Medicaid Administrator Kelly Cunningham said last week they expect to have conversations in the coming months with federal partners regardingIllinois’ recently-submitted1115 waiver for behavioral health services.

The five-year extension application to the Centers for Medicare and Medicaid Services proposes 10 programs, including efforts to address food and nutrition services, employment assistance, non-medical transportation and community reintegration for previously incarcerated individuals.

While they await those negotiations with the federal agency, Cunningham told the Medicaid Advisory Board Friday that the next big step for the agency will be creating an implementation design for the initiatives. She said the agency will be working with stakeholders to help plan how to roll out the programs.

“It's really how do we design an implementation strategy so that these services and that this planning actually has the desired outcome in terms of improving health and addressing the needs of the Medicaid population," Cunningham said.

CMS said earlier this summer that they have extended the state’s demonstration through next June as the two sides negotiate over the current extension application.

The agency also said it is preparing to schedule a public hearing on changes to the Medicaid-like program for undocumented individuals ages 42 and older. The changes include a pause on new enrollees between the age of 42 and 64 and copays for hospital services not eligible for a federal match, such as $250 for inpatient hospitalizations and $100 for emergency room visits.

The changes also will pause enrollment in the program for those 65 and older once the total number of members reaches 16,500. Officials said last week it has yet to meet that threshold.

Laura Phelan, policy director at the department, said the details of the meeting “will be forthcoming.”

Additionally, she said work is underway to create a dashboard to track enrollment data on the program.

“Our goal is to make it consumer friendly and also easily consumable,” Phelan said.

 The committee also approved a motion for the department to respond by year’s end to a report created by the MAC’s community integration subcommittee. The report lays out short- and long-term recommendations to increase the number of seniors and persons with all types of disabilities receiving services in community settings.

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When Denver Health wanted to open an inpatient opioid detox unit specifically for teens, doctors there searched high and low for a model to copy. They didn’t find one. [KFF Health News]

Teens who land in emergency rooms with an opioid overdose generally receive naloxone to reverse the effects of dangerous drugs in their system and are sent home with a list of places they can go for follow-up care. But too often, those teens never seek additional help. They are left to suffer through the agony of withdrawal with no medications to ease their cravings. As a result, many, seeking relief, go back to opioids, often with tragic consequences.

Christian Thurstone, the director of behavioral health services at the Denver hospital, said six of his teen patients have died of fentanyl overdoses in the past two years. Denver Health has now opened what he believes to be the nation’s first adolescent inpatient detox unit.

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It’s estimated that at least 1 in 5 people with a SARS-CoV-2 infection never develop symptoms. Genetics might explain some of these asymptomatic cases, it turns out. In a new study appearing in Nature, people with a particular gene variant appeared to have preexisting T cell immunity to the virus, likely a holdover from previous bouts of the common cold. [JAMA Network]

Why This Is Important

Hollenbach and her coauthors note that many studies have looked at genetic factors in severe COVID-19 disease, but fewer have examined the underpinnings of asymptomatic or mild infection. Insight into factors that allow the immune system to quickly clear the virus could help scientists better understand the disease and improve immunotherapies and vaccines, they say.

Benjamin Solomon, MD, who was not involved with the work, is clinical director of the National Human Genome Research Institute, part of the US National Institutes of Health. “It’s interesting to see a major study focus on people on the less-affected end of the curve, as this can be clinically important and offer useful biological insights, but may be less studied than the other end of the curve,” Solomon wrote in an email.

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-the misinformation is about misinformation.

Robert Califf, MD, the head of the FDA, doesn't seem to be having fun on the job.

"I would describe this year as hand-to-hand combat. Really, every day," he said at an academic conference at Stanford in April. It's a sentiment the FDA commissioner has expressed often. [MedPage Today]

What's been getting Califf's goat? Misinformation, which gets part of the blame for Americans' stagnating life expectancy. To Califf, the country that invents many of the most advanced drugs and devices is terrible at using those technologies well. And one reason for that is Americans' misinformed choices, he has suggested. Many don't use statins, vaccines, or COVID-19 therapies. Many choose to smoke cigarettes and eat the wrong food.

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...Findings  In 2018, the estimated economic burden of racial and ethnic health inequities was $421 billion (using MEPS) or $451 billion (using BRFSS data) and the estimated burden of education-related health inequities was $940 billion (using MEPS) or $978 billion (using BRFSS). Most of the economic burden was attributable to the poor health of the Black population; however, the burden attributable to American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander populations was disproportionately greater than their share of the population. Most of the education-related economic burden was incurred by adults with a high school diploma or General Educational Development equivalency credential. However, adults with less than a high school diploma accounted for a disproportionate share of the burden. Although they make up only 9% of the population, they bore 26% of the costs.

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In a round of interviews before he stepped down as director of the US National Institutes of Health (NIH) in December 2021, Francis Collins, MD, PhD, frequently discussed the problem of misinformation, which, many argue, became more rampant during the COVID-19 pandemic, thanks in large part to social media. [JAMA Network]

Some have used the term “infodemic” to describe the glut of COVID-19 information—much of it false or misleading—on social media. During a disease outbreak, an infodemic “causes confusion and risk-taking behaviors that can harm health” and “leads to mistrust in health authorities and undermines the public health response,” according to the World Health Organization.

When asked about the NIH’s role in pushing back against misinformation, Collins told Nature, “I wish we had more insights from behavioral social science research into how this has come to pass, and why it could have gotten so completely widespread.”

At the end of Collins’ tenure as NIH director, the agency planted the seed of a new program to support that very kind of research.

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Illinois Gov. JB Pritzker joined health leaders Monday to unveil several steps to increase access to reproductive care.

That includes a new hospital navigation program, set to debut this month, designed to give appropriate and expeditious treatment to patients who need a higher level of care than can be provided at a clinic. [Health News Illinois]

The hotline, to be staffed by nurse navigators, will help patients schedule appointments, acquire pre-operative testing and arrange payment, transportation and childcare for treatment.

The initiative will be a partnership between the Chicago Abortion Fund, the University of Illinois Chicago, Rush University System for Health and the departments of Public Health and Healthcare and Family Services. 

Pritzker said at an event at the University of Illinois Chicago that the plan will help reduce disparities for hospital-based abortion care, speed up medically urgent referrals and alleviate the strain on abortion clinics.

“In the Land of Lincoln, we've doubled down on our commitment to maintain and expand reproductive health access for patients and protect providers," he said.

Other initiatives announced Monday include:

·    The opening of requests for proposals to support a public-facing hotline for abortion service navigation throughout Illinois. The hotline is funded through $10 million allocated to IDPH in the current budget.

·    The creation of a Medicaid family planning program for people otherwise not eligible for Medicaid due to income. Covered services will include annual preventive exams, family planning counseling and all Food and Drug Administration-approved methods of contraception.

·    A new $5 million capital investment program to support reproductive healthcare providers in Illinois that are experiencing increased demand for their services for improvements and repairs to new or existing facilities.

·    Authorization for Illinois to cover transportation and lodging for state employees who must travel to access reproductive healthcare. 

Some of the initiatives will be supported by the $18 million allocated to IDPH in the current budget to support efforts to expand access to such services. The family planning program will be paid for with a mix of federal Medicaid and Title X funding.

“I feel so fortunate that IDPH is committed and dedicated to working across the administration and with our provider community to ensure that those seeking family planning and abortion services in Illinois get access to the reproductive care they need,” said department Director Dr. Sameer Vohra.

Chicago Abortion Fund Executive Director Megan Jeyifo said they have helped over 250 individuals that required hospital care in the year since the Supreme Court overturned the constitutional right to an abortion, a 26 percent increase from the prior year. 

An already stressful situation of receiving an abortion is made worse by individuals having to travel out of state to a place where they may not know anyone or know where services are available, she said. The hotline will help alleviate some of those challenges.

 “(The initiative) will strengthen the working relationships we have with four major hospitals in the Chicagoland area to make sure our callers and all people who require hospital-based care can access appointments as soon as possible,” Jeyifo said. “And most importantly, it will strengthen Illinois’ ability to do what we have already been doing in this landscape: stepping up as a national access point for hospital-based care.”

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E-cigarettes are now part of a state law that prohibits smoking in nearly all indoor public places. [Health News Illinois]

Gov. JB Pritzker signed the plan into law on Friday, which adds the use of alternative nicotine products and e-cigarettes to a law that bans smoking in public spaces, places of employment and within 15 feet of public entrances.

“Illinoisans deserve to enjoy public spaces without being exposed unwillingly to secondhand vapor and other electronic cigarettes byproducts,” Pritzker said in a statement.

Retail tobacco stores that derive at least 80 percent of total revenue from the sale of e-cigarette products are exempt.

Health advocates praised the law, saying it will further protect individuals from secondhand exposure to toxicants in public places.

“We commend the General Assembly for passing this important legislation and look forward to working with them to pass further public health initiative,” said Ally Lopshire, government relations director for the American Cancer Society Cancer Action Network.

Prtizker also signed other healthcare-related proposals into law Friday that will:

·    Task the Department of Natural Resources and the Department of Human Services with developing and administering an outdoor Rx program.

·    Establish primary goals for the Illinois Nursing Workforce Center and task the group with developing a strategic plan to address the state’s nursing workforce.

·    Clarify existing language related to the definition of abuse or criminal neglect of a long-term care facility resident.

·    Expand the definition of a “healthcare employer” to include a financial management services entity contracted with the Department of Human Services’ Division of Developmental Disabilities.

·    Require the state long-term care ombudsman to be notified when a resident is involuntarily transferred or discharged from a nursing home facility.

·    Require the Department of Public Health to create a pilot program so it can employ a certified plumbing inspector to perform municipal inspections.

·    Require hospitals to screen patients for financial assistance eligibility and to pursue all cost-reducing options before taking collection action against the patient.

·    Prevent health insurers, starting in 2025, from applying a higher standard of clinical evidence for the coverage of proton beam therapy than the insurer applies for the coverage of any other form of radiation therapy treatment.

·    Require the Department of Public Health to adopt rules for meeting specific standards for at-home continuing care. The department is also allowed to deny, suspend or revoke a certificate of registration for cause.

·    Expand access to those who can sell fentanyl test strips over-the-counter to pharmacists and retailers.

Create a state act outlining ways to improve quality and access to behavioral health crisis services, including requiring the Department of Human Services' Division of Mental Health to determine the “sound costs” associated with developing and maintaining a statewide initiative for the coordination and delivery of the continuum of behavioral health crisis response services. 

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The nation’s maternal mortality rate increased by nearly 40% between 2020 and 2021. The rate of US women who died during or soon after their pregnancies in the US is higher than at any other time since 2000, according to new data from the Centers for Disease Control and Prevention (CDC). [USA Facts]

The rate was higher for certain groups in the population, such as pregnant Black women. The COVID-19 pandemic and the rising age of pregnant women also contributed to the worsening rate.

It's not a new problem in the US. Although the maternal mortality rate dropped in some years over the last two decades, the overall trend has been upwards.

The World Health Organization defines maternal mortality as the death of a woman while pregnant or within 42 days of the end of pregnancy, regardless of how long the pregnancy lasted or any cause related to the pregnancy.[1]

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This issue features a collection of articles under the umbrella of “HIV, Substance Use, and Trauma: Mentoring to Dismantle Structural  Racism. [APHJ]

”Historically, most research on racial discrimination and trauma and HIV and substance use has examined these issues primarily as individual-level processes. Echoing themes from Krieger’s eco-social  theory (https://bit.ly/3MC6vIk), the articles in this collection seek to advance knowledge about how structural racism and intergenerational trauma are embodied for racialized US communities, resulting in disproportionate rates of HIV and substance abuse .Leveraging theoretical and empirical insights from the intergenerational trauma and structural racism literature, this collection seeks to contextualize racialized health inequities and pinpoint opportunities for multi-level (i.e., individual, community, and structural) intervention. These structural racism and intergenerational trauma contexts are vital because, as Resmaa Menakemwrites in his book, My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies(Las Vegas, NV: Central Recovery; 2017),

Many African Americans know trauma intimately—from their own nervous systems, from the experiences of people they love, and most often, from both. But African Americans are not alone in this. A different but equally real form or racialized trauma lives in the bodies of most white Americans. And a third, often deeply toxic type of racialized trauma lives and breathes in the bodies of many of America’s law enforcement officers. All three types of trauma are routinely passed on from person to person and from generation to generation. (p. 9)

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