Medicaid Reimbursement for Naloxone: A Toolkit for Advocates

Naloxone is an opioid antagonist drug used to counter the effects of an opiate overdose. It can be administered in medical settings, such as an emergency room, or prescribed as a take‑home medication to be used in case of an emergency. Currently, most types of insurance will cover and reimburse for naloxone administered directly in a medical setting. However, coverage of prescription take‑home naloxone is limited. The Medicaid program provides health insurance for a large and growing number of Americans. Therefore, securing coverage for take‑home naloxone—including costs of counseling/training and for the medicine itself—within Medicaid should be a critical priority for advocates. This toolkit is designed to facilitate advocacy for that goal. It provides background information on naloxone, the Medicaid program, and Medicaid drug coverage policies. It then outlines an action plan for advocating that state Medicaid programs cover take‑home naloxone. The toolkit concludes with success stories from Washington State, North Carolina, California and New York, highlighting important lessons for advocates

Building on the Affordable Care Act to Make the Health System Work for Young Gay Men: An Action Plan

The Affordable Care Act (ACA), the health reform law that was enacted in 2010, is expected to greatly expand access to stable and affordable insurance coverage for millions of Americans. Extensive research has documented that insurance matters; people with insurance coverage are less likely to report going without necessary care due to inability to pay and are more likely to report positive health outcomes than people who are uninsured.1 Young gay men, however, are a population with distinct needs that has rarely been the focus of attention for the health system. They may be among the least likely to automatically translate having insurance coverage into receiving consistent, high quality medical care. Therefore, focused efforts are needed to explain the importance of health coverage, facilitate enrollment in coverage, address structural barriers to care, and support their engagement with the health system once they obtain coverage. With the ACA developing new systems of care and new ways of paying for services, there is a fresh opportunity to examine key aspects of the healthcare delivery system to ensure that it is designed to facilitate good care and improved health outcomes for program beneficiaries and health plan enrollees. Indeed, the ACA includes several key provisions that create new protections and new opportunities to more proactively meet the needs of lesbian, gay, bisexual, and transgender (LGBT) individuals, including important protections against discrimination on the basis of sexual orientation and gender identity

The Changing Roles of Community Health Workers

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts. This report provides a snapshot of the varied landscape of CHW programs to better understand how CHWs are integrating with the health system both in terms of the structural elements of these programs, and the relational elements of CHW-health system interaction that make integrated models succeed. Authors suggest that there is no blueprint for success; rather, there are certain unifying structural elements of various integration types, and certain useful mechanisms that enable the preservation of the CHW concept

Alternate Payment Models for Ryan White HIV/AIDS Program Funded Services: Strategies Used by Nine Grantees

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. While not an exhaustive list, the seven Part A and two Part B grantees demonstrate a range of payment methods that might provide ideas for other grantees

Gender Identity, Health, and the Law: An Overview of Key Laws Impacting the Health of Transgender and Gender Non-Conforming People

A growing population of transgender, nonbinary, and other gender non-conforming Americans experience the burden of multiple physical and mental health inequities. Largely rooted in discrimination and stigma, these disparities are compounded by barriers to respectful, appropriate healthcare. A range of new policies, including state laws attempting to limit access to gender-affirming care for minors, may further compound health disparities. However, in some states and at the federal level, protective laws seek to prohibit discrimination and support access to care. Meanwhile, the constitutional status of gender identity under the Equal Protection Clause, and the legality of certain federal protections challenged on various grounds, remain undecided. This Article offers a snapshot of this rapidly evolving legal landscape, as well as the challenges and opportunities it offers for the health of transgender, nonbinary, and other gender non-conforming people

Drawing on the Strengths of Community Health Workers to Address Sexually Transmitted Infections: Roles, Medicaid Reimbursement, and Partnerships

Rates of bacterial sexually transmitted infections (STIs) in the United States are high and, largely, still soaring. Though chlamydia cases have decreased slightly since 2017, gonorrhea and syphilis have increased by 25% and 68%, respectively, and congenital syphilis has increased by 184%. Bacterial STI can lead to pain, infertility, and even, in the case of syphilis and congenital syphilis, death. With appropriate detection and treatment, all of these STIs are curable. And yet a range of barriers between communities and the healthcare system perpetuate the STI epidemic. Community health workers (CHWs) could play a key role in helping bridge the gap between the public health and healthcare systems and communities to provide STI education, prevention, detection and treatment services. The Medicaid program, which covers 89 million Americans, is slowly beginning to include CHWs into payment models. However, to date, CHWs’ potential to help address STIs has not been fully explored. This study was undertaken to identify ways that CHWs could be integrated into the STI field with the support of Medicaid coverage and in collaboration with the existing STI workforce

Naïve rat umbilical cord matrix stem cells significantly attenuate mammary tumor growth through modulation of endogenous immune responses

Background: Un-engineered human and rat umbilical cord matrix stem cells (rUCMSC) attenuate growth of several types of tumors in mice and rats. However, the mechanism by which UCMSC attenuate tumor growth has not been studied rigorously. Methods- The possible mechanisms of tumor growth attenuation by rUCMSC were studied using orthotopic Mat B III rat mammary tumor grafts in female F344 rats. Tumor-infiltrating leukocytes were identified and quantified by immunohistochemical image analysis. Potential cytokines involved in lymphocyte infiltration in the tumors were determined by microarray and Western blot analysis. The Boyden chamber migration assay was performed for the functional analysis of identified cytokines. Results: rUCMSC markedly attenuated the tumor growth; this attenuation was accompanied by considerable lymphocyte infiltration. Immunohistochemical analysis revealed that the majority of infiltrating lymphocytes in the rUCMSC-treated tumors were CD3+ T cells. In addition, treatment with rUCMSC significantly increased infiltration of CD 8+ and CD4+ T cells and NK cells throughout tumor tissue. CD68+ monocytes/macrophages and FoxP3+ regulatory T cells were scarcely observed, only in the tumors of the PBS control group. Microarray analysis of rUCMSC identified that monocyte chemotactic protein (MCP)-1 is involved in rUCMSCinduced lymphocyte infiltration in the tumor tissues. Discussion: These results suggest that naïve rUCMSC attenuated mammary tumor growth at least in part by enhancing host anti-tumor immune responses. Thus, naïve UCMSC can be used as powerful therapeutic cells for breast cancer treatment, and MCP-1 may be a key molecule to enhance the effect of UCMSC at the tumor site