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Medicaid expansion a lifesaver for some new patients, Sanford official says

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BISMARCK — North Dakota’s participation in Medicaid expansion has saved the lives of residents who otherwise might not have sought medical treatment because of the costs, a Sanford Health Plan official said Wednesday.

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Meanwhile, leaders of the North Dakota Pharmacists Association told a legislative committee that had they known the expansion would be unfairly administered to many of its members, they would have opposed it.

Lisa Carlson, director of planning and regulation for Sanford Health Plan, said the success stories of Medicaid expansion include a smoker who complained of issues with swallowing and was diagnosed with esophageal cancer and a woman with intestinal symptoms who delayed being evaluated by a doctor and is now being treated for rectal cancer.

“It’s amazing how much pain people will put themselves through when they have the fear of the bills,” Carlson said after testifying to the Legislature’s interim Health Care Reform Review Committee.

North Dakota is one of at least 25 states implementing Medicaid expansion in 2014 under the federal Affordable Care Act.

The act originally required all states to expand Medicaid coverage to eligible residents with incomes below 138 percent of the federal poverty line, which is about $32,500 for a four-person household. But a June 2012 ruling by the U.S. Supreme Court allowed states to opt out of Medicaid expansion. North Dakota Gov. Jack Dalrymple supported expansion, and lawmakers approved it by votes of 57-36 in the House and 33-14 in the Senate, with Republicans casting all of the opposition votes.

As of May 6, nearly 7,900 North Dakotans had enrolled for Medicaid expansion since the beginning of the year, and enrollment continues to grow steadily, a Department of Human Services official testified Wednesday.

The state has estimated that the expansion could make an additional 20,500 to 32,000 North Dakotans eligible for Medicaid. Most of the enrollees so far are childless adults, and 56 percent are between the ages of 19 and 44, said Julie Schwab, the department’s director of medical services.

Sanford Health Plan is the only private insurer involved in Medicaid expansion in North Dakota. Carlson said she expects enrollment will hit 8,000 by the end of June.

Among those signing up for expanded Medicaid coverage, Carlson said there’s a consistent theme of delaying testing and not filling prescriptions or making follow-up appointments because of a lack of insurance coverage and finances. As a result, some haven’t been seen by a doctor or taken their medications for up to five years, she said.

Those who have enrolled are using medical services more often: Forty percent have experienced a claim in each month of coverage, compared with about 30 percent among Sanford Health Plan’s commercial population, Carlson said.

Carlson said the two groups also differ in which medications are most frequently prescribed. Painkillers top the list among Medicaid expansion enrollees but rank third among the commercial population.

“It’s because they have health issues, so they’ve had surgeries, or they have conditions that they’re managing that cause (pain),” she said.

Mike Schwab, executive vice president of the Pharmacists Association, said more than 30 pharmacies have expressed concerns about the effects of Medicaid expansion on their businesses. Many are frustrated over what he called “take it or leave it” contract negotiations with Express Scripts, the pharmacy benefits manager that is administering the Medicaid expansion’s prescription benefit on behalf of Sanford Health.

Association president Steve Boehning of Linson Pharmacy in Fargo said the reimbursement rates being provided for serving Medicaid expansion patients “are ridiculously low.” He and Schwab said reimbursement needs to at least cover the cost of dispensing, and that pharmacies should be able to opt-out of serving Medicaid expansion patients without losing existing contracts.

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Mike Nowatzki
Mike Nowatzki reports for Forum News Service. He can be reached at (701) 255-5607.
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