Maximizing Health Care Reform for New York's Immigrants

As New York State works to implement health reform, key opportunities exist to expand coverage options for immigrants. This NYSHealth-supported report, written by the New York Immigration Coalition in conjunction with Empire Justice Center, presents the choices New York State policymakers will need to make to preserve and promote immigrants' access to health care coverage and to mitigate disparities between citizens and noncitizens in health care.The report emphasizes the options in areas in which states have a high degree of flexibility, including eligibility classifications; documentation and verification policies and practices; marketing and outreach; and oversight and monitoring. It also includes recommendations for ensuring access to care for those immigrants who will remain uninsured even after health reform is implemented. Among the report's recommendations:Shape the State's eligibility classification to ensure the broadest possible inclusion of immigrants under the Affordable Care Act. Currently, immigration status definitions, and eligibility for public benefits, vary by federal and state program rules. The report recommends the cases in which New York can apply the more expansive eligibility standards.Develop mechanisms for verifying citizenship and immigration status while protecting confidentiality and due process. Enrollment into public insurance programs and the Health Benefit Exchange will require verification and documentation of status. The report recommends specific options for verification that also maintain privacy.Conduct tailored, active outreach and marketing to engage immigrants and enroll them in health insurance coverage programs. Given the tremendous racial, ethnic, cultural, and language diversity of the State's residents, a range of tailored approaches can meet the unique needs of immigrant communities.Secure the safety net and charity care programs. Undocumented immigrants and some others will remain uninsured even after health reform is implemented, so the safety-net system of care will remain important to New York State's health care infrastructure

The Nuts and Bolts of New Yorks Healthcare Marketplace: A Tool Kit for Caregivers and Advocates

This toolkit is intended to provide caregivers and advocates for low income consumers with an understanding of what New York's Health Insurance Exchange has to offer their patients and clients. New York opened New York State of Health: the Official Health Plan Marketplace on October 1, 2013. The Marketplace represents a tremendous advancement in providing access to affordable health insurance coverage and has the potential to reduce the ranks of New York's uninsured by over a million people. New York's Marketplace implements three fundamental advancements for low income patients and consumers as laid out in the federal Affordable Care Act: New application technology, Expanded eligibility for Medicaid, and Federal subsidies to help those over?income for public programs afford private insurance

Oral tolerance to cancer can be abrogated by T regulatory cell inhibition

Oral administration of tumour cells induces an immune hypo-responsiveness known as oral tolerance. We have previously shown that oral tolerance to a cancer is tumour antigen specific, non-cross-reactive and confers a tumour growth advantage. We investigated the utilisation of regulatory T cell (Treg) depletion on oral tolerance to a cancer and its ability to control tumour growth. Balb/C mice were gavage fed homogenised tumour tissue – JBS fibrosarcoma (to induce oral tolerance to a cancer), or PBS as control. Growth of subcutaneous JBS tumours were measured; splenic tissue excised and flow cytometry used to quantify and compare systemic Tregs and T effector (Teff) cell populations. Prior to and/or following tumour feeding, mice were intraperitoneally administered anti-CD25, to inactivate systemic Tregs, or given isotype antibody as a control. Mice which were orally tolerised prior to subcutaneous tumour induction, displayed significantly higher systemic Treg levels (14% vs 6%) and faster tumour growth rates than controls (p<0.05). Complete regression of tumours were only seen after Treg inactivation and occurred in all groups - this was not inhibited by tumour feeding. The cure rates for Treg inactivation were 60% during tolerisation, 75% during tumour growth and 100% during inactivation for both tolerisation and tumour growth. Depletion of Tregs gave rise to an increased number of Teff cells. Treg depletion post-tolerisation and post-tumour induction led to the complete regression of all tumours on tumour bearing mice. Oral administration of tumour tissue, confers a tumour growth advantage and is accompanied by an increase in systemic Treg levels. The administration of anti-CD25 Ab decreased Treg numbers and caused an increase in Teffs. Most notably Treg cell inhibition overcame established oral tolerance with consequent tumor regression, especially relevant to foregut cancers where oral tolerance is likely to be induced by the shedding of tumour tissue into the gut

Clinical Effectiveness, Access to, and Satisfaction with Care Using a Telehomecare Substitution Intervention: A Randomized Controlled Trial

Background. Hospitalization accounts for 70% of heart failure (HF) costs; readmission rates at 30 days are 24% and rise to 50% by 90 days. Agencies anticipate that telehomecare will provide the close monitoring necessary to prevent HF readmissions. Methods and Results. Randomized controlled trial to compare a telehomecare intervention for patients 55 and older following hospital discharge for HF to usual skilled home care. Primary endpoints were 30- and 60-day all-cause and HF readmission, hospital days, and time to readmission or death. Secondary outcomes were access to care, emergency department (ED) use, and satisfaction with care. All-cause readmissions at 30 days (16% versus 19%) and over six months (46% versus 52%) were lower in the telehomecare group but were not statistically significant. Access to care and satisfaction were significantly higher for the telehomecare patients, including the number of in-person visits and days in home care. Conclusions. Patient acceptance of the technology and current home care policies and processes of care were barriers to gaining clinical effectiveness and efficiency

Criteria for the diagnosis of corticobasal degeneration

Current criteria for the clinical diagnosis of pathologically confirmed corticobasal degeneration (CBD) no longer reflect the expanding understanding of this disease and its clinicopathologic correlations. An international consortium of behavioral neurology, neuropsychology, and movement disorders specialists developed new criteria based on consensus and a systematic literature review. Clinical diagnoses (early or late) were identified for 267 nonoverlapping pathologically confirmed CBD cases from published reports and brain banks. Combined with consensus, 4 CBD phenotypes emerged: corticobasal syndrome (CBS), frontal behavioral-spatial syndrome (FBS), nonfluent/agrammatic variant of primary progressive aphasia (naPPA), and progressive supranuclear palsy syndrome (PSPS). Clinical features of CBD cases were extracted from descriptions of 209 brain bank and published patients, providing a comprehensive description of CBD and correcting common misconceptions. Clinical CBD phenotypes and features were combined to create 2 sets of criteria: more specific clinical research criteria for probable CBD and broader criteria for possible CBD that are more inclusive but have a higher chance to detect other tau-based pathologies. Probable CBD criteria require insidious onset and gradual progression for at least 1 year, age at onset ≥50 years, no similar family history or known tau mutations, and a clinical phenotype of probable CBS or either FBS or naPPA with at least 1 CBS feature. The possible CBD category uses similar criteria but has no restrictions on age or family history, allows tau mutations, permits less rigorous phenotype fulfillment, and includes a PSPS phenotype. Future validation and refinement of the proposed criteria are needed

Low-Income Individuals’ Perceptions About Fruit and Vegetable Access Programs: A Qualitative Study

To examine how fruit and vegetable (F&V) programs address barriers to F&V access and consumption as perceived by low-income individuals