Health agency details Medicaid, opioid efforts

DOVER — The first round of Joint Finance Committee hearings just about wrapped up this week, with the Department of Health and Social Services presenting to lawmakers across three days.

Over the course of Tuesday, Wednesday and Thursday, the committee heard about the agency’s many focuses, challenges and budgetary needs, with members from the public also chiming in to urge legislators to fund this or that.

Covering subjects as disparate as rabies vaccinations, child support and cancer care, DHSS is a mammoth agency spanning 11 divisions and boasting an authorized personnel strength of about 3,900. Its budget for the fiscal year that ends June 30 is $1.23 billion, meaning it takes up a sizable chunk of the state’s $4.45 billion General Fund spending.

Two of the most important and far-reaching divisions both appeared before JFC Wednesday, with officials from Public Health and from Medicaid and Medical Assistance giving an overview of their work.

While JFC had tough questions for Medicaid officials a few years ago over rapidly increasing costs, spending has stabilized (for now, at least). As of January, about 235,000 Delawareans — nearly 25 percent of the state’s population — were enrolled in Medicaid. The division’s budget for the current fiscal year totals about $2.4 billion, $1.5 billion of which is from the federal government.

The state expanded its Medicaid program under the Affordable Care Act, and legislation passed last year instructed DHSS to create an adult dental benefit for Medicaid recipients.

The Division of Medicaid and Medical Assistance is working to set up the program but won’t have it by the target date of April 1. Instead, the program is expected to begin Oct. 1, with the extra months giving DHSS needed time to work out some kinks.

Division Director Stephen Groff told JFC the state’s Medicaid contracts with Highmark Health Options and AmeriHealth Caritas now include new measures designed to ensure Delaware pays for quality of services rather than quantity.

“The purpose of the three-year agreement is to transition the system away from traditional fee-for-service, volume-based care to a system that focuses on rewarding and incentivizing improved patient outcomes, value, quality improvements and reduced expenditures,” Mr. Groff said. “The managed care organizations will be required to implement provider payment and contracting strategies that promote value over volume and reach minimum payment threshold levels.”

He also informed the committee of a change regarding Medicaid recipients who are sentenced to jail time. While it’s unclear what percentage of inmates were on Medicaid before going to prison, they will no longer lose their eligibility, although that doesn’t mean they will get health benefits from the program while in prison.

Instead, starting last month, Medicaid recipients will be suspended from the program while incarcerated (the Department of Correction covers most medical care for offenders).

If not for this, “people would still be walking out of the prison without full coverage, without care coordination at one of the most vulnerable periods of their life, so the fact that we’re able to get (providers) in prior to release to work with people, we can share medical information, can develop care plans, I think is going to make a huge difference,” Mr. Groff said.

Previously, the agency would essentially reactivate someone’s benefits upon release, but there would be lag time of up to two months to get everything fully squared away, he said.

DHSS is hopeful the minor adjustment can keep people healthier and reduce recidivism.

Lawmakers also heard about pregnancy mortality rates, including the sad fact childbirth remains risky for a segment of the population: Both black mothers and babies are several times more likely to die during pregnancy than white women and babies in Delaware. That’s due to a mix of factors, including the reality that many black women are in worse socio-economic situations than their white counterparts and thus have added challenges and stress, according to DPH Director Karyl Rattay.

Institutional racism has an impact as well, she said.

Dr. Rattay highlighted the state’s steps to combat the opioid epidemic, which has hit Delaware especially hard. Per DHSS, which cited the Centers for Disease Control and Prevention, Delaware is first in the country in per capita high-dose and long-acting opioid prescriptions and was sixth in per capita overdoses in 2017, the most recent year with data.

The state saw 395 overdose deaths in 2018 and figures to see a similar number in 2019 when the final figures are, Dr. Rattay said.

The department is focusing on identifying patterns that could hopefully enable it to identify individuals struggling with or at risk of developing an addiction. Because many of the victims were employed in the construction, HVAC or restaurant industries, DHSS is working with those fields. It’s also locked in on emergency departments, since half of overdose victims were in the ER in the year before their deaths.

Many people start on prescribed painkillers and move on to heroin or the synthetic drug fentanyl, which Dr. Rattay said has been identified in about 80 percent of overdoses. Not everyone gets pain medication for a legitimate injury, though: Also an issue are “outlier” doctors and pharmacies, which Delaware’s Prescription Monitoring Program helps the state identify, Dr. Rattay told JFC.

Lawmakers urged DHSS to continue looking for those practitioners who stand out for the number of scripts or medications they issue to patients.

“We’re not going to make any traction in this if we just continue to make more addicts unnecessarily,” Sen. Trey Paradee, D-Dover, said.