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Despite Successes, Addiction Treatment Programs for Families Struggle to Stay Open

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Christina Saint Louis
Wed, 13 Sep 2023 10:00:00 +0000

MORA, Minn. — Two playgrounds border the Recovering Hope Treatment Center for addiction that sits at the end of a gravel road in eastern Minnesota's rural Kanabec County. A meeting room inside is furnished with rocking chairs and baby walkers. And there are strollers in the halls.

Recovering Hope is one of only five providers in the state that offer -based residential treatment, allowing women to enter the program while pregnant or to bring one of their younger than 5 with them for the duration of their stay. Men can receive outpatient treatment but aren't permitted in the residential program.

It's the only such residential program located in a rural Minnesota county and is licensed for 108 beds. It has a waitlist that can span from two to six weeks, depending on whether a woman plans to enter treatment alone or with her child.

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“If you don't family services, the run the risk of losing their kids,” said Ashley Snyder, a licensed drug and alcohol counselor at Recovering Hope.

Family-based residential treatment has been recognized by behavioral professionals as having better outcomes for women and their children. But such programs often struggle to stay afloat because of staffing shortages and volatile . And because of that complexity, families in rural are less likely to find such a residential treatment program in their communities.

Meanwhile, maternal opioid-related diagnoses have increased nationwide. From 2010 to 2017, the rates of women with those diagnoses at delivery increased by 131% and babies born with withdrawal symptoms increased by 82%, according to the Centers for Disease Control and Prevention. The increases disproportionately affected rural areas. At Recovering Hope, opioids are among the top substances, along with alcohol and meth, that women to seek treatment.

“There are too few programs,” said Margaret Ratcliff, an executive vice president at Volunteers of America, which co-published a national directory of family-based residential treatment programs with Wilder Research in 2019. At that time, the directory listed 362 family-based residential treatment programs nationwide, a number that experts, including Ratcliff, say is continually in flux.

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Many of the programs offer some variation of the model in place at Recovering Hope, though the maximum age of children varies.

From its own affiliations with such programs, Ratcliff said, Volunteers of America has seen that “the problem is that Medicaid does not cover the cost of a comprehensive program, and grants come and go.”

Even at Recovering Hope, which has operated since 2016 and is expanding its outpatient treatment to include teenagers and building sober houses, smaller insurance reimbursements have affected care. Women in the center's residential program previously spent up to an average of 40 days in high-intensity care at the beginning of their treatment, but that timespan is now closer to 30 days to contain costs due to those low reimbursement rates. Most of the women in the residential treatment program are covered by Medicaid.

High-intensity care accounts for a third of the center's treatment plan. On average, women's full residential treatment at Recovering Hope lasts 90 to 120 days. During that time, women can enroll their children in on-site day care and bring them along to programming. The kids receive regular visits from a Head Start educator and a psychologist.

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Researchers say that family-based residential treatment can improve women's pregnancy outcomes by keeping them away from drug use during their pregnancy and strengthening their bond with their children. Experts also say the programs increase the likelihood that women will complete treatment.

Beyond the financial hurdles involved in running family treatment programs, managers face logistical constraints. Providing schooling is one of the challenges that come with operating a family-based treatment center, Snyder said. For example, she said, part of the reason the facility allows only for children younger than 5 is to not affect local school enrollment.

“The school district kind of said, ‘Hey, if you put kids in our school district, and then take them out, that's not great for us,'” she said. “‘We don't have enough teachers. So, if you put three kids in the classroom that's already at max, we would technically need to hire another teacher, but they're only here for three months.'”

In addition to the age restriction, Recovering Hope limits the women to bringing one child each.

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For Lisa Thompson, who was in residential treatment there from January to April, that limit led her to both of her kids with their grandmother rather than split them up.

“First getting there, it was really hard seeing women with their children and not having mine,” Thompson, 40, said. “But after being there, and becoming more comfortable, it was just nice being able to have that connection with other mothers there.”

For Gabriela Cajucom, Recovering Hope's ability to accommodate one child helped her reunite with her oldest son one month into her inpatient program, which ran from November to February. Child Protective Services had originally placed him with his grandmother but allowed him to with Cajucom as she completed her treatment.

“He even just ran up to one of the old day care ladies, like totally remembered her and gave her a hug,” said Cajucom, 26, who since has moved to outpatient treatment and is set to graduate in October. “It was a very good community feeling.”

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CPS granted her custody of her son in May.

But despite success stories from Recovering Hope and other programs, some states have found it difficult to keep such facilities running.

In neighboring North Dakota, the state Department of Health and Human Services has been trying to establish a family-based residential treatment option like Recovering Hope since 2020. The state has been without one since April 2019, when its lone provider shut down.

The department has issued three requests for proposals seeking providers to offer a treatment model that allows children to live with a parent undergoing residential treatment but didn't receive any responses.

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“It was during covid, the height of covid, and programs were really trying to maintain what they had, or they were already decreasing some of their services due to capacity or changing their practices to go to telehealth,” said Lacresha Graham, the department's manager of addiction treatment and recovery program and policy. “I guess that caused providers to not want to look at expanding.”

In requesting proposals, the state outlined requirements, such as: The provider must have the residential capacity to serve at least 10 women and their children at once and situate the facility in a community with a neonatal intensive care unit.

Though the expectation is that providers already have experience in adult addiction treatment, they also must change their care model to accommodate both the physical and health needs of mothers and children, Graham said.

In May, Republican Gov. Doug Burgum approved a one-time $1 million allocation in the state Health and Human Services 2023-25 budget to fund family-based residential treatment, which can be used to cover construction and renovation costs. As a result, the department is working to issue another request for proposals to find a provider that offers services like those at Recovering Hope.

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“Ideally, there would be multiple across the state so there'd be better access to locations for women that would need it,” Graham said. “Our priority is getting one up and running and see where we can go from there.”

——————————
By: Christina Saint Louis
Title: Despite Successes, Addiction Treatment Programs for Families Struggle to Stay Open
Sourced From: kffhealthnews.org/news/article/family-addiction-treatment-centers-scarce-rural-minnesota-north-dakota/
Published Date: Wed, 13 Sep 2023 10:00:00 +0000

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Kaiser Health News

When You Think About Your Health, Don’t Forget Your Eyes

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Bernard J. Wolfson
Fri, 22 Sep 2023 09:00:00 +0000

I vividly remember that late Friday afternoon when my eye pressure spiked and I staggered on to my ophthalmologist's office as the rapidly thickening fog in my field of vision shrouded passing cars and traffic lights.

The office was already closed, but the whole eye care team was there waiting for me. One of them pricked my eyeballs with a sharp instrument, allowing the ocular fluid that had built up to drain. That relieved the pressure and restored my vision.

But it was the fourth vision-impairing pressure spike in nine days, and they feared it would happen again — into a . So off I went to the emergency room, where I spent the night hooked up to an intravenous tube that delivered a powerful anti-swelling agent.

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Later, when I told this story to friends and colleagues, some of them didn't understand the importance of eye pressure, or even what it was. “I didn't know they could measure blood pressure in your eyes,” one of them told me.

Most people consider their vision to be vitally important, yet many lack an understanding of some of the most serious eye diseases. A 2016 study published in JAMA Ophthalmology, based on an online national poll, showed that nearly half of respondents feared losing their eyesight more than their memory, speech, hearing, or limbs. Yet many “were unaware of important eye diseases,” it found.

A study released this month, conducted by Wakefield Research for the nonprofit Prevent Blindness and Regeneron Pharmaceuticals, showed that one-quarter of adults deemed at risk for diseases of the retina, such as macular degeneration and diabetic retinopathy, had delayed seeking care for vision problems.

“There is significantly less of an emphasis placed on eye than there is on general health,” says Rohit Varma, founding director of the Southern California Eye Institute at Hollywood Presbyterian Medical Center.

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Because eye diseases can be painless and progress slowly, Varma says, “people get used to it, and as they age, they begin to feel, ‘Oh, this is a normal part of aging and it's OK.'” If people felt severe pain, he says, they would go get care.

For many people, though, it's not easy to get an eye exam or eye treatment. Millions are uninsured, others can't afford their share of the cost, and many live in communities where eye are scarce.

“Just because people know they need the care doesn't necessarily mean they can afford it or that they have the access to it,” says Jeff Todd, and president of Prevent Blindness.

Another challenge, reflecting the divide between eye care and general health care, is that medical insurance, except for children, often covers only eye care aimed at diagnosing or treating diseases. More health plans are covering routine eye exams these days, but that generally does not include the type of test used to determine eyeglass and contact lens prescriptions — or the cost of the lenses. You may need separate vision insurance for that. Ask your health plan what's covered.

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Since being diagnosed with glaucoma 15 years ago, I've had more pressure checks, eye exams, eyedrops, and laser surgeries than I can remember. I should know not to take my eyesight for granted. And yet, when my peepers were filling with that vision-threatening fog last March, I felt oddly sanguine.

It turned out that those serial pressure spikes were triggered by an adverse reaction to steroid-based eyedrops prescribed to me following cataract surgery. My ophthalmologist told me later that I had come “within hours” of losing my eyesight.

I hope my brush with blindness can help inspire people to be more conscious of their eyes.

Eyeglasses or contact lenses can make a huge difference in one's quality of life by correcting refractive errors, which affect 150 million Americans. But don't ignore the risk of far more serious eye conditions that can sneak up on you. They are often manageable if caught early enough.

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Glaucoma, which affects about 3 million people in the U.S., attacks peripheral vision first and can cause irreversible to the optic nerve. It runs in families and is five times as prevalent among African Americans as in the general population.

Nearly 10 million in this country have diabetic retinopathy, a complication of diabetes in which blood vessels in the retina are damaged. And some 20 million people age 40 and up have macular degeneration, a disease of the retina associated with aging that diminishes central vision over time.

The formation of cataracts, which cause cloudiness in the eye's natural lens, is very common as people age: Half of people 75 and older have them. Cataracts can cause blindness, but they are eminently treatable with surgery.

If you are over 40 and haven't had a comprehensive eye exam in a while, or ever, put that on your to-do list. And get an exam at a younger age if you have diabetes, a history of glaucoma, or if you are African American or part of another racial or ethnic group at high risk for certain eye diseases.

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And don't forget children. Multiple eye conditions can affect kids. Refractive errors, treatable with corrective lenses, can cause impairment later in life if they are not addressed early enough.

Healthful lifestyle choices also benefit your eyes. “Anything that helps your general health helps your vision,” says Andrew Iwach, a clinical spokesperson for the American Academy of Ophthalmology and executive director of the Glaucoma Center of San Francisco.

Minimize stress, get regular exercise, and eat a healthy diet. Also, quit smoking. It increases the risk of major eye diseases.

And consider adopting habits that protect your eyes from injury: Wear sunglasses when you go outside, take regular breaks from your computer screen and cellphone, and wear goggles when working around the house or playing .

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The Prevent Blindness website offers information on virtually everything related to eye health, including insurance. Other good sources include the American Academy of Ophthalmology's “EyeSmart” site and the National Eye Institute.

So read up and share what you've learned.

“When you get together for the holidays,” says Iwach, “if you aren't sure what to about, talk about your eyes.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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——————————
By: Bernard J. Wolfson
Title: When You Think About Your Health, Don't Forget Your Eyes
Sourced From: kffhealthnews.org/news/article/eye-health-glaucoma-asking-never-hurts/
Published Date: Fri, 22 Sep 2023 09:00:00 +0000

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Kaiser Health News

Biden Administration to Ban Medical Debt From Americans’ Credit Scores

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Noam N. Levey
Thu, 21 Sep 2023 19:47:00 +0000

The Biden administration announced a major initiative to protect Americans from medical debt on Thursday, outlining plans to develop federal rules barring unpaid medical bills from affecting patients' credit scores.

The regulations, if enacted, would potentially tens of millions of people who have medical debt on their credit reports, eliminating information that can depress consumers' scores and make it harder for many to get a job, rent an apartment, or secure a car loan.

New rules would also represent one of the most significant federal actions to tackle medical debt, a problem that burdens about 100 million people and forces legions to take on extra work, give up their homes, and ration food and other essentials, a KFF Health News-NPR investigation found.

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“No one in this country should have to go into debt to get the quality health care they need,” said Vice President Kamala Harris, who announced the new moves along with Rohit Chopra, head of the Consumer Financial Protection Bureau, or CFPB. The agency will be charged with developing the new rules.

“These measures will improve the credit scores of millions of Americans so that they will better be able to invest in their future,” Harris said.

Enacting new regulations can be a lengthy process. Administration said Thursday that the new rules would be developed next year.

Such an aggressive step to restrict credit reporting and debt collection by hospitals and other medical providers will also almost certainly stir industry opposition.

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At the same time, the Consumer Financial Protection Bureau, which was formed in response to the 2008 financial crisis, is under fire from Republicans, and its future may be jeopardized by a case before the Supreme Court, whose conservative majority has been chipping away at federal regulatory powers.

But the move by the Biden administration drew strong praise from patients' and consumer groups, many of whom have been pushing for years for the federal to strengthen protections against medical debt.

“This is an important milestone in our collective efforts and will immediate relief to people that have unfairly had their credit impacted simply because they got sick,” said Emily Stewart, executive director of Community Catalyst, a Boston nonprofit that has helped lead national medical debt efforts. 

Credit reporting, a threat designed to induce patients to pay their bills, is the most common collection tactic used by hospitals, a KFF Health News analysis has shown.

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“Negative credit reporting is one of the biggest pain points for patients with medical debt,” said Chi Chi Wu, a senior attorney at the National Consumer Center. “When we hear from consumers about medical debt, they often talk about the devastating consequences that bad credit from medical debts has had on their financial lives.”

Although a single black mark on a credit score may not have a huge effect for some people, the impact can be devastating for those with large unpaid medical bills. There is growing evidence, for example, that credit scores depressed by medical debt can threaten people's access to housing and fuel homelessness in many communities.

At the same time, CFPB researchers have found that medical debt — unlike other kinds of debt — does not accurately predict a consumer's creditworthiness, calling into question how useful it is on a credit report.

The three largest credit agencies — Equifax, Experian, and TransUnion — said they would stop including some medical debt on credit reports as of last year. The excluded debts included paid-off bills and those less than $500.

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But the agencies' voluntary actions left out millions of patients with bigger medical bills on their credit reports. And many consumer and patient advocates called for more action. 

The National Consumer Law Center, Community Catalyst, and some 50 other groups in March sent letters to the CFPB and IRS urging stronger federal action to rein in hospital debt collection.

leaders also have taken steps to expand consumer protections. In June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on residents' credit reports or factored into their credit scores.

Many groups have urged the federal government to bar tax-exempt hospitals from selling patient debt or denying medical care to people with past-due bills, practices that remain widespread across the U.S., KFF Health News found.

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Hospital leaders and representatives of the debt collection industry have warned that such restrictions on the ability of medical providers to get their bills paid may have unintended consequences, such as prompting more hospitals and physicians to require upfront payment before delivering care.

Looser credit requirements could also make it easier for consumers who can't handle more debt to get loans they might not be able to pay off, others have warned.

“It is unfortunate that the CFPB and the White House are not considering the host of consequences that will result if medical providers are singled out in their billing, to other professions or industries,” said Scott Purcell, chief executive of ACA International, the collection industry's leading trade association.

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

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The draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health , and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers' balances may be affected by major medical expenses. And the CED , a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

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Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

——————————
By: Noam N. Levey
Title: Biden Administration to Ban Medical Debt From Americans' Credit Scores
Sourced From: kffhealthnews.org/news/article/medical-debt-credit-score-ban-biden-administration/
Published Date: Thu, 21 Sep 2023 19:47:00 +0000

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KFF Health News’ ‘What the Health?’: Countdown to Shutdown

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Thu, 21 Sep 2023 17:30:00 +0000

The Host

Julie Rovner
KFF Health


@jrovner


Read Julie's stories.

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Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news , “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “ and Policy A to Z,” now in its third edition.

Health and other federal programs are at risk of shutting down, at least temporarily, as Congress races toward the Oct. 1 start of the fiscal year without having passed any of its 12 annual appropriations bills. A small band of conservative House are refusing to approve spending bills unless domestic spending is cut beyond levels agreed to in May.

Meanwhile, former President Donald Trump roils the GOP presidential primary field by vowing to please both sides in the divisive debate.

This 's panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat News, and Tami Luhby of CNN.

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Panelists

Alice Miranda Ollstein
Politico


@AliceOllstein


Read Alice's stories

Rachel Cohrs
Stat News

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@rachelcohrs


Read Rachel's stories

Tami Luhby
CNN


@Luhby

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Read Tami's stories

Among the takeaways from this week's episode:

  • The odds of a government shutdown over spending levels are rising. While entitlement programs like Medicare would be largely spared, past shutdowns have shown that closing the federal government hobbles things Americans rely on, like food safety inspections and air travel.
  • In Congress, the discord isn't limited to spending bills. A House bill to increase price transparency in health care melted down before a vote this week, demonstrating again how hard it is to take on the hospital industry. Legislation on how pharmacy benefit managers operate is also in disarray, though its projected government savings means it could resurface as part of a spending deal before the end of the year.
  • On the Senate side, legislation intended to strengthen primary care is teetering under Bernie Sanders' stewardship — in large part over questions about how to pay for it. Also, this week Democrats broke Alabama Republican Sen. Tommy Tuberville's abortion-related blockade of military promotions (kind of), going around him procedurally to confirm the new chair of the Joint Chiefs of Staff.
  • And some Republicans are breaking with abortion opponents and mobilizing in support of legislation to renew the United States President's Emergency Plan for AIDS Relief — the former president who spearheaded the program, George W. Bush. Meanwhile, polling shows President Joe Biden is struggling to claim credit for the new Medicare drug negotiation program.
  • And speaking of past presidents, former President Donald Trump gave NBC an interview over the in which he offered a muddled stance on abortion. Vowing to settle the long, inflamed debate over the procedure — among other things — Trump's comments were strikingly general election-focused for someone who has yet to win his party's nomination.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Washington Post's “Inside the Gold Rush to Sell Cheaper Imitations of Ozempic,” by Daniel Gilbert.

Alice Miranda Ollstein: Politico's “The Anti-Vaccine Movement Is on the Rise. The White House Is at a Loss Over What to Do About It,” by Adam Cancryn.

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Rachel Cohrs: KFF Health News' “Save Billions or Stick With Humira? Drug Brokers Steer Americans to the Costly Choice,” by Arthur Allen.

Tami Luhby: CNN's “Supply and Insurance Issues Snarl Fall Covid-19 Vaccine Campaign for Some,” by Brenda Goodman.

Also mentioned in this week's episode:

Credits

Francis Ying
Audio producer

Emmarie Huetteman
Editor

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To hear all our click here.

And subscribe to KFF Health News' “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

——————————
Title: KFF Health News' ‘What the Health?': Countdown to Shutdown
Sourced From: kffhealthnews.org/news/podcast/what-the-health-315-countdown-to-shutdown-september-21-2023/
Published Date: Thu, 21 Sep 2023 17:30:00 +0000

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