninsured. Living far from his tribe’s health resources, he struggled to access specialty care under the federal Indian Health Service. A new tribal sponsorship program in Nevada aims to address this gap by allowing tribes to purchase health insurance through the state’s Affordable Care Act marketplace. This initiative increases access to coverage for Native Americans and reduces financial burdens associated with uninsured care. While successful in providing assistance, concerns over expiring tax credits could jeopardize ongoing support for these programs, impacting health access further.
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Kaiser Health News
Hospitales dicen que no rechazarán pacientes, mientras los estados se posicionan sobre inmigración
SUMMARY: California está aconsejando a los proveedores de atención médica que no incluyan el estatus migratorio de los pacientes en registros y facturas, mientras que Florida y Texas exigen que se reporte. Trump ha declarado una emergencia en la frontera y ha anulado polÃticas que protegen a indocumentados cerca de lugares sensibles, lo que ha generado miedo en la comunidad inmigrante y ha incrementado la reluctancia a buscar atención médica. A pesar de las disparidades en las polÃticas estatales, los hospitales afirman que no denegarán atención por el estatus migratorio de los pacientes, buscando garantizar su privacidad y acceso a servicios esenciales.
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