Copays will remain suspended in a program that provides Medicaid-like coverage to undocumented individuals, an official from the Department of Healthcare and Family Services said Tuesday. [Health News Illinois]

Omar Shaker, a department attorney, told members of the Joint Committee on Administrative Rules that work continues to address an issue that prevented the existing system from allowing them to receive matching federal dollars when a non-citizen requires an emergency room visit.

“We do concede that at this time we are not prepared to move forward with the copay and cost-sharing elements,” Shaker said.

The agency sent a notice last month to providers saying they should not charge cost-sharing for the population “until further notice.” Any cost-sharing that providers may have already collected must be returned.

Shaker said they do not have a hard timeline for when cost-sharing measures may return. The earliest could be January.

The agency this summer also placed a pause on new enrollees between the ages of 42 and 64. Seniors can still join the program until their enrollment reaches 16,500.

Shaker said Tuesday that 16,117 individuals 65 years and older are enrolled in the program.

 Additionally, Shaker said the department remains in communication with managed care organizations to establish a coordinated effort to incorporate them into the program next January. The move, he said, will help in “lowering the cost of the program while still providing all of the necessary elements.”

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Social determinants of health (SDOH), the “conditions in which people are born, grow, live, work, and age,”^1,2 can affect health outcomes,^3-5 including mental, cognitive, and physical well-being.^6,7 Children are raised in neighborhoods with diverse SDOH profiles, including high poverty levels and unemployment; rural settings; limited access to quality health care, nutritious food, clean water, or educational opportunities; and increased exposure to crime and drug sales, and these SDOH are linked to an array of developmental problems, including mental health disorders,^7-12 suicidal behaviors,^13-15 cognitive performance,^6,7,16 and physical health issues.^10,17 Unraveling the complex relationships between SDOH and child development is crucial to understanding which SDOH combinations are associated with which developmental outcomes. Without such information, it is not possible to devise effective, targeted policies and interventions. [JAMA]

This study shows that an unbiased quantitative analysis of multidimensional SDOH can permit the determination of how SDOH patterns are associated with child developmental outcomes. Children exposed to socioeconomic deprivation showed the worst outcomes relative to other SDOH categories. These findings suggest the need to determine whether improvement in socioeconomic conditions can enhance child developmental outcomes. 

More> 

Download paper here>

See previous IOMC presentation with Dr. Matt Davis, MD, Lurie Children's Hospital and Northwestern Medicine here> 

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Sen. Tammy Duckworth is calling on health plans to do more to boost access for children to a drug that helps treat respiratory syncytial virus. [Health News Illinois]

The Democratic senator wrote in a letter to America’s Health Insurance Plans CEO Matt Eyles that increased access to nirsevimab will help ensure that millions of Americans can receive affordable care ahead of the expected rise in respiratory illnesses this fall.

“What must never be a hindrance to providing children with this potentially life-saving immunization is provider confusion over policies and coverage, or worse, a penny-wise, but deadly-foolish decision to deny coverage of the RSV immunization or subject families to onerous out-of-pocket costs,” she said.

The association should work with its members to cover nirsevimab and with the Biden administration on “clear and urgent guidance on the importance and need for all insurance carriers to update every plan beneficiary of the cost-free RSV immunization coverage," Duckworth said.

The association did not return a request for comment.

 The Food and Drug Administration approved nirsevimab this summer for children younger than 8 months of age born during or entering their first RSV season and for those between 8 and 19 months who remain vulnerable to severe disease through their second RSV season.

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Eric Topol with Medscape's Medicine and the Machine podcast. We have a new episode today with a really interesting fellow physician, Dr Adam Rodman. He's an internist at Beth Israel Deaconess Medical Center. He's an educator and instructor at Harvard Medical School, author of the book Short Cuts: Medicine, and has a podcast called Bedside Rounds. He also had articles in both the August 3 and August 10 issues of The New England Journal of Medicine.

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The annual publication of the US maternal mortality rate leads to extensive, often alarmed, commentary from politicians, public health officials, and women’s health advocates. The official 2021 rate from the National Vital Statistics System (NVSS) was 32.9 maternal deaths per 100 000 births,¹ which is the highest rate since 1964. The US rate, even accounting for COVID-19–related cases,² remains higher than any other high-income country. [JAMA]

Download viewpoint here>

There are currently 3 different government data sources on US maternal mortality: the NVSS, which provides official reports used for international comparisons (includes deaths related to pregnancy that occur during pregnancy and up to 42 days postpartum); the Centers for Disease Control and Prevention’s Pregnancy Related Mortality Surveillance System (PMSS), which reports the pregnancy-related mortality rate (pregnancy-related deaths that occur during pregnancy and up to 1 year postpartum); and state Maternal Mortality Review Committees (MMRCs), which report either or both of these rates for individual states, as well as a third category of pregnancy-associated deaths (deaths of pregnant/birthing people whether related to pregnancy or not). All 3 measures rely on state vital statistics systems to provide the initial data, which are then refined into mortality estimates using different approaches. These different sources typically yield inconsistent estimates of the magnitude of, and trends in, maternal mortality, with the NVSS system reporting a core national public health measure more than 50% higher than the PMSS. The NVSS system does have the considerable advantage of timeliness, having already produced a 2021 national estimate. In contrast, the most recent PMSS rate is for 2019, and most state MMRCs have not published rates past 2017.

It is challenging to identify deaths in those who were pregnant or recently pregnant and then make a judgment as to whether the pregnancy caused or contributed to the death.³ The World Health Organization has offered guidance on improving identification of pregnancy-related deaths, including adding a pregnancy checkbox to death certificates asking certifiers to identify whether the individual had been pregnant at the time of death or the death occurred within 42 days or 1 year of a birth.⁴ The US added the checkbox in a 2003 revision of the standard death certificate and all states adopted the pregnancy checkbox by 2018, although California opted to exclude the 42-day cutoff.⁵ Although the checkbox has improved identification of deaths during pregnancy, NVSS research identified numerous false-positive responses associated with the pregnancy checkbox, and steps have been taken to minimize this problem.⁵

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For the first time, firearm-related deaths exceeded motor vehicle collisions as the leading cause of death for U.S. youth across all racial and ethnic groups in 2020, according to an analysis of Centers for Disease Control and Prevention (CDC) mortality data by researchers at NIMHD.

Researchers used the CDC WONDER database to compare rates of firearm-related deaths for children and adolescents ages 1 year to 19 years across all racial and ethnic groups in 2020 and compared only Black and White youths from 1999 to 2020. The database compiles cause-of-death estimates that medical examiners list on death certificates for all U.S. counties. Firearm-related deaths include gun assaults, suicides by gun, deaths due to accidental discharge of a gun, legal intervention leading to gun death, and gun-involved deaths where the cause was unknown.

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Emergency departments trying to help patients with social problems such as food insecurity and housing insecurity are meeting with varying degrees of success, according to reports from researchers here at the annual meeting of the American College of Emergency Physicians. [MedPage Today]

Although screening in the emergency department for food insecurity is becoming more common, "many patients experience difficulty in connecting to the resources that we refer them to," Alex Ulintz, MD, of the Ohio State University in Columbus and formerly a resident at Indiana University in Bloomington, said Tuesday.

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Illinois ranks 15th nationally when it comes to the health of women and children, according to a report released by the United Health Foundation last week. [Health News Illinois]

The report from America's Health Rankings placed Illinois atop the country for its prevalence of neighborhood amenities and second-best for low prevalence of frequent mental distress among women. Other strengths include Illinois placing 8th for high enrollment in early childhood education and 9th for its low percentage of uninsured children.

Download report here>

However, the state received low marks for having a low prevalence of cervical cancer screening, which was the 4th worst in the country. 

Illinois also placed 45th for Special Supplemental Nutrition Program for Women, Infants, and Children coverage among children 4 and younger, 41st for employment among women and 40th for fruit and vegetable consumption among women.

Illinois finished 16th for women’s health and 17th for children’s health.

Minnesota was ranked the healthiest state for women and children in the country, while Mississippi finished last.

Overall, the report found that rates of maternal mortality increased 29 percent between 2014-2018 and 2017-2021, with non-white women being disproportionately affected. The rate of drug deaths among women increased 27 percent from 2016-2018 to 2019-2022.

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As professionals working closely with child protective services (CPS) for many years, we are well aware of its shortcomings, particularly undertrained and overwhelmed staff who may inadequately protect children and serve families as mandated by states’ laws. Some professionals and media have highlighted the problems, feeding into a popular narrative that damns CPS as a dangerous, damaging structure.¹ Missing from this picture are data and stories of when children are protected and families are helped. We think a balanced perspective is much needed, recognizing both CPS’ strengths and shortcomings, to move forward constructively. [JAMA}

The history of CPS in the United States clearly points to a broad concern for vulnerable children.² A seminal article on the “battered child” in 1962 in JAMA³ galvanized enormous attention and quickly led to civil laws in all 50 states to protect abused and neglected children. The primary intent has been and remains to help families, not to punish parents; in a small minority of instances, accountability does lead to criminal prosecution.

Despite the above goals, some argue that mandated reporting of suspected child maltreatment to CPS is implemented in a racist and paternalistic manner.¹ There is some dated support for this position, although recent research clarifies that the association is confounded by poverty.⁴ Indeed, after analyses control for sociodemographic variables, Black newborns exposed to illicit drugs appear less likely to be reported than White newborns. Similarly, others found that racial disproportionality in CPS’ overall statistics is largely confounded by poverty,⁵ with further support by a recent analysis.⁶ Reported Black children were less likely to have maltreatment substantiated and less likely to be placed out of home than White children.⁶ Clearly, child poverty and its many associated burdens are strongly linked to a lengthy list of problems.

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When Sukky Bleck’s infant son was diagnosed last year with bilateral hydronephrosis, a condition preventing urine from draining from the kidney into the bladder, she started questioning herself. [Chicago Tribune]

“Was it something I did? What did I do wrong? How can I fix it,” the 27-year-old Southeast Side resident said.

Bleck said she soon became haunted by whether lead-contaminated drinking water might have contributed to his condition. While kidney damage from lead exposure is uncommon in the United States, according to the National Kidney Foundation, lead found in drinking water has been proven to cause kidney damage on rare occasions, usually after many years of exposure.

“I shouldn’t have to stockpile cases of water for my children’s home. No parent should,” she said. “The lead pipe crisis is not just a statistic. It’s a harsh reality we’re facing daily. Our children, our future are at risk.”

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